Sports Injuries

Athletes and physically active individuals who participate in activities, exercises, and sports that involve kicking, pivoting, and/or shifting directions can develop pelvis overuse injury of the pubic symphysis/joint at the front of the pelvis known as osteitis pubis. Can recognizing the symptoms and causes help in treatment and prevention?

Osteitis Pubis Injury

Osteitis pubis is the inflammation of the joint that connects the pelvic bones, called the pelvic symphysis, and the structures around it. The pubic symphysis is a joint in front of and below the bladder. It holds the two sides of the pelvis together in the front. The pubis symphysis has very little motion, but when abnormal or continued stress is placed on the joint, groin and pelvic pain can present. An osteitis pubis injury is a common overuse injury in physically active individuals and athletes but can also occur as the result of physical trauma, pregnancy, and/or childbirth.

Symptoms

The most common symptom is pain over the front of the pelvis. The pain is most often felt in the center, but one side may be more painful than the other. The pain typically radiates/spreads outward. Other signs and symptoms include: (Patrick Gomella, Patrick Mufarrij. 2017)

• Lower abdominal pain in the center of the pelvis
• Limping
• Hip and/or leg weakness
• Difficulty climbing stairs
• Pain when walking, running, and/or shifting directions
• Clicking or popping sounds with movement or when shifting directions
• Pain when lying down on the side
• Pain when sneezing or coughing

Osteitis pubis can be confused with other injuries, including a groin strain/groin pull, a direct inguinal hernia, ilioinguinal neuralgia, or a pelvic stress fracture.

Causes

An osteitis pubis injury usually occurs when the symphysis joint is exposed to excessive, continued, directional stress and overuse of the hip and leg muscles. Causes include: (Patrick Gomella, Patrick Mufarrij. 2017)

• Sports activities
• Exercising
• Pregnancy and childbirth
• Pelvic injury like a severe fall

Diagnosis

The injury is diagnosed based on a physical examination and imaging tests. Other tests may be used to rule out other possible causes.

• The physical exam will involve manipulation of the hip to place tension on the rectus abdominis trunk muscle and adductor thigh muscle groups.
• Pain during the manipulation is a common sign of the condition.
• Individuals may be asked to walk to look for irregularities in gait patterns or to see if symptoms occur with certain movements.

1. X-rays will typically reveal joint irregularities as well as sclerosis/thickening of the pubic symphysis.
2. Magnetic resonance imaging - MRI may reveal joint and surrounding bone inflammation.
3. Some cases will show no signs of injury on an X-ray or MRI.

Treatment

Effective treatment can take several months or longer. Because inflammation is the underlying cause of symptoms, the treatment will often involve: (Tricia Beatty. 2012)

Rest

• Allows the acute inflammation to subside.
• During recovery, sleeping flat on the back may be recommended to reduce pain.

Ice and Heat Applications

• Ice packs help reduce inflammation.
• The heat helps ease pain after the initial swelling has gone down.

Physical Therapy

• Physical therapy can be extremely helpful in treating the condition to help regain strength and flexibility. (Alessio Giai Via, et al., 2019)

Anti-inflammatory Medication

• Over-the-counter nonsteroidal anti-inflammatory medications - NSAIDs like ibuprofen and naproxen can reduce pain and inflammation.

Assistive Walking Devices

• If the symptoms are severe, crutches or a cane may be recommended to reduce stress on the pelvis.

Cortisone

• There have been attempts to treat the condition with cortisone injections, but the evidence supporting its use is limited and needs further research. (Alessio Giai Via, et al., 2019)

Prognosis

Once diagnosed, the prognosis for full recovery is optimal but can take time. It can take some individuals six months or more to return to pre-injury level of function, but most return by around three months. If conservative treatment fails to provide relief after six months, surgery could be recommended. (Michael Dirkx, Christopher Vitale. 2023)

Sports Injuries Rehabilitation

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

Gomella, P., & Mufarrij, P. (2017). Osteitis pubis: A rare cause of suprapubic pain. Reviews in urology, 19(3), 156–163. https://doi.org/10.3909/riu0767

Beatty T. (2012). Osteitis pubis in athletes. Current sports medicine reports, 11(2), 96–98. https://doi.org/10.1249/JSR.0b013e318249c32b

Via, A. G., Frizziero, A., Finotti, P., Oliva, F., Randelli, F., & Maffulli, N. (2018). Management of osteitis pubis in athletes: rehabilitation and return to training - a review of the most recent literature. Open access journal of sports medicine, 10, 1–10. https://doi.org/10.2147/OAJSM.S155077

Dirkx M, Vitale C. Osteitis Pubis. [Updated 2022 Dec 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK556168/

The low back is a common source of discomfort and soreness among volleyball players because of repetitive jumping, bending, and rotating of the trunk. Adolescents have an increased risk of this injury because their vertebral bones are still developing, which increases the risk for stress fractures. Chiropractic care, massage therapy, decompression, rest, and athletic training can help expedite pain relief and heal the injury.

