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Injury Care

Back Clinic Injury Care Chiropractic and Physical Therapy Team. There are two approaches to injury care. They are active and passive treatment. While both can help get patients on the road toward recovery, only active treatment has a long-term impact and keeps patients moving.

We focus on treating injuries sustained in auto accidents, personal injuries, work injuries, and sports injuries and provide complete interventional pain management services and therapeutic programs. Everything from bumps and bruises to torn ligaments and back pain.

Passive Injury Care

A doctor or a physical therapist usually gives passive injury care. It includes:

  • Acupuncture
  • Applying heat/ice to sore muscles
  • Pain medication

It’s a good starting point to help reduce pain, but passive injury care isn’t the most effective treatment. While it helps an injured person feel better in the moment, the relief doesn’t last. A patient won’t fully recover from injury unless they actively work to return to their normal life.

Active Injury Care

Active treatment also provided by a physician or physical therapist relies on the injured person’s commitment to work. When patients take ownership of their health, the active injury care process becomes more meaningful and productive. A modified activity plan will help an injured person transition to full function and improve their overall physical and emotional wellness.

  • Spine, neck, and back
  • Headaches
  • Knees, shoulders, and wrists
  • Torn ligaments
  • Soft tissue injuries (muscle strains and sprains)

What does active injury care involve?

An active treatment plan keeps the body as strong and flexible as possible through a personalized work/transitional plan, which limits long-term impact and helps injured patients work toward a faster recovery. For example, in injury Medical & Chiropractic clinic’s injury care, a clinician will work with the patient to understand the cause of injury, then create a rehabilitation plan that keeps the patient active and brings them back to proper health in no time.

For answers to any questions, you may have, please call Dr. Jimenez at 915-850-0900


The Power of Instrument-Assisted Soft Tissue Mobilization

The Power of Instrument-Assisted Soft Tissue Mobilization

Can physical therapy with instrument-assisted soft tissue mobilization or IASTM improve mobility, flexibility, and health for individuals with musculoskeletal injuries or illnesses?

The Power of Instrument-Assisted Soft Tissue Mobilization

Instrument Assisted Soft Tissue Mobilization

Instrument-assisted soft tissue mobilization or IASTM is also known as the Graston technique. It is a myofascial release and massage technique used in physical therapy where the therapist uses metal or plastic tools to improve soft tissue mobility in the body. The ergonomically shaped tool is gently or vigorously scraped and rubbed across the injured or painful area. The rubbing is used to locate and release tightness in the fascia/collagen covering the muscles and the tendons. This helps reduce pain and improve movement.

Massage and Myofascial Release

Instrument-assisted soft tissue mobilization rehabilitation helps:

  • Improve soft tissue mobility.
  • Release of restrictions in tight fascia.
  • Decrease muscle spasms.
  • Improve flexibility.
  • Increased circulation to the tissues.
  • Relieve pain. (Fahimeh Kamali et al., 2014)

Individuals often develop tissue tightness or restrictions in the muscles and fascia after an injury. These soft tissue restrictions can limit the range of motion – ROM and can trigger pain symptoms. (Kim J, Sung DJ, Lee J. 2017)

History

The Graston technique of instrument-assisted soft tissue mobilization was developed by an athlete who created their instruments to treat soft tissue injuries. The practice has grown with input from medical experts, trainers, researchers, and clinicians.

  • Physical therapists use different types of tools to perform IASTM.
  • These massage instruments comprise various types for specific massage and release.
  • The Graston company designs some of the tools.
  • Other companies have their version of metal or plastic scraping and rubbing tools.
  • The objective is to help release soft tissue and myofascial restrictions to improve body movement. (Kim J, Sung DJ, Lee J. 2017)

How It Works

  • The theory is that scraping the tissues causes microtrauma to the affected area, activating the body’s natural inflammatory response. (Kim J, Sung DJ, Lee J. 2017)
  • The body activates to reabsorb the tightened or scar tissue, causing the restriction.
  • The therapist can then stretch the adhesions to alleviate pain and improve mobility.

Treatment

Certain conditions respond well to instrument-assisted soft tissue mobilization, including (Kim J, Sung DJ, Lee J. 2017)

  • Limited mobility
  • Decreased muscle recruitment
  • Loss of range of motion – ROM
  • Pain with movement
  • Excessive scar tissue formation

Augmented soft tissue mobilization or ASTM techniques can treat certain injuries and medical conditions that include:

  • Musculoskeletal imbalance/s
  • Ligament sprains
  • Plantar fasciitis
  • Myofascial pain
  • Tendonitis and tendinopathy
  • Scar tissue from surgery or trauma (Morad Chughtai et al., 2019)

Benefits and Side Effects

Benefits include: (Kim J, Sung DJ, Lee J. 2017)

  • Improved range of motion
  • Increased tissue flexibility
  • Improved cell activity at the site of injury
  • Reduced pain
  • Reduced scar tissue formation

Side effects may include:

Research

  • A review compared hands-on myofascial release to instrument myofascial release for chronic low back pain. (Williams M. 2017)
  • Little difference was found between the two techniques for pain relief.
  • Another review compared IASTM to other methods for treating pain and function loss. (Matthew Lambert et al., 2017)
  • The researchers concluded that IASTM could positively affect blood circulation and tissue flexibility and reduce pain.
  • Another study examined the use of IASTM, pseudo-fake ultrasound therapy, and spinal manipulation for patients with thoracic/upper back pain. (Amy L. Crothers et al., 2016)
  • All groups improved over time with no significant negative events.
  • The researchers concluded that instrument-assisted soft tissue mobilization is no more or less effective than spinal manipulation or pseudo-ultrasound therapy for thoracic back pain.

Every case is different, and musculoskeletal conditions respond differently to various treatments. For any questions or concerns, contact your primary healthcare provider to determine if IASTM is an appropriate treatment that can help.


