Neuropathy "The Painful Enigma"

For individuals experiencing pelvic pain, it could be a disorder of the pudendal nerve known as pudendal neuropathy or neuralgia that leads to chronic pain. The condition can be caused by pudendal nerve entrapment, where the nerve becomes compressed or damaged. Can knowing the symptoms help healthcare providers correctly diagnose the condition and develop an effective treatment plan?

Pudendal Neuropathy

The pudendal nerve is the main nerve that serves the perineum, which is the area between the anus and the genitalia - the scrotum in men and the vulva in women. The pudendal nerve runs through the gluteus muscles/buttocks and into the perineum. It carries sensory information from the external genitalia and the skin around the anus and perineum and transmits motor/movement signals to various pelvic muscles. (Origoni, M. et al., 2014) Pudendal neuralgia, also referred to as pudendal neuropathy, is a disorder of the pudendal nerve that can lead to chronic pelvic pain.

Causes

Chronic pelvic pain from pudendal neuropathy can be caused by any of the following (Kaur J. et al., 2024)

• Excessive sitting on hard surfaces, chairs, bicycle seats, etc. Bicyclists tend to develop pudendal nerve entrapment.
• Trauma to the buttocks or pelvis.
• Childbirth.
• Diabetic neuropathy.
• Bony formations that push against the pudendal nerve.
• Thickening of ligaments around the pudendal nerve.

Symptoms

Pudendal nerve pain can be described as stabbing, cramping, burning, numbness, or pins and needles and can present (Kaur J. et al., 2024)

• In the perineum.
• In the anal region.
• In men, pain in the scrotum or penis. 
• In women, pain in the labia or vulva.
• During intercourse.
• When urinating.
• During a bowel movement.
• When sitting and goes away after standing up.

Because the symptoms are often hard to distinguish, pudendal neuropathy can often be hard to differentiate from other types of chronic pelvic pain.

Cyclist’s Syndrome

Prolonged sitting on a bicycle seat can cause pelvic nerve compression, which can lead to chronic pelvic pain. The frequency of pudendal neuropathy (chronic pelvic pain caused by entrapment or compression of the pudendal nerve) is often referred to as Cyclist’s Syndrome. Sitting on certain bicycle seats for long periods places significant pressure on the pudendal nerve. The pressure can cause swelling around the nerve, which causes pain and, over time, can lead to nerve trauma. Nerve compression and swelling can cause pain described as burning, stinging, or pins and needles. (Durante, J. A., and Macintyre, I. G. 2010) For individuals with pudendal neuropathy caused by bicycling, symptoms can appear after prolonged biking and sometimes months or years later.

Cyclist's Syndrome Prevention

A review of studies provided the following recommendations for preventing Cyclist's Syndrome (Chiaramonte, R., Pavone, P., Vecchio, M. 2021)

Rest

• Take breaks at least 20–30 seconds after each 20 minutes of riding.
• While riding, change positions frequently.
• Stand up to pedal periodically.
• Take time off between riding sessions and races to rest and relax the pelvic nerves. 3–10 day breaks can help in recovery. (Durante, J. A., and Macintyre, I. G. 2010)
• If pelvic pain symptoms are barely starting to develop, rest and see a healthcare provider or specialist for an examination.

Seat

• Use a soft, wide seat with a short nose.
• Have the seat level or tilted slightly forward.
• Seats with cutout holes place more pressure on the perineum.
• If numbness or pain is present, try a seat without holes.

Bike Fitting

• Adjust the seat height so the knee is slightly bent at the bottom of the pedal stroke.
• The body's weight should rest on the sitting bones/ischial tuberosities.
• Keeping the handlebar height below the seat can reduce pressure.
• The Triathlon bike's extreme-forward position should be avoided.
• A more upright posture is better.
• Mountain bikes have been associated with an increased risk of erectile dysfunction than road bikes.

Shorts

• Wear padded bike shorts.

Treatments

A healthcare provider may use a combination of treatments.

• The neuropathy can be treated with rest if the cause is excessive sitting or cycling.
• Pelvic floor physical therapy can help relax and lengthen the muscles.
• Physical rehabilitation programs, including stretches and targeted exercises, can release nerve entrapment.
• Chiropractic adjustments can realign the spine and pelvis.
• The active release technique/ART involves applying pressure to muscles in the area while stretching and tensing. (Chiaramonte, R., Pavone, P., Vecchio, M. 2021)
• Nerve blocks may help relieve pain caused by nerve entrapment. (Kaur J. et al., 2024)
• Certain muscle relaxers, antidepressants, and anticonvulsants may be prescribed, sometimes in combination.
• Nerve decompression surgery may be recommended if all conservative therapies have been exhausted. (Durante, J. A., and Macintyre, I. G. 2010)

Injury Medical Chiropractic and Functional Medicine Clinic care plans and clinical services are specialized and focused on injuries and the complete recovery process. Our areas of practice include Wellness and nutrition, Chronic Pain, Personal Injury, Auto Accident Care, Work Injuries, Back Injury, Low Back Pain, Neck Pain, Migraine Headaches, Sports Injuries, severe sciatica, Scoliosis, Complex Herniated Discs, Fibromyalgia, Chronic Pain, Complex Injuries, Stress Management, and Functional Medicine Treatments. If the individual requires other treatment, they will be referred to a clinic or physician best suited for their condition, as Dr. Jimenez has teamed with the top surgeons, clinical specialists, medical researchers, therapists, trainers, and premiere rehabilitation providers.

Pregnancy and Sciatica

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research studies or studies supporting our posts. We provide copies of supporting research studies that are available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please contact Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Origoni, M., Leone Roberti Maggiore, U., Salvatore, S., & Candiani, M. (2014). Neurobiological mechanisms of pelvic pain. BioMed research international, 2014, 903848. https://doi.org/10.1155/2014/903848

Kaur, J., Leslie, S. W., & Singh, P. (2024). Pudendal Nerve Entrapment Syndrome. In StatPearls. https://www.ncbi.nlm.nih.gov/pubmed/31334992

Durante, J. A., & Macintyre, I. G. (2010). Pudendal nerve entrapment in an Ironman athlete: a case report. The Journal of the Canadian Chiropractic Association, 54(4), 276–281.

Chiaramonte, R., Pavone, P., & Vecchio, M. (2021). Diagnosis, Rehabilitation and Preventive Strategies for Pudendal Neuropathy in Cyclists, A Systematic Review. Journal of functional morphology and kinesiology, 6(2), 42. https://doi.org/10.3390/jfmk6020042

For individuals living with cyclical or chronic endometriosis symptoms, can incorporating support therapies help in disease management?

Support Therapies

Endometriosis is a disorder in which tissue similar to the uterine lining begins to grow outside the uterus where it does not belong. Endometriosis support therapies involve a comprehensive approach to treatment. It involves non-invasive treatments to help manage symptoms that can include:

• Pelvic floor physical therapy
• Massage
• Medication
• Transcutaneous Electrical Nerve Stimulation
• Acupuncture
• Chiropractic

Pelvic Floor Physical Therapy - PFPT

• Endometriosis can cause or contribute to pelvic floor dysfunction, causing pain, urinary disorders, bowel problems, and painful sexual intercourse.
• Pelvic floor physical therapy improves the strength and function of the pelvic floor muscles.
• Example support therapies can include kegel exercises and biofeedback. (Christine Mansfield et al., 2022)

Therapeutic Massage

A physical therapist uses various pressures, stretching, and/or trigger point release. This helps: (Sylvia Mechsner, 2022)

• Release muscle tension
• Lower cortisol - stress hormone
• Improve circulation
• Release endorphins - the body's natural painkillers

Medications

Nonsteroidal anti-inflammatory drugs or NSAIDs and hormonal contraceptives - birth control are the first line of treatment. Advil and Motrin are over-the-counter NSAIDs. If those don't manage pain effectively, a healthcare provider may recommend prescription NSAIDs. (Sylvia Mechsner, 2022) Hormonal suppression agents or estrogen modulators are a second line of treatment for endometriosis and can include: (Christian M. Becker et al., 2022)

• Gonadotropin-releasing hormone agonists (GnRH)
• Antigonadotropic meds
• Aromatase inhibitors
• Selective estrogen receptor modulators (SERMs)

Other medications include:(Sylvia Mechsner, 2022)

• Valium - diazepam suppositories - Muscle-relaxing medications.
• Gabapentinoids - Medications that treat nerve pain.
• Antidepressants - these can increase the pain-reducing effect of other medications.

An endometriosis specialist. (Endometriosis Foundation of America. 2015) may suggest seeing a pain management specialist who provides nerve blocks or Botox injections. (Augusto Pereira et al., 2022)

Birth Control

Hormonal contraceptives suppress or regulate periods. They are effective for management, but not everyone can take them because of medical history, side effects, or fertility disorders and conditions. (Mert Ilhan et al., 2019) A healthcare provider can recommend alternative support therapies.

Transcutaneous Electrical Nerve Stimulation

• A transcutaneous electrical nerve stimulation utilizes a battery-operated device that delivers low-voltage electrical stimulation to nerve fibers through electrodes placed on the skin.
• Sessions are usually 15 to 30 minutes and work by disrupting pain signals. (Sylvia Mechsner, 2022)

Acupuncture

• Acupuncture is a therapy in which a practitioner inserts thin needles into specific acupoints on the body to promote the flow of energy and alleviate pain. (Nora Giese et al., 2023)

Chiropractic

• Chiropractic care focuses on spinal adjustments and alignment to enhance nervous system function, help alleviate pelvic discomfort and nerve pain - sciatica - and improve overall well-being. (Robert J. Trager et al., 2021)
• Non-surgical decompression could be recommended to gently stretch the spine, relieve pressure, and flood the spine with added nutrients.

Movement Medicine: Chiropractic Care

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research studies or studies supporting our posts. We provide copies of supporting research studies that are available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please contact Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Mansfield, C., Lenobel, D., McCracken, K., Hewitt, G., & Appiah, L. C. (2022). Impact of Pelvic Floor Physical Therapy on Function in Adolescents and Young Adults with Biopsy-Confirmed Endometriosis at a Tertiary Children's Hospital: A Case Series. Journal of pediatric and adolescent gynecology, 35(6), 722–727. https://doi.org/10.1016/j.jpag.2022.07.004

Mechsner S. (2022). Endometriosis, an Ongoing Pain-Step-by-Step Treatment. Journal of clinical medicine, 11(2), 467. https://doi.org/10.3390/jcm11020467

Ilhan, M., Gürağaç Dereli, F. T., & Akkol, E. K. (2019). Novel Drug Targets with Traditional Herbal Medicines for Overcoming Endometriosis. Current drug delivery, 16(5), 386–399. https://doi.org/10.2174/1567201816666181227112421

Becker, C. M., Bokor, A., Heikinheimo, O., Horne, A., Jansen, F., Kiesel, L., King, K., Kvaskoff, M., Nap, A., Petersen, K., Saridogan, E., Tomassetti, C., van Hanegem, N., Vulliemoz, N., Vermeulen, N., & ESHRE Endometriosis Guideline Group (2022). ESHRE guideline: endometriosis. Human reproduction open, 2022(2), hoac009. https://doi.org/10.1093/hropen/hoac009

Endometriosis Foundation of America. (2015). Seeking a doctor: finding the right endometriosis specialist. https://www.endofound.org/preparing-to-see-a-doctor

Pereira, A., Herrero-Trujillano, M., Vaquero, G., Fuentes, L., Gonzalez, S., Mendiola, A., & Perez-Medina, T. (2022). Clinical Management of Chronic Pelvic Pain in Endometriosis Unresponsive to Conventional Therapy. Journal of personalized medicine, 12(1), 101. https://doi.org/10.3390/jpm12010101

Giese, N., Kwon, K. K., & Armour, M. (2023). Acupuncture for endometriosis: A systematic review and meta-analysis. Integrative medicine research, 12(4), 101003. https://doi.org/10.1016/j.imr.2023.101003

Trager, R.J., Prosak, S.E., Leonard, K.A. et al. (2021). Diagnosis and management of sciatic endometriosis at the greater sciatic foramen: a case report. SN Comprehensive Clinical Medicine, 3. https://doi.org/doi:10.1007/s42399-021-00941-0

For individuals starting to lift weights, motor units are important for muscle movement. Can building more motor units help build strength and maintain muscle mass?

