Neuropathy "The Painful Enigma"

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

Noninvasive treatments like chiropractic care, non-surgical decompression, massage therapy, non-steroidal anti-inflammatory drugs/NSAIDs, targeted/specific exercises, and ice/heat therapy successfully treat most cases of sciatica. However, more aggressive treatment could be necessary for severe cases, and this is where sciatica nerve block injections come in. The Injury Medical Chiropractic team can help you understand the diagnosis and explain the benefits.

Sciatica Nerve Block

Sciatic nerve block treatments can provide profound relief for intense, non-stop symptoms. The procedure can also provide important diagnostic information to help the spine specialist locate the exact nerve fibers contributing to the symptoms.

• The nerve block stops sciatic pain signals from transmitting.
• The procedure involves injecting an anesthetic and a steroid into the nerve roots.
• The steroid reduces inflammation.
• The anesthetic prevents nerve impulses from reaching the central nervous system - CNS.
• If the procedure is successful, surgery could be avoided altogether.

What to Expect

Individuals undergoing a sciatic nerve block will be awake during the procedure. Individuals that rather be sedated are recommended to speak with their healthcare provider during the planning phase.

• When the procedure begins, a nurse sterilizes the area around the injection site and applies a local anesthetic.
• The nurse will check the injection area for numbness.
• Then the spine physician inserts a needle using direct visualization from an ultrasound, fluoroscope, or CT scan and then injects the medications.
• After the procedure, the individual is moved to a recovery area and monitored.
• Most individuals can walk almost immediately after the injection, and vigorous exercise can be resumed a few days following the procedure, depending on the injury and what the spine specialist recommends.

Possible Complications

The procedure is done under direct visualization to minimize the risk of complications. However, possible complications could present and are usually linked to the needle insertion into the spinal column. These include:

• Bleeding
• Nerve Injury
• Infection

Complications are rare, but side effects like soreness around the injection site, nausea, and a headache are common and only last a little while.

Candidates

Individuals with underlying conditions and that are taking various medications may not qualify for a sciatic nerve block or have to consult their doctor for reasons that include the following:

Long-Term Anticoagulant Use

• Individuals taking blood thinners like daily aspirin, Plavix, or coumadin, will need to stop taking these medications before the procedure.

Allergy to Contrast Dye

• Sciatic nerve blocks are done using contrast dye or ultrasound.
• Individuals with an allergy to contrast dye will need to verify with their doctor or surgeon the feasibility of only using ultrasound guidance.

Abnormal Spinal Anatomy

• Individuals with abnormal spine anatomy have an increased risk for complications and are recommended not to have the procedure.

Morbid Obesity

• Morbid obesity is a significant risk factor for developing sciatica.
• The pain and symptoms often improve with weight loss.

Infection

• Inserting a needle with an injury, wound, or active infection near or around the injection site could cause spreading.

Treatment Duration

There is a wide range of responses to sciatic nerve blocks.

• Most individuals experience pain and symptom relief between two weeks and two to four months.
• Some individuals have a long-term resolution of their symptoms.
• However, it is also possible for the nerve block to be unsuccessful.

Unsuccessful Outcomes

The sciatic nerve is the longest in the body, and there are multiple potential sites for an anesthetic blockade.

• If a sciatic nerve block does not work, the spine specialist will reanalyze the diagnosis and see if the injection site was correct.
• Identifying the exact section of the nerve to anesthetize can be difficult and may require multiple nerve block attempts.

Individuals who continue to experience debilitating sciatica symptoms after a sciatic nerve block could be recommended to undergo surgical procedures.

• Sciatic nerve ablation is a procedure that destroys nerve pathways identified to cause pain and can provide long-term relief.
• If sciatica is caused by misalignment of the vertebrae or intense external pressure on the sciatic nerve, surgery to correct the underlying cause could offer a permanent solution.

Sciatica Syndrome

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, 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*

References

5 Questions to Answer Before Considering Sciatica Surgery, Johns Hopkins Medicine, accessed September 28, 2022, https://www.hopkinsmedicine.org/health/conditions-and-diseases/back-pain/5-questions-to-answer-before-considering-sciatica-surgery.

Jönsson, B et al. “Diagnostic lumbar nerve root block.” Journal of spinal disorders vol. 1,3 (1988): 232-5.