From Injury To Recovery


References

Kamali, F., Panahi, F., Ebrahimi, S., & Abbasi, L. (2014). Comparison between massage and routine physical therapy in women with sub acute and chronic nonspecific low back pain. Journal of back and musculoskeletal rehabilitation, 27(4), 475–480. doi.org/10.3233/BMR-140468

Kim, J., Sung, D. J., & Lee, J. (2017). Therapeutic effectiveness of instrument-assisted soft tissue mobilization for soft tissue injury: mechanisms and practical application. Journal of exercise rehabilitation, 13(1), 12–22. doi.org/10.12965/jer.1732824.412

Chughtai, M., Newman, J. M., Sultan, A. A., Samuel, L. T., Rabin, J., Khlopas, A., Bhave, A., & Mont, M. A. (2019). Astym® therapy: a systematic review. Annals of translational medicine, 7(4), 70. doi.org/10.21037/atm.2018.11.49

Williams M. (2017). Comparing pain and disability outcomes of instrumental versus hands-on myofascial release in individuals with chronic low back pain: a meta-analysis. Doctoral dissertation, California State University, Fresno. repository.library.fresnostate.edu/bitstream/handle/10211.3/192491/Williams_csu_6050D_10390.pdf?sequence=1

Matthew Lambert, Rebecca Hitchcock, Kelly Lavallee, Eric Hayford, Russ Morazzini, Amber Wallace, Dakota Conroy & Josh Cleland (2017) The effects of instrument-assisted soft tissue mobilization compared to other interventions on pain and function: a systematic review, Physical Therapy Reviews, 22:1-2, 76-85, DOI: 10.1080/10833196.2017.1304184

Crothers, A. L., French, S. D., Hebert, J. J., & Walker, B. F. (2016). Spinal manipulative therapy, Graston technique® and placebo for non-specific thoracic spine pain: a randomised controlled trial. Chiropractic & manual therapies, 24, 16. doi.org/10.1186/s12998-016-0096-9

How Acupuncture Can Help Alleviate Knee Pain

How Acupuncture Can Help Alleviate Knee Pain

For individuals dealing with knee pain symptoms from injury and/or arthritis, can incorporating an acupuncture and/or electroacupuncture treatment plan help in pain relief and management?

How Acupuncture Can Help Alleviate Knee Pain

Acupuncture For Knee Pain

Acupuncture involves inserting very thin needles into the skin at specific acupoints on the body. It is based on the premise that the needles restore the flow of the body’s energy to activate and promote healing, relieve pain, and help the body relax.

  • Acupuncture can help address various health conditions, including knee pain caused by arthritis or injury.
  • Depending on the type and severity of pain, treatments can help reduce the pain for days or weeks.
  • Acupuncture is often used as a complementary therapy – treatment in addition to other treatment or therapy strategies like massage and chiropractic.

Acupuncture Benefits

Knee pain caused by osteoarthritis or injury can reduce flexibility, mobility, and quality of life. Acupuncture can help provide relief.

When the acupuncture needles are placed on the body, a signal is sent along the spinal cord to the brain, which triggers a release of endorphins/pain hormones. Medical researchers believe this helps reduce pain. (Qian-Qian Li et al., 2013) Acupuncture also helps decrease the production of cortisol, a hormone that helps control inflammation. (Qian-Qian Li et al., 2013) With reduced pain sensations and less inflammation after acupuncture treatments, knee function and mobility can be improved.

  • Various factors play a role in the pain relief experienced from acupuncture. Some evidence suggests that an individual’s expectations may impact the results of acupuncture treatment. (Stephanie L. Prady et al., 2015)
  • Researchers are currently assessing whether the expectation that acupuncture is beneficial contributes to a better outcome after treatment. (Zuoqin Yang et al., 2021)
  • In 2019, acupuncture was recommended in treating knee osteoarthritis in the American College of Rheumatology/Arthritis Foundation guidelines for hand, hip, and knee osteoarthritis pain management. (Sharon L. Kolasinski et al., 2020)

Research

  • Different clinical studies support acupuncture’s ability to help in knee pain relief and management.
  • One study found that acupuncture helps manage various conditions that cause chronic pain. (Andrew J. Vickers et al., 2012)
  • A scientific review analyzed previous studies on pain management interventions after knee surgery and found supporting evidence that the treatments delayed and reduced the use of medications for pain relief post-surgery. (Dario Tedesco et al., 2017)

Osteoarthritis

  • A systematic review analyzed randomized control studies to determine whether or not acupuncture reduced pain and improved joint function in individuals with chronic osteoarthritis knee pain. (Xianfeng Lin et al., 2016)
  • Individuals received six to twenty-three weekly acupuncture sessions for three to 36 weeks.
  • The analysis determined that acupuncture can improve short and long-term physical function and mobility and provide up to 13 weeks of pain relief in individuals with chronic knee pain caused by osteoarthritis.

Rheumatoid Arthritis

  • Rheumatoid arthritis is a chronic disease that affects joints, including the knee joint, causing pain and stiffness.
  • Acupuncture is beneficial in treating rheumatoid arthritis/RA.
  • A review found that acupuncture alone and in combination with other treatment modalities benefits individuals with RA. (Pei-Chi, Chou Heng-Yi Chu 2018)
  • Acupuncture is believed to have anti-inflammatory and antioxidant effects to help regulate immune system function.

Chronic Knee Pain

  • Various conditions and injuries can cause chronic knee pain, making mobility difficult.
  • Individuals with joint pain often turn to complementary therapies for pain relief management, with acupuncture being one of the popular modalities. (Michael Frass et al., 2012)
  • A study showed modest improvements in pain relief at 12 weeks. (Rana S. Hinman et al., 2014)
  • Acupuncture resulted in modest improvements in mobility and function at 12 weeks.

Safety

Side Effects

  • Side effects can include soreness, bruising, or bleeding at the site of needle insertion and dizziness.
  • Less common side effects include fainting, increased pain, and nausea. (Harvard Medical School. 2023)
  • Working with a licensed, professional acupuncture practitioner can reduce the risk of unwanted side effects and complications.