Motor Units

Motor units control the skeletal muscles and are the force behind every body movement. (C J. Heckman, Roger M. Enoka 2012)
This includes voluntary movements like lifting weights and involuntary movements like breathing. When lifting objects and weights, the body adapts to motor unit needs, meaning that individuals must consistently increase the weight to progress. 

• Lifting weights regularly trains the body to generate more motor units and force.
• General guidelines recommend lifting weights for all muscle groups two to three non-consecutive days a week.
• Consistency helps maintain muscle mass.
• Regular progression increases the risk of plateauing.

What They Are

Exercise increases the body's muscle strength, while sedentariness and inactivity weaken them. A motor unit is a single nerve cell/neuron that supplies the nerves to innervate a group of skeletal muscles. The neuron receives signals from the brain that stimulate all the muscle fibers in that particular motor unit to generate movement.

• Muscles comprise different fiber types.
• They are attached to the bones with connective tissue, which is stronger than the muscle.
• Multiple motor units are dispersed throughout the muscle.
• The motor units help ensure muscle contraction force is evenly spread throughout the muscle.
• Motor units are different sizes and operate differently depending on where and what they do.
• Small motor units might only innervate five or ten fibers. For example, to blink or sniff.
• Large motor units can comprise hundreds of muscle fibers for swinging or jumping movements.

How They Work

The number of units activated depends on the task. Stronger muscle contractions require more. However, fewer units are needed to accomplish the movement for individuals expending less effort.

Contraction

• Once a unit receives a signal from the brain, the muscle fibers contract simultaneously.
• The force generated depends on how many units are required to accomplish the task. (Purves D. et al., 2001)
• For example, picking up small objects like a pen and paper requires only a few units to generate the force needed.
• If picking up a heavy barbell, the body needs more units because more force is needed to lift the heavier load.
• The body can generate more force with stronger muscles.
• This happens when lifting weights on a regular basis and overloading the muscles with more weight than they can handle.
• This process is known as adaptation.

Adaptation

The purpose of lifting weights is to challenge the muscles so they adapt to the new challenge and grow in strength and mass. Motor units are a major part of the adaptation process. (Dr. Erin Nitschke. American Council on Exercise. 2017)

• When first starting weight training, the brain recruits more units every time a muscle is contracted. (Pete McCall. American Council on Exercise. 2015)
• As individuals continue working out, their ability to generate more force increases and units activate more rapidly.
• This makes movements more efficient.
• Individuals can increase motor unit recruitment by consistently increasing the weight challenge to their muscles.
• The development creates movement memory.
• A relationship between the brain, muscles, and motor units is established even if the individual stops working out. The pathways are still there no matter how long the individual takes off.
• When returning to training, the body will remember how to ride a bike, do a bicep curl, or squat.
• However, the muscles will not have the same strength as the strength needs to be built back along with endurance that may have been lost.
• It is the movement memory that remains.

Military Training and Chiropractic Care: Maximizing Performance

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research studies or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please contact Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Heckman, C. J., & Enoka, R. M. (2012). Motor unit. Comprehensive Physiology, 2(4), 2629–2682. https://doi.org/10.1002/cphy.c100087

Purves D, Augustine GJ, Fitzpatrick D, et al., editors. (2001). Neuroscience. 2nd edition. Sunderland (MA): Sinauer Associates; 2001. The Motor Unit. Available from: https://www.ncbi.nlm.nih.gov/books/NBK10874/

Dr. Erin Nitschke. American Council on Exercise. (2017). How Muscle Grows (Exercise Science, Issue. https://www.acefitness.org/resources/everyone/blog/6538/how-muscle-grows/

Pete McCall. American Council on Exercise. (2015). 10 Things to Know About Muscle Fibers (Exercise Science, Issue. https://www.acefitness.org/resources/pros/expert-articles/5411/10-things-to-know-about-muscle-fibers/

Individuals experiencing pain symptoms like shooting, stabbing, or electrical sensations to the latissimus dorsi of the upper back could be caused by a nerve injury to the thoracodorsal nerve. Can knowing the anatomy and symptoms help healthcare providers develop an effective treatment plan?

Thoracodorsal Nerve

Also known as the middle subscapular nerve or the long subscapular nerve, it branches out from a part of the brachial plexus and provides motor innervation/function to the latissimus dorsi muscle.

Anatomy

The brachial plexus is a network of nerves that stem from the spinal cord in the neck. The nerves supply most of the sensation and movement of the arms and hands, with one on each side. Its five roots come from the spaces between the fifth through eighth cervical vertebrae and the first thoracic vertebra. From there, they form a larger structure, then divide, re-combine, and divide again to form smaller nerves and nerve structures as they travel down the armpit. Through the neck and chest, the nerves eventually join and form three cords that include:

• Lateral cord
• Medial cord
• Posterior cord

The posterior cord produces major and minor branches that include:

• Axillary nerve
• Radial nerve

The minor branches include:

• Superior subscapular nerve
• Inferior subscapular nerve
• Thoracodorsal nerve

Structure and Position

• The thoracodorsal nerve branches off the posterior cord in the armpit and travels down, following the subscapular artery, to the latissimus dorsi muscle.
• It connects to the upper arm, stretches across the back of the armpit, forming the axillary arch, and then expands into a large triangle that wraps around the ribs and the back.
• The thoracodorsal nerve lies deep in the latissimus dorsi, and the lower edge typically reaches close to the waist.

Variations

• There is a standard location and course of the thoracodorsal nerve, but individual nerves are not the same in everyone.
• The nerve typically branches off the posterior cord of the brachial plexus from three different points.
•  However, different subtypes have been identified.
• The thoracodorsal nerve supplies the teres major muscle in about 13% of individuals. (Brianna Chu, Bruno Bordoni. 2023)
• The lats can have a rare anatomical variation known as a Langer’s arch, which is an extra part that connects to muscles or connective tissue of the upper arm beneath the common connecting point.
• In individuals with this abnormality, the thoracodorsal nerve supplies function/innervation) to the arch. (Ahmed M. Al Maksoud et al., 2015)

Function

The latissimus dorsi muscle cannot function without the thoracodorsal nerve. The muscle and nerve help:

• Stabilize the back.
• Pull the body weight up when climbing, swimming, or doing pull-ups.
• Assist with breathing by expanding the rib cage during inhalation and contracting when exhaling. (Encyclopaedia Britannica. 2023)
• Rotate the arm inward.
• Pull the arm toward the center of the body.
• Extend the shoulders by working with the teres major, teres minor, and posterior deltoid muscles.
• Bring down the shoulder girdle by arching the spine.
• To bend to the side by arching the spine.
• Tilt the pelvis forward.

Conditions

The thoracodorsal nerve can be injured anywhere along its path by trauma or disease. Symptoms of nerve damage can include: (U.S. National Library of Medicine: MedlinePlus. 2022)

• Pain that can be shooting, stabbing, or electrical sensations.
• Numbness, tingling.
• Weakness and loss of function in the associated muscles and body parts, including wrist and finger drop.
• Because of the nerve's path through the armpit, doctors have to be cautious of the anatomical variants so they don’t inadvertently damage a nerve during breast cancer procedures, including axillary dissection.
• The procedure is performed to examine or remove lymph nodes and is used in staging breast cancer and in treatment.
• According to a study, 11% of individuals with axillary lymph node dissection suffered damage to the nerve. (Roser Belmonte et al., 2015)

Breast Reconstruction

• In breast reconstruction surgery, the lats can be used as a flap over the implant.
• Depending on the circumstances, the thoracodorsal nerve can be left intact or severed.
• The medical community has not agreed on which method has the best outcomes. (Sung-Tack Kwon et al., 2011)
• There is some evidence that leaving the nerve intact can cause the muscle to contract and dislocate the implant.
• An intact thoracodorsal nerve may also cause atrophy of the muscle, which can lead to shoulder and arm weakness.

Graft Uses

A portion of the thoracodorsal nerve is commonly used in nerve graft reconstruction to restore function after injury, which includes the following:

• Musculocutaneous nerve
• Accessory nerve
• Axillary nerve
• The nerve can also be used to restore nerve function to the triceps muscle in the arm.

Rehabilitation

If the thoracodorsal nerve is injured or damaged, treatments can include:

• Braces or splints.
• Physical therapy to improve range of motion, flexibility, and muscle strength.
• If there is compression, surgery may be required to alleviate the pressure.

Exploring Integrative Medicine

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research studies or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to discuss the subject matter above further, please contact Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Chu B, Bordoni B. Anatomy, Thorax, Thoracodorsal Nerves. [Updated 2023 Jul 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539761/

Al Maksoud, A. M., Barsoum, A. K., & Moneer, M. M. (2015). Langer's arch: a rare anomaly affects axillary lymphadenectomy. Journal of surgical case reports, 2015(12), rjv159. https://doi.org/10.1093/jscr/rjv159

Britannica, The Editors of Encyclopaedia. "latissimus dorsi". Encyclopedia Britannica, 30 Nov. 2023, https://www.britannica.com/science/latissimus-dorsi. Accessed 2 January 2024.

U.S. National Library of Medicine: MedlinePlus. Peripheral neuropathy.

Belmonte, R., Monleon, S., Bofill, N., Alvarado, M. L., Espadaler, J., & Royo, I. (2015). Long thoracic nerve injury in breast cancer patients treated with axillary lymph node dissection. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 23(1), 169–175. https://doi.org/10.1007/s00520-014-2338-5

Kwon, S. T., Chang, H., & Oh, M. (2011). Anatomic basis of interfascicular nerve splitting of innervated partial latissimus dorsi muscle flap. Journal of plastic, reconstructive & aesthetic surgery : JPRAS, 64(5), e109–e114. https://doi.org/10.1016/j.bjps.2010.12.008

For individuals dealing with chronic pain conditions can having a better understanding of pain management specialists help in developing effective multidisciplinary treatment plans?

Pain Management Specialists

Pain management is a growing medical specialty that takes a multi-disciplinary approach to treating all types of pain. It is a branch of medicine that applies scientifically proven techniques and methods to relieve, reduce, and manage pain symptoms and sensations. Pain management specialists evaluate, rehabilitate, and treat a spectrum of conditions, including neuropathic pain, sciatica, postoperative pain, chronic pain conditions, and more. Many primary healthcare providers refer their patients to pain management specialists if pain symptoms are ongoing or significant in their manifestation.