Kanaan, Tareq, et al. “The Efficacy of Therapeutic Selective Nerve Block in Treating Lumbar Radiculopathy and Avoiding Surgery.” Journal of pain research vol. 13 2971-2978. 18 Nov. 2020, doi:10.2147/JPR.S276331

Rodziewicz TL, Stevens JB, Ajib FA, et al. Sciatic Nerve Block. [Updated 2022 June 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470391/

Sciatica: Harvard Health Publishing, (2016, February 19), accessed September 28, 2022, of all the nerve https://www.health.harvard.edu/pain/sciatica-of-all-the-nerve.

Senthelal S, Dydyk AM, Mesfin FB. Ablative Nerve Block. [Updated 2022 April 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499975/

Back pain and soreness are widespread conditions that affect all genders, races, and lifestyles. The causes for back pain are varied from injury, poor posture, arthritis, age, overuse, etc. If back pain is frequent, perhaps the last assumption is that the pain could be caused by cancer. While it’s far from the most common causes, cancer back pain is possible, which makes consulting a doctor that will figure out the root cause, especially if there are other non-related symptoms, and treat the back pain very important.

Cancer Back Pain

Back pain that could be caused by cancer usually occurs with other symptoms and include:

• Back pain that is not related to movement.
• Pain does not get worse with activity.
• Back pain usually presents at night or early in the morning and fades away or improves as the day progresses.
• Back pain persists even after physical therapy or other treatments.
• Changes in bowel movements or blood in urine or stool.
• Unexplained, sudden weight loss.
• Unexplained fatigue/exhaustion.
• Weakness, tingling, or numbness in the arms or legs.
• Back pain does not have to be severe to be cancer, as it can range in severity.
• Having a family history of cancer and these symptoms can increase the risk.

Types of Cancer That Can Contribute To Back Pain

Types of cancer that can form around, in, and near the spine can cause back pain. These include:

Spinal Tumor

• A spinal tumor can grow in the spinal bone or the membranes around the spinal cord.
• The spine is a common source for bone metastasis, where cancer starts in one location and spreads to others.
• 30 to 70 percent of individuals with cancer spreads to the spine, according to the American Association of Neurological Surgeons - AANS.

Lung

• Lung cancer is one of the most common cancers that can spread to the spine.
• A lung tumor can press on the spine, affecting nerve transmissions.
• An individual with lung cancer may notice becoming tired/fatigued more easily, shortness of breath, coughing up blood, and back pain.

Breast

• Rare but possible breast cancer symptom.
• Breast cancers can metastasize to the back.
• Like lung cancers, some breast cancer tumors can press on nerves connected to the spine, causing discomfort and pain.

Gastrointestinal

• Cancers of the stomach, colon, and rectum can cause back pain.
• The pain radiates from where the cancer is to the back.

Tissue and Blood Cancers

Blood and tissue cancers like:

• Multiple myeloma
• Lymphoma
• Melanoma
• Can cause back pain.

Diagnosing Cancer and Back Pain

Medical treatments for back pain-related cancer depend on its type and how advanced it is. A doctor will consider symptoms and medical history when diagnosing possible back pain causes. Because cancer is a rare cause of back pain, a doctor may recommend various treatments before a full cancer work-up. The doctor may order imaging studies and blood testing if the pain persists after chiropractic, physical therapy, or anti-inflammatory medications. These tests will help identify potential cancer markers causing back pain.

• Treatments usually include chemotherapy and radiation to shrink a tumor.
• A doctor will recommend surgery to remove a tumor.

Chiropractic

Cancer patients have found chiropractic treatment to be effective for:

• Pain management.
• Flexibility improvement.
• Mobility improvement.
• Strengthening muscles.
• Helping to reduce stress.
• Helping the body function more efficiently.

Chiropractic physiotherapy benefits patients undergoing chemotherapy, as it helps the body withstand the debilitating effects of the treatment based on the whole-body approach.