Types

Other acupuncture options that may be offered include:

Electroacupuncture

  • A modified form of acupuncture where a mild electrical current passes through the needles, providing additional stimulation to the acupoints.
  • In one research study, individuals with knee osteoarthritis reported significant improvements in their pain, stiffness, and physical function after electroacupuncture treatment. (Ziyong Ju et al., 2015)

Auricular

  • Auricular or ear acupuncture works on acupoints in the ear corresponding to the body’s different parts.
  • A research review analyzed several studies on auricular acupuncture for pain relief and found that it can provide relief within 48 hours of pain onset. (M. Murakami et al., 2017)

Battlefield Acupuncture

  • The military and veteran healthcare facilities use a unique form of auricular acupuncture for pain management.
  • Studies show that it is effective at providing immediate pain relief, but more research is necessary to determine long-term pain relief effectiveness. (Anna Denee Montgomery, Ronovan Ottenbacher 2020)

Before trying acupuncture, consult a healthcare professional for guidance, as it may be integrated with other therapies and lifestyle adjustments.


Overcoming an ACL Injury


References

Li, Q. Q., Shi, G. X., Xu, Q., Wang, J., Liu, C. Z., & Wang, L. P. (2013). Acupuncture effect and central autonomic regulation. Evidence-based complementary and alternative medicine : eCAM, 2013, 267959. doi.org/10.1155/2013/267959

Prady, S. L., Burch, J., Vanderbloemen, L., Crouch, S., & MacPherson, H. (2015). Measuring expectations of benefit from treatment in acupuncture trials: a systematic review. Complementary therapies in medicine, 23(2), 185–199. doi.org/10.1016/j.ctim.2015.01.007

Yang, Z., Li, Y., Zou, Z., Zhao, Y., Zhang, W., Jiang, H., Hou, Y., Li, Y., & Zheng, Q. (2021). Does patient’s expectation benefit acupuncture treatment?: A protocol for systematic review and meta-analysis. Medicine, 100(1), e24178. doi.org/10.1097/MD.0000000000024178

Kolasinski, S. L., Neogi, T., Hochberg, M. C., Oatis, C., Guyatt, G., Block, J., Callahan, L., Copenhaver, C., Dodge, C., Felson, D., Gellar, K., Harvey, W. F., Hawker, G., Herzig, E., Kwoh, C. K., Nelson, A. E., Samuels, J., Scanzello, C., White, D., Wise, B., … Reston, J. (2020). 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis care & research, 72(2), 149–162. doi.org/10.1002/acr.24131

Vickers, A. J., Cronin, A. M., Maschino, A. C., Lewith, G., MacPherson, H., Foster, N. E., Sherman, K. J., Witt, C. M., Linde, K., & Acupuncture Trialists’ Collaboration (2012). Acupuncture for chronic pain: individual patient data meta-analysis. Archives of internal medicine, 172(19), 1444–1453. doi.org/10.1001/archinternmed.2012.3654

Tedesco, D., Gori, D., Desai, K. R., Asch, S., Carroll, I. R., Curtin, C., McDonald, K. M., Fantini, M. P., & Hernandez-Boussard, T. (2017). Drug-Free Interventions to Reduce Pain or Opioid Consumption After Total Knee Arthroplasty: A Systematic Review and Meta-analysis. JAMA surgery, 152(10), e172872. doi.org/10.1001/jamasurg.2017.2872

Lin, X., Huang, K., Zhu, G., Huang, Z., Qin, A., & Fan, S. (2016). The Effects of Acupuncture on Chronic Knee Pain Due to Osteoarthritis: A Meta-Analysis. The Journal of bone and joint surgery. American volume, 98(18), 1578–1585. doi.org/10.2106/JBJS.15.00620

Chou, P. C., & Chu, H. Y. (2018). Clinical Efficacy of Acupuncture on Rheumatoid Arthritis and Associated Mechanisms: A Systemic Review. Evidence-based complementary and alternative medicine : eCAM, 2018, 8596918. doi.org/10.1155/2018/8596918

Frass, M., Strassl, R. P., Friehs, H., Müllner, M., Kundi, M., & Kaye, A. D. (2012). Use and acceptance of complementary and alternative medicine among the general population and medical personnel: a systematic review. Ochsner journal, 12(1), 45–56.

Hinman, R. S., McCrory, P., Pirotta, M., Relf, I., Forbes, A., Crossley, K. M., Williamson, E., Kyriakides, M., Novy, K., Metcalf, B. R., Harris, A., Reddy, P., Conaghan, P. G., & Bennell, K. L. (2014). Acupuncture for chronic knee pain: a randomized clinical trial. JAMA, 312(13), 1313–1322. doi.org/10.1001/jama.2014.12660

National Center for Complementary and Integrative Health. (2022). Acupuncture in depth. National Center for Complementary and Integrative Health. www.nccih.nih.gov/health/acupuncture-what-you-need-to-know

Harvard Medical School. (2023). Acupuncture: what is it? Harvard Health Publishing Harvard Medical School Blog. www.health.harvard.edu/a_to_z/acupuncture-a-to-z#:~:text=The%20most%20common%20side%20effects,injury%20to%20an%20internal%20organ.

Ju, Z., Guo, X., Jiang, X., Wang, X., Liu, S., He, J., Cui, H., & Wang, K. (2015). Electroacupuncture with different current intensities to treat knee osteoarthritis: a single-blinded controlled study. International journal of clinical and experimental medicine, 8(10), 18981–18989.

Murakami, M., Fox, L., & Dijkers, M. P. (2017). Ear Acupuncture for Immediate Pain Relief-A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Pain medicine (Malden, Mass.), 18(3), 551–564. doi.org/10.1093/pm/pnw215

Montgomery, A. D., & Ottenbacher, R. (2020). Battlefield Acupuncture for Chronic Pain Management in Patients on Long-Term Opioid Therapy. Medical acupuncture, 32(1), 38–44. doi.org/10.1089/acu.2019.1382

Expert Tips to Avoid Weightlifting Knee Injuries

Expert Tips to Avoid Weightlifting Knee Injuries

Knee injuries can present in physically active individuals that lift weights. Can understanding the types of weightlifting knee injuries help in prevention?