Specialists

Healthcare providers specializing in pain management recognize the complex nature of pain and approach the problem from all directions. Treatment at a pain clinic is patient-centric but depends on the clinic's available resources. Currently, there are no set standards for the types of disciplines needed, another reason treatment options vary from clinic to clinic. Experts say that a facility should offer patients:

• A coordinating practitioner specializing in pain management and consulting specialists on the patient's behalf.
• A physical rehabilitation specialist.
• A psychiatrist to help the individual deal with any accompanying depression or anxiety, especially when dealing with chronic pain. (American Society of Regional Anesthesia and Pain Medicine. 2023)

Other Medical Specialties

Other specialties represented in pain management are anesthesiology, neurosurgery, and internal medicine. A coordinating healthcare provider may refer an individual for services from:

• Occupational medicine specialists
• Social workers
• Alternative medicine practitioners
• Complementary medicine practitioners (American Academy of Pain Medicine. 2023)

A healthcare provider should have completed additional training and credentialing in pain medicine and be an MD with board certification in at least one of the following (American Board of Medical Specialties. 2023)

• Anesthesiology
• Physical rehabilitation
• Psychiatry
• Neurology

A pain management physician should also have their practice limited to the specialty they hold the certification.

Management Goals

The field of pain management treats all types of pain as a disease. Chronic, such as headaches; acute, from surgery, and more. This allows for applying science and the latest medical advances to pain relief. There are now many modalities, including:

• Medication
• Interventional pain management techniques - nerve blocks, spinal cord stimulators, and similar treatments.
• Physical therapy
• Alternative medicine

1. The objective is to minimize and make symptoms manageable.
2. Improve function.
3. Increase the quality of life. (Srinivas Nalamachu. 2013)

A pain management clinic will go through the following:

• Evaluation.
• Diagnostic tests, if necessary.
• Physical therapy - increases the range of motion, strengthens the body, and prepares individuals to return to work and daily activities.
• Interventional treatment - injections or spinal cord stimulation.
• Referral to a surgeon if indicated by the tests and evaluation.
• Psychiatry to deal with depression, anxiety, and/or other issues that accompany chronic pain symptoms.
• Alternative medicine to support and enhance the other treatments.

Individuals who do well with a pain management program

Individuals who have:

• Back pain
• Neck pain
• Had multiple back surgeries
• Failed surgeries
• Neuropathy
• Individuals determined that surgery does not benefit their condition.

A better understanding of pain syndromes by communities and insurance companies and increased pain studies will help increase insurance coverage for treatments and technology to improve interventional outcomes.

Chiropractic Care for Leg Instability

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research studies or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, don't hesitate to contact Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

American Society of Regional Anesthesia and Pain Medicine. (2023). The specialty of chronic pain management.

American Academy of Pain Medicine (2023). About the American Academy of Pain Medicine.

American Board of Medical Specialties. (2023). The Most Trusted Medical Specialty Certification Organization.

Nalamachu S. (2013). An overview of pain management: the clinical efficacy and value of treatment. The American journal of managed care, 19(14 Suppl), s261–s266.

American Society of Interventional Pain Physicians. (2023). Pain Physician.

Individuals diagnosed with peripheral neuropathy, or with small fiber neuropathy, can understanding symptoms and causes help with potential treatments?

Small Fiber Neuropathy

Small fiber neuropathy is a specific classification of neuropathy, as there are different types, which are nerve injury, damage, disease, and/or dysfunction. Symptoms can result in pain, loss of sensation, and digestive and urinary symptoms. Most cases of neuropathy like peripheral neuropathy involve small and large fibers. Common causes include long-term diabetes, nutritional deficiencies, alcohol consumption, and chemotherapy.

• Small fiber neuropathy is diagnosed after diagnostic testing showing it is clear that the small nerve fibers are involved.
• The small nerve fibers detect sensation, temperature, and pain and help regulate involuntary functions.
• Isolated small-fiber neuropathy is rare, but research is ongoing on the type of nerve damage and potential treatments. (Stephen A. Johnson, et al., 2021)
• Small fiber neuropathy is not specifically dangerous but is a sign/symptom of an underlying cause/condition that is damaging the body’s nerves.

Symptoms

Symptoms include: (Heidrun H. Krämer, et al., 2023)

• Pain - symptoms can range from mild or moderate discomfort to severe distress and can happen at any time.
• Loss of sensation.
• Because the small nerve fibers help with digestion, blood pressure, and bladder control - symptoms of autonomic dysfunction can vary and can include:
• Constipation, diarrhea, incontinence, urinary retention - the inability to completely drain the bladder.
• If there is progressing nerve damage, the intensity of the pain can decrease, but the loss of normal sensation and autonomic symptoms can worsen. (Josef Finsterer, Fulvio A. Scorza. 2022)
• Hypersensitivity to touch and pain sensations can cause pain without a trigger.
• The loss of sensation can make individuals unable to accurately detect sensations of touch, temperature, and pain in affected areas, which can lead to various types of injuries.
• Although more research is needed, certain disorders that were not considered neuropathies may have small fiber neuropathy components involved.
• A study suggested that neurogenic rosacea, a skin condition, could have some elements of small fiber neuropathy. (Min Li, et al., 2023)

Small Nerve Fibers

• There are several types of small nerve fibers; two in small fiber neuropathy include A-delta and C. (Josef Finsterer, Fulvio A. Scorza. 2022)
• These small nerve fibers are distributed throughout the body including the tops of the fingers and toes, trunk, and internal organs.
• These fibers are usually located in the superficial areas of the body, such as close to the skin’s surface. (Mohammad A. Khoshnoodi, et al., 2016)
• The small nerve fibers that get damaged are involved in transmitting pain and temperature sensations.
• Most nerves have a special type of insulation called myelin that protects them and increases the speed of nerve impulses.
• Small nerve fibers may have a thin sheath, making them more susceptible to injury and damage at earlier stages of conditions and diseases. (Heidrun H. Krämer, et al., 2023)

Individuals At Risk

Most types of peripheral neuropathy cause damage to the small and large peripheral nerve fibers. Because of this, most neuropathies are a mix of small-fiber and large-fiber neuropathy. Common risk factors for mixed fiber neuropathy include: (Stephen A. Johnson, et al., 2021)

• Diabetes
• Nutritional deficiencies
• Overconsumption of alcohol 
• Autoimmune disorders
• Medication toxicity

Isolated small-fiber neuropathy is rare, but there are conditions that are known to contribute to the cause and include: (Stephen A. Johnson, et al., 2021)

Sjogren Syndrome

• This autoimmune disorder causes dry eyes and mouth, dental problems, and joint pain.
• It can also cause nerve damage throughout the body.

Fabry Disease

• This condition causes a buildup of certain fats/lipids in the body that can lead to neurological effects.

Amyloidosis

• This is a rare disorder that causes a buildup of proteins in the body.
• The proteins can damage tissues like the heart or nerves.

Lewy Body Disease

• This is a neurological disorder that causes dementia and impaired movement and can lead to nerve damage.

Lupus

• This is an autoimmune disease that affects joints, skin, and sometimes nerve tissue.

Viral Infection

• These infections typically cause a cold or gastrointestinal/GI upsetness.
• Less often they can cause other effects like small fiber neuropathy.

These conditions have been seen to cause isolated small-fiber neuropathy or begin as small-fiber neuropathy before progressing to the large nerve fibers. They can also begin as a mixed neuropathy, with small and large fibers.

Progression

Often the damage progresses at a relatively moderate rate, leading to added symptoms within months or years. The fiber nerves that are affected by the underlying condition usually progressively deteriorate, regardless of where they are located. (Mohammad A. Khoshnoodi, et al., 2016) Medications can help alleviate damage to the peripheral nerves. For individuals that are diagnosed in the early stage, it is possible to stop the progression, and potentially prevent involvement of the large fibers.

Treatments

Treatment toward preventing the progression requires controlling the underlying medical condition with treatment options depending on the cause. Treatments that can help prevent the progression include:

• Blood sugar control for individuals with diabetes.
• Nutritional supplementation for the treatment of vitamin deficiencies.
• Quitting alcohol consumption.
• Immune suppression for control of autoimmune diseases.
• Plasmapheresis - blood is taken and the plasma is treated and returned or exchanged for the treatment of autoimmune diseases.

Symptom Treatment

Individuals can get treatment for the symptoms that will not reverse or cure the condition but can help with temporary relief. Symptomatic treatment can include: (Josef Finsterer, Fulvio A. Scorza. 2022)

• Pain management can include medications and/or topical analgesics.
• Physical therapy - stretching, massage, decompression, and adjustments to keep the body relaxed and flexible.
• Rehabilitation to help improve coordination, which can be impaired by loss of sensation.
• Medications to relieve GI symptoms.
• Wearing specialized clothes such as neuropathy socks to help with foot pain symptoms.

Treatment and medical management of neuropathies usually involve a neurologist. A neurologist may prescribe medication to help alleviate pain symptoms and provide medical interventions like immunotherapy if there is concern that an autoimmune process could be the cause. Additionally, treatment could include the care of a physical medicine and rehabilitation physician or a physical therapy team to provide stretches and exercises to help strengthen the body and maintain mobility and flexibility.

Peripheral Neuropathy Myths & Facts

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please contact Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Johnson, S. A., Shouman, K., Shelly, S., Sandroni, P., Berini, S. E., Dyck, P. J. B., Hoffman, E. M., Mandrekar, J., Niu, Z., Lamb, C. J., Low, P. A., Singer, W., Mauermann, M. L., Mills, J., Dubey, D., Staff, N. P., & Klein, C. J. (2021). Small Fiber Neuropathy Incidence, Prevalence, Longitudinal Impairments, and Disability. Neurology, 97(22), e2236–e2247. https://doi.org/10.1212/WNL.0000000000012894

Finsterer, J., & Scorza, F. A. (2022). Small fiber neuropathy. Acta neurologica Scandinavica, 145(5), 493–503. https://doi.org/10.1111/ane.13591

Krämer, H. H., Bücker, P., Jeibmann, A., Richter, H., Rosenbohm, A., Jeske, J., Baka, P., Geber, C., Wassenberg, M., Fangerau, T., Karst, U., Schänzer, A., & van Thriel, C. (2023). Gadolinium contrast agents: dermal deposits and potential effects on epidermal small nerve fibers. Journal of neurology, 270(8), 3981–3991. https://doi.org/10.1007/s00415-023-11740-z

Li, M., Tao, M., Zhang, Y., Pan, R., Gu, D., & Xu, Y. (2023). Neurogenic rosacea could be a small fiber neuropathy. Frontiers in pain research (Lausanne, Switzerland), 4, 1122134. https://doi.org/10.3389/fpain.2023.1122134

Khoshnoodi, M. A., Truelove, S., Burakgazi, A., Hoke, A., Mammen, A. L., & Polydefkis, M. (2016). Longitudinal Assessment of Small Fiber Neuropathy: Evidence of a Non-Length-Dependent Distal Axonopathy. JAMA neurology, 73(6), 684–690. https://doi.org/10.1001/jamaneurol.2016.0057

Cisgender has nothing to do with an individual's sexual orientation. Therefore how do sex and gender differ and where does cisgender fall within the spectrum of gender identities?