Body Composition

Don’t Hate Dieting

Individuals hate dieting, usually because they go about it the wrong way. Individuals do not need to starve themselves and live at the gym. Reaching quick weight loss goals might sound appealing; however, going through it for an extended time can make individuals feel:

• Tired
• Depressed
• Unmotivated

Individuals can find a nutrition plan/exercise balance that works for them and their lifestyle. For some individuals, dieting alone is effective, but more than likely, they have increased metabolisms. Trying to lose fat by only cutting calories can be difficult for individuals with smaller metabolisms. The goal is to find a balance between diet and exercise. This does not mean having to go on an extreme diet, skip meals, or cut out entire macronutrient groups like fat or carbs, as the body needs both of these nutrients. Finding a sustainable long-term nutrition plan takes planning and support. A dietician, nutritionist, or health coach can offer a variety of nutrition and exercise plans customized to the individual.

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*

References

Downie, Aron et al. “Red flags to screen for malignancy and fracture in patients with low back pain: a systematic review.” BMJ (Clinical research ed.) vol. 347 f7095. 11 Dec. 2013, doi:10.1136/bmj.f7095

Mabry, Lance M et al. “Metastatic cancer mimicking mechanical low back pain: a case report.” The Journal of manual & manipulative therapy vol. 22,3 (2014): 162-9. doi:10.1179/2042618613Y.0000000056

Vasser, Melinda, and Matthew Koroscil. “When Back Pain Turns Deadly: An Unusual Presentation of Lung Cancer.” Respiratory medicine case reports vol. 29 101009. 28 Jan. 2020, doi:10.1016/j.rmcr.2020.101009

Verhagen, Arianne P et al. “Red flags presented in current low back pain guidelines: a review.” 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. 25,9 (2016): 2788-802. doi:10.1007/s00586-016-4684-0

Pinched nerves occur when added pressure is applied to a nerve or set of nerves from surrounding tissues like bones, cartilage, muscles, or tendons. The pressure affects the nerve's ability to function properly and usually causes pain, tingling, numbness, or weakness. A pinched nerve can occur at various sites in the body. Whether located in the neck, shoulder, arm, hand, back, or knees, if left untreated they can lead to other debilitating conditions/injuries and permanent nerve damage.

Pinched Nerves

The nerves are not actually being pinched, but are being compressed. The added pressure on or around the nerve causes painful sensations that can also include:

• Burning
• Delayed pain
• Electrical pain sensations
• Tingling
• Sharp pain
• Stabbing pain
• Numbness
• Pins and needles sensation
• Radiculopathy

Pinched nerves are nothing to dismiss. Individuals experiencing any of the above symptoms should get a proper diagnosis from a chiropractor.

Compression Goes Away By Itself

A compressed nerve can go away on its own if the pain has recently started or is not severe. Home remedies like rest, heat, ice, and stretching can be utilized to help the compression subside on its own.

Length of Time It Takes for a Pinched Nerve to Heal

The length of time depends on the reason why the nerve is compressed and irritated. Some pinched nerves are brought on from poor posture and tight muscles. These can usually heal within 4 weeks. However, if the pain has been going on for some time, like more than 3 months it will take longer, especially to identify the root cause/s and address them according to their severity.

Treatment Options

Chiropractic Adjustments and Massage

These two types of treatment/therapy highly complement each other. A chiropractor understands the importance of massage when it comes to healing and stress relief. Some cases of pinched nerves come from tight muscles and muscle spasms. Massage therapy along with chiropractic adjustments are perfect for releasing and stretching out the nerves back to their natural form.

Studies show that chiropractic massage therapy offers pain relief and also helps reduce any depression and anxiety that the pain symptoms can generate. Comprehensive chiropractic treatment has been proven to be the best and fastest way to deal with pinched nerves.

Get More Sleep

Whenever the body is going through stress and needs repair more sleep gives the body the time it needs to heal itself. An extra hour of sleep also ensures that the injured area moves less. However, try to avoid sleeping on the stomach and make sure that the pillows being used provide plenty of support.

Warm/Hot Soothing Bath

Ice can really help lower swelling and inflammation but if icing the area has not relieved the pain after 72 hours, then it is time for a warm/hot bath. Warm water increases blood circulation, which delivers oxygen and nutrients to help heal and restore. Heat relaxes the muscles of the body, which relieves pressure on the affected area.