Volley Back Pain

Muscle or ligament strains are the most common injury from repetitive jumping, bending, rotating movements, and hyperextension during serving, hitting and setting. This can lead to excessive compression forces on the discs and joints, causing reduced blood circulation, increasing the risk of overload injuries. One study reported that low back pain is experienced in 63% of players. However, if low-back pain is accompanied by pain that runs down the leg along with numbness or weakness in the foot or ankle, the issue could be a herniated disc.

Causes

One common reason is endurance imbalances in the muscles that stabilize the low back. The core muscles provide stability to the low back and spine for all movements. If imbalances are present, a player may spike or serve the ball with intense turning and arching. The added actions cause increased pressure in the joints and hip, gluteal, and leg muscles, affecting the spine's stability.

• The gluteals run from the back of the pelvis/hip bones down to the outside of the thigh.
• The gluteal muscles prevent the trunk and hips from overbending forward when landing.
• If the gluteal muscles do not have the strength and endurance to perform this motion, the upper body will bend too far forward, causing poor landing posture and decreased spine stability.

Anterior Pelvic Tilt

Studies have shown that players with low back pain tend to stand and land with an anterior pelvic tilt. This is an unhealthy posture when the front of the pelvis tilts forward, and the back of the pelvis raises. Landing hard with an anterior pelvic tilt causes increased arching and increases the pressure in the joints.

Chronic back pain

Warning signs of a more serious back problem include:

• Pain that has lasted for more than 1 week and is not improving or getting worse.
• Pain that prevents sleep or causes the individual to constantly wake up.
• Difficulty sitting.
• Back soreness when performing basic tasks and chores.
• Significant pain on the court when jumping, landing, or rotating.
• Chronic pain ranges from aches to shooting or throbbing pain that can run down the buttocks and legs.

Chiropractic Care

A chiropractor can alleviate volleyball back pain, rule out a more severe injury, such as a stress fracture or herniated disc, and provide a healthier and faster recovery. According to a study, athletes who received chiropractic care showed better speed and mobility. Quick reflexes and hand-eye coordination depend on an optimal functioning nervous system. 90% of the central nervous system travels through the spine. When one or more spinal segments are misaligned, the effect on the nervous system can seriously impact and disrupt nerve circulation, affecting speed, mobility, reflexes, and hand-eye coordination. Chiropractic adjustments will:

• Relax and reset the back muscles.
• Realign and decompress the spine. 
• Remove the pressure around the nerve roots.
• Strengthen the core.
• Improve and increase range of motion, strength, and overall endurance.

Anterior Pelvic Tilt

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 your own 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

Haddas R, Sawyer SF, Sizer PS, Brooks T, Chyu MC, James CR. "Effects of Volitional Spine Stabilization and Lower-Extremity Fatigue on the Knee and Ankle During Landing Performance in a Population With Recurrent Low Back Pain." J Sport Rehabil. 2017 Sep;26(5):329-338. doi: 10.1123/jsr.2015-0171.

Hangai M. et al., Relationship Between Low Back Pain and Competitive Sports Activities During Youth, Am J Sports Med 2010; 38: 791-796; published online before print January 5, 2010, doi:10.1177/0363546509350297.

Jadhav, K.G., Deshmukh, P.N., Tuppekar, R.P., Sinku, S.K.. A Survey of Injuries Prevalence in Varsity Volleyball Players. Journal of Exercise Science and Physiotherapy, Vol. 6, No. 2: 102-105, 2010 102

Mizoguchi, Yasuaki, et al. "Factors associated with low back pain in elite high school volleyball players." Journal of physical therapy science vol. 31,8 (2019): 675-681. doi:10.1589/jpts.31.675

Movahed,Marziehet al. (2019). "Single leg landing kinematics in volleyball athletes: A comparison between athletes with and without active extension low back pain."

