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Category: Athletes

ChiroMedBlogAthletes

Empower your performance with expert sports therapy for athletes in El Paso, TX. Our specialists provide personalized treatment plans designed to enhance strength, recovery, and injury prevention. Whether you’re a professional or amateur, we offer cutting-edge therapies that help you stay at the top of your game. Optimize your training and performance—book your consultation today and experience the best in sports therapy for athletes in El Paso

By Dr. Alexander Jimenez DC, APRN, FNP-C 0 Comments Athletes, Sporting , , , , , , , , , , , , , , , , , ,

Running Fartlek Training for All Skill Levels

Can adding fartlek training improve speed and endurance for runners and running enthusiasts?

Running Fartlek Training

Fartlek training, which means speed play in Swedish, is a form of running training that involves alternating between bursts of fast running and slower recovery jogging.

  • It is a form of interval or speed conditioning.
  • It involves varying one’s pace throughout their run, alternating between fast treks and slow jogs.
  • Workouts are unstructured and allow runners to decide the duration and intensity of the fast and slow sections.
  • Unlike formal interval training, this flexibility offers a new way to improve speed, endurance, mental preparedness, and stamina.

Training Benefits

Traditional interval training uses specific timed or measured segments. Fartleks are more unstructured, with work-rest intervals based on how the body feels. With fartlek training, individuals can experiment with pace and endurance as they run, which helps them tune in to their body and adjust how it performs. Many runners enjoy the training because it involves speed work and is more flexible and less demanding.

  • A stopwatch is not needed for time intervals.
  • Training doesn’t have to be done on a track and can be performed on all terrain, such as roads, trails, or hills.
  • The training stresses the body’s systems, leading to faster speeds and improving anaerobic threshold. (Bacon, A. P. et al., 2013)
  • Improves the anaerobic threshold and increases the body’s ability to train longer at higher intensities. (Mazurek K. et al., 2016)
  • This is due to an increased VO2 max, which measures how much oxygen the body can take in and use.
  • A better VO2 Max generally leads to improved performance. (Scribbans T. D. et al., 2016)

Disadvantages

  • Training includes a higher risk of injury and strain.
  • Beginners are more prone to shin splints.
  • The training is demanding, so it should not be done daily.

Workout

The method is to vary brief periods of slightly higher pace into regular runs (Kumar P. 2015). Maintain a faster pace for a short distance or time interval, such as 200 meters or 30 seconds. Intervals can vary throughout the workout, and landmarks such as streetlights or telephone poles can be used to mark segments instead of measuring miles or meters. Once a fast segment is completed, slow to below-normal running cadence until the body fully recovers and breathing returns to normal. Return to running normally and incorporate slightly faster intervals later in the run.

  • Fartleks should be short because they are intense.
  • The actual higher-pace portion of the run should last up to 30 seconds.
  • Gradually add more time to the faster-paced portion as conditioning improves, up to 60 seconds.

Training Example

An example of a 40- to 45-minute fartlek workout suitable for beginners.

  • 10-minute warm-up at a light pace
  • 1 minute on (fast pace)
  • 2 minutes off (easy)
  • 2 minutes on
  • 1 minute off
  • Repeat the set 3 to 4 times
  • 10-minute cooldown at an easy pace

Remember that beginners should go slow when introducing fartlek training into their workouts. It is more intense and can increase the risk of injuries and strains, such as shin splints. Get help from a running coach or trainer if you are unsure how to incorporate the training into your routine.

Training on a Treadmill

Speed play can be done on a treadmill. The idea is to find ways to create speed variation intervals and help relieve treadmill boredom. Some examples include:

  • If watching television, use commercials to go into speed intervals.
  • At the gym, make a game out of the sprints and/or
  • Speed up during certain parts of songs where you can feel the energy moving you faster.

One precaution is learning to use the treadmill’s buttons to increase and decrease the pace. This can slow you down and disrupt form, so maybe do longer durations for each phase so there is less contact with the control panel.

Injury Medical Chiropractic & Functional Medicine Clinic

Fartlek training is an excellent way to add variety, fun, and interest to running. This speed work can also enhance performance, increase cardiovascular output, and allow individuals to run at higher intensities for longer periods. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. We can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.

Building a Stronger Body

References

Bacon, A. P., Carter, R. E., Ogle, E. A., & Joyner, M. J. (2013). VO2max trainability and high-intensity interval training in humans: a meta-analysis. PloS one, 8(9), e73182. https://doi.org/10.1371/journal.pone.0073182

Mazurek, K., Zmijewski, P., Krawczyk, K., Czajkowska, A., Kęska, A., Kapuściński, P., & Mazurek, T. (2016). High-intensity interval and moderate continuous cycle training in a physical education programme improves health-related fitness in young females. Biology of Sport, 33(2), 139–144. https://doi.org/10.5604/20831862.1198626

Scribbans, T. D., Vecsey, S., Hankinson, P. B., Foster, W. S., & Gurd, B. J. (2016). The Effect of Training Intensity on VO2max in Young Healthy Adults: A Meta-Regression and Meta-Analysis. International journal of exercise science, 9(2), 230–247. https://doi.org/10.70252/HHBR9374

Kumar, P. (2015). Effect of fartlek training for developing endurance ability among athletes. Int J Phys Ed Sports Health., 2(2), 291-293. https://www.kheljournal.com/archives/2015/vol2issue2/PartE/3-3-75-957.pdf

By Dr. Alexander Jimenez DC, APRN, FNP-C 0 Comments Athletes, Physio, Sporting , , , , , , , , , , , , , , , , , ,

Post Surgery Leg Strengthening Tips for Patients

What are some leg-strengthening exercises that will expedite recovery for athletes and physically active individuals who have undergone leg surgery?