Collagen Nerve Joint Repair

Collagen adds cushion to the spaces between the joints and bones while damaged tissues are being repaired. Collagen is the most plentiful natural protein in the human body. Supplements that have glucosamine, chondroitin, hyaluronic acid can help, as well as consuming bone broth, which is a healthy source of collagen. An anti-inflammatory diet can also help. Inflammation contributes to pain symptoms. Lowering inflammation lowers pain as well.

Proper Posture

Slouching and poor posture, whether sitting or standing, places added pressure/stress on the joints. When this goes on for long periods or when something traumatic occurs, a pinched nerve can be the result. A chiropractor will restore the body's natural curvature. A chiropractor will discuss and show what proper posture should be, as well as, how to strengthen the core to maintain proper posture.

Other Treatment Options

Conventional treatments usually include:

• Over the counter pain relievers
• Prescription pain relievers for severe cases
• Corticosteroids
• Microdiscectomy spinal surgery
• Regular surgery

Most individuals want to avoid any of the above treatment options. The body has a tremendous ability to heal itself. Chiropractic will reduce the amount of time that is required to heal a pinched nerve. It's about treating the entire body, not just the symptoms. A customized treatment/recovery diet plan will be developed according to each individual's needs. At Injury Medical Chiropractic and Functional Medicine Clinic, we encourage anyone who is experiencing any type of pain to call us right away.

Composition of the Body

What happens to the body when you stop eating

Not eating for a few hours causes the levels of glucose in the blood to drop and insulin release stops. There are Alpha cells in the pancreas that produce a hormone called glucagon that helps the liver to break down the body's stored glycogen, converting it back into glucose. The liver can also produce glucose by utilizing fats, amino acids, and waste.

If the body's blood sugar levels drop too low a condition called hypoglycemia happens. It occurs a few hours after eating when there is too much insulin in the blood, or from certain medications. This is why an individual might feel dizzy, shaky, anxious, or irritable when they have not eaten for several hours. Eating at least 15 to 20 grams of carbohydrates will reverse the symptoms.

Dr. Alex Jimenez’s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate 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 also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to 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. The provider(s) Licensed in Texas& New Mexico*

References

• Dubinsky RM, Miyasaki J.Assessment: Efficacy of transcutaneous electric nerve stimulation in the treatment of pain in neurologic disorders (an evidence-based review). Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2010;74:173-176.
• Shrier I. Does stretching help prevent injuries? Evidence-based Sports Medicine. Williston, VT: BMJ Books; 2002.

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

The spine consists of multiple vertebral bones separated by gel-like discs. The discs are the shock absorbers, cushioning the vertebrae. Normal wear and tear, underlying conditions, and injuries can cause the discs to crack, tear, and leak out, also known as a slipped or herniated disc, which is the most common cause of sciatica. In certain cases, physicians are using a medication that is used to control seizures known as gabapentin. Gabapentin is an anticonvulsant used to treat nerve-related back pain, like sciatica.

First Line Medications

• Doctors' first-line medications for sciatica include anti-inflammatories/NSAIDs such as naproxen or ibuprofen and corticosteroids.
• Back spasms can accompany sciatica, increasing the sensations and pain; a muscle relaxer could be added.
• If these treatments do not provide adequate symptom relief, a combination of gabapentin, naproxen, ibuprofen (NSAIDs), corticosteroids, and Tylenol could be recommended.
• Before going to bed is the recommended time for taking the meds because of the potential for drowsiness.
• This allows the patient to be more comfortable and get better sleep.

Gabapentin

Gabapentin is a non-narcotic prescription medication that is part of the anticonvulsant family. FDA approved for the following:

Seizures

• It can be used with other medications for controlling epileptic seizures.

Postherpetic Neuralgia

• Painful blisters caused by reactivation of herpes zoster virus, aka shingles.

Off-label uses include:

Nerve Pain

• Treats sharp burning nerve pain often experienced from:
• Shingles outbreak
• Diabetes
• Spinal cord injury

Restless Legs Syndrome

• Manages the various sensations commonly experienced with the condition.

Fibromyalgia

• It can be effective in treating pain symptoms.

Brain Signals

Gabapentin alters the way the brain and body transmit signals. It works by blocking the pain-causing neurotransmitters to calm the pain signals to the nerves. This is why it is used for sciatica and neurogenic pain. Individuals dealing with nerve pain, numbness, and tingling in the legs from sciatica or have diabetic neuropathy benefit the most. It is not recommended for chronic, non-specific low back pain. Gabapentin may take up to a month to provide maximum relief; individuals may start to experience some relief within the first week. However, notify a physician if significant pain persists after using Tylenol, NSAIDs, corticosteroids, and gabapentin.

