Sports Injuries

Delayed Onset Muscle Soreness - DOMS is when muscle pain or stiffness develops a day or two after playing sports, weight lifting, exercise, or work that involves concentrated physical activity like lifting and carrying objects. DOMS is considered a normal response to extended exertion and is part of the adaptation process that the recovering muscles experience as they undergo hypertrophy or an increase in muscle size. It is common in individuals who have just started exercising, increased the duration or intensity of their workouts, or just beginning a physically demanding job.

DOMS

When muscle contracts as it lengthens is known as eccentric muscle contractions, which is most associated with DOMS. It is related to increased stress in muscle fibers as they are exerted excessively. This also happens when engaging in movements the muscles are not used to, like a new exercise or helping a friend move heavy boxes, furniture, etc. Examples include:

• New exercise or unusual physical task.
• Descending stairs.
• Lifting/Lowering weights or heavy objects.
• Running downhill.
• Deep squats.

Symptoms

Individuals will not feel DOMS during the workout or physical activity. Delayed symptoms include:

• Swelling in the affected muscles.
• Muscles feel tender to the touch.
• Muscle fatigue.
• Reduced range of motion and movement.
• Pain and stiffness when moving.
• Decreased muscle strength.

Treatment Options

Time and waiting for the muscles to repair themselves is the natural healing process, but steps can be taken to ease the soreness, stiffness, and pain. This includes:

• Stretching.
• Hot or cold bath/massage shower.
• Ice/heat therapy.
• Topical analgesics.
• Percussive massage therapy.

It is different for everybody; personal experience will determine which works best for the individual.

Active Recovery

• Active recovery is a technique that uses low-impact aerobic exercise right after a workout to increase blood flow to the muscles.
• The increased blood supply can help relieve the inflammation.

RICE

This technique is used for acute injuries but can be applied to delayed onset muscle soreness. It stands for:

• Rest
• Ice
• Compression
• Elevation

Chiropractic

A chiropractic massage is for healing sore muscles, tendons, ligaments after an intense game, workout, etc. Chiropractic increases the blood and nerve circulation around the muscles delivering added oxygen and nutrients. This type of massage helps loosen the muscles/connecting tissues allowing the body to recover and heal quicker.

Body Composition

When Muscles Are Not Rested

Not taking time to recover because of overtraining/working can have consequences on the body. Inflammation that is not given the time to heal can lead to:

• Injuries.
• Weakened immune system.
• Muscle mass loss.
• Mental health issues.

The body’s immune system cannot function at total capacity during intense physical stress. This causes difficulty when trying to fight off germs and viruses. Studies have found preventing inflammation and injury requires prioritizing rest. Constantly being on the go and under intense physical stress can take a toll not only on the body but the brain as well. This can lead to irritability, frustration, anger, which leads to other health problems generating a vicious cycle.

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

Cheung, Karoline et al. “Delayed onset muscle soreness: treatment strategies and performance factors.” Sports medicine (Auckland, N.Z.) vol. 33,2 (2003): 145-64. doi:10.2165/00007256-200333020-00005

Guo, Jianmin et al. “Massage Alleviates Delayed Onset Muscle Soreness after Strenuous Exercise: A Systematic Review and Meta-Analysis.” Frontiers in physiology vol. 8 747. 27 Sep. 2017, doi:10.3389/fphys.2017.00747

Reinke, Simon et al. “The influence of recovery and training phases on body composition, peripheral vascular function and immune system of professional soccer players.” PloS one vol. 4,3 (2009): e4910. doi:10.1371/journal.pone.0004910

The body is a connected whole and more than just separate parts and regions. When back pain presents, it might not be the back muscles or spine but could be tense, tight hips, and hamstrings causing low back pain. How it happens, how to stretch and loosen up, and target these areas could help alleviate the pain.

The Hips and Hamstrings

When the hip flexors and hamstrings become tense, the tightness can alter the pelvic alignment. This affects spinal alignment leading to discomfort and low back pain. The hip flexors are a group of muscles around the front of the hips, and they activate when moving the leg and knee upward. The hamstrings are the muscles in the back of the thighs that allow for flexion of the knees and hip extension. Muscle tightness in the hips and/or hip joint stiffness can also contribute to low back pain. Not being able to rotate, flex, or extend the hip forward or backward can affect:

• Walking
• Running
• Swinging
• Twisting movements
• This increases mechanical strain on the lower back.