Post Surgery Leg Strengthening

Leg muscles may weaken after hip, knee, ankle, or foot surgery. This happens because those muscles are not used as much during recovery. Gaining back strength and muscle endurance after an injury or surgery is an important step in recovery. Leg exercises can help regain mobility and prevent complications like blood clots and pressure sores after surgery or an injury, which is why engaging in post-surgery leg strengthening is important once the doctor gives the ok.

Benefits

post-surgery leg strengthening exercises have several benefits, including

  • Rebuilds strength and confidence
  • Retraining for optimal mobility and flexibility
  • Prevents pressure sores
  • Prevents blood clots

When the leg muscles are contracted, they move blood like a pump, maintaining proper circulation. Moving in a bed after surgery also helps prevent pressure sores from forming and blood clots. A physical therapy team will determine the right leg exercises for each individual and their injury/condition. This is an important step when moving forward after surgery. (Hoogeboom T. J. et al., 2014)

Starting Out

The first exercises should target all the major muscles of the leg. (Madara K. C. et al., 2019)

Gluteal Sets

This isometric exercise means the muscles contract while no motion occurs at the hip joints. To perform:

  • Lie on your back and tighten your buttock muscles.
  • Hold the muscles tight for 5 seconds, then relax.
  • Repeat 10 or 15 times.
  • Gluteal sets can be done several times per day.

Heel Slide

Heel slides can help regain strength in the major muscles of the leg. To perform:

  • Lie on your back.
  • Bend the knee of the surgical leg and slowly slide the heel toward your butt.
  • Slide as far as possible and hold for 5 seconds.
  • Slowly return to the starting position and repeat.

Short Arc Quad

The short arc quad, or SAQ, is a simple way to get the quadricep muscles working. To perform:

  • Lie on your back with a towel roll, small ball, or something similar under the knee.
  • Slowly straighten the knee.
  • Tighten the quad muscle on the top of the thigh.
  • Hold for 3 seconds, then relax.
  • Repeat 10 to 15 times.

Quad Set

This exercise helps get the quad muscles working. It also helps control the position of the kneecap. To perform:

  • Lie on your back.
  • Place a small towel roll under the knee.
  • Try to press the back of the knee flat against the floor.
  • Hold for 10 seconds and release.
  • Repeat 10 to 15 times.

Individuals can complete quad sets bilaterally or with both knees simultaneously. This makes the stronger leg help strengthen the weaker side.

Straight Leg Raise

To perform:

  • Lie on your back.
  • Lift your leg straight off the floor until it is at the height of the opposite bent knee.
  • Hold for 10 seconds and slowly lower.
  • Repeat 10 to 15 times.

Be sure to keep the knee straight for the entire exercise. Keep the opposite knee bent for comfort. To ensure the knee is straight, individuals can complete a quad set first and then the straight leg raise. The exercise can be more challenging by increasing repetitions or adding a 2- to 3-pound ankle weight on the thigh. For even more challenge, add the ankle weight to the ankle.

Hamstring Strengthening

Working out the hamstrings after injury or surgery is important. The hamstring muscles bend the knee and extend the hip backward. To perform:

  • Lie on your stomach.
  • Bend one knee to raise the lower limb straight in the air.
  • Hold for 5 seconds and lower slowly.
  • Repeat 10 to 15 times.

Once the exercise is easy to do, increase the repetitions to 30. Individuals can also try adding a 2- to 3-pound ankle weight.

Physical therapy can help individuals regain mobility after injury or surgery. A therapist may prescribe exercises as part of an at-home exercise program. Over time progress will go from simple exercises to more challenging ones to improve balance and mobility. (Madara K. C. et al., 2019)

Injury Medical Chiropractic & Functional Medicine Clinic

Before starting this or any other exercise program, consult a doctor and a physical therapist to find the right exercises for your situation. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.

Are You Recovering From Ankle Sprains?

References

Hoogeboom, T. J., Dronkers, J. J., Hulzebos, E. H., & van Meeteren, N. L. (2014). Merits of exercise therapy before and after major surgery. Current opinion in anaesthesiology, 27(2), 161–166. https://doi.org/10.1097/ACO.0000000000000062

Madara, K. C., Marmon, A., Aljehani, M., Hunter-Giordano, A., Zeni, J., Jr., & Raisis, L. (2019). PROGRESSIVE REHABILITATION AFTER TOTAL HIP ARTHROPLASTY: A PILOT AND FEASIBILITY STUDY. International Journal of Sports Physical Therapy, 14(4), 564–581.

By Dr. Alexander Jimenez DC, APRN, FNP-C 0 Comments Athletes, Sporting , , , , , , , , , , , , , , , , , ,

Finger Pulley Anatomy: Understanding Your Fingers’ Structure

Finger pulley injuries are unique digital injuries distinct from sprains or dislocations. They occur specifically in rock climbers and occasionally in baseball pitchers. What are the symptoms, diagnoses, and treatments available?

Finger Pulley Injury

A finger pulley injury, common in activities like climbing, involves damage to the fibrous bands (pulleys) that hold tendons against bones. This causes pain, swelling, and potentially bowstringing of the tendons.