Sheikhhoseiniet al. (2018). "Altered Lower Limb Kinematics during Jumping among Athletes with Persistent Low Back Pain"

Acute and chronic sports injuries. Individuals that participate in sports or physical activities have an increased risk of experiencing an injury. These types of damages range from minor to severe and could require medical attention. Acute sports injuries happen suddenly and are usually the result of trauma to the area. A specific, identifiable incident is what causes an acute injury. Chronic sports injuries, also known as repetitive/overuse injuries, happen with time and are not caused by a single incident.

Acute and Chronic Sports Injuries Identification

Acute injuries can be identified by their cause. This could be a falling down during a run, sharp pain that presents in the shoulder after a throw, or a sprained ankle. The ability to focus on one cause usually means it’s acute. Acute injuries are characterized by:

• Sudden pain in an area where there was none.
• Swelling
• Redness
• Tenderness
• Limited range of motion.
• The inability of the injured area to support its weight.
• A broken bone.
• Dizziness
• Headache
• Nausea
• Vomiting

Chronic injuries are different but are usually easy to identify. The pain begins gradually, usually over weeks or months. Repetitive activities like running, throwing, swinging can exacerbate the pain. However, it is difficult to point to a specific issue that first caused the discomfort or pain. Chronic sports injuries are characterized by:

• Pain and tenderness in the area, especially during and immediately after activity.
• Minor swelling and limited range of motion.
• Dull pain when resting.

These two types of injuries have different causes - trauma for acute and wear-and-tear for chronic - they can both result in similar issues. For example, shoulder rotator cuff injuries are common, especially those that repeatedly use their shoulder to swing, throw, swim, etc. The individual needs to undergo a rotator cuff injury test to diagnose the injury correctly, whether the damage is acute or chronic. Chronic injuries can cause acute injuries, and acute injuries can lead to chronic injuries if left untreated.

Examples of Acute and Chronic Sports Injuries

Chronic and acute injuries are common in every type of sport. There’s an opportunity for both types of injuries. The most common include:

Acute Injuries:

• Sprain and Strains
• Burners and Stingers
• A.C.L. Tears
• Rotator Cuff Tear
• Dislocated Shoulder
• Broken Bones or Fractures
• Concussion
• Whiplash

Chronic Injuries:

• Runner’s Knee
• Achilles Tendon Issues
• Shin Splints
• Swimmer’s Shoulder
• Lateral epicondylitis tennis elbow
• Stress Fractures

Other injuries from trauma, overuse, or both include:

• Nonspecific Back Pain
• Herniated Disc/s
• Spondylolysis

Treatment

Minor acute injuries can be treated with rest, ice, compression, and elevation, aka R.I.C.E. Overuse injuries, are different as the injury has been gradually increasing in its severity, possibly causing scar tissue and ganglion cysts to develop. To prevent the injury from worsening, it’s recommended to see a sports injury chiropractor or physical therapist. These professionals can help heal the body and educate the individual on self-care and prevention.

Chiropractic

The musculoskeletal system takes a beating. Chronic injuries usually affect the bones, joints, muscles, or a combination. Chiropractic helps keep the musculoskeletal system limber and in proper alignment. Adjustments include:

• Neck adjustments
• Arm and hand adjustments
• Shoulder adjustments
• Knee adjustments
• Hip adjustments
• Foot adjustments

Physical Therapy

Physical therapy for a chronic injury can help prevent future injuries. A physical therapist helps:

• Improve range of motion
• Reduces pain and swelling
• Increases strength

Whether an athlete or are just staying active and having some fun with sports, acute and chronic injuries can sneak up and worsen if they are not treated properly. Healing with the help of a professional can quicken recovery time and prevent future injuries.

Body Composition

Maintain Muscle Mass While Losing Fat

Individuals that want to lose weight should focus on losing excess fat tissue, not muscle mass. Studies have shown that diet and exercise are crucial to preserving Skeletal Muscle Mass while losing weight. Losing weight healthily includes:

• A healthy balance of cardio and resistance training to burn calories and build muscle.
• A caloric deficit diet to burn through extra fat stores.
• Get enough protein to support and maintain healthy muscle mass.