Expert Tips to Avoid Weightlifting Knee Injuries

Weightlifting Knee Injuries

Weight training is very safe for the knees as regular weight training can improve knee strength and prevent injury as long as the correct form is followed. For Individuals with knee injuries from other activities, incorrect weight-training exercises could worsen the injury. (Ulrika Aasa et al., 2017) As well as, sudden twisting movements, poor alignment, and pre-existing injuries can increase the risk of worsening or creating further injuries. (Hagen Hartmann et al, 2013) The body and the knees are designed to support vertical forces on the joints.

Common Injuries

Weightlifting knee injuries occur as the knee joints endure a wide range of stresses and strains. In weight training, the ligaments that attach to the complex bone system of the knee joint can be damaged by incorrect movements, overloading the weight, and increasing the weight too soon. These injuries can result in pain, swelling, and immobility that can range from minor to severe, from a sprain or a slight tear to a complete tear in serious cases.

Anterior Cruciate Ligament – ACL – Injury

This ligament attaches the thigh’s femur bone to the lower leg’s shin bone/tibia and controls excessive rotation or extension of the knee joint. (American Academy of Family Physicians. 2024)

  • Anterior means front.
  • ACL injuries are seen mostly in athletes but can happen to anybody.
  • Severe damage to the ACL usually means surgical reconstruction and up to 12 months of rehabilitation.
  • When weightlifting, try to avoid twisting knee movements, intentionally or accidentally, under excessive load.

Posterior Cruciate Ligament – PCL – Injury

  • The PCL connects the femur and tibia at different points to the ACL.
  • It controls any backward motion of the tibia at the joint.
  • Injuries occur most with high-impact forces as a result of accidents and sometimes in activities where forceful trauma to the knee occurs.

Medial Collateral Ligament – MCL – Injury

  • This ligament maintains the knee from bending too far to the inside/medially.
  • Injuries mostly occur from impact to the outside of the knee or from accidental bodyweight force on the leg that bends at an unusual angle.

Lateral Collateral Ligament – LCL – Injury

  • This ligament connects the smaller bone of the lower leg/fibula to the femur.
  • It is opposite to the MCL.
  • It maintains excessive outward movement.
  • LCL injuries occur when a force pushes the knee out.

Cartilage Injury

  • Cartilage prevents bones from rubbing together and cushions impact forces.
  • Knee menisci are cartilage that cushions the knee joints inside and outside.
  • Other types of cartilage protect the thigh and shin bones.
  • When cartilage gets torn or damaged, surgery may be required.

Tendonitis

  • Aggravated and overused knee tendons can lead to weightlifting knee injuries.
  • A related injury known as iliotibial band syndrome/ITB causes pain to the outside of the knee, usually in runners, but it can occur from overuse.
  • Rest, stretching, physical therapy, and anti-inflammatory medication are a common treatment plan.
  • Individuals should consult a physical therapist for pain lasting longer than two weeks. (Simeon Mellinger, Grace Anne Neurohr 2019)

Osteoarthritis

  • As the body ages, normal wear and tear can cause the development of osteoarthritis of the knee joints. (Jeffrey B. Driban et al., 2017)
  • The condition causes the cartilage to deteriorate and bones to rub together, resulting in pain and stiffness.

Prevention

  • Individuals can minimize their risk of weightlifting knee injuries and pain by following their doctor’s and personal trainers’ recommendations.
  • Individuals with an existing knee injury should follow their doctor’s or physical therapist’s recommendations.
  • A knee sleeve can keep the muscles and joints secure, providing protection and support.
  • Stretching the leg and knee muscles can maintain joint flexibility.
  • Avoid sudden lateral movements.
  • Possible recommendations can include:

Avoiding Certain Exercises

  • Isolation exercises like leg curls, standing, or on a bench, as well as using the leg extension machine, can stress the knee.

Deep Squat Training

Research shows that the deep squat can protect against lower leg injury if the knee is healthy. However, this is when done with proper technique, under expert supervision, and with a gradual progressive load. (Hagen Hartmann et al, 2013)

Individuals should talk to their doctor before beginning a new exercise routine. A personal trainer can provide training in learning the proper technique and weightlifting form.


How I Tore my ACL Part 2


References

Aasa, U., Svartholm, I., Andersson, F., & Berglund, L. (2017). Injuries among weightlifters and powerlifters: a systematic review. British journal of sports medicine, 51(4), 211–219. doi.org/10.1136/bjsports-2016-096037

Hartmann, H., Wirth, K., & Klusemann, M. (2013). Analysis of the load on the knee joint and vertebral column with changes in squatting depth and weight load. Sports medicine (Auckland, N.Z.), 43(10), 993–1008. doi.org/10.1007/s40279-013-0073-6

American Academy of Family Physicians. ACL injury. (2024). ACL injury (Diseases and Conditions, Issue. familydoctor.org/condition/acl-injuries/

Mellinger, S., & Neurohr, G. A. (2019). Evidence based treatment options for common knee injuries in runners. Annals of translational medicine, 7(Suppl 7), S249. doi.org/10.21037/atm.2019.04.08

Driban, J. B., Hootman, J. M., Sitler, M. R., Harris, K. P., & Cattano, N. M. (2017). Is Participation in Certain Sports Associated With Knee Osteoarthritis? A Systematic Review. Journal of athletic training, 52(6), 497–506. doi.org/10.4085/1062-6050-50.2.08

Using Acupuncture for Pain Management

Using Acupuncture for Pain Management

For individuals dealing with injuries and pain conditions, can incorporating acupuncture into a treatment plan help alleviate and manage pain?

Using Acupuncture for Pain Management

Acupuncture Pain Management

Pain management techniques include physical therapy, medications, cold therapies, chiropractic, and massages. One method that is growing is acupuncture. (World Health Organization. 2021) According to a report by the World Health Organization, acupuncture is the most commonly used form of traditional medicine practiced globally. (World Health Organization. 2021) More than 10 million acupuncture treatments are administered annually in the U.S. (Jason Jishun Hao, Michele Mittelman. 2014)

What Is It?