  • Finger pulleys are structures that hold tendons against the bones of the fingers.
  • Injury symptoms include pain, swelling, and a popping sound heard at the time of the injury.
  • Finger pulley injuries, or ruptures of the digital pulley, are seen almost exclusively in rock climbers. (Miro P. H. et al., 2021)

This activity stresses the digits when maneuvering along uneven surfaces while supporting the entire body’s weight. The injuries result from the mechanics of the finger tendons and joints and the position the fingers hold while rock climbing. Rock climbing has grown in popularity. The only other sport in which this injury has been described is baseball, in pitchers. The forces acting on the finger are very different in these activities, but both place high stress on the finger pulleys.

Digital Pulleys

Everyone has structures in their fingers called digital pulleys. These pulleys hold the tendons against the bones of the fingers. Each finger has eight pulleys, but only two are considered critical to prevent the finger tendons’ bowstringing (when one pulley gives out or ruptures). This can result in various injury outcomes, from a simple strain of the pulley to ruptures of multiple pulleys in a single digit. Pain, stiffness, and an inability to fully flex the finger can occur. (Carruthers K. H., Skie M., & Jain M. 2016) In severe situations, when the tendons are bowstringing, the tendon may lift away from the finger when making a fist.

Symptoms

Pain and Tenderness

  • Localized pain and tenderness at the finger’s base, particularly when gripping or bending. Pain on the palm side of finger and tenderness with pressure

Swelling

  • Swelling and bruising around the affected finger joint, especially on the palm side.

Popping Sound

Stiffness and Difficulty Bending

  • Stiffness and pain when bending the fingers or difficulty gripping. Difficulty forming a fist

Bowstringing

  • Visible displacement of the tendon from its normal position, causing a bulge at the finger’s base.

Most commonly, the middle or index digit is the injured finger. The two critical pulleys in the finger are designated the A2 and A4. (Carruthers K. H., Skie M., & Jain M. 2016) Individuals may see swelling, redness, and inflammation at the base of the finger (A2) and/or in the space between the two finger joints closest to the tip of the finger (A4). In rock climbers, either or both of those pulleys may be injured. In baseball pitchers, the injury is typically isolated to the A4 pulley.

Causes

  • Overuse and Repetitive Strain: Frequent or intense gripping or crimping, common in rock climbing and other activities, can cause pulley injuries.
  • Dynamic or Sudden Movements: Desperate or dynamic moves or poor technique can lead to injury.
  • Excessive Force: Pulleys can rupture when the force exerted on them is too great.
  • Mechanism of injury: The A2 pulley is the most commonly injured, followed by the A4 pulley.

Diagnosis

Emergency treatment is generally unnecessary. However, it is important to have suspected digital pulley injuries examined by a specialist within several days to a week after the injury. The most important aspect of an evaluation is determining whether the injury has caused the bowstringing of the tendons. Imaging tests may be performed to help with the diagnosis and plan treatment. An ultrasound is recommended as the initial imaging technique. (Miro P. H. et al., 2021)

If an ultrasound is inconclusive, an MRI may be advised. Sometimes, an MRI is performed with the finger held straight and then bent to see if the tendons are bowstringing. An X-ray can also help exclude other causes of finger pain, including sprains and fractures.

Treatment

Conservative Care

  • Immobilization, physical therapy, and pulley-protective measures, such as splints or taped fingers, are often used.

Surgery

  • Surgery may be necessary for severe grade IV injuries where conservative care fails.
  • Only in situations where there are multiple pulley ruptures or if there is delayed treatment should surgery be necessary.

Rehabilitation

  • Focuses on regaining flexibility, strength, and grip function through exercises and physical therapy.

If the tendons do not bowstring, treatment usually protects the injured finger until swelling and pain subside. If there is bowstringing of the tendons, more careful management of the injury is needed. Individuals who suspect a pulley injury rest or splint the finger and use nonsteroidal anti-inflammatory drugs as necessary for pain until they can get a medical evaluation. (Carruthers K. H., Skie M., & Jain M. 2016) Physical therapy is recommended for most injuries, along with immobilization, the H-tape method, and a protective pulley splint. (Miro P. H. et al., 2021) Specialized splints and therapy techniques can allow the pulleys to heal properly.

Returning to activity varies significantly with the severity of the injury. With mild pulley strains, full activity can be resumed as soon as swelling and pain have subsided. Treatment for full ruptures being treated non-surgically is typically between one and three months. For individuals requiring surgical reconstruction of a pulley injury, restrictions may apply up to a year after the surgery.

Injury Medical Chiropractic & Functional Medicine Clinic

To prevent complications, a healthcare provider should evaluate pulley injuries as soon as possible. Treatment most often consists of physical therapy, but surgery may be necessary. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.

Sports Injury Treatments

References

Miro, P. H., vanSonnenberg, E., Sabb, D. M., & Schöffl, V. (2021). Finger Flexor Pulley Injuries in Rock Climbers. Wilderness & environmental medicine, 32(2), 247–258. https://doi.org/10.1016/j.wem.2021.01.011

Carruthers, K. H., Skie, M., & Jain, M. (2016). Jam Injuries of the Finger: Diagnosis and Management of Injuries to the Interphalangeal Joints Across Multiple Sports and Levels of Experience. Sports Health, 8(5), 469–478. https://doi.org/10.1177/1941738116658643

By Dr. Alexander Jimenez DC, APRN, FNP-C 0 Comments Athletes, Sporting, Therapy , , , , , , , , , , , , , , , , , , ,

Female Hernia: Insights into Diagnosis and Care

In females, hernia symptoms are often smaller and deeper without a noticeable lump and can mimic gynecological issues, with misdiagnoses being common. Can knowing the risk factors and how female hernias are treated help women get relief?