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

Cava, Edda et al. “Preserving Healthy Muscle during Weight Loss.” Advances in nutrition (Bethesda, Md.) vol. 8,3 511-519. 15 May. 2017, doi:10.3945/an.116.014506

https://www.niams.nih.gov/health-topics/sports-injuries

https://link.springer.com/article/10.2165/00007256-199418030-00004

https://journals.lww.com/acsm-csmr/FullText/2010/09000/An_Overview_of_Strength_Training_Injuries__Acute.14.aspx?casa_token=8sCDJWxhcOMAAAAA:CDEFNkTlCxFkl-77MtALBQAkttW0PqWwCj4masQzEcYOJNuwFKyZgHZ9npQoHhWgMKOPSbnkLyfcQACYGpuu7gg

Wörtler, K, and C Schäffeler. “Akute Sportverletzungen und chronische Überlastungsschäden an Vor- und Mittelfuß” [Acute sports injuries and chronic overuse stress damage to the forefoot and midfoot]. Der Radiologe vol. 55,5 (2015): 417-32. doi:10.1007/s00117-015-2855-3

Yang, Jingzhen et al. “Epidemiology of overuse and acute injuries among competitive collegiate athletes.” Journal of athletic training vol. 47,2 (2012): 198-204. doi:10.4085/1062-6050-47.2.198

Gymnastics is a demanding and challenging sport. Gymnasts train to be powerful and graceful. Today's moves have become increasingly technical acrobatic moves with a much higher degree of risk and difficulty. All the stretching, bending, twisting, jumping, flipping, etc., increases the risk of neuromusculoskeletal injuries. Gymnastics injuries are inevitable. Bruises, cuts, and scrapes are common, as are overuse strains and sprains, but severe and traumatic injuries can occur. 

Injury Medical Chiropractic and Functional Medicine Team can treat and rehabilitate injuries and help to strengthen and prevent injuries. The therapy team will thoroughly evaluate the individual to determine the injury/s severity, identify any weaknesses or limitations, and develop a personalized plan for optimal recovery, stability, and strength.

Gymnastic Injuries

One of the main reasons injuries are more prevalent is because today's athletes start earlier, spend more time practicing, perform more complex skill sets, and have higher levels of competition. Gymnasts learn to perfect a skill and then train to make their bodies look elegant while executing the routine. These moves require precision, timing, and hours of practice. 

Injury Types 

Sports injuries are classified as:

• Chronic Overuse injuries: These cumulative aches and pains occur over time.
• They can be treated with chiropractic and physical therapy and prevented with targeted training and recovery.
• Acute Traumatic injuries: These are typically accidents that happen suddenly without warning.
• These require immediate first aid.

Most Common Injuries

Gymnasts are taught how to fall and land to lessen the impact on the spine, head, neck, knees, ankles, and wrists. 

Back

• Common back injuries include muscle strains and spondylolysis.

Bruises and Contusions

• Tumbling, twisting, and flipping can result in various bruises and contusions.

Muscle Soreness

• This is the sort of muscle soreness experienced 12 to 48 hours after a workout or competition.
• Proper rest is necessary for the body to recover fully.

Overtraining Syndrome

• Overtraining syndrome happens when individuals train beyond the body's ability to recover.

Sprains and Strains

• Sprains and strains.
• The R.I.C.E. method is recommended. 

Ankle Sprains

• Ankle sprains are the most common.
• When there is a stretching and tearing of ligaments surrounding the ankle joint.

Wrist Sprains

• A sprained wrist happens when stretching or tearing the ligaments of the wrist.
• Falling or landing hard on the hands during handsprings is a common cause.

Stress Fractures

• Leg stress fractures result from overuse and repeated impact from tumbling and landings.

The most common include:

• Shoulder instability.
• Ankle sprains.
• Achilles tendon strains or tears.
• Gymnasts wrist.
• Colles' fracture.
• Hand and Finger injuries.
• Cartilage damage.
• Knee discomfort and pain symptoms.
• A.C.L. tears - anterior cruciate ligament.
• Burners and stingers.
• Low back discomfort and pain symptoms.
• Herniated discs.
• Spinal fractures.

Causes

• Insufficient flexibility.
• Decreased strength in the arms, legs, and core.
• Balance issues.
• Strength and/or flexibility imbalances - one side is stronger.

Chiropractic Care

Our therapists will start with an evaluation and a biomechanical assessment to identify all the factors contributing to the injury. This will consist of a thorough medical history to understand overall health status, training schedule, and the physical demands on the body. The chiropractor will develop a comprehensive program that includes manual and tool-assisted pain relief techniques, mobilization work, MET, core strengthening, targeted exercises, and injury prevention strategies.