Hamstring tightness can be a side effect of:

• Low back pain
• Pelvic positioning
• Muscle guarding
• Weakness
• All can contribute to the hamstrings feeling tight.

Tense Hips and Hamstrings

The factors creating this tightness can come from:

• A sedentary lifestyle
• Little to no physical activity
• Sitting too long with no stretching or movement.
• Injury
• Intense workout

Losing the ability to function through the entire length of motion can also indicate muscle weakness and a lack of joint movement where the joint around the muscle becomes stiff. This can be caused by:

• A lack of movement
• Arthritis
• Age-related changes

Stretching and Treatment

Stretching exercises can be the first line of treatment. It is recommended to start with gentle stretches targeting these areas. What works best for the individual is the stretch they are comfortable repeating enough to make a difference. Warming up the muscles first will generate the best results. An easy place to begin is a gentle forward fold stretch.

• Stand up straight, or sit with the legs extended out in front.
• Then, reach with the fingers toward the toes. Don’t worry if you can’t reach them.
• Don’t bounce.
• Hold the position for a few seconds.
• Repeat five to 10 times.

For the hip flexors, stretches include:

• High lunge
• Low lunge
• Warrior 1 pose

If the stretching does not bring relief, it is recommended to progress to a personalized treatment and stretching program with a chiropractor or physical therapist. Chiropractic and physical therapy can relieve the problems without medication, injections, or surgery and provide lifelong techniques for maintaining optimal flexibility, mobility, and strength. The hands-on treatment loosens and relieves the tense tightness, reinforcing the flexibility and range of motion. Treatment includes:

• Joint mobilization to the hips and spine.
• Soft tissue mobilization.
• A personalized strengthening program with stretches and exercises that target the specific muscles.
• Health coaching.
• Anti-inflammatory diet recommendations.

Body Composition

Monounsaturated Fats

Monounsaturated fat is considered healthy fat. This type of fat makes up a significant component of the Mediterranean diet. Studies have shown monounsaturated fats like extra-virgin olive oil can help prevent adverse events related to cardiovascular disease. A meta-analysis evaluating diets high in monounsaturated fats indicated a significant reduction in:

• Triglycerides
• Bodyweight
• Systolic blood pressure in individuals with type II diabetes.
• A significant increase in HDL or good cholesterol.

Another study showed the protective effects of monounsaturated fatty acids reduced the risk factors associated with metabolic syndrome and cardiovascular disease. Monounsaturated fats can have a positive impact on overall health. Monounsaturated fat sources include:

• Olive, peanut, and canola oil
• Avocados
• Almonds
• Pecans
• Hazelnuts
• Sesame and pumpkin seeds

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

Estruch, Ramón et al. “Retraction and Republication: Primary Prevention of Cardiovascular Disease with a Mediterranean Diet. N Engl J Med 2013;368:1279-90.” The New England journal of medicine vol. 378,25 (2018): 2441-2442. doi:10.1056/NEJMc1806491

Gillingham, Leah G et al. “Dietary monounsaturated fatty acids are protective against metabolic syndrome and cardiovascular disease risk factors.” Lipids vol. 46,3 (2011): 209-28. doi:10.1007/s11745-010-3524-y

American College of Physicians. (February 2017) “American College of Physicians issues guideline for treating non-radicular low back pain” https://www.acponline.org/acp-newsroom/american-college-of-physicians-issues-guideline-for-treating-nonradicular-low-back-pain

MedlinePlus. (2019) Hip flexor strain – aftercare https://medlineplus.gov/ency/patientinstructions/000682.htm

NCBI. (2021) Hamstring Injury https://www.ncbi.nlm.nih.gov/books/NBK558936/

When stress is placed on the shins with physical activity from walking, running, or exercise, the connective tissues attaching the leg muscles to the tibia can become inflamed, causing medial tibial stress syndrome, more commonly known as shin splints. This inflammation is caused by tiny tears in the muscles and tendons of the shin. Chronic shin pain could be related to foot arch problems, underlying issues with the muscles, or shoes that don't support the feet properly. Although it usually goes away within a few days, it's important to monitor to ensure that it does not progress into a stress fracture. A chiropractor can offer treatments to relieve the pain and help prevent shin splints from recurring.

Medial Tibial Stress Syndrome

Medial tibial stress syndrome can impact anyone. It can come from walking far distances or in awkward positions like going downstairs with small steps, jumping rope, and playing with the kids on the playground can all cause burning, tightness, and pain in the shins. Shin splints affect individuals differently. For some, the pain recedes when the triggering activity is stopped. For others, the pain can become a chronic condition that results in continuous pain, even when at rest.