What To Expect

• The medication is available in a capsule, tablet with immediate or extended release, and liquid form.
• Starting dosage is 300mg once a day.
• A physician may increase the dosage up to three times a day.
• The medication needs to be taken as prescribed.
• Treating neuropathic sciatic pain with gabapentin is standard practice.
• This is an off-label usage meaning the FDA has not determined if the medication is safe and effective for sciatica.

Side Effects and Interactions

The most common side effects include:

• Dizziness
• Fatigue
• Tremors

Due to these potential side effects, Individuals should not drive or operate heavy machinery while taking gabapentin. Rare but more serious side effects can include:

• Vision changes
• Confusion
• Trouble breathing
• Behavioral changes or suicidal ideation
• Swelling

In 2019, the FDA released a statement cautioning the elderly and those with significant breathing conditions, such as chronic obstructive pulmonary disease/COPD, to use extreme caution when taking gabapentin and similar medications. Elderly individuals are more likely to experience side effects due to age-related changes, decreased kidney function, poor balance, and mobility issues. There is an increased risk of experiencing breathing problems when taking gabapentin with any of the following:

• Alcohol
• Opioids
• CNS/Central Nervous System depressants slow brain activity for sleep, anxiety, and panic disorders.

The consumption of alcohol, opioids, or CNS depressants while taking gabapentin can increase the sedating effects of each substance and lead to respiratory depression. It is imperative that your physician knows all prescription and non-prescription medications, herbal supplements, and vitamins to prevent negative interactions between medications.

Does Gabapentin Work?

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, 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*

References

Center for Drug Evaluation and Research. (n.d.). Serious breathing difficulties with gabapentin and pregabalin. U.S. Food and Drug Administration. Retrieved September 30, 2022, from https://www.fda.gov/drugs/drug-safety-and-availability/fda-warns-about-serious-breathing-problems-seizure-and-nerve-pain-medicines-gabapentin-neurontin

Grice, Gloria R, and Marsha K Mertens. "Gabapentin as a potential option for treatment of sciatica." Pharmacotherapy vol. 28,3 (2008): 397-402. doi:10.1592/phco.28.3.397

U.S. Department of Health and Human Services. (2022, March 22). Prescription CNS depressants DrugFacts. National Institutes of Health. Retrieved September 30, 2022, from https://nida.nih.gov/publications/drugfacts/prescription-cns-depressants

U.S. National Library of Medicine. (n.d.). Gabapentin: Medlineplus drug information. MedlinePlus. Retrieved September 30, 2022, from https://medlineplus.gov/druginfo/meds/a694007.html

U.S. National Library of Medicine. (n.d.). Pregabalin: Medlineplus drug information. MedlinePlus. Retrieved September 30, 2022, from https://medlineplus.gov/druginfo/meds/a605045.html

Yasaei R, Katta S, Saadabadi A. Gabapentin. [Updated 2022 May 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK493228/

The diabetic disease processes can be a contributor to chronic back pain. Diabetes can damage the human body from the eyes to the feet if left untreated, and the spine/back is a prime target. Data from 11 studies consisted of individuals over 18 years of age diagnosed with type 1 or type 2 diabetes. The results showed individuals with diabetes had a 35% increased risk of experiencing lower back pain. According to the Centers for Disease Control and Prevention, around 34 million people were found to have diabetes in 20201. Diabetes primarily impacts blood sugar/glucose levels. However, the disease can affect several of the body's systems. It is a state of chronic inflammation.

Diabetic Back Pain Connection

The connection between diabetes and back pain include:

Neuropathy

Diabetic neuropathy happens when constant high glucose levels damage/injure the nerves. The result is symptoms like pain, tingling, and numbness. It affects up to 50% of individuals with diabetes and can lead to severe chronic back pain. High sugar levels damage various organ systems including the nervous system that results in neuropathy that causes pain/discomfort.