Cisgender

Cisgender is a segment of the larger spectrum of gender identities. Also referred to as "cis," it describes an individual whose gender identity corresponds to the sex they were assigned at birth. Therefore if an individual assigned sex at birth is female and identifies as a girl or a woman they are a cisgender woman.

• The term describes how a person sees themselves and helps others communicate more accurately and respectfully.
• Although many individuals may identify as cisgender, a cisgender person is not typical nor has qualities or characteristics that inherently differentiate them from a person of other gender identities.
• Cisgender women commonly use the pronouns she and her.
• A common mistake is using the term cis-gendered.
• The proper usage of the term is cisgender.

Sex and Gender Differences 

• The terms sex and gender are often used interchangeably, however, they are not the same.
• Sex is a biological and physiological designation based on an individual's sex chromosomes and sexual organs.
• It refers to an individual's sex chromosomes and the characteristics assigned by those chromosomes. (Janine Austin Clayton, Cara Tannenbaum. 2016)
• This includes an individual's genitals and sex organs.
• It also encompasses secondary characteristics - like body size, bone structure, breast size, and facial hair - that are regarded as female or male.

Differences

Gender is a social construct that refers to roles and behaviors that society assigns as being masculine or feminine. The construct infers behaviors that are accepted or appropriate based on how an individual behaves, speaks, dresses, sits, etc.

• Gender titles include sir, ma'am, mister, or miss.
• Pronouns include him, she, he, and her.
• Roles include actress, actor, prince, and princess.
• Many of these suggest a power hierarchy of who has it and who does not.
• Cisgender women often fall victim to these dynamics.

Sex

• Refers to an individual's chromosomes and the way that their genes are expressed.
• Typically described in terms of male and female characteristics or the sex assigned at birth.

Gender

• A social construct.
• Refers to the social roles, behaviors, and expectations considered and/or deemed appropriate for men and women.
• Historically defined as masculine and feminine, however, definitions can change as society changes.

Gender Identities Glossary

Today, gender is viewed as a spectrum where an individual might identify as one gender, more than one gender, or no gender. The definitions are often subtle and can often overlap, co-exist, and/or change. Gender identities include:

Cisgender

• An individual whose gender identity matches their assigned sex at birth.

Transgender

• An individual whose gender identity does not align with their assigned sex at birth.

Non-binary

• An individual who feels their gender identity cannot be defined.

Demigender

• An individual who experiences a partial, but not full/complete connection to a particular gender.

Agender

• An individual who feels neither male nor female.

Genderqueer

• Similar to non-binary but infers refusal of societal expectations.

Gender-neutral

• Non-binary similarities but focuses on abandoning gender labels.

Gender fluid

• An individual who experiences multiple genders or shifts between genders.

Polygender

• An individual who experiences or expresses more than one gender.

Pangender

• An individual who identifies with all genders.

Third gender

• Third gender is a concept in which individuals are categorized, either by themselves or by society, as neither male nor female, not transitioning.
• They are a different gender altogether.

Twin gender

• A Native American term describing someone who is male and female or of two spirits simultaneously.

Cis Woman Identity

The terms cis woman or cis female are used to describe individuals who were assigned female at birth and identify as a woman or female. For cisgender woman, this means their gender identity aligns with their primary sex organs and secondary sex traits that include:

• Higher pitch voice.
• Wider pelvis.
• Broadening of hips.
• Breast development 

It can also involve cisnormativity - a concept that everyone identifies as the gender they were assigned at birth. This could inform how a cis woman is expected to dress and act. An even more extreme concept is gender essentialism - this is the belief that gender differences are rooted purely in biology and cannot be changed. However, even cisnormativity beauty standards can influence the perceptions of transgender women that end up reinforcing gender stereotypes. (Monteiro D, Poulakis M. 2019)

Cisgender Privilege

Cisgender privilege is the concept that individuals who are cisgender receive added benefits compared to individuals who don't conform to the gender binary norm. This includes cisgender women and men. Privilege happens when a cisgender individual assumes they are the norm and consciously or unconsciously takes action against those who are outside the definition of masculine and feminine. Examples of cisgender privilege include:

• Not being denied work and social opportunities because of not fitting into the boy's or girl's club.
• Not having to have sexual orientation questioned.
• Not being denied healthcare due to provider discomfort.
• Not fearing that civil rights or legal protections will be taken.
• Not worrying about being bullied.
• Not having to worry about attracting questioning looks in public.
• Not being challenged or questioned about the clothes being worn.
• Not being demeaned or mocked because of pronoun use.

Gender Identity and Sexual Orientation

• Gender identity and sexual orientation are not the same. (Carla Moleiro, Nuno Pinto. 2015)
• Gender identity and sexual orientation are not the same.
• A cisgender individual can be heterosexual, homosexual, bisexual, or asexual and so can a transgender individual.
• Being cisgender has no correlation to an individual's sexual orientation.

Chiropractic Care After Accidents and Injuries

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please contact Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Clayton, J. A., & Tannenbaum, C. (2016). Reporting Sex, Gender, or Both in Clinical Research? JAMA, 316(18), 1863–1864. https://doi.org/10.1001/jama.2016.16405

Monteiro, Delmira and Poulakis, Mixalis (2019) "Effects of Cisnormative Beauty Standards on Transgender Women’s Perceptions and Expressions of Beauty," Midwest Social Sciences Journal: Vol. 22: Iss. 1, Article 10. DOI: https://doi.org/10.22543/2766-0796.1009 Available at: https://scholar.valpo.edu/mssj/vol22/iss1/10

Moleiro, C., & Pinto, N. (2015). Sexual orientation and gender identity: review of concepts, controversies and their relation to psychopathology classification systems. Frontiers in Psychology, 6, 1511. https://doi.org/10.3389/fpsyg.2015.01511

The brachial plexus is a network of nerves that begin in the cervical/neck spinal cord and travel down the cervicoaxillary canal into the armpit. Forming in the area of the shoulder joint at the branch junction of the brachial plexus, the radial nerve extends down the arm, through the elbow joint, into the forearm, across the wrist, and tips of the fingers. The nerves are susceptible to injury that can cause abnormal function leading to unusual sensations and impaired muscle function.

Radial Nerve

One of the major nerves of the upper extremity.

• There is one brachial plexus on each side of the body that carries the nerves to each arm.
• The radial nerve has two major functions.
• One is to provide sensations in the hands, forearms, arms, and fingers.
• The other is to deliver messages to muscles about when to contract.

Motor Function

• The radial nerve transmits signals to the muscles of the back of the arm and forearm on when to contract.
• Individuals who have abnormal radial nerve function can experience weakness of the muscles and symptoms like wrist drop.
• A wrist drop occurs when the back forearm muscles cannot support the wrist, causing the individual to hold the wrist in a flexed posture.
• Abnormal radial nerve function can cause symptoms of numbness or tingling in the back of the hand.

Conditions

Associated conditions to the radial nerve include lacerations, contusions, fractures, and palsies.

Nerve Contusion

• A contusion typically occurs through blunt force trauma that can crush and smash the nerve area.
• This causes abnormal or no function.
• A nerve contusion can occur from a personal, work, or sports injury or other conditions that generate intense pressure on the nerve/s.

Nerve Lacerations

• A laceration occurs when there is a penetrating injury that cuts and/or severs the nerve.
• This injury can occur from stab wounds or sliced by broken glass, metal, etc.

Fractures

• Broken bones of the upper extremity can lead to extended damage to the nerves near the damaged bone.
• The most common type of fracture associated with radial nerve malfunction is fractures to the humerus bone.
• The nerve wraps tightly around the humerus and can be injured with a fracture.
• Most fracture-related radial nerve injuries heal on their own and do not require surgery.
• However, the way the injury heals can be the difference between normal function and chronic pain.

Crutch Palsy

• Crutch palsy is pressure on the radial nerve in the armpit resulting from using crutches incorrectly.
• To use crutches properly, the individual needs to support their body weight through the hands.
• However, many tend to place pressure around the armpit at the top of the crutch, causing irritation to the nerve in that area.
• Padding the top of crutches and using the proper form can prevent the condition.

Saturday Night Palsy

• Saturday night palsy is the abnormal function of the radial nerve after sleeping in a position that causes direct pressure against the nerve.
• This often occurs when an individual falls asleep with their arm draped over an armrest on a chair.
• The name comes from when individuals are intoxicated and fall asleep in a location other than the bed and in awkward positions.

Treatment

Nerve injuries often cause symptoms at different locations other than where the nerve damage is, complicating diagnosis. Determining the specific location of nerve damage is the first step in developing an appropriate treatment plan. Once the location has been identified, steps can be taken to prevent worsening damage to the nerve.

• The objective is to relieve the pressure from the irritation or compression.
• Chiropractic treatment can relieve symptoms and restore function through:
• Massage to relax the area and increase blood circulation.
• Decompression to physically restore alignment.
• Adjustments to restore body balance.
• Exercises and stretches to maintain treatment, strengthen the muscles, and prevent injuries.
• In cases where there is structural damage, surgery may be necessary to remove pressure or repair damage.

Avoid Surgery

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please contact Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Ansari FH, Juergens AL. Saturday Night Palsy. [Updated 2023 Apr 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557520/

Barton, N J. “Radial nerve lesions.” The Hand vol. 5,3 (1973): 200-8. doi:10.1016/0072-968x(73)90029-6

Daly, Michael, and Chris Langhammer. “Radial Nerve Injury in Humeral Shaft Fracture.” The Orthopedic Clinics of North America vol. 53,2 (2022): 145-154. doi:10.1016/j.ocl.2022.01.001

DeCastro A, Keefe P. Wrist Drop. [Updated 2022 Jul 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532993/

Eaton, C J, and G D Lister. “Radial nerve compression.” Hand Clinics vol. 8,2 (1992): 345-57.

Glover NM, Murphy PB. Anatomy, Shoulder and Upper Limb, Radial Nerve. [Updated 2022 Aug 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534840/

Ljungquist, Karin L et al. “Radial nerve injuries.” The Journal of hand surgery vol. 40,1 (2015): 166-72. doi:10.1016/j.jhsa.2014.05.010

Węgiel, Andrzej, et al. “Radial nerve compression: anatomical perspective and clinical consequences.” Neurosurgical review vol. 46,1 53. 13 Feb. 2023, doi:10.1007/s10143-023-01944-2

When temperatures are elevated in summer, heat-induced and severe headaches like migraines are common during the hot months. However, a migraine caused by heat is not the same as a headache caused by heat, as the two have different symptoms. What they have in common is that they’re both triggered by the way hot weather affects the body. Understanding the causes and the warning signs of a heat headache can help prevent and treat potentially dangerous heat-related conditions. Injury Medical Chiropractic and Functional Medicine Clinic use various techniques and therapies customized to the individual to relieve pain and improve function.

Heat-Induced Headaches

Headaches and migraines are common, affecting 20 percent of women and nearly 10 percent of men. An increase in frequency can be caused by

• Dehydration.
• Environmental factors.
• Heat exhaustion.
• Heat stroke.

A heat-induced headache can feel like a dull pulsing ache around the temples or in the back of the head. Depending on the cause, a heat-induced headache may escalate to a more intensely felt internal pain.