Facet Syndrome Chiropractic 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 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

Armstrong, Ross, and Nicola Relph. "Screening Tools as a Predictor of Injury in Gymnastics: Systematic Literature Review." Sports medicine - open vol. 7,1 73. 11 Oct. 2021, doi:10.1186/s40798-021-00361-3

Farì, Giacomo, et al. "Musculoskeletal Pain in Gymnasts: A Retrospective Analysis on a Cohort of Professional Athletes." International journal of environmental research and public health vol. 18,10 5460. 20 May. 2021, doi:10.3390/ijerph18105460

Kreher, Jeffrey B, and Jennifer B Schwartz. "Overtraining syndrome: a practical guide." Sports Health vol. 4,2 (2012): 128-38. doi:10.1177/1941738111434406

Meeusen, R, and J Borms. "Gymnastic injuries." Sports medicine (Auckland, N.Z.) vol. 13,5 (1992): 337-56. doi:10.2165/00007256-199213050-00004

Sweeney, Emily A et al. "Returning to Sport After Gymnastics Injuries." Current sports medicine reports vol. 17,11 (2018): 376-390. doi:10.1249/JSR.0000000000000533

Westermann, Robert W et al. "Evaluation of Men's and Women's Gymnastics Injuries: A 10-Year Observational Study." Sports Health vol. 7,2 (2015): 161-5. doi:10.1177/1941738114559705

Squat exercises are highly effective, as they strengthen the back and core muscles, helping the prevention of injury. They can be done anywhere with or without equipment like weights and resistance bands and can be part of an aerobic workout. Squatting requires following proper form and posture. Using the improper form, adding too much weight too soon, overdoing it without enough recovery time can cause soreness, back pain, and injury. Having muscle soreness after performing squats is expected; however, if symptoms like chronic soreness, tingling, numbness, or sharp aches that come and go, begin to appear, it is recommended to consult a medical trainer, chiropractor, doctor, or spine specialist to evaluate the symptoms, and if necessary develop a treatment plan, as well as a prevention plan to continue exercising safely.

Squat Exercises

Squatting is a highly beneficial form of exercise. Athletes, trainers, coaches, and individuals just staying healthy use the technique as a part of their training and workouts. This is because squatting increases core muscle strength, increasing body power. Squat exercises benefits include:

Increased Flexibility

• Improved strength and a range of motion allow the body to move flawlessly in various directions with minimal effort.

Increased Core Strength

• All major muscles work together during a squat.
• This increases muscle stabilization, maintains body balance, increasing core strength.

Injury Prevention

• Squats work all leg muscles simultaneously, synchronizing the body.
• This increases body stability decreasing the risk of injury.

Back Pain and Potential Injury

The spine is exposed and unprotected during a squat. This is where back pain and injury can happen. Potential causes include:

• Not warming up/priming muscles properly.
• Tight muscles and a limited range of motion.
• Improper form and squatting technique.
• Adding weight or loading too soon.
• Weak core muscles.
• Incorrect or improper footwear with inadequate arch support.
• Weak ankle muscles are not used to the weight and shift, causing misalignment and awkward positioning.
• Previous injuries to the lower back can cause a flare-up to the area and potentially worsen.

Prevention

Ways to troubleshoot and prevent back pain during squat exercises.

Warmup

• Using a proper and effective warmup will ensure that the body is ready for the workout stress.
• Priming each muscle is recommended. This could be:
• Starting with glute work.
• Then planks to activate the core.
• Finish off with stretching and range of motion exercises.
• A personal trainer can assist in creating a customized workout routine.

Starting Position

• The feet should always face forward to protect the hips and knees when beginning a squat.
• If the feet face at an angle, the form can be impacted, leading to back pain or collapsing arches.

Spinal Alignment

• Maintaining a straight-ahead or upward gaze, which increases center awareness during squat exercises, can prevent the body from leaning forward and placing stress on the spine.
• Only squat as far as possible, making sure to feel in control and maintain the form.
• Squatting too deep can cause muscle strain leading to pain.
• Focus on form, as it is more important than depth.

Joint mobility

• Ankle mobility and stability are essential to balance and control.
• If the ankle is compromised, the feet could lift off the floor, forcing the body to compensate, leading to strain and potential injuries.
• Only squat as far as ankle stability allows.
• Ankle flexibility exercises will help improve squat form.

Variations

• Choose the correct squat variation.
• Goblet or front squats can be easier for beginners.
• Barbell back squats are more advanced and, if done incorrectly, can cause injury.