Bone Health

A complication that diabetes can cause is compromised bone health. High glucose levels can damage the collagen that makes up bone. This creates an increased risk of vertebral and other types of fractures. The high-risk compounds fractures that do not heal properly or correctly. Diabetics have an increased risk of fracture because of the accumulation increase of advanced glycation products. This substance forms when proteins or lipids combine with sugar. With time these products can cause damage to various tissues that include bone.

Obesity

Obesity contributes to the development of type 2 diabetes and is also a complication that results from incorrect glucose level management. Regardless of which came first, the added weight is a major contributor to back pain because of the added pressure/load on the spine. Excess weight and physical inactivity can result in serious issues of the musculoskeletal system.

Additional Factors

Poorly controlled diabetes also reduces muscle blood flow and increases cartilage inflammation. Other types of tissue damage can occur like degeneration of intervertebral discs and spinal canal stenosis. Disc degeneration and spinal stenosis are common causes of back and neck pain. Diabetics are prone to infection/s. This can cause back pain if it is in the bone known as osteomyelitis.

Diabetic Back Pain Management

There are steps that can help ease pain and discomfort.

Getting Involved In Physical Activity

Exercising/physical activity is a must. The body needs to move to get all the systems flowing improving diabetes and back pain. A sedentary lifestyle can take back pain to new levels with time. Even though when pain presents the first instinct is to stop and rest. Simple ways to get moving include:

• Walks
• Stretches
• Gentle laps in a pool
• All can help with:
• Improved blood flow
• Aids in weight loss
• Recommended for both conditions
• Exercising releases endorphins, which are the pain relief chemicals that the body produces naturally.

Reducing Stress

Reducing stress will help manage back pain. A few ways to decompress and reduce stress include:

• Meditating
• Listening to relaxation/soothing music
• Stress therapy
• Yoga can reduce physical pain and discomfort throughout the body

Quitting Bad Habits

Smokers have a significantly higher risk for low back pain compared to non-smokers. Nicotine can alleviate pain short term, but over time the nerves become more sensitive and can increase the pain. Alcohol use can help numb the pain short term, but it can cause muscle spasms and dehydration intensifying the pain. Complications can arise if taking pain medication. The most important thing is managing diabetes effectively. Injury Medical Chiropractic and Functional Medicine Clinic will help the individual feel better, move better, and keep back pain away.

Body Composition

Vitamin D and Healthy Blood Sugar Levels

Vitamin D benefits muscle health, muscle mass, and blood sugar. Insulin is the hormone that lets blood sugar into the muscles. Individuals with adequate blood vitamin D levels significantly lower the risk of hyperglycemia than those with below-recommended levels. Research shows daily vitamin D supplements used in combination with calcium decelerate the gradual rise in blood sugar in those with prediabetes. Adequate vitamin D levels can prevent the progression of hyperglycemia. Supplementation is beneficial for individuals going through a deficiency. Adults should aim for a dietary intake of 600 – 800 IU per day. However, supplements are never a substitute for a healthy and diverse diet.

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 musculoskeletal system’s injuries or disorders. 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, CTG*
email: coach@elpasofunctionalmedicine.com
phone: 915-850-0900
Licensed in Texas & New Mexico

References

Pozzobon, Daniel, et al. “Is There an Association between Diabetes and Neck and Back Pain? A Systematic Review with Meta-Analyses.” PLOS ONE, vol. 14, no. 2, 2019, doi:10.1371/journal.pone .0212030.

“Diabetic Neuropathy.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 3 Mar.

2020, www.mayoclinic.org/diseases-conditions/diabetic-neuropathy/symptoms-causes/syc-20371580.

Murray, Cliodhna E, and Cynthia M Coleman. “Impact of Diabetes Mellitus on Bone Health.” International Journal of Molecular Sciences, MDPI, 30 Sept.

2019, www.ncbi.nlm.nih.gov/pmc/articles/PMC6801685/. 

Groen BBL, Hamer HM, Snijders T, van Kranenburg J, Frijns D, Vink H, et al. Skeletal muscle capillary density and microvascular function are compromised with aging and type 2 diabetes. Journal of Applied Physiology. 2014;116(8):998–1005. pmid:24577061

Eivazi M, Abadi L. Low Back Pain in Diabetes Mellitus and Importance of Preventive Approach. Health Promotion Perspectives. 2012;2(1):80–8. pmid:24688921