Causes

A heat-induced headache may not be caused by the hot weather but by how the body responds to heat. Weather-related triggers of headaches and migraine include:

• Sun glare
• Bright light
• High humidity
• Sudden drops in barometric pressure
• Weather conditions can also cause changes in serotonin levels.
• Hormonal fluctuations are common migraine triggers that can also cause headaches.
• Dehydration - can trigger both headaches and migraine.

When exposed to higher temperatures, the body needs more water to compensate for the lost water as it uses and sweats it out. Prolonged exposure to high temperatures puts the body at risk for heat exhaustion, one of the stages of heat stroke, with headaches as a symptom of heat exhaustion. Any time the body is exposed to high temperatures or spends a long time outside in the hot sun, and a headache occurs afterward, a heat stroke is possible.

Heat Headache Symptoms

Symptoms of a heat-induced headache can vary according to the situation. If the headache is triggered by heat exhaustion, the body will have heat exhaustion symptoms and head pain. Heat exhaustion symptoms include:

• Dizziness.
• Muscle cramps or tightness.
• Nausea.
• Fainting.
• An extreme thirst that does not go away.

If the headache or migraine is related to heat exposure but not connected to heat exhaustion, the symptoms may include the following:

• A throbbing, dull sensation in the head.
• Dehydration.
• Fatigue.
• Sensitivity to light.

Relief

Individuals can be proactive about prevention.

• If possible, limit time outside, protect the eyes with sunglasses, and wear a hat with a brim when staying outdoors.
• Exercise indoors in an air-conditioned environment if able.
• Increase water consumption as temperatures rise, and utilize healthy sports drinks to replenish electrolytes.

Home remedies can include:

• Lavender or peppermint essential oils.
• Cold packs.
• Iced herbal teas.
• Over-the-counter acetaminophen and ibuprofen.

Chiropractic Care

Chiropractic treatment can include:

• Craniocervical mobilization involves gentle chiropractic pressure on the neck to adjust the joints.
• Spinal manipulation involves applying more force and pressure at certain points along the spine.
• Neuromuscular massage includes kneading joints and muscles and relieves pain by releasing pressure from compressed nerves.
• Myofascial release massage is aimed at the tissues that connect and support muscles and focuses on trigger points in the back and neck or head to relax muscles and improve blood circulation.
• Trigger point therapies target tense areas to help relax muscles while improving blood flow and relieving stress.
• Traction therapy.
• Decompression therapy.
• Exercises designed specifically to reduce pain.

From Inflammation to Healing

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, don't hesitate to get in touch with Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Bryans, Roland, et al. “Evidence-based guidelines for the chiropractic treatment of adults with headache.” Journal of Manipulative and physiological therapeutics vol. 34,5 (2011): 274-89. doi:10.1016/j.jmpt.2011.04.008

Demont, Anthony, et al. “Efficacy of physiotherapy interventions for the management of adults with cervicogenic headache: A systematic review and meta-analyses.” PM & R: the journal of Injury, Function, and Rehabilitation vol. 15,5 (2023): 613-628. doi:10.1002/pmrj.12856

Di Lorenzo, C et al. “Heat stress disorders and headache: a case of new daily persistent headache secondary to heat stroke.” BMJ case reports vol. 2009 (2009): bcr08.2008.0700. doi:10.1136/bcr.08.2008.0700

Fernández-de-Las-Peñas, César, and María L Cuadrado. “Physical therapy for headaches.” Cephalalgia: an international journal of Headache vol. 36,12 (2016): 1134-1142. doi:10.1177/0333102415596445

Swanson JW. (2018). Migraines: Are they triggered by weather changes? mayoclinic.org/diseases-conditions/migraine-headache/expert-answers/migraine-headache/faq-20058505

Victoria Espí-López, Gemma, et al. “Effectiveness of Physical Therapy in Patients with Tension-type Headache: Literature Review.” Journal of the Japanese Physical Therapy Association = Rigaku ryoho vol. 17,1 (2014): 31-38. doi:10.1298/jjpta.Vol17_005

Whalen, John, et al. “A Short Review of the Treatment of Headaches Using Osteopathic Manipulative Treatment.” Current pain and headache reports vol. 22,12 82. 5 Oct. 2018, doi:10.1007/s11916-018-0736-y

A pinched, compressed, overly stretched, twisted, and entangled nerve can happen throughout the body. The most common locations are the neck, shoulder, upper back, upper chest, arm, elbow, hand, wrist, low back, legs, and feet. This disrupts the nerve's ability to function properly. Each nerve stimulates muscles and detects sensations in specific areas of the skin or internal organs so they work properly. Common symptoms are tingling, numbness, pain, weakness, and musculoskeletal problems. The average pinched nerve duration can last a few days to as long as 4 to 6 weeks or, in some cases, longer, in which case individuals should see a doctor or neurologist. Injury Medical Chiropractic and Functional Medicine Clinic can relieve, release, and restore nerve health.

Pinched Nerve

A pinched nerve is caused by pressure from surrounding tissues that place added stress on it. Muscles, bones, cartilage, and tendons can all press, pull, or entangle a nerve. This can result in a loss of function, which can then lead to symptoms including:

• Tingling
• Numbness
• Muscle weakness
• Various types of pain - sharp, electrical, throbbing, aching, and radiating/spreading out to other areas.
• Burning sensation
• A pinched nerve can become serious, cause chronic pain conditions and lead to permanent nerve damage.
• More severe cases may require surgery.

Pinched Nerve Duration

Pinched nerve duration depends on the injury, which can happen suddenly or gradually. A temporary case with an acute cause, such as injury or poor posture, can last several days. Cases related to chronic conditions, like arthritis, may last longer. Treatment, as well as recovery, also vary based on the location of the injury and what’s causing the pressure.

Body Locations

Neck

A pinched nerve in the neck can cause tingling sensations and pain, which can travel to the shoulders and arms. This type can be caused by:

• Sleeping position
• Repetitive movements
• Injuries
• The pain will usually ease within several days unless a chronic health condition is the cause of the pinching.

Lower back

A pinched nerve in the lower back is often brought on by herniated discs that compress nerve roots.

• It may also be caused by arthritis or injuries.
• Individuals may feel a sharp pain in the lower back, as well as in the buttocks and back of the leg.
• Sciatica may be a symptom.
• Lower back pain may be acute, lasting only a few days.
• If the injury doesn’t resolve, it may cause chronic back pain that can last 12 weeks or more.

Leg

• The legs can develop pinched nerves from herniated discs or injuries.
• If left untreated can lead to peripheral neuropathy.
• This can develop over several weeks or years.

Hip

A pinched nerve in the hip can last a few days if related to an injury. If the pain lasts longer than a few days, consult a doctor. Possible causes of chronic hip pain may include:

• Obesity
• Bone spurs
• Arthritis

Shoulder

Shoulder pain brought on by a pinched nerve usually starts in the upper spine and is caused by:

• Injury
• Tendinitis
• Arthritis
• To tell if the pain symptoms are from a pinched nerve and not a muscle strain, the pain tends to occur in one shoulder, and there is a sharpness to the aches.
• Left untreated, arthritis or tendinitis can lead to chronic pain that can come and go for several weeks, months, or years.

Wrist

Repetitive overuse is commonly linked to pinched nerves in the wrist.

• Pinched nerves can lead to carpal tunnel syndrome - pain and numbness extending through the arm, hand, and fingers.
• Pain lasting over two months could indicate other underlying conditions, like arthritis.

Chiropractic Relief

Chiropractic adjustments identify the impacted nerve/s and use various therapies to remove the compression, relieving symptoms and the injury or issue. A personalized treatment plan can include the following:

• Different types of massage.
• Multiple adjustments.
• Non-surgical decompression therapy.
• Muscle Energy Technique - MET
• Targeted stretches and exercises.
• Posture training.
• Anti-inflammatory nutritional recommendations.

Sciatica During Pregnancy

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, don't hesitate to get in touch with Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Cornwall, R, and T E Radomisli. “Nerve injury in traumatic dislocation of the hip.” Clinical orthopedics and related research, 377 (2000): 84-91. doi:10.1097/00003086-200008000-00012

Dmytriv, Mariya, et al. “PT or cervical collar for cervical radiculopathy?.” The Journal of family practice vol. 59,5 (2010): 269-72.

Hochman, Mary G, and Jeffrey L Zilberfarb. “Nerves in a pinch: imaging of nerve compression syndromes.” Radiologic clinics of North America vol. 42,1 (2004): 221-45. doi:10.1016/S0033-8389(03)00162-3

Lopez-Ben, Robert. “Imaging of nerve entrapment in the foot and ankle.” Foot and ankle clinics vol. 16,2 (2011): 213-24. doi:10.1016/j.fcl.2011.04.001

Needham, C W. “Pinched nerves and signature signs.” Connecticut Medicine vol. 57,1 (1993): 3-7.

Siccoli, Alessandro, et al. “Tandem Disc Herniation of the Lumbar and Cervical Spine: Case Series and Review of the Epidemiological, Pathophysiological and Genetic Literature.” Cureus vol. 11,2 e4081. 16 Feb. 2019, doi:10.7759/cureus.4081

As humans, there are a variety of stressors experienced daily. Stress collects in various body areas, most commonly the upper back, jaw, and neck muscles. Stress leads to tension in the muscles. The built-up tension can cause the spinal bones to shift out of alignment, irritating the nerves between the spinal bones. A cycle begins as increased nerve tension causes the muscles to continue to contract/tighten. The extra muscle tension continues to pull the spinal bones out of alignment, making the spine stiff and less flexible affecting posture, balance, coordination, and mobility, causing the spine to become further unstable. Chiropractic treatment at regular intervals is recommended to help realign and maintain proper position.

Why The Spine Goes Out of Alignment

The nerves in the body are intricately linked to the spinal cord, and small distortions in the alignment can cause nerves to misfire and malfunction. When the spine goes out of alignment, the nervous system/brain and nerves get stuck in a stressed or tense state. Even a minor misalignment can cause a series of discomfort symptoms to travel throughout the body.

Causes

Causes of misalignment that creates tension in the nerves and muscles include:

• Previous injuries.
• Unhealthy sleep.
• Stress - mental and physical.
• Physically demanding jobs.
• Overtraining.
• Sedentary habits.
• Foot conditions and problems.
• Unhealthy eating habits.
• Being overweight.
• Chronic inflammation.
• Arthritis.

Chiropractic Treatment

Chiropractic examination procedures:

Palpation

• A chiropractor will feel/palpate the spine to see if the bones are in alignment, move well, or are out of alignment and not moving correctly or moving at all.

Posture Exam

• If the head, shoulders, and hips are uneven or the shoulders and head are pulling forward, the spinal bones are out of alignment/subluxations.

Balance and Coordination

• Unhealthy balance and coordination can indicate the brain, nerves, and muscles are malfunctioning by spinal misalignment.

Range of Motion

• A loss of spinal movement flexibility can show tension in the nerves, muscles, and misalignments.

Muscle Test

• Loss of strength in a muscle can indicate the nerve signals are weak.

Orthopedic Tests

• Tests that put the body in stressful positions focus on what tissue/s may be injured and the causes.

X-rays

• X-rays look for abnormalities, dislocations, bone density, fractures, hidden/invisible injuries, and infections.