Female Hernia

A hernia occurs when an internal structure pushes through a weak spot in the abdominal wall, the muscles, and the tissue covering the front of the torso. The more common include:

  • Groin hernia, known as an inguinal hernia.
  • Upper thigh or femoral hernia.

However, a hernia can develop anywhere from the ribcage to the upper thigh. Hernias are less common in women, have different symptoms than in men, and are often misdiagnosed. Lower abdominal and pelvic hernias present differently in women than men, who typically have a visible bulge. Instead, female hernias tend to be smaller, deeper, and less noticeable. They can also cause chronic pelvic pressure or pain that can be mistaken for gynecological problems.

Hernia Symptoms For a Woman

Hernias in women tend to be smaller and deeper than male hernias, with no lump showing. Instead, female hernias can cause chronic, deep pelvic pain and occasional sharp, stabbing pain that comes on fast and lingers. (Köckerling F., Koch A., & Lorenz R. 2019) Hernia pain worsens with exercise, laughing, coughing, or straining to evacuate the bowels. The pain is often described as:

  • Dull
  • Aching
  • Pinching
  • Sharp
  • Shooting
  • Burning

Inguinal hernia pain is usually felt at or above the groin and may radiate to the hip, lower back, vulva, or thigh. Many women find the pain increases during their menstrual cycle. The pain can also be exacerbated by any activity that generates extra pressure on the pelvic floor, including:

  • Prolonged sitting or standing.
  • Bending
  • Getting in or out of bed.
  • Getting in or out of a car.
  • Sexual intercourse

Emergency

Hernias in the pelvic area are at risk of becoming incarcerated hernias. An incarcerated hernia occurs when a portion of the intestine or other abdominal tissue becomes trapped in the hernial sac, making it impossible to push it back into place. If this gets trapped or strangulated, it can cause tissue death. Strangulated hernias are a medical emergency. Symptoms include:

  • Deep red or purple tissues.
  • The hernia bulge does not shrink when you lie down.

Other  symptoms that warrant immediate medical attention include: (Johns Hopkins Medicine, 2025)

  • Worsening pain
  • Bloating
  • Difficulty with bowel movements
  • Nausea
  • Fever
  • A fast, racing heartbeat.

Contact a healthcare provider or the emergency room if experiencing any of the above symptoms.

Types

Hernias can occur anywhere on the abdominal wall. They may be caused by:

  • Internal pressure, such as during pregnancy.
  • A sports injury
  • Tissue weakness

Hernias in the lower abdomen or groin are typically indirect inguinal hernias. The inguinal canal comprises multiple layers of muscles and fascia that the thin round ligament threads through. Other groin and pelvic hernias include:

  • A direct inguinal hernia
  • A femoral hernia at the top of the inner thigh.
  • An obturator hernia in the front upper thigh, although this type is rare.

Other common hernias in women are:

  • Incisional hernia – at the site of a surgical incision
  • Umbilical hernia – around the belly button
  • Ventral hernia – abdominal midline

Less common hernias include:

  • Hiatal hernia – diaphragm
  • Perineal hernia – pelvic floor

Risk Factors

Risk factors for developing a hernia include: (Johns Hopkins Medicine, 2025)

  • Obesity
  • Frequent constipation
  • Abdominal or pelvic surgery.
  • Allergies with chronic sneezing.
  • A chronic cough.
  • Collagen defects or connective tissue disorders.

Pregnancy and repeated pregnancies are linked to an increased risk of hernia. Types that are more common in pregnancy include:

  • Umbilical hernia
  • Ventral hernia
  • Inguinal hernia

Umbilical hernias are the most common. However, only a small percentage of pregnant individuals get them. (Kulacoglu H. 2018)

Diagnosis

A hernia diagnosis is made with a physical examination and, if needed, imaging studies. Patients are asked to describe their symptoms precisely, where the pain is located, and any activities that exacerbate it. To check for a hernia, the healthcare provider will palpate for a hernia while the patient sits, stands, or coughs. Imaging tests can include:

  • Ultrasound
  • CT scan
  • Endoscopy – a camera is used to see inside the esophagus and stomach.

Misdiagnoses

Female hernia symptoms can be vague, which often points healthcare providers in the wrong direction. Female hernias are commonly misdiagnosed as: (Köckerling F., Koch A., & Lorenz R. 2019)

  • Cysts in the reproductive organs
  • Endometriosis
  • Fibroid tumors

Treatment

A small hernia that does not cause problems or pain may be treated with a wait-and-evaluate protocol. A hernia often worsens over time and could eventually require surgery. (University of Michigan Health, 2024) Self-care treatments include:

Medical treatments usually start with conservative measures, including physical therapy, stretching, exercise, and rest. Physical therapists often use myofascial release techniques to relieve muscle spasms. Surgery may be needed to repair the weak area of the abdominal wall to relieve symptoms. (University of Michigan Health, 2024) Hernia repair surgery is typically performed as a laparoscopic surgery. (Köckerling F., Koch A., & Lorenz R. 2019) Most patients heal quickly from the surgery and can return to regular activities in a week or two.

Injury Medical Chiropractic and Functional Medicine Clinic

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.