A chiropractor or physical therapist will be able to evaluate spinal health, exercise form, and advise if there is an issue.

Body Composition

Achieve Health and Fitness Goals By Doing What You Enjoy

Don't engage in workouts or fitness programs that make you miserable. Do workouts/activities that you enjoy and have fun doing. Exercise for the love of the body, keeping it healthy and in shape, not because there is a feeling of obligation.

• Try and experiment with different workouts/physical activities to see and feel what works for you.
• Individuals who don't like lifting weights try using resistance bands or bodyweight exercises.
• The same goes for nutrition. Don't base diet and supplement choices on misperceptions about health.

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

Calatayud, Joaquín et al. "Tolerability and Muscle Activity of Core Muscle Exercises in Chronic Low-back Pain." International journal of environmental research and public health vol. 16,19 3509. 20 Sep. 2019, doi:10.3390/ijerph16193509

Clark, Dave R et al. "Muscle activation in the loaded free barbell squat: a brief review." Journal of strength and conditioning research vol. 26,4 (2012): 1169-78. doi:10.1519/JSC.0b013e31822d533d

Cortell-Tormo, Juan M et al. "Effects of functional resistance training on fitness and quality of life in females with chronic nonspecific low-back pain." Journal of back and musculoskeletal rehabilitation vol. 31,1 (2018): 95-105. doi:10.3233/BMR-169684

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It was once believed that inflammation caused impairments such as plantar fasciitis, tendonitis and iliotibial band syndrome -- but new research shows that may not be the case. Injury specialist Dr. Alexander Jimenez examines the data.

The body was made to move; however, moving too far or too often in a repetitive way can overexert tissues. New research is now calling into question the concept that inflammation causes these conditions -- and this may affect our understanding and treatment to what had been considered tendonitis and fasciitis.

Connective Tissue

Ligaments, tendons, ligaments and fascia hold the bony skeleton together. Quite simply, the muscles move the manhood; the tendons connect muscles to bones; the fascia encases the musculotendinous unit, and sometimes become a functional part of the unit, as is true for the iliotibial band and the gluteus maximus and tensor fasciae latae muscles; and the ligaments connect bones to bones.

An athlete might have the occasional ligament strain or inherent ligament laxity, but the tissue itself typically either does its job or doesn't. Current thought on the causes and therapy of the chronic injury of those tissues may change the way you exude your endurance athletes.

Fascinating Fascia

Fascia exists as an uninterrupted matrix of collagen that extends throughout the entire body, forming a web of covering and connection between all organs and muscles. Therefore, it is nearly impossible to isolate and name a region of the continuum in any other way than its nearest anatomical structure. It's three- dimensional and contains freedom in all three planes of motion(1).

While one continuous membrane, fascia has distinct inherent characteristics based on its location and function. Fascia that exists among muscles aids to transmit forces in addition to absorb strain.Studiesinlive specimens with ultrasound reveal that fascia is viscoelastic -- using both viscous and elastic characteristics when deformed -- and is therefore able to slip independently of the contraction of the muscle that it surrounds(1).

Fascia is composed of at least nine of the 28 types of known collagen. Collagen gives construction, durability and strength to the tissue. The extracellular matrix of fascia includes the elastic fibers which provide flexibility. Myofibroblasts are also present in fascia, leading, hypothetically, to its contractility, tension, and equilibrium(1). Fascia has a characteristic fiber arrangement parallel to the common force vectors to which it can be exposed.

Tendons are also viscoelastic structures, composed primarily of type-I collagen fibers, using a little amount of type-III and type-X as well(2). The collagen fibers lie in a parallel structure, with a resultant tensile strength capable of transmitting large forces. The fibroblasts within the tendon, known as tenocytes, lie along the collagen fibers and provide the structure for collagen cross- links. Their sensitivity allows them to regulate the protein synthesis within the extra-cellular matrix dependent on the changes from the load encountered by the tendon. It is the unloading and loading of the tendon that activates the chemical and structural changes in the thoracic structure, which may be why specific types of exercise are important in tendon rehabilitation and recovery.

Mechanism Of Injury

Tendon and fascial injuries both result from overloading. Acute injuries are usually considered as resulting after a one-time incident of intense loading. A chronic injury, subsequently, is considered something that occurs after repeated excessive strain. However, some theories assert that acute accidents occur due to chronic underlying micro-stress into the tissue(two). In any case, nearly 50% of sports injuries reported from the USA are the result of overuse(3).