Injury Medical Chiropractic and Functional Medicine Clinic provide personalized treatment plans. These specific therapies are made to generate long-term spine benefits. Spinal manipulation, deep tissue massage, MET, and other manual therapy techniques, combined with exercise, help get the bones moving properly, the muscles functioning correctly, and the spine back into proper form. Treatment relieves muscle spasms, tension, and joint dysfunction, increases circulation, and retrains the muscles to remain relaxed.

The Natural Way to Heal

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, don't hesitate to get in touch with Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Ando, Kei et al. “Poor spinal alignment in females with obesity: The Yakumo study.” Journal of Orthopaedics vol. 21 512-516. 16 Sep. 2020, doi:10.1016/j.jor.2020.09.006

Le Huec, J C et al. “Sagittal balance of the spine.” The European spine journal: official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society vol. 28,9 (2019): 1889-1905. doi:10.1007/s00586-019-06083-1

Meeker, William C, and Scott Haldeman. “Chiropractic: a profession at the crossroads of mainstream and alternative medicine.” Annals of internal medicine vol. 136,3 (2002): 216-27. doi:10.7326/0003-4819-136-3-200202050-00010

Oakley, Paul A et al. “X-Ray Imaging is Essential for Contemporary Chiropractic and Manual Therapy Spinal Rehabilitation: Radiography Increases Benefits and Reduces Risks.” Dose-response: a publication of International Hormesis Society vol. 16,2 1559325818781437. 19 Jun. 2018, doi:10.1177/1559325818781437

Shah, Anoli A, et al. “Spinal Balance/Alignment - Clinical Relevance and Biomechanics.” Journal of biomechanical engineering, 10.1115/1.4043650. 2 May. 2019, doi:10.1115/1.4043650

The lumbar/low back muscles support the upper body's weight and are involved in moving, twisting, bending, pushing, pulling, and reaching. These repetitive actions can result in a lumbar strain, which is muscle damage or injury to the tendons or muscles of the lower back, causing spasms, soreness, and pain. A lumbar strain can be the source of severe pain symptoms; it can be debilitating and, if left untreated, can lead to chronic conditions. Injury Medical Chiropractic and Functional Medicine Clinic can relieve symptoms, realign the body, relax, rehabilitate, strengthen muscles, and restore function.

Lumbar Strain

The lumbar vertebra makes up the region of the spine in the lower back. Sudden injuries or overuse injuries can damage the tendons and muscles. Lumbar muscle strain is caused when the muscle fibers are abnormally stretched or torn. Lumbar strain can be acute/sudden or chronic/lingering. A strain that has been present for days or weeks is referred to as acute. It is considered chronic if it has persisted for over three months. It can occur at any age but is most common in individuals in their forties. Increased risk factors can include:

• Weakened back or abdominal muscles can cause
• Tight hamstrings can pull the low back muscles down.
• Excessive lower back curvature.
• Forward-tilted pelvis.

Symptoms

Lumbar strain can have varied signs and symptoms depending on the location, damage, and cause of injury. The damage can range from simple overstretching injuries to partial or complete tears of varying degrees. The tears cause inflammation in the surrounding area, resulting in back spasms and difficulty moving. A muscle spasm is a cramp caused by a sudden and involuntary contraction or twitch and can be one of the symptoms of a lumbar strain. Other symptoms can include:

• Muscle spasms either with activity or when resting.
• Stiffness in the low back.
• Difficulty standing or walking, with slight relief when resting.
• Trouble doing simple tasks like bending or climbing stairs.
• Low back pain can radiate into the buttocks without affecting the legs.
• The lower back may be tender and sore to the touch.
• Decreased muscle strength.
• Restricted or limited range of motion.
• Inability to maintain healthy posture because of stiffness and/or pain.
• Discomfort symptoms that persist.
• Discomfort ranges from mild aches to sharp, debilitating pain.
• Intermittent flare-ups.

Causes

There are often multiple underlying risk factors contributing to the injury or damage. A few of the most common causes:

• Aging
• Unhealthy posture
• Repetitive motions
• Overusing the muscles
• Improper body mechanics
• Trauma caused by injuries
• Muscle atrophy
• Genetics

Chiropractic

Depending on the severity, a doctor or health care provider could recommend chiropractic treatment and physical therapy. The chiropractor will perform an evaluation, combined with the doctor's diagnosis, to develop a customized/personalized treatment plan. Treatment may include:

• Ice and heat therapy
• Massage to stimulate blood circulation
• Percussive muscle stimulation
• Pelvic traction
• Ultrasound
• Stretching exercises
• Exercises to do at home for long-term relief.

It is a safe option to loosen tight back muscles, relieve pain, and promote lower back healing.

Spine Injuries In Sports

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please contact Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Ball, Jacob R et al. "Lumbar Spine Injuries in Sports: Review of the Literature and Current Treatment Recommendations." Sports medicine - open vol. 5,1 26. 24 Jun. 2019, doi:10.1186/s40798-019-0199-7

Domljan, Z et al. "Lumbalni strain-sindromi" [Lumbar strain syndromes]. Reumatizam vol. 38,5-6 (1991): 33-4.

Li, H et al. "Rehabilitation effect of exercise with soft tissue manipulation in patients with a lumbar muscle strain." Nigerian journal of clinical practice vol. 20,5 (2017): 629-633. doi:10.4103/njcp.njcp_126_16

Williams, Whitney, and Noelle M Selkow. "Self-Myofascial Release of the Superficial Back Line Improves Sit-and-Reach Distance." Journal of sport rehabilitation vol. 29,4 400-404. 18 Oct. 2019, doi:10.1123/jsr.2018-0306

Nerve irritation occurs when the nerves exiting the spine become irritated and sensitized. Also known as nerve gliding restriction, it is a condition whereby a nerve becomes irritated by inflamed swelling of structures close to the nerve, such as joints, ligaments, muscles, or discs, that have sustained an accumulative strain which results in swelling and inflammation. A thorough chiropractic assessment and examination can diagnose the extent of the irritation and develop a personalized treatment plan.

Nerve Irritation

When swelling and inflammation interfere with the nerve root, the nerve transmits signals to the brain to let it know there is a threat. The brain interprets these signals and creates a protective response to avoid worsening the damage to the nerve. The protective reactions vary from person to person but can include the following:

• Muscle tightness and guarding
• Aching sensation
• Cramping
• Radiating discomfort or pain
• Pins and needles
• Tingling
• Numbness
• Nerve root irritation also inhibits the body from recovering as fast as it should.

Nerve irritation is not to be confused with nerve root compression or radiculopathy. This is when the nerve becomes compressed/pinched, resulting in the loss of its functions like muscle strength and sensation. Sometimes individuals with nerve irritation can also experience increased neural tension. The nerves adapt to the mechanical loads placed on them through regular movements. Restrictions to neural mobility can cause symptoms to worsen along the pathway and distribution of the nerve.

• The nervous system consists of the brain, spine, and nerve branches.
• The branches, similar to electrical cables, cannot stretch.
• Tension is generated when straightening out body areas, creating a pull and gliding of the nerve to the spinal cord.
• When nerve irritation occurs, signals are sent to protect the body, brain, spine, and branches.

Causes

Most commonly, nerve irritation occurs when a structure adjacent to the nerve; this could be a joint, ligament, and/or muscle that accumulates strain and becomes dysfunctional, swollen, inflamed, and/or spasms resulting from protective guarding.

• Mild nerve irritation can include accumulated strain from postural overload and swelling from a minor tear in an adjacent ligament.
• Often nothing shows as a problem on an MRI scan.
• Severe nerve irritation can include disc herniation and shows up on an MRI scan; surgery could be required in some cases.

Symptoms

• Stiffness
• Tightness
• Aches
• Pains
• Persist even after days of rest, stretching, targeted exercises, avoiding movements, etc.
• Stretching feels good at first, but the pain returns or worsens a few hours later or the next day.
• The irritation blocks the effective recovery of muscle, joint, tendon, and ligament discomfort symptoms.

Chiropractic Care

Treatment involves various therapies and strengthening the supporting structures while relaxing and releasing tight structures to avoid recurring injuries. Chiropractic care realigns the spine, corrects joints that have shifted out of place, helps to regulate the nervous system's function, and relieves irritation and inflammation. Whether in the form of an adjustment, traction, or guided exercise, all systems in the body are moved closer to a balanced state. This includes the:

• Nervous system
• Immune system
• Respiratory system
• Circulatory system
• Endocrine system
• Skeletal system
• All help support the body's self-healing process and increase the nervous system's function.

The chiropractic team will guide the patient through the rehabilitation process to get back to full strength.

Peroneal Nerve Irritation

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, don't hesitate to get in touch with Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Ellis, Richard F, and Wayne A Hing. "Neural mobilization: a systematic review of randomized controlled trials with an analysis of therapeutic efficacy." The Journal of manual & manipulative therapy vol. 16,1 (2008): 8-22. doi:10.1179/106698108790818594

Gibson, William, et al. "Transcutaneous electrical nerve stimulation (TENS) for neuropathic pain in adults." The Cochrane database of systematic reviews vol. 9,9 CD011976. 14 Sep. 2017, doi:10.1002/14651858.CD011976.pub2

O'Shea, Simone D et al. "Peripheral muscle strength training in COPD: a systematic review." Chest vol. 126,3 (2004): 903-14. doi:10.1378/chest.126.3.903

Rozmaryn, L M et al. "Nerve and tendon gliding exercises and the conservative management of carpal tunnel syndrome." Journal of hand therapy: official Journal of the American Society of Hand Therapists vol. 11,3 (1998): 171-9. doi:10.1016/s0894-1130(98)80035-5

Sipko, Tomasz, et al. "Mobility of cervical spine and postural equilibrium in patients with spinal overload syndrome." Ortopedia, traumatologia, rehabilitacja vol. 9,2 (2007): 141-8.

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)

• Lyrica - pregabalin
• Neurontin - gabapentin
• Elavil - amitriptyline
• Effexor - venlafaxine
• Cymbalta - duloxetine
• In severe cases, intravenous/IV lidocaine may be necessary. (Sanja Horvat 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 relieve pain and improve quality of life.

Peripheral Neuropathy: A Successful Recovery Story

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research studies or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, don't hesitate to get in touch with Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

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. https://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. https://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. https://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. https://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. https://doi.org/10.1053/j.jfas.2016.07.004

Can physical therapy treatment protocols aimed at improving range of motion and flexibility around the hip and relieving inflammation around the sciatic nerve help individuals experiencing deep buttock pain or piriformis syndrome?

Deep Buttock Pain

• Piriformis syndrome, a.k .a. deep buttock pain, is described as sciatic nerve irritation from the piriformis muscle.
• The piriformis is a small muscle behind the hip joint in the buttocks.
• It is about one centimeter in diameter and functions in the hip joint's external rotation or turning outward.
• The piriformis muscle and tendon are close to the sciatic nerve, which supplies the lower extremities with motor and sensory functions.
• Depending on an individual's anatomic variation of the muscle and tendon:
• The two cross over, under, or through each other behind the hip joint in the deep buttock.
• This relationship is thought to irritate the nerve, leading to sciatica symptoms.