Lumbar Spine Injuries in Sports: Chiropractic Healing

References

Köckerling, F., Koch, A., & Lorenz, R. (2019). Groin Hernias in Women-A Review of the Literature. Frontiers in surgery, 6, 4. https://doi.org/10.3389/fsurg.2019.00004

Johns Hopkins Medicine. (2025). How to tell if you have a hernia. https://www.hopkinsmedicine.org/health/conditions-and-diseases/how-to-tell-if-you-have-a-hernia

Kulacoglu H. (2018). Umbilical Hernia Repair and Pregnancy: Before, during, after…. Frontiers in surgery, 5, 1. https://doi.org/10.3389/fsurg.2018.00001

University of Michigan Health. (2024). Inguinal hernia: Should I have surgery now, or should I wait? https://www.uofmhealth.org/health-library/za1162

American Academy of Orthopaedic Surgeons. (2022). Sports hernia. https://orthoinfo.aaos.org/en/diseases–conditions/sports-hernia-athletic-pubalgia/

Northeast Georgia Health System. (2022). Living with a hernia. Northeast Georgia Health System Improving the health of our community in all we do. https://www.nghs.com/2022/02/15/living-with-a-hernia

By Dr. Alexander Jimenez DC, APRN, FNP-C 0 Comments Athletes, Chiropractic Care, Therapy , , , , , , , , , , , , , ,

Peroneal Tendon Injuries and Their Symptoms

Are individuals with high foot arches or participating in sports involving repetitive ankle motion at risk for developing peroneal tendon injuries?

Peroneal Tendon Injuries

The peroneal tendons connect the muscles of the outer side of the lower leg to the foot. They may be acute—occurring suddenly—or chronic—developing over time. The basic types of peroneal tendon injuries are tendonitis, tears, and subluxation. 

Anatomy and Function

The two major peroneal muscles (peroneus longus and peroneus brevis) are outside the lower leg, next to the calf muscles. The peroneal tendons run along the outer side of the ankle and attach to the foot, connecting these muscles to bone. They help stabilize the ankle joint, point the foot downward (plantarflexion), and turn the foot outward (eversion). In normal gait, the motion of the peroneal muscles is balanced by the muscles that invert the foot or rock the foot inward from the ankle.​ The two peroneal tendons sit one on top of the other right behind the fibula (the smaller lower leg bone). This closeness can contribute to problems with the peroneal tendons, as they rub together behind the ankle.

Tendonitis

The most common problem is inflammation or tendonitis. The tendons are usually inflamed just behind the fibula bone at the ankle joint. This part of the fibula is the bump on the outside of the ankle, and the peroneal tendons are located just behind that bony prominence. Tendonitis can either result from repetitive overuse or an acute injury. Common symptoms of tendonitis include:

  • Pain behind the ankle
  • Swelling over the peroneal tendons
  • Tenderness of the tendons
  • Pain usually worsens if the foot is pulled down and inwards, stretching the peroneal tendons.
  • X-rays of the ankle are taken.
  • MRI may show inflammation and fluid around the tendons. (Walt J. & Massey P. 2023)

Typical treatment of peroneal tendonitis is accomplished by:

Ice application

  • Applying ice to the area can help reduce swelling and control pain.

Rest

  • Resting is important to allow the tendon to heal.
  • A supportive device (walking boot or ankle brace) or crutches can help in severe cases.
  • Braces and boots provide support, reduce tendons’ stress, and allow rest and inflammation to subside.

Anti-inflammatory Medications

  • Motrin or Aleve are anti-inflammatory and can reduce the swelling around the tendon.

Physical Therapy

  • Physical therapy can help restore normal ankle joint mechanics, help with swelling and pain relief, and correct strength imbalances.

Cortisone Injections

  • Cortisone injections are low-risk if administered to the area around the tendon and not more often than every three months.
  • Ultrasound guidance can help ensure the medication is injected into the correct area. (Walt J. & Massey P. 2023)

Tendon Tears

Tears can occur and are more likely to happen in the peroneus brevis tendon. Tears are believed to be the result of two issues with the tendon. One is the blood supply. Tears of the peroneus brevis tendon almost always occur in the area where the blood supply and nutrition of the tendon are the poorest.

The second issue is the closeness between the two tendons, causing the peroneus brevis tendon to be wedged between the peroneus longus tendon and the bone. (Saxena A., & Bareither D. 2001) Tears of the peroneus brevis tendon are often treated with the same treatments for tendonitis. About half of the tears diagnosed by imaging are found to be asymptomatic. For individuals who don’t find lasting relief from symptoms, surgery may be necessary. Surgical options for peroneal tendon tears (Dombek M. F. et al., 2001)

Tendon Debridement and Repair

  • During a tendon debridement, the damaged tendon and the surrounding inflammatory tissue are removed.
  • The tear can be repaired, and the tendon can be tubularized to restore its normal shape.

Tenodesis

  • A tenodesis is a procedure where the damaged area of the tendon is sewn to the normal tendon.
  • In this case, the damaged segment of the peroneal tendon is removed, and the ends left behind are sewn to the adjacent remaining peroneal tendon.
  • Tenodesis is often recommended for tears involving more than 50% of the tendon. (Castilho R. S. et al., 2024)

Depending on the surgical procedure, Recovery after surgery can take several weeks of restricted weight-bearing and immobilization. Following immobilization, therapy can begin. Recovery is usually six to 12 weeks, depending on the surgery, but a full return to sports and activities may take several months. Risks of surgery include infection, stiffness, skin numbness near the incision, persistent swelling, and persistent pain.

Injury Medical Chiropractic and Functional Medicine Clinic

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to build optimal health and wellness solutions. We focus on what works for you to relieve pain, restore function, prevent injury, and help mitigate issues through adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.