Acupuncture is a medical practice that involves placing solid but super thin needles at specific points in the body to treat certain health issues. They can be used on their own or stimulated with electric currents, called electroacupuncture. Acupuncture originated in China about 3,000 years ago and is known as traditional Chinese medicine or TCM. In more recent years, the practice has gained acceptance and demand worldwide. (Jason Jishun Hao, Michele Mittelman. 2014)

How Does It Work?

Acupuncture pain management works by balancing the flow of qi/chi/energy, which moves through meridians, or channels in the body. By inserting needles into specific points along these channels, balance is reestablished for overall health and well-being. When the energy is imbalanced due to internal and external stressors that can include injuries, underlying conditions, unhealthy diet, and stress, individuals can present with symptoms and illness. Using diagnostic techniques and comprehensive interviews, practitioners can determine which organ systems and meridian channels need addressing to restore function. There are more than 2,000 acupoints in the body. (Johns Hopkins Medicine. 2024) Each point has its own purpose and function: some increase energy, others decrease it, helping balance the body to support healing and recovery. Acupuncture pain management goes beyond energy healing and can help alleviate pain by stimulating nerves, muscles, and fascia/connective tissue, regulating immune response, nervous system response, lymphatic flow, and increasing muscle relaxation.

Types

Different types of acupuncture have been modified in training and styles, but all involve needling into certain points and include:

Orthopedic/Dry Needling

  • This technique combines Traditional Chinese Medicine and structure manipulation to treat pain, tissue injuries, imbalances in the body, and other general systemic disorders.

Five Element Style

  • This is a spiritual and emotional technique that uses the five elements of nature, including wood, fire, earth, metal, and water, to transfer energy, creating balance in the body.

Japanese Style

  • uses similar techniques to TCM but uses a more subtle approach, such as using fewer needles or inserting them at lower depths in the body.

Korean

  • This technique uses both techniques from Chinese and Japanese acupuncture.
  • Practitioners may use more needles and different kinds of needles, like a copper variety, instead of the standard stainless steel type.
  • This type of acupuncture uses only acupoints on the hand to treat different areas of the body.

Auricular

  • This is similar to Korean acupuncture but relies on certain points in the ear to treat other areas of the body.
  • The goal is to overcome imbalances and disharmonies.

Distal

  • This technique treats pain indirectly.
  • Practitioners place needles in spots other than the area of discomfort.
  • For example, practitioners may place needles around the elbows for knee pain or the lower legs for shoulder pain.

Acupressure

  • This form of therapy stimulates different acupoints without using needles.
  • Practitioners use precise finger placements, hands, or other tools and essential oils to apply pressure over specific points to enhance energy flow.

Providers can combine and use various forms based on an individual’s needs.

Conditions

One analysis of more than 2,000 scientific reviews of acupuncture therapies found it to be effective for post-stroke aphasia, neck, shoulder, lower back pain, muscle pain, fibromyalgia pain, lactation issues after delivery, vascular dementia symptoms, and allergy symptoms. (Liming Lu et al., 2022) A study on mice by neuroscientists found that electroacupuncture can decrease inflammation. (Shenbin Liu et al., 2020) The National Center for Complementary and Integrative Health found that acupuncture can be helpful for: (National Center for Complementary and Integrative Health. 2022)

  • Carpal tunnel syndrome
  • Back and neck pain
  • Sciatica
  • Myofascial pain syndrome
  • Chronic pelvic pain syndrome
  • Fibromyalgia
  • Osteoarthritis
  • Improves sleep
  • Stress
  • Headaches
  • Migraines
  • Menopausal hot flashes
  • Post-surgery pain
  • Cancer pain
  • Nausea and vomiting in cancer patients undergoing treatment
  • Chronic prostatitis
  • Digestion
  • Irritable bowel syndrome
  • Seasonal allergies
  • Urinary incontinence
  • Infertility
  • Asthma
  • Quitting smoking
  • Depression

Safety

When the treatment is performed by a highly trained, licensed, and certified acupuncturist, it is very safe. The most common serious adverse events were pneumothorax/collapsed lung, cardiovascular problems, and fainting, which in some cases caused trauma, like fractures. (Petra Bäumler et al., 2021) There are some short-term risks associated with acupuncture, including:

  • Pain
  • Bleeding
  • Bruising
  • Drowsiness
  • Dizziness for individuals that have not eaten or fear of needles.

Serious side effects associated with acupuncture, like a punctured lung or infection, are very rare. For individuals that have a metal allergy, infection, or open wound in the area where the needles will be inserted, it is recommended to avoid acupuncture. Individuals who have a bleeding disorder, are taking any medicines like an anticoagulant, or are pregnant, should talk to the acupuncturist before beginning a treatment plan.

What to Expect

Everyone’s visit will be tailored to their specific needs, and the first visit will likely last an hour or two. The initial evaluation will include a full medical/health history. The individual will spend a few minutes discussing concerns and health goals with the acupuncturist. Individuals will be asked to lie on the treatment table so the practitioner can access their limbs, back, and abdomen. After inserting needles, they will stay in place for about 20 to 30 minutes. At this time, individuals can relax, meditate, sleep, listen to music, etc. The practitioner may monitor if and how the pulse has changed and add or remove needles. After the needles are removed, the practitioner will determine the course of treatment. Depending on how chronic or severe the condition is, they may recommend several acupuncture pain management treatments over the course of several weeks.


Chiropractic Care For Healing After Trauma


References

World Health Organization. (2021). WHO benchmarks for the practice of acupuncture.

Hao, J. J., & Mittelman, M. (2014). Acupuncture: past, present, and future. Global advances in health and medicine, 3(4), 6–8. doi.org/10.7453/gahmj.2014.042

Johns Hopkins Medicine. (2024). Acupuncture.