Piriformis Syndrome

• When diagnosed with piriformis syndrome, it is thought that the muscle and tendon bind to and/or spasm around the nerve, causing irritation and pain symptoms.
• The theory supported is that when the piriformis muscle and its tendon tighten, the sciatic nerve becomes compressed or pinched. This decreases blood circulation and irritates the nerve from the pressure. (Shane P. Cass 2015)

Symptoms

Common signs and symptoms include: (Shane P. Cass 2015)

• Tenderness with pressure on the piriformis muscle.
• Discomfort in the back of the thigh.
• Deep buttock pain behind the hip.
• Electric sensations, shocks, and pains travel down the back of the lower extremity.
• Numbness in the lower extremity.
• Some individuals develop symptoms abruptly, while others go through a gradual increase.

Diagnosis

• Doctors will order X-rays, MRIs, and nerve conduction studies, which is normal.
• Because piriformis syndrome can be challenging to diagnose, some individuals with minor hip pain may receive a piriformis syndrome diagnosis even if they don't have the condition. (Shane P. Cass 2015)
• It is sometimes referred to as deep buttock pain. Other causes of this type of pain include back and spinal problems like:

1. Herniated discs
2. Spinal stenosis
3. Radiculopathy - sciatica
4. Hip bursitis
5. A piriformis syndrome diagnosis is usually given when these other causes are eliminated.

• When the diagnosis is uncertain, an injection is administered in the area of the piriformis muscle. (Danilo Jankovic et al., 2013)
• Different medications can be used, but the injection itself is used to help determine the specific location of the discomfort.
• When an injection is given into the piriformis muscle or tendon, it is often administered by ultrasound guidance to ensure the needle delivers the medication to the correct location. (Elizabeth A. Bardowski, J. W. Thomas Byrd 2019)

Treatment

Common treatments include the following. (Danilo Jankovic et al., 2013)

Rest

• Avoiding activities that cause symptoms for at least a few weeks.

Physical Therapy

• Emphasize stretching and strengthening the hip rotator muscles.

Non-Surgical Decompression

• Gently pulls the spine to release any compression, allowing optimal rehydration and circulation and taking the pressure off the sciatic nerve.

Therapeutic Massage Techniques

• To relax and release muscle tension and increase circulation.

Acupuncture

• To help relax the piriformis muscle, sciatic nerve, and surrounding area.
• Relieve pain.

Chiropractic Adjustments

• Realignment rebalances the spine and musculoskeletal system to alleviate pain. 

Anti-Inflammatory Medication

• To decrease inflammation around the tendon.

Cortisone Injections

• Injections are used to decrease inflammation and swelling.

Botulinum Toxin Injection

• Injections of botulinum toxin paralyze the muscle to relieve pain.

Surgery

• Surgery can be performed in rare cases to loosen the piriformis tendon, known as a piriformis release. (Shane P. Cass 2015)
• Surgery is a last resort when conservative treatments have been tried for at least 6 months with little to no relief.
• Recovery can take several months.

Sciatica Causes and Treatment

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research studies or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please contact Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

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

Jankovic, D., Peng, P., & van Zundert, A. (2013). Brief review: piriformis syndrome: etiology, diagnosis, and management. Canadian journal of anaesthesia = Journal canadien d'anesthesie, 60(10), 1003–1012. https://doi.org/10.1007/s12630-013-0009-5

Bardowski, E. A., & Byrd, J. W. T. (2019). Piriformis Injection: An Ultrasound-Guided Technique. Arthroscopy techniques, 8(12), e1457–e1461. https://doi.org/10.1016/j.eats.2019.07.033

For individuals dealing with chronic pain, can undergoing a nerve block procedure help alleviate and manage symptoms?

Nerve Blocks

A nerve block is a procedure done to interrupt/block pain signals due to nerve dysfunction or injury. They can be used for diagnostic or treatment purposes, and their effects can be short or long-term, depending on the type being used.

• A temporary nerve block may involve the application or injection that stops pain signals from transmitting for a short time.
• For example, in pregnancy, an epidural injection can be used during labor and delivery.
• Permanent nerve blocks involve cutting/severing or removing certain parts of a nerve to stop pain signals.
• These are used in cases with severe injuries or other chronic pain conditions that have not improved with other treatment approaches.

Treatment Usage

When healthcare providers diagnose a chronic pain condition caused by nerve injury or dysfunction, they may use a nerve block to locate the area generating pain signals. They may perform electromyography and/or a nerve conduction velocity/NCV test to pinpoint the cause of chronic nerve pain. Nerve blocks can also treat chronic neuropathic pain, such as pain caused by nerve damage or compression. Nerve blocks are regularly used to treat back and neck pain caused by herniated discs or spinal stenosis. (Johns Hopkins Medicine. 2024)

Types

Three types include:

• Local
• Neurolytic
• Surgical

All three can be used for conditions that cause chronic pain. However, neurolytic and surgical blocks are permanent and are only used for severe pain that has worsened with other treatments unable to provide relief.

Temporary Blocks

• A local block is done by injecting or applying local anesthetics, like lidocaine, to a certain area.
• An epidural is a local nerve block that injects steroids or analgesics into an area around the spinal cord.
• These are common during pregnancy, labor, and delivery.
• Epidurals can also be used to treat chronic neck or back pain due to a compressed spinal nerve.
• Local blocks are usually temporary, but in a treatment plan, they can be repeated over time to manage chronic pain from conditions like arthritis, sciatica, and migraines. (NYU Langone Health. 2023)

Permanent Blocks

• A neurolytic block uses alcohol, phenol, or thermal agents to treat chronic nerve pain. (National Institute of Neurological Disorders and Stroke. 2023) These procedures damage certain areas of the nerve pathway on purpose so that pain signals cannot be transmitted. A neurolytic block is mainly used for severe chronic pain cases, like pain from cancer or complex regional pain syndrome/CRPS. They are sometimes used to treat ongoing pain from chronic pancreatitis and pain in the chest wall after surgery. (Johns Hopkins Medicine. 2024) (Alberto M. Cappellari et al., 2018)
• The neurosurgeon performs a surgical nerve block that involves surgically removing or damaging specific areas of the nerve. (National Institute of Neurological Disorders and Stroke. 2023) A surgical nerve block is only used for severe pain cases, such as cancer pain or trigeminal neuralgia.
• Although neurolytic and surgical nerve blocks are permanent procedures, pain symptoms, and sensations can come back if the nerves are able to regrow and repair themselves. (Eun Ji Choi et al., 2016) However, symptoms and sensations may not return months or years after the procedure.

Different Body Areas

They can be administered in most body areas, including: (Hospital for Special Surgery. 2023) (Stanford Medicine. 2024)

• Scalp
• Face
• Neck
• Collarbone
• Shoulders
• Arms
• Back
• Chest
• Ribcage
• Abdomen
• Pelvis
• Buttocks
• Legs
• Ankle
• Feet

Side Effects

These procedures can have the potential risk of permanent nerve damage. (Anthem BlueCross. 2023) Nerves are sensitive and regenerate slowly, so a tiny error can cause side effects. (D O'Flaherty et al., 2018) Common side effects include:

• Muscle paralysis
• Weakness
• Frequent numbness
• In rare cases, the block could irritate the nerve and cause added pain.
• Skilled and licensed health practitioners like surgeons, pain management physicians, anesthesiologists, and dentists are trained to perform these procedures carefully.
• There is always a risk of nerve damage or injury, but the majority of nerve blocks safely and successfully decrease and help manage chronic pain. (Anthem BlueCross. 2023)

What to Expect

• Individuals may feel numbness or soreness and/or notice redness or irritation near or around the area that is temporary.
• There can also be swelling, which compresses the nerve and requires time to improve. (Stanford Medicine. 2024)
• Individuals may be asked to rest for a certain amount of time after the procedure.
• Depending on the type of procedure, individuals may have to spend a few days in a hospital.
• Some pain may still be present, but that does not mean the procedure did not work.

Individuals should consult with a healthcare provider about the risks and benefits to ensure it is the right treatment.

Sciatica, Causes, Symptoms, and Tips

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research studies or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to discuss the subject matter above further, please contact Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Johns Hopkins Medicine. (2024). Nerve blocks. (Health, Issue. https://www.hopkinsmedicine.org/health/conditions-and-diseases/nerve-blocks

NYU Langone Health. (2023). Nerve block for migraine (Education and Research, Issue. https://nyulangone.org/conditions/migraine/treatments/nerve-block-for-migraine

National Institute of Neurological Disorders and Stroke. (2023). Pain. Retrieved from https://www.ninds.nih.gov/health-information/disorders/pain#3084_9

Johns Hopkins Medicine. (2024). Chronic pancreatitis treatment (Health, Issue. https://www.hopkinsmedicine.org/health/conditions-and-diseases/chronic-pancreatitis/chronic-pancreatitis-treatment

Cappellari, A. M., Tiberio, F., Alicandro, G., Spagnoli, D., & Grimoldi, N. (2018). Intercostal Neurolysis for The Treatment of Postsurgical Thoracic Pain: a Case Series. Muscle & nerve, 58(5), 671–675. https://doi.org/10.1002/mus.26298

Choi, E. J., Choi, Y. M., Jang, E. J., Kim, J. Y., Kim, T. K., & Kim, K. H. (2016). Neural Ablation and Regeneration in Pain Practice. The Korean journal of pain, 29(1), 3–11. https://doi.org/10.3344/kjp.2016.29.1.3

Hospital for Special Surgery. (2023). Regional anesthesia. https://www.hss.edu/condition-list_regional-anesthesia.asp

Stanford Medicine. (2024). Types of nerve blocks (For Patients, Issue. https://med.stanford.edu/ra-apm/for-patients/nerve-block-types.html

Anthem BlueCross. (2023). Peripheral nerve blocks for treatment of neuropathic pain. (Medical Policy, Issue. https://www.anthem.com/dam/medpolicies/abc/active/policies/mp_pw_c181196.html

O'Flaherty, D., McCartney, C. J. L., & Ng, S. C. (2018). Nerve injury after peripheral nerve blockade-current understanding and guidelines. BJA education, 18(12), 384–390. https://doi.org/10.1016/j.bjae.2018.09.004

Stanford Medicine. (2024). Common patient questions about nerve blocks. (For Patients, Issue. https://med.stanford.edu/ra-apm/for-patients/nerve-block-questions.html

Can individuals with sensory nerve dysfunction incorporate nonsurgical decompression to restore sensory-mobility function to their bodies?

Introduction

The spinal column in the musculoskeletal system comprises bones, joints, and nerves that work together with various muscles and tissues to ensure that the spinal cord is protected. The spinal cord is part of the central nervous system where the nerve roots are spread out to the upper and lower body parts that supply sensory-motor functions. This allows the body to move and function without pain or discomfort. However, when the body and spine ages or when a person is dealing with injuries, the nerve roots can become irritated and cause weird sensations like numbness or tingling, often correlating with body pain. This can cause a socio-economic burden on many individuals and, if not treated right away, can lead to chronic pain. To that point, it can lead to many individuals dealing with body extremity pain associated with sensory nerve dysfunction. This causes many individuals dealing with musculoskeletal disorders to start looking for treatment. Today’s article examines how nerve dysfunction affects the extremities and how nonsurgical decompression can help reduce nerve dysfunction to allow mobility back to the upper and lower limbs. We speak with certified medical providers who incorporate our patients’ information to provide nonsurgical solutions like decompression to help individuals with nerve dysfunction. We also inform patients how nonsurgical decompression can restore mobility-sensory to the upper and lower extremities. We encourage our patients to ask intricated and educational questions to our associated medical providers about the pain-like symptoms they are experiencing correlating with the sensory nerve dysfunction. Dr. Alex Jimenez, D.C., utilizes this information as an academic service. Disclaimer.