The Difference of Using Custom Foot Orthotics

References

Walt, J., & Massey, P. (2025). Peroneal Tendon Syndromes. In StatPearls. https://www.ncbi.nlm.nih.gov/pubmed/31335074

Saxena, A., & Bareither, D. (2001). Magnetic resonance and cadaveric findings of the “watershed band” of the Achilles tendon. The Journal of foot and ankle surgery: official publication of the American College of Foot and Ankle Surgeons, 40(3), 132–136. https://doi.org/10.1016/s1067-2516(01)80078-8

Dombek, M. F., Orsini, R., Mendicino, R. W., & Saltrick, K. (2001). Peroneus brevis tendon tears. Clinics in podiatric medicine and surgery, 18(3), 409–427.

Castilho, R. S., Magalhães, J. M. B., Veríssimo, B. P. M., Perisano, C., Greco, T., & Zambelli, R. (2024). Minimally Invasive Peroneal Tenodesis Assisted by Peroneal Tendoscopy: Technique and Preliminary Results. Medicina (Kaunas, Lithuania), 60(1), 104. https://doi.org/10.3390/medicina60010104

By Dr. Alexander Jimenez DC, APRN, FNP-C 0 Comments Athletes, Exercises , , , , , , , , , , , , , , , , , , ,

Push-Pull Workout: A Comprehensive Guide

Can a push-pull workout routine be an option for individuals who want focused training on specific muscle groups and balanced muscle development throughout the body?

Push-Pull Strength Training

A “push-pull” workout is a training style in which you split your exercise routine into separate days dedicated to “push” exercises (targeting muscles like the chest, shoulders, and triceps) and “pull” exercises (targeting muscles like the back and biceps). This allows focused training on each muscle group by isolating their primary movement patterns—pushing away from the body or pulling towards it. The workout often accompanies a separate leg day to complete the full-body workout. This routine comes from bodybuilding. Bodybuilders use this method to maximize their workouts and rest periods. By splitting their workouts into push exercises one day and pull exercises another, they can work out more often without overtraining. (Castanheira R. P. M. et al., 2017)

Upper Body Push Exercises

These exercises involve all the movements that push the weights away from your body. These exercises typically focus on the quads, outer thighs, chest, shoulders, and triceps. (Collins P. 2009)

Pushups

  • Push-ups are a versatile bodyweight exercise that engages multiple muscle groups, including the chest, shoulders, triceps, and core.

Chest Presses

  • Chest presses are exercises that target the pectoral muscles (chest muscles).
  • They can be performed with various equipment and techniques, providing a comprehensive workout for the chest.

Chest Flies

  • Chest flies are a weightlifting exercise that targets the pectoral muscles (chest muscles).
  • They are performed by lying on a bench and extending the arms outward with weights in each hand.
  • The weights are then lowered in an arc motion until they are slightly below chest level before being raised back to the starting position.

Overhead Presses

  • An overhead press is a weight-training exercise that involves pushing a weight above your head.
  • Also known as a shoulder, military, or strict press.

Lateral Raises

  • Lateral raises are an isolation exercise that targets the lateral deltoid muscle on the shoulder’s side.
  • They raise the arms laterally (out to the sides) while slightly bending at the elbows.

Bent Arm Lateral Raises

  • A bent-over lateral raise is a weightlifting exercise that strengthens the rear deltoids, the muscles on the back of the shoulders.
  • It also works other upper and lower body muscles, including the trapezius, rhomboids, triceps, hamstrings, and lower back.

Front Raises

  • Front raises are a weight training exercise that targets the shoulder muscles.
  • They can also help build strength and stability in the upper body.

Dips

  • Dips are an upper-body exercise that uses your body weight to strengthen your triceps and chest.

Triceps Extensions

  • Triceps extensions are resistance exercises that target the triceps muscles in the back of the upper arm.
  • They involve extending the arms at the elbows while keeping the shoulders stationary.

Skull Crushers

  • Skull crushers are a weightlifting exercise that targets the triceps muscles in the upper arms.
  • They are performed by lying on a bench or floor, holding a weight (such as a dumbbell or barbell) overhead, and then lowering it towards the forehead while keeping the elbows slightly bent.
  • This exercise helps to strengthen and build muscle mass in the triceps.

Upper Body Pull Exercises

Pull exercises are movements where you are pulling the weight toward your body. These exercises primarily use the biceps, hamstrings, glutes, and back muscles. A routine set up in which you do a push routine one day and a pull routine the next without working the same muscles two days in a row.

Barbell Rows

  • Often referred to as a “bent-over row” due to the hinged position of your body during the movement.
  • A barbell row is a weightlifting exercise in which you bend over at the hips, grasp a barbell with an overhand grip, and pull the weight toward your stomach.
  • This exercise primarily targets the upper back muscles, including the latissimus dorsi, while also engaging the core and posterior chain muscles.

One Arm Rows

  • A variation of the bent-over row, a one-arm row, also known as a single-arm dumbbell row, is an upper-body exercise that targets the back muscles using a dumbbell and a bench.

Double arm rows

  • A “double arm row” is a rowing exercise in which you simultaneously pull a weight toward your body using both arms, typically with a barbell or dumbbell.
  • This exercise engages your upper back muscles, including the latissimus dorsi, trapezius, and rhomboids.
  • To effectively target the back muscles, you maintain a bent-over position. Essentially, it’s the opposite movement of a chest press, but you use both arms simultaneously.

Barbell High Rows

  • A barbell high row, also known as a wide row, is an exercise that uses a barbell to work the upper and mid back muscles.

Dumbell Pullovers

  • Dumbbell pullovers are a weightlifting exercise that targets the chest, back, and shoulder muscles.

Seated Rows with Resistance Bands

  • A “seated row with bands” is an exercise where you sit on the ground, loop a resistance band around your feet, and then pull the handles towards your chest, mimicking a rowing motion.
  • By squeezing the shoulder blades together, this motion primarily targets the upper back muscles, including the latissimus dorsi and rhomboids.
  • You are essentially performing a seated row movement using the tension of a resistance band instead of weights.