The Shin

• The shin is a part of the tibia bone in the lower leg.
• This bone absorbs the shocks when moving through daily activities.
• The muscles that run along the shin support the foot's arch and raise the toes during movement.
• Medial tibial stress syndrome is caused by excessive force on the shinbone and the tissue around it, which causes the muscles to swell and increases pressure around the bone.
• If left untreated, small tears in the muscle and the bone can form, leading to chronic pain and stress fractures.

Medial tibial stress syndrome is more likely to happen from:

• Not stretching before physical activity or exercise.
• Constantly walking or running on hard surfaces.
• Wearing the wrong shoes that don't provide enough cushioning or arch support.
• Over-exertion on the body with activity and movement.
• The body is not given the proper amount of time to recover.
• Athletes often experience shin splints when they've intensified their training routine or changed it up.

Symptoms

• Pain during exercise or activity.
• Pain in the front of the lower leg.
• Soreness in the lower leg.
• Swelling in the lower leg.
• Shin is hot to the touch.

Treatment

Whenever pain is being experienced, some muscles will either get tight or weak in response. By identifying the weak and/or tight muscles, a chiropractor can prescribe stretches and exercises that will help alleviate the pain and prevent it. One of the main principles of chiropractic is to treat the body as an interconnected system. A chiropractor may work on an unrelated part of the body to treat the symptomatic area. For example, they may work to align the spine and pelvis to lessen the impact on the lower legs.

Part of a treatment plan may include:

Soft Tissue Mobilization

• A handheld instrument loosens tight tissues during soft tissue mobilization therapy and breaks scar tissue around the tibia.
• Massaging tight muscles in the leg keeps them loose and alleviates the pain.
• Percussion massage can be added to reduce muscle knots, improve blood flow, and loosen up scar tissue.
• The treatment relieves pain and can help avoid shin splints when returning to normal activities.

Ultrasound and Low Laser Therapy

• Ultrasound and low laser therapy use heat to warm the deep tissues in the lower leg gently.
• The treatment eases pain, reduces inflammation, swelling, and increases blood flow.

Kinesio Taping

• Applying flexible Kinesio tape to the foot and lower leg can reduce stress on the shins.
• The chiropractor or physical therapist will show how to apply the tape correctly.

Foot Orthotics

• Individuals may be more likely to develop shin splints if they have high or low arches or their feet tend to roll inward or outward when walking.
• Prescription foot orthotics can be made to keep the feet properly balanced and supported.

Stretching Exercises

• Shin splints could be related to tight muscles in the back of the calf and weak muscles in the front of the lower leg.
• A chiropractor or physical therapist will show stretching and strengthening exercises to maintain muscle balance.

Body Composition

Retaining Water Due To Salt Intake

Salt/sodium is everywhere and hard to avoid.

It might not be a surprise that a single patty cheeseburger contains over 500 mg of sodium - almost a quarter of the daily recommended level, but it is a surprise to know that the ranch dressing on a salad contains as much as 270 mg or a tablespoon of soy sauce on a healthy, vegetable-only stir-fry has 879 mg of sodium. The Mayo Clinic estimates that the average individual consumes about 3,400 mg of sodium a day: close to double what is recommended. Sodium is linked with water retention, and it is the kidneys' job to expel unneeded sodium out of the body. Until the kidneys activate, an individual will temporarily be retaining extra water. If daily water and sodium intake habits change daily, this can contribute to water retention, causing fluctuations in daily weight. So, if an individual was on a diet but flooded the body with more salt than usual, expect to see a temporary increase in weight.

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

Bates, P. "Shin splints--a literature review." British journal of sports medicine vol. 19,3 (1985): 132-7. doi:10.1136/bjsm.19.3.132

Chiropractic Economics: The Science Behind Percussion Massage.

Gross, ML et al. "Effectiveness of orthotic shoe inserts in the long-distance runner." The American journal of sports medicine vol. 19,4 (1991): 409-12. doi:10.1177/036354659101900416

Heer, Martina et al. "Increasing sodium intake from a previous low or high intake affects water, electrolyte and acid-base balance differently." The British journal of nutrition vol. 101,9 (2009): 1286-94. doi:10.1017/S0007114508088041

McClure, Charles J. and Robert Oh. "Medial Tibial Stress Syndrome." StatPearls, StatPearls Publishing, 11 August 2021.