Lu, L., Zhang, Y., Tang, X., Ge, S., Wen, H., Zeng, J., Wang, L., Zeng, Z., Rada, G., Ávila, C., Vergara, C., Tang, Y., Zhang, P., Chen, R., Dong, Y., Wei, X., Luo, W., Wang, L., Guyatt, G., Tang, C., … Xu, N. (2022). Evidence on acupuncture therapies is underused in clinical practice and health policy. BMJ (Clinical research ed.), 376, e067475. doi.org/10.1136/bmj-2021-067475

Liu, S., Wang, Z. F., Su, Y. S., Ray, R. S., Jing, X. H., Wang, Y. Q., & Ma, Q. (2020). Somatotopic Organization and Intensity Dependence in Driving Distinct NPY-Expressing Sympathetic Pathways by Electroacupuncture. Neuron, 108(3), 436–450.e7. doi.org/10.1016/j.neuron.2020.07.015

National Center for Complementary and Integrative Health. (2022). Acupuncture: what you need to know.

Bäumler, P., Zhang, W., Stübinger, T., & Irnich, D. (2021). Acupuncture-related adverse events: systematic review and meta-analyses of prospective clinical studies. BMJ open, 11(9), e045961. doi.org/10.1136/bmjopen-2020-045961

Physical Therapy After Total Ankle Replacement Surgery

Physical Therapy After Total Ankle Replacement Surgery

Progress can be challenging for individuals in post total ankle replacement surgery. How can physical therapy help in recovery and restoring leg function?

Physical Therapy After Total Ankle Replacement Surgery

Total Ankle Replacement Post Surgery Physical Therapy

Total ankle replacement surgery is a major procedure that takes time to recover. A total ankle replacement surgery or arthroplasty can benefit individuals with chronic ankle pain or disability. This procedure can significantly improve an individual’s overall pain and function with time. Physical therapy is essential to regaining movement in the ankle and restoring full mobility. A physical therapist will work with the individual to control pain and swelling, restore the ankle’s range of motion, train on walking gait and balance, and rebuild strength in the leg. This will help maximize the chances of a successful outcome after surgery.

Total Ankle Replacement

The ankle joint is the section of the lower leg where the shinbone/tibia meets the talus bone on the top of the foot. What can happen is the slippery surface/articular cartilage that coats the ends of these bones begins to thin or deteriorate. As the deterioration progresses, it can lead to significant pain, disability, and difficulty walking. (Cleveland Clinic. 2021) This is where a specialist may recommend total ankle replacement for the best results. Various conditions can be helped by this procedure, including:

  • Joint damage caused by gout
  • Post-traumatic arthritis
  • Rheumatoid arthritis
  • Advanced osteoarthritis
  • Osteonecrosis
  • Septic arthritis (Cort D. Lawton et al., 2017)

During an ankle replacement procedure, an orthopedic surgeon removes the damaged ends of the tibia and talus bones and replaces them with an artificial covering. A polyethylene component is also secured between the two structures to support the smooth movement of the new joint endings. (Massachusetts General Hospital. N.D.) Following the procedure, individuals are typically placed in a protective boot or splint. The healthcare provider will recommend staying off the leg for 4 to 8 weeks to allow healing.

Physical Therapy

Outpatient physical therapy is usually initiated several weeks after the ankle operation. (UW Health Orthopedics and Rehabilitation. 2018) Physical therapy can last for five months or more, depending on the severity of the condition and injury. The physical therapist will focus on different areas to get the best results. (Cort D. Lawton et al., 2017)

Pain and Swelling Control

Post-operative pain and swelling are normal after a total ankle replacement. It is not unusual for an ankle to be swollen for even six to 12 months after the operation. (UW Health Orthopedics and Rehabilitation. 2018) The surgeon will normally prescribe medication to help manage discomfort early on, and physical therapy also plays an important role in addressing the symptoms. Treatments used can include:

  • Electrical stimulation – mild electrical pulses applied to the muscles.
  • Ice
  • Vasopneumatic compression, where an inflatable sleeve is used to create pressure around the area, is commonly utilized at the beginning of physical therapy to reduce pain or swelling.
  • Other modalities, such as stretching and targeted exercises, are combined with other treatments.

Range of Motion

  • Early after the procedure, the ankle will be very stiff and tight. This is due to several factors, including the inflammation and swelling after surgery and the time spent immobilized in a boot.
  • The physical therapist will employ various techniques to improve the ankle joint’s range of motion to rotate and flex.
  • The physical therapist may employ passive stretching induced by an outside force such as the therapist or a resistance band) to help improve mobility.
  • Manual techniques like soft tissue massage and joint mobilizations are also utilized. (Massachusetts General Hospital. N.D.)
  • The therapist will develop a home rehabilitation program comprising self-stretching techniques and gentle movements.

Gait and Balance Training

  • After weeks of staying off the affected ankle, the surgeon will clear the patient to begin walking training.
  • The physical therapist will work to improve the overall gait pattern and reduce limping.
  • They will also help transition from using crutches or a walker to walking independently. (UW Health Orthopedics and Rehabilitation. 2018)
  • After multiple weeks of reduced movement and lack of bearing any weight on the ankle, the muscles that surround the ankle have often atrophied/weakened, which can impact balance.
  • When the individual can begin placing weight on the leg, the therapist will apply proprioceptive/sense of body position training to improve overall stability. (UW Health Orthopedics and Rehabilitation. 2018)
  • Balance exercises will be added to the home program and will progress from week to week.

Strength

The muscles in the leg, ankle, and foot become weak from the surgery and the time spent in a splint or boot. These structures have a significant role in balance, the ability to stand, walk, and go up or down the stairs.

  • Regaining the strength and power of these muscles is a critical goal of rehabilitation.
  • In the first weeks, the physical therapist will focus on gentle strengthening exercises.
  • Isometrics lightly activate the muscles but avoid irritating the surgical site.
  • As time passes and weight-bearing is allowed, these gentle moves are replaced with more challenging ones, like resistance bands and standing exercises, to accelerate strength gains.

Treating Ankle Sprains with Chiropractic Care


References

Cleveland Clinic. (2021). Total ankle replacement.