Lat Pulls with Resistance Band

  • Lat pulls with a resistance band are a back exercise that strengthens the latissimus dorsi muscles and can improve posture.

Back extensions

  • Back extensions are an exercise that strengthens and isolates the lower back muscles, also known as the erector spinae.

Seated Alternating Rows

  • A seated alternating row is an exercise that targets the upper back, biceps, and lats.
  • It can be performed using a resistance machine or with a band.

Renegade Rows

  • A renegade row is a full-body exercise that combines a plank with a dumbbell row.
  • It’s an advanced exercise that targets the upper body, back, shoulders, and core.

Biceps Curls

  • A bicep curl involves bending the arm at the elbow towards the body, strengthening the biceps, the large muscles in the front of the upper arm.

Home Equipment

Resistance bands and a quality pair of adjustable dumbbells are recommended for home training. These don’t take up much space and can be used for most upper-body exercises. To set up a more dedicated space for workouts, add a weight bench or a full home gym to increase your push-pull training options.

Benefits

Push-pull workouts are great for anybody, whether you’re a bodybuilder or just someone lifting weights to be strong and fit. This routine is usually spread out over three days of training, allowing for shorter workouts. These can help you stay committed despite a busy schedule and are easier than longer, total-body workouts. These exercises can also be done with a cable pulley system or resistance bands.

  1. Day 1 might be a push upper body workout.
  2. Day 2 might be a lower-body workout.
  3. Day 3 might be the pull upper body workout.

First, push-pull workouts allow you to work your muscles without overstressing them. (Castanheira R. P. M. et al., 2017) Second, although they are more frequent, push-pull workouts are shorter, so more can be done because your other muscles are resting. Third, push-pull routines are more interesting and contain more variety, as they can be done in various ways.

Alternating Workouts

Trainers recommend changing workouts every 6-12 weeks to avoid hitting a plateau, which can delay weight loss (American Council on Exercise, 2001). For example, you could do a push-pull routine for a few weeks and then switch to a different training method, pyramid training. Then, return to total body workouts, which you can do up to 3 non-consecutive days a week. Circuit training may be an option because the quick workouts allow you to get your cardio in simultaneously. (Haltom R. W. et al., 1999) With so many different training methods, there’s no need to do the same workouts repeatedly.

Injury Medical Chiropractic and Functional Medicine Clinic

For those who are easily bored with weight training and prefer a variety of exercises, this can be a refreshing way to stay focused and avoid burnout. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to build optimal health and wellness solutions. We focus on what works for you to relieve pain, restore function, prevent injury, and help mitigate issues through adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.

Transform Your Body

References

Castanheira, R. P. M., Ferreira-Junior, J. B., Celes, R. S., Rocha-Junior, V. A., Cadore, E. L., Izquierdo, M., & Bottaro, M. (2017). Effects of Synergist vs. NonSynergist Split Resistance Training Routines on Acute Neuromuscular Performance in Resistance-Trained Men. Journal of strength and conditioning research, 31(12), 3482–3488. https://doi.org/10.1519/JSC.0000000000001762

Collins, P. (2009). Functional Fitness. Germany: Meyer & Meyer Sport, Limited.

American Council on Exercise. (2001). Weight Loss Plateaus and Pitfalls. ACE. https://contentcdn.eacefitness.com/assets/education-resources/lifestyle/fitfacts/pdfs/fitfacts/itemid_69.pdf

Haltom, R. W., Kraemer, R. R., Sloan, R. A., Hebert, E. P., Frank, K., & Tryniecki, J. L. (1999). Circuit weight training and its effects on excess postexercise oxygen consumption. Medicine and science in sports and exercise, 31(11), 1613–1618. https://doi.org/10.1097/00005768-199911000-00018

By Dr. Alexander Jimenez DC, APRN, FNP-C 0 Comments Athletes, Sleep Hygiene , , , , , , , , , , , , , , , , , , ,

The Importance of Sleep for Athletes: Maximizing Performance

Athletic individuals must train regularly, eat healthy, and rest properly to recover and perform their best. Is sleep different for athletes?

Athletes and Sleep

Physical activity is an important component of a healthy lifestyle. Regular exercise increases longevity and can also reduce the risk of anxiety and depression and improve sleep (Centers for Disease Control and Prevention, 2024). When one area is lacking for athletes, overall performance can suffer. Evidence shows that more or extended sleep can benefit athletes and their recovery and performance. (Bird, Stephen P. 2013) Recommendations for athletes range between seven and nine hours nightly, and elite athletes are encouraged to get at least nine hours of sleep nightly and to treat sleep as much as athletic training and diet.

Sleep is essential for overall health and well-being for both athletes and non-athletes. Everyone needs sleep to feel restored and function their best daily. (Richard J. Schwab, 2024) Other physical benefits include:

Cardiovascular Recovery

This allows the heart to rest and cells and tissue to be repaired. (MedlinePlus, 2017) This can help the body recover after physical exertion. As an individual progresses through the stages of sleep, the changes in heart rate and breathing throughout the night promote cardiovascular health (National Heart, Lung, and Blood Institute, 2011)

Illness Prevention 

The proper amount of sleep helps the body recover from illness. During sleep, the body produces cytokines/hormones that help the immune system fight off infections. These therapeutic effects are important for an athlete’s recovery and performance.