Traditionally, both tendon and fascial injuries were considered inflammatory processes and were consequently named tendonitis and fasciitis. As more is understood concerning the mechanics of both injury and healing, this nomenclature is now called into question. Tendinopathy is the catch-all phrase that covers any abnormal state of the tendon. Tendonitis refers to some true inflammatory reaction due to bleeding within the gut as a result of an intense event. Tendinosis is the condition of tendon degeneration that develops over time in the lack of a true inflammatory response. It's considered a state of overuse, however, though, can coexist with an inflammatory process from the paratenon. Actually, degeneration along various points on this spectrum can be found all within exactly the same tendon.

A barbell with tendinosis differs histologically from tissue that is healthy. The collagen alignment in tendinosis is no more parallel and the distance between the collagen bundles increases. The tenocytes become much more notable. The quantity of type-III collagen additionally increases when compared to type-I, which generally composes 90 percent of the collagen in healthy tendon(3). Despite an increase in fibroblasts, there are no inflammatory cells present in the extra-cellular matrix. There is an infiltration of blood vessels and nerves, which is referred to as neovascularisation. These microscopic findings are indicative of a fix process gone awry, resulting in further tendon degeneration.

It appears that in response to excessive strain or overuse, the tendon attempts to initiate a healing process that fails to regenerate and really further degenerates the tissue. Some theorize that inflammation occurs initially, but that the repetitive nature of the mechanical stress results in interruption of the normal recovery procedure. When inflammation occurs within a healthy tendon the tenocytes turn into myofibroblasts. The myofibroblasts then normally undergo cell death; however, in tendinosis, the repeated stress may interrupt this process, causing a proliferation of myofibroblasts which cause fibrosis of the tissue.

Hypoxia can interrupt the homeostasis of this extra-cellular matrix, which causes an increase in blood vessels and corresponding nerve pathways. The gain in sensory nerve pathways at the neovascularisation process is thought to be the cause of greater pain in tendonosis(3). The pain of this neo- vascularisation may cause an athlete to insufficiently load the tendon to activate the normal tenocyte reaction to strain, thus further inhibiting healing. The lack of repair contributes to microscopic tears which can finally cause tendon rupture.

Treatment

Fasciitis and tendinopathy are often considered difficult conditions to deal with because of the poor outcomes when using conventional inflammation combating strategies. Understanding that an athlete's condition might not really be an inflammatory process is important when choosing the proper healing modalities. The exact same is true with the usage of non-steroidal anti-inflammatory medications (NSAIDs). While maybe mediating the pain, they don't improve the condition. Masking the pain might cause additional harm as the athlete continues to execute the offending action. Treatment with NSAIDs must be undertaken acknowledging the lack of evidence of efficiency, in addition to the risks related to such drugs, most especially gastro-intestinal upset.

Some modalities are found to be useful in the management of tendinosis and fascial injuries. Intense friction massage, using a tool or merely manually, is often used to evoke changes in the tissue through a physical manipulation that triggers a recovery reaction. True randomized controlled studies are lean for its treatment of tendinosis, and lacking altogether about fasciitis. However, case studies show great results with friction massage when utilized as an adjunct to other therapeutic methods(4).

The use of low-level laser therapy (LLLT) is controversial at best. An overview of six distinct systemic literature reviews on the use of LLLT with tendinopathy came to the conclusion that there isn't enough conclusive evidence to advocate its use in the therapy of tendinopathy(3). The same holds true in the case of ultrasound treatment. While thought to trigger recovery through adrenal effects, ultrasound hasn't been found to be beneficial. The accession of drugs through using ultrasound (phonophoresis) or electric impulses (iontophoresis) conveys nearly the very same effects as LLLT and ultrasound alone. Studies conflict as to the effectiveness of all of these modalities.

What's New?

Another new treatment is the use of exogenous nitric oxide (NO). NO is thought to assist in cell signaling and in the modulation of the immune reaction. Animal studies demonstrate that treatment with exogenous NO contributes to higher collagen synthesis and recovery inside joints, and also depleting NO has a negative influence on the strength and size of a healing tendon(3). The Food and Drug Administration believe the use of exogenous nitric acid to deal with tendinopathy or fasciitis, via a glyceryl trinitrate patch, an off-label usage in america. But, studies show that using a 5mg/24-hour glyceryl trinitrate patch, divided into quarters, is effective in controlling pain and assisting in tendon healing. Treatment lasts from eight weeks to six months, and also the quarter-patch is put directly over the thoracic and changed everyday. Side effects are typically the same as treatment with nitroglycerine -- headache and dizziness due to hypotension -- and therapy using concurrent active therapeutic exercise is recommended.