How Nerve Dysfunction Affects The Extremities

Do you experience tingling or numb sensations in your hands or feet that don’t want to go away? Do you feel pain in different back portions that can only be relieved through stretching or resting? Or does it hurt to walk for long distances that you feel like you need to rest constantly? Many pain-like scenarios are associated with sensory nerve dysfunction that can affect the upper and lower extremities. When many individuals experience sensory nerve dysfunction and deal with weird sensations in their extremities, many think it is due to musculoskeletal pain in their neck, shoulders, or back. This is only part of the issue, as many environmental factors can be associated with sensory nerve pain, as the nerve roots are being compressed and agitated, causing sensory nerve dysfunction in the extremities. Since the nerve roots are spread out from the spinal cord, the brain sends the neuron information to the nerve roots to allow sensory-mobility function in the upper and lower extremities. This allows the body to be mobile without discomfort or pain and functional through daily activities. However, when many individuals start to do repetitive motions that cause the spinal disc to be compressed constantly, it can lead to potential disc herniation and musculoskeletal disorders. Since numerous nerve roots are spread to the different extremities, when the main nerve roots are aggravated, it can send pain signals to each extremity. Hence, many people are dealing with nerve entrapment that leads to lower back, buttock, and leg pain that can affect their daily routine. (Karl et al., 2022) At the same time, many people with sciatica are dealing with sensory nerve dysfunction that affects their walking ability. With sciatica, it can be associated with spinal disc pathology and causes many individuals to seek treatment. (Bush et al., 1992)

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, licensed physician, and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request. We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

Individuals experiencing headaches on top of the head could be caused by different factors. Can recognizing the what triggers pain or pressure help prevent this type of headache, and healthcare providers develop effective treatment plans?

Headache On Top of The Head

Various factors could cause a headache on top of the head; common causes include:

• Stress
• Sleep problems
• Eye strain
• Caffeine withdrawal
• Dental problems
• Hormonal changes
• Alcohol consumption

Causes

Many causes have to do with underlying issues happening in other parts of the body.

Stress

• Stress is a common cause of headaches, including one on top of the head.
• Researchers don't know exactly how stress causes headaches, but they think it causes tightening of the muscles in the back of the head or neck, which
• pulls the tissues down, resulting in pain or pressure in the scalp and/or forehead area.
• These are also called tension headaches.
• Headaches caused by stress generally feel like dull pressure rather than throbbing pain.

Sleep Problems

• Not getting enough sleep can induce a headache on top of the head.
• When the mind and body do not get proper sleep, it can interfere with body functions like temperature, hunger, and sleep-wake cycles, which can lead to headaches.
• It is common to feel more stressed when sleep-deprived, which can cause or compound a headache and other symptoms.

Eye Strain

• You may develop a headache on the top of your head after you've been reading, watching, or otherwise focusing on something for a while.
• Over time, your eye muscles tire and have to work harder, causing them to contract.
• These spasms can lead to headaches. Squinting can make the muscle contractions even worse.

Caffeine Withdrawl

• Individuals may feel pain on the top of their heads if they skip their regular coffee.
• Regular caffeine consumption can lead to dependency and withdrawal symptoms, which include headaches when intake is reduced or stopped.
• This type of headache can be moderate to severe and can feel worse with activity.
• Most individuals start to feel better from caffeine withdrawal after a week. (World Health Organization. 2016)

Dental Problems

• Teeth issues like cracks, cavities, or impaction can irritate the trigeminal nerve, setting off head pain.
• Teeth grinding can also lead to headaches.

Hormonal Changes

• Individuals who have a low level of thyroid hormone may experience headaches.
• This could be from having too little thyroid or a symptom of the condition.
• Like stress-induced headaches, this type is generally dull and not throbbing.
• Some women may feel pain on the top of their heads before menstruation triggered by estrogen levels dropping.

Alcohol

• Some individuals develop a headache on the top of their head or elsewhere within a few hours after drinking alcohol.
• This is known as a cocktail headache.
• Alcohol-induced headaches usually resolve within 72 hours.
• The mechanism behind this headache is not fully researched, but it's been thought that the widening of blood vessels in the brain/vasodilation when consuming alcohol may trigger head pain.
• This type of headache is different than a hangover headache that comes from overconsumption and is based on dehydration and the toxic effects of alcohol. (J G Wiese, M. G. Shlipak, W. S. Browner. 2000)

Rare Causes

Top-of-the-head pain can also result from more serious and rare causes:

Brain Tumor

• Headaches are one of the most common symptoms of brain tumors.
• A headache on the top of the head depends on the location and size of the tumor. (MedlinePlus. 2021)

Brain Aneurysm

• This is a weak or thin area in a brain artery that bulges and fills with blood, which can cause a life-threatening rupture.
• Headaches are the most common symptom. (Brigham and Women's Hospital. 2023)

Brain Bleed

• Also known as a brain hemorrhage, this condition can cause intensely painful and quick headaches.
• Brain bleeds can be caused by head trauma, high blood pressure, an aneurysm, a bleeding disorder, or liver disease. (New York-Presbyterian. 2023)

Treatment

Treatment for reducing a headache on top of the head includes:

• Putting an ice bag over the area to reduce inflammation.
• Getting an eye examination.
• Making healthy lifestyle adjustments like drinking more water throughout the day.
• Less caffeine intake.
• Changing sleep patterns for a healthier, rested mind and body. 
• Taking a therapeutic bath to relax the body.
• Gentle exercises like walking, pilates, or yoga.
• Practicing deep breathing.
• Mindfulness exercises like meditation.
• Taking non-steroidal anti-inflammatory medication or NSAIDs like aspirin, Advil/ibuprofen), or Aleve/naproxen.

Depending on the cause and symptoms, a doctor may suggest specialist treatment options like:

• Physical therapy
• Cognitive behavioral therapy
• Chiropractic therapy
• Acupuncture
• Prescription medication

A medical professional will be able to help identify the type of headache being experienced, offer treatment options, and advise on how to manage triggers.

Neck Injuries, El Paso, Texas

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research studies or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, don't hesitate to get in touch with Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

World Health Organization. (2016) Headache disorders.

Wiese, J. G., Shlipak, M. G., & Browner, W. S. (2000). The alcohol hangover. Annals of internal medicine, 132(11), 897–902. https://doi.org/10.7326/0003-4819-132-11-200006060-00008

MedlinePlus. (2021) Brain tumor.

Brigham and Women's Hospital. (2023) Brain aneurysm.

New York-Presbyterian. (2023) Brain hemorrhage.

For individuals about to engage in physical activity or exercise, how does warming up the body help prepare for the work ahead?

Central Nervous System Activation

A proper warm-up before physical activity or working out prepares the mind and body to reduce risks of injury, mentally and physically transition to physical activity work, and enhance performance. A well-designed warm-up also primes the central nervous system/CNS for activity. The central nervous system transmits messages to the muscles to prepare them for action. Central nervous system activation increases motor neuron recruitment and engages the sympathetic nervous system so the body can better handle the physical stressors. The process may seem complex, but priming the nervous system is as simple as warming up with light aerobic activity before getting into more explosive movements.

CNS

The CNS consists of the brain and spinal cord. This central communication system uses another part of the nervous system known as the peripheral nervous system or PNS to transmit and receive messages throughout the body. The PNS is connected to the entire body and the brain and spinal cord (CNS).

• Nerves run throughout the body, receiving signals from the CNS to the muscles, fibers, and organs, transmitting various information back to the brain. (Berkeley University. N.D.)
• There are two types of systems within the peripheral nervous system - somatic and autonomic.

1. Somatic nervous system actions are those controlled by the person through voluntary actions like choosing to pick something up.
2. The autonomic system is involuntary and generates actions like breathing or heartbeat. (Cleveland Clinic. 2020)

Properly preparing the body for an intense strength training session or other physical activity needs the correct messages to be sent through the autonomic nervous system.

Parasympathetic and Sympathetic States

The autonomic nervous system consists of two subcategories, which are parasympathetic and sympathetic.

• The sympathetic nervous system helps the body get ready to face stress which includes physical stress. (R. Bankenahally, H. Krovvidi. 2016)
• The fight, flight, or freeze response describes the sympathetic nervous system's aspect.
• The parasympathetic nervous system is responsible for relaxation and de-stressing.

Individuals are recommended to perform a few calming movements and actions after a workout to return the body to a parasympathetic state. This can be:

• Stretching
• Lying with the legs elevated
• Relaxing yoga poses
• Box breathing
• Taking a warm shower or bath
• Foam rolling
• Massage

Returning the mind and body to a calm state helps with recovery and reduces stress hormone production. (National Academy of Sports Medicine. 2022)

Why Activate the CNS

Activating the CNS can increase performance and prevent injuries. The process wakes up and alerts the body for the activity. Individuals are recommended before beginning a training session, to communicate to the body about the physical stress it is about to endure and to prepare for the work ahead. This is a concept known as post-activation potentiation/PAP. (Anthony J Blazevich, Nicolas Babault. 2019) PAP helps increase force and power production, which enhances physical performance.

• Whenever an individual trains, the brain adapts and learns what the body is doing and the purpose of the training.
• Muscle memory describes this interaction.
• Individuals who have started up a new strength training routine or after an extended break report feeling awkward for the first few sessions, or even weeks, depending on their experience. (David C Hughes, Stian Ellefsen, Keith Baar, 2018)
• However, after a few sessions, the body is more adept at performing the movements and ready to increase resistance, repetitions, or both.
• This has to do with the neural drive and muscle memory than it has to do with true potential physical abilities. (Simon Walker. 2021)
• Training the CNS to be alert and pay attention can increase the development of a healthy mind-muscle connection combined with muscle memory. (David C Hughes, Stian Ellefsen, Keith Baar, 2018)

General Warm-Up

The first step is a general warm-up that should use large muscle groups and be of low intensity so as not to exhaust the body before beginning the actual training. General warm-up benefits central nervous system activation and the entire body include: (Pedro P. Neves, et al., 2021) (D C. Andrade, et al., 2015)

• Increases blood circulation.
• Assists the release of oxygen from hemoglobin and myoglobin.
• Warms the muscles, so they contract more effectively.
• Increases nerve impulse speed.
• Increases nutrient delivery.
• Lowers joints' resistance through increased synovial fluid/joint lubrication.
• Increases joint range of motion.
• Improves joint resiliency.
• Removes metabolic waste quicker.
• Reduces risk of injury.

A general warm-up can be simple as any aerobic activity will work. This can include:

• Performing bodyweight movements - light jumping jacks or jogging in place.
• Treadmill
• Rowing machine
• Stair climber
• Elliptical trainer

It is recommended to use the rating perceived exertion scale/RPE to determine the general warm-up effort. An exertion rating of between 5 to 6 is equivalent to moderate walking or a slow jog. Individuals should be able to speak clearly without taking a pause.

Try this strategy before the next workout to see increased performance and reduced injury risks.

Ankle Sprains Recovery

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please contact Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*