Lack of Sleep Affects Performance

Poor quality and quantity of sleep can lead to several negative effects. Sleep deprivation reduces the ability to react quickly and think clearly. A lack of sleep also increases irritability and risk for anxiety and depression. Sleep-deprived individuals are more likely to make poor decisions and take unnecessary risks. From a physical standpoint, a lack of sleep increases the risk for medical concerns, including type 2 diabetes, high blood pressure, kidney disease, and stroke. When athletes do not receive adequate sleep, it can:

Inhibit Ability

  • In a study of sleep-deprived male team athletes, average and total sprint times decreased. (Skein, M. et al., 2011)

Decrease Accuracy

  • In a study, male and female sleep-deprived tennis players had decreased serve accuracy by up to 53% compared to performance after normal sleep. (Reyner L. A. & Horne J. A. 2013)

Cause Quicker Exhaustion

  • A study of male runners and volleyball players found that both athletes exhausted faster after sleep deprivation. (Azboy O. & Kaygisiz Z. 2009)

Decrease Reaction Time

Difficulty Learning and Decision Making

  • A lack of sleep negatively impacts cognitive skills and functions.
  • Athletes can become distracted, and decisions like passing the ball or going for the smash can be difficult or made too late.

Increases Risk of Injury

  • Research on middle—and high-school athletes showed that chronic lack of sleep was associated with increased rates of injury. (Milewski M. D. et al., 2014)

Increases The Risk of Illness or Immunosuppression

Athletic Sleep Hygiene

Common components to sleep well include:

Avoid alcohol and Caffeine

  • Before bedtime, these can interrupt sleep or lead to more disturbed sleep.

Have a Wind-Down Routine

  • Activities such as reading, bathing, or meditating can help the body relax and get ready for sleep.

Reduce Stressors

  • Not only do mental stressors affect sleep quality, but they also impact performance overall.

Create an Optimal Sleep Environment

  • A sleeping space should be dark and cool with little to no noise.
  • The environment should be used only for sleep and sex.

No Electronics Before Bed

  • This includes TVs, cell phones, and computers.
  • The blue light that these devices emit can affect circadian rhythm.

Don’t Stay Awake In Bed

  • If you can’t fall asleep after 20 minutes of trying, get out of bed.
  • Do a quiet activity in another space until you feel sleepy.

Avoid Overtraining

  • Keep a consistent training schedule so as not to overexert yourself.

Quick Naps

  • Keep naps brief. Naps should be longer than an hour and not after 3 p.m.

Injury Medical Chiropractic and Functional Medicine Clinic

The right bed and mattress contribute to overall health and can improve one’s quality of life. Doctor Alexander Jimenez, DC, at Injury Medical Chiropractic and Functional Medicine Clinic, says a healthy mattress can improve sleep, reduce pain, increase energy levels, and elevate mood. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, prevent injury, and help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.

Lumbar Spine Injuries In Athletes

References

Centers for Disease Control and Prevention. (2024). Benefits of Physical Activity. Retrieved from https://www.cdc.gov/physical-activity-basics/benefits/?CDC_AAref_Val=https://www.cdc.gov/physicalactivity/basics/pa-health/index.htm

Bird, Stephen P. PhD. (2013). Sleep, Recovery, and Athletic Performance: A Brief Review and Recommendations. Strength and Conditioning Journal, 35(5), 43-47. https://doi.org/DOI: 10.1519/SSC.0b013e3182a62e2f

Schwab, R. J. (2024). Overview of Sleep. Merck Manual Consumer Version. https://www.merckmanuals.com/home/brain-spinal-cord-and-nerve-disorders/sleep-disorders/overview-of-sleep

National Library of Medicine. MedlinePlus. (2017). Healthy Sleep Also called: Sleep Hygeine. Retrieved from https://medlineplus.gov/healthysleep.html

National Heart, Lung, and Blood Institute. (2011). Your guide to healthy sleep. Retrieved from https://www.nhlbi.nih.gov/resources/your-guide-healthy-sleep

Skein, M., Duffield, R., Edge, J., Short, M. J., & Mündel, T. (2011). Intermittent-sprint performance and muscle glycogen after 30 h of sleep deprivation. Medicine and science in sports and exercise, 43(7), 1301–1311. https://doi.org/10.1249/MSS.0b013e31820abc5a

Reyner, L. A., & Horne, J. A. (2013). Sleep restriction and serving accuracy in performance tennis players, and effects of caffeine. Physiology & behavior, 120, 93–96. https://doi.org/10.1016/j.physbeh.2013.07.002

Azboy, O., & Kaygisiz, Z. (2009). Effects of sleep deprivation on cardiorespiratory functions of the runners and volleyball players during rest and exercise. Acta physiologica Hungarica, 96(1), 29–36. https://doi.org/10.1556/APhysiol.96.2009.1.3

Taheri, M., & Arabameri, E. (2012). The effect of sleep deprivation on choice reaction time and anaerobic power of college student athletes. Asian journal of sports medicine, 3(1), 15–20. https://doi.org/10.5812/asjsm.34719

Milewski, M. D., Skaggs, D. L., Bishop, G. A., Pace, J. L., Ibrahim, D. A., Wren, T. A., & Barzdukas, A. (2014). Chronic lack of sleep is associated with increased sports injuries in adolescent athletes. Journal of pediatric orthopedics, 34(2), 129–133. https://doi.org/10.1097/BPO.0000000000000151

Prather, A. A., Janicki-Deverts, D., Hall, M. H., & Cohen, S. (2015). Behaviorally Assessed Sleep and Susceptibility to the Common Cold. Sleep, 38(9), 1353–1359. https://doi.org/10.5665/sleep.4968