A Shot In The Arm, Leg, Or Ankle...

A well known method of handling inflammation, corticosteroid shots have long been used with limited success in the management of tendinopathies and fasciitis. The reason for the limited success must now be nicely apparent. Theoretically, tendon degeneration may result in inflammation of the paratenon, which leads to the pain of the injury. Injection adjoining to the injury can help with the inflammation there, but the root cause of degeneration is not assisted whatsoever. If shots are undertaken, they need to be achieved with the assistance of fluoroscopic guidance to assure that the delivery of this steroid is adjacent to the tendon, not inside.

Despite a dearth of evidence to support its use, corticosteroids are still a first line treatment for fasciitis, particularly plantar fasciitis. A British Medical Journal Clinical Evidence report even went so far as to say that steroid injections might be injurious to the plantar fascia through the years(6). This lack of evidence prompted researchers in the section of rheumatology in Musgrave Park Hospital in Belfast to compare the use of ultrasound guided corticosteroid injection to that of non-guided injection and placebo injection in the treatment of plantar fasciitis(7). Results revealed considerable improvement utilizing corticosteroid as opposed to placebo at six and twelve months, although no gap between guided and unguided injection was shown. But, glaringly absent in this research is a description of concurrent or previous treatments undertaken by the participants, or restrictions from the same. Additionally, knowing that, oftentimes, plantar fasciitis is self-limiting, together with progress generally in three to six months, more studies are required to encourage the regular use of steroid injections in treating fasciitis.

Platelet-rich plasma (PRP) is just another process of injection therapy that's gaining in popularity. A concentration of platelets is drawn from an individual's own blood and re-injected at the site of injury. The theory is that the lab-activated platelets will activate enhanced collagen production and promote healing. There aren't any dependable, controlled studies now that reveal PRP to be greater compared to other injectables or physical therapy alone, in treating tendinopathy and fasciitis(3,5). Better-regulated research are required before clinical evidence as to the efficacy of the injection-based treatment approach can be revealed.

First-Line Treatment & Last-Ditch Effort

Overwhelming evidence exists to support the use of eccentric exercise in the treatment of tendinopathy(2,3). Loading the injured tendon appropriately appears to be crucial in preventing the degenerative cascade and initiating proper recovery. The specific mechanism through which eccentric exercise can reorganize the tendon structure isn't well understood; however, it's thought to nourish the tenocytes and reunite the extracellular matrix into homeostasis.

Surgery is considered in hard cases as a last resort. What is consistent, however, is that return to sport after surgery can be a four- to - 12-month time frame, and invasive procedures are not without their own set of risks, including unsuccessful outcomes(3).

Frustrated Yet?

Indeed, that is how many coaches, therapists and athletes believe about the nagging injury that, despite everyone's best efforts, just won't go away. The new comprehension of connective tissue structure and function challenges how typical overuse injuries are treated. No longer considered inflammatory in nature, unless very obviously acute, tendon and fascial injuries call for a novel approach to treatment. In order to bring about healing, a change has to be triggered in the harmful physiological cascade that leads to tissue degeneration. Eccentric exercise, ESWT, transdermal NO, and possibly deep friction massage, are all demonstrating the best results thus far in causing tendon healing and halting degeneration. The specific mechanism by which these treatments work isn't well known. Other remedies methods ought to be inspected, and possibly discarded, until study reveals their efficacy.

Truly halting the progression of an overuse connective tissue harm needs the expert eye of a physiotherapist, trainer, and coach to evaluate musculoskeletal status and motion routines, technique, training schedule, and gear. Very often, there's an offending component that's been overlooked. Once corrected, the connective tissue strain will be eliminated and curative intervention will have a chance to get the job done. In overuse injuries, a more comprehensive approach has to be taken to avoid additional tissue degeneration and injury.

References
1. J Can Chiropr Assoc. 2012;56(3):179-91
2. J Bone Joint Surg Am. 2013;95:1620-8
3. Prim Care Clin Office Pract. 2013;40:453-73
4. J Sport Rehabil. 2012 Nov;21(4):343-53
5. J Fam Pract. 2013 Sep;62(9):466-71
6. Clin Evid 2008. 2008:1111
7. Ann Rheum Dis. 2013;72:996-1002