Lawton, C. D., Butler, B. A., Dekker, R. G., 2nd, Prescott, A., & Kadakia, A. R. (2017). Total ankle arthroplasty versus ankle arthrodesis-a comparison of outcomes over the last decade. Journal of orthopaedic surgery and research, 12(1), 76. doi.org/10.1186/s13018-017-0576-1

Massachusetts General Hospital. (N.D.). Physical therapy guidelines for total ankle arthroplasty.

UW Health Orthopedics and Rehabilitation. (2018). Rehabilitation guidelines following total ankle arthroplasty.

Break Up Scar Tissue With Friction Massage

Break Up Scar Tissue With Friction Massage

For individuals having difficulty moving or functioning normally due to injury, surgery, or illness, can a chiropractic and physical therapy team help expedite recovery?

Break Up Scar Tissue With Friction Massage

Friction Massage

Individuals may develop scar tissue or tissue adhesions that limit normal motion after injury or surgery. A pain management team may use various treatments and modalities and may incorporate friction massage as part of a rehabilitation treatment plan. Friction massage, also known as transverse friction or cross friction massage, is a technique used to help improve scar tissue and adhesion mobility to move better and decrease the negative effects. The therapist uses their fingers to massage the scar in a direction that is at right angles to the scar line. It is a specialized technique that breaks up tissue adhesions that are limiting normal movement in the skin and underlying tissues. (Haris Begovic, et al., 2016)

Scar Tissue and Adhesions

For individuals who require surgery due to an injury or an orthopedic condition, their doctor will cut into the skin, tendons, and muscle tissue during the operation. Once sutured and healing has begun, scar tissue forms. Healthy tissue is made up of collagen that is comprised of cells that are arranged in a regular pattern. Healthy collagen is strong and can resist forces when tissues are pulled and stretched. (Paula Chaves, et al., 2017)

During the healing process after an injury, the collagen cells are laid down in a haphazard pattern and form scar tissue. The random accumulation of cells becomes tight and does not react well to tension and stretching forces. (Qing Chun, et al., 2016) The body can form scar tissue after a soft tissue injury, like a muscle or tendon strain. (Qing Chun, et al., 2016)

If a muscle or tendon gets strained the body will generate new collagen during the healing. The new collagen is laid down in a random fashion, and scar tissue or tissue adhesions can form that can limit the normal range of motion. Healthy tissue stretches and glides as the body moves. Scar tissue is rigid. At the site of the scar tissue, there can be some movement, but it is tight, less pliable, and can be painful. If scar tissue or adhesions are limiting motion, cross-friction massage can improve tissue gliding and sliding. This process is referred to as remodeling.

Massage Objectives

The objectives and goals of friction massage to adhesions or scar tissue may include:

  • Stimulation of nerve fibers to decrease and relieve pain.
  • Increase blood circulation to the tissues.
  • Working the affected tissue to break up scarring.
  • Collagen fibers tissue realignment.
  • Improve mechanoreceptor activity.

Massage Technique

Friction massage treatment follows a specific technique: (Paula Chaves, et al., 2017)

  • The entire area of scar tissue or adhesion should be treated.
  • If the scar tissue is in a muscle, it should be relaxed.
  • If the scar tissue is in a tendon sheath, that tendon should be slightly stretched during the procedure.
  • The therapist places two or three fingers over the scar or adhesion and moves their fingers perpendicular to the scar to smooth the collagen fibers down.
  • The fingers and underlying tissues move together.
  • The massage should feel deep and uncomfortable but not painful.
  • There may be some pain, but should remain within the individual’s tolerance.
  • If the massage is too painful, less pressure may be used.
  • After several minutes the therapist will assess the tissue mobility.
  • Specific stretches may be done to elongate the scar tissue or adhesions.
  • At-home exercises and stretches may be prescribed to maintain flexibility.

Contraindications

There are situations where friction massage should not be used and can include: (Paula Chaves, et al., 2017)

  • Around an active open wound.
  • If there is a bacterial infection.
  • Areas with decreased sensation.
  • If calcification is present in the muscle or tendon tissue.

The therapist will explain the procedure and inform of the goals and risks associated with it.

Diagnoses Treated

Diagnoses that can be treated with friction massage can include: (Paula Chaves, et al., 2017)

  • Muscle tears or strains.
  • For tendonitis or tendinopathy.
  • After a tendon tear.
  • Adhesive capsulitis in the shoulder/frozen shoulder.
  • Joint contracture.
  • Ligament tears.
  • Scar tissue buildup after surgery or trauma.

Friction massage is a popular technique used in physical therapy, but some research suggests it is not any more effective than other rehabilitation techniques. One study found that static stretches and exercises were more effective than massage in improving tissue length and strength in uninjured soccer players. Other studies have supported this, but individuals may find that the massage helps improve injured tissues’ movement as well. (Mohammed Ali Fakhro, et al. 2020)

The main goal of any treatment in physical therapy is to help the individual regain movement and flexibility. Friction massage, combined with targeted stretches and exercises, can help individuals expedite recovery and get back to normal.


Chiropractic Care After Accidents and Injuries


References

Begovic, H., Zhou, G. Q., Schuster, S., & Zheng, Y. P. (2016). The neuromotor effects of transverse friction massage. Manual therapy, 26, 70–76. doi.org/10.1016/j.math.2016.07.007

Chaves, P., Simões, D., Paço, M., Pinho, F., Duarte, J. A., & Ribeiro, F. (2017). Cyriax’s deep friction massage application parameters: Evidence from a cross-sectional study with physiotherapists. Musculoskeletal science & practice, 32, 92–97. doi.org/10.1016/j.msksp.2017.09.005

Chun, Q., ZhiYong, W., Fei, S., & XiQiao, W. (2016). Dynamic biological changes in fibroblasts during hypertrophic scar formation and regression. International wound journal, 13(2), 257–262. doi.org/10.1111/iwj.12283

Fakhro, M. A., Chahine, H., Srour, H., & Hijazi, K. (2020). Effect of deep transverse friction massage vs stretching on football players’ performance. World journal of orthopedics, 11(1), 47–56. doi.org/10.5312/wjo.v11.i1.47

How to Recognize and Treat a Groin Strain Injury

How to Recognize and Treat a Groin Strain Injury

When a groin strain injury happens, can knowing the symptoms help in the diagnosis, treatment, and recovery times?

How to Recognize and Treat a Groin Strain Injury

Groin Strain Injury

A groin strain is an injury to an inner thigh muscle. A groin pull is a type of muscle strain affecting the adductor muscle group (the muscles help pull the legs apart). (Parisa Sedaghati, et al., 2013) The injury is caused when the muscle is stretched beyond its normal range of motion, creating superficial tears. Severe strains can tear the muscle in two. (Parisa Sedaghati, et al., 2013)

  • A groin muscle pull causes pain and tenderness that worsens when squeezing the legs together.
  • There may also be swelling or bruising in the groin or inner thigh.
  • An uncomplicated groin pull takes four to six weeks to heal with proper treatment. (Andreas Serner, et al., 2020)

Symptoms

A groin pull can be painful, interfering with walking, navigating stairs, and/or driving a car. In addition to pain, other symptoms around the injured area include: (Parisa Sedaghati et al., 2013)

  • A popping sound or snapping sensation when the injury occurs.
  • Increased pain when pulling the legs together.
  • Redness
  • Swelling
  • Bruising of the groin or inner thigh.

Groin pulls are graded by severity and how much they impact mobility:

Grade 1

  • Mild discomfort but not enough to limit activities.

Grade 2

  • Moderate discomfort with swelling or bruising that limits running and/or jumping.

Grade 3

  • Severe injury with significant swelling and bruising can cause pain while walking and muscle spasms.

Signs of a severe groin strain

  • Difficulty walking
  • Groin pain while sitting or resting
  • Groin pain at night
  • A healthcare provider should see severe groin pulls because the muscle may have ruptured or be on the verge of rupturing.
  • In severe cases, surgery is necessary to reattach the torn ends.

Groin pulls are sometimes accompanied by a stress fracture of the pubis/forward-facing pelvic bones, which can significantly extend healing and recovery time. (Parisa Sedaghati et al., 2013)

Causes

Groin pulls are often experienced by athletes and individuals who play sports where they must stop and change directions quickly, placing excessive strain on the adductor muscles. (Parisa Sedaghati et al., 2013) The risk is increased in individuals who: (T. Sean Lynch et al., 2017)

  • Have weak hip abductor muscles.
  • Are not in adequate physical condition.
  • Have a previous groin or hip injury.
  • Pulls can also occur from falls or extreme activities without the proper conditioning.

Diagnosis

A healthcare provider will perform a thorough investigation to confirm the diagnosis and characterize the severity. This involves: (Juan C. Suarez et al., 2013)

Medical History Review

  • This includes any previous injuries and specifics about where and when the symptoms started.

Physical Examination

  • This involves palpating – lightly touching and pressing the groin region and manipulating the leg to understand better where and how extensive the injury is.

Imaging Studies

  • Ultrasound or X-rays.
  • If a muscle rupture or fracture is suspected, an MRI scan may be ordered to visualize soft tissue injuries and stress fractures better.

Differential Diagnosis

Certain conditions can mimic a groin pull and require different treatments. These include: (Juan C. Suarez, et al., 2013)

Sports Hernia

  • This type of inguinal hernia occurs with sports and work injuries.
  • It causes a portion of the intestine to pop through a weakened muscle in the groin.

Hip Labral Tear

  • This is a tear in the cartilage ring of the labrum outside the rim of the hip joint socket.

Hip Osteoarthritis

  • This is the wear-and-tear form of arthritis that can present with groin pain symptoms.

Osteitis Pubis

  • This is inflammation of the pubic joint and surrounding structures, usually caused by the overuse of the hip and leg muscles.

Referred Groin Pain

  • This nerve pain originates in the lower back, often due to a pinched nerve, but is felt in the groin.

Treatment

Beginning treatment is conservative and includes rest, ice application, physical therapy, and prescribed gentle stretching and exercises.

  • Individuals may need crutches or a walking device to reduce pain and prevent further injury if the pain is significant. (Andreas Serner, et al., 2020)
  • Physical therapy will be a part of the treatment plan.
  • Over-the-counter pain medications like Tylenol/acetaminophen or Advil/ibuprofen can help with pain relief short term.
  • If there is severe pain from a grade 3 injury, prescription medications may be used for a short period to help minimize pain. (Andreas Serner, et al., 2020)
  • Surgery is not usually necessary. (Andreas Serner, et al., 2020)

Recovery

Recovery times can vary based on the injury’s severity and physical condition before the injury.

  • Most injuries will heal within four to six weeks with rest and proper treatment.
  • Severe groin strains can take up to 12 weeks or longer if surgery is involved. (Andreas Serner, et al., 2020)

Injury Rehabilitation


References

Sedaghati, P., Alizadeh, M. H., Shirzad, E., & Ardjmand, A. (2013). Review of sport-induced groin injuries. Trauma monthly, 18(3), 107–112. doi.org/10.5812/traumamon.12666

Serner, A., Weir, A., Tol, J. L., Thorborg, K., Lanzinger, S., Otten, R., & Hölmich, P. (2020). Return to Sport After Criteria-Based Rehabilitation of Acute Adductor Injuries in Male Athletes: A Prospective Cohort Study. Orthopaedic journal of sports medicine, 8(1), 2325967119897247. doi.org/10.1177/2325967119897247

Lynch, T. S., Bedi, A., & Larson, C. M. (2017). Athletic Hip Injuries. The Journal of the American Academy of Orthopaedic Surgeons, 25(4), 269–279. doi.org/10.5435/JAAOS-D-16-00171

Suarez, J. C., Ely, E. E., Mutnal, A. B., Figueroa, N. M., Klika, A. K., Patel, P. D., & Barsoum, W. K. (2013). Comprehensive approach to the evaluation of groin pain. The Journal of the American Academy of Orthopaedic Surgeons, 21(9), 558–570. doi.org/10.5435/JAAOS-21-09-558