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Category: Chiropractic Care

ChiroMedBlogChiropractic Care

Experience expert Chiropractic care in El Paso, TX for effective pain relief and improved mobility. Our skilled chiropractors provide personalized treatments for back pain, neck pain, and joint issues. Utilizing advanced techniques, we help restore alignment, reduce discomfort, and enhance your overall well-being. Visit us today for top-rated chiropractic care in El Paso. Book your appointment now and take the first step toward a pain-free life

By Dr. Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP 0 Comments Advanced Practice Registered Nurses (APRN), Chiropractic Care , , , , , , , , , , , , , , , , , ,

Center of Gravity Explained: A Comprehensive Guide

What is the body’s center of gravity to understand and maintain a healthy posture and balance?

Center of Gravity

The human center of gravity, or COG, also known as the center of mass, with the two terms being interchangeable, is where the body’s weight appears to be concentrated. It’s a point in space where the entire body’s mass can be concentrated. When standing upright, the COG is generally located behind the navel and in front of the sacrum, around the level of the second vertebra. (Le Huec, J. 2011) The center of gravity is related to posture, including issues such as swayback, the design of posture exercise programs, and much more.

  • Gravity is a downward pull or force the Earth exerts on the body, creating weight. (NASA, 2013)
  • The center of gravity (COG) is where a body’s weight is equally balanced in all directions. (Physiopedia, 2025)
  • When the COG is defined, it is done from the reference of a static, standing position.
  • Because the body is in motion when we change positions, the COG is located in a new position with each new position.
  • The center of gravity is the point around which all the parts balance, which may be inside or outside the body.
  • Even slight changes in position can change where the COG is. (Physiopedia, 2025)

Key aspects of the COG

Location

  • When standing upright, the COG is typically found at the second vertebral level, behind the navel and in front of the sacrum. (Le Huec, J. 2011)

Shifting COG

  • The COG can shift depending on body position, posture, and movements like bending forward or backward. (Physiopedia, 2025)

Balance Impact 

  • The relationship between the COG and the base of support (the area of the body in contact with the ground) is fundamental to maintaining balance.

Variations

  • There can be variations in the COG location based on factors like gender (men tend to have a slightly higher COG), body shape, and even conditions like obesity or chronic low back pain. (Physiopedia, 2025)

Biomechanics

  • Understanding the COG is crucial in biomechanics and movement analysis, as it’s an index of total body motion and how the body responds to external forces.

The Human Center

The center of gravity is the point at which the body’s mass is equally balanced. This point changes depending on one’s position:

  • Arms up/down
  • Leaning
  • Turning

With strength and flexibility training, the human body can change its center of gravity, as gymnasts and dancers do.

  • When standing, the center of gravity is normally located behind the navel and in front of the sacrum bone (made up of five vertebrae fused vertically) at about the second vertebra level. (Hasegawa K. et al., 2022)
  • Because the body has moving parts, its overall shape changes every time it moves. Carrying something like a suitcase or grocery bag or wearing a backpack adds weight to some areas but not others, changing the center of gravity as it does.
  • The center of gravity is a continually changing point inside or outside the body that represents where the weight or mass of the rest of the body is equally balanced in every direction.
  • This point can and does change based on what is being carried and how it is carried, as well as body position and movements.

Chronic Lower Back Pain

  • A study in the Journal of Back and Musculoskeletal Rehabilitation found that individuals with chronic lower back pain tend to have their center of gravity located excessively towards the back. (Kim D. H., Park J. K., & Jeong M. K. 2014)
  • In the study, the individuals had decreased low back strength upon extension and a reduced normal low back curve.
  • The researchers found that those with chronic lower back pain whose center of gravity was too far back may need physical therapy to retrain the body to overcome strength and balance challenges to re-establish and maintain a healthy posture.

Injury Medical Chiropractic and Functional Medicine Clinic

As a Family Practice Nurse Practitioner, Dr. Jimenez combines advanced medical expertise with chiropractic care to address various conditions. Our clinic integrates Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine to create customized care plans that promote natural healing, mobility, and long-term wellness. By focusing on flexibility, agility, and strength, we empower patients to thrive, regardless of age or health challenges. At El Paso’s Chiropractic Rehabilitation Clinic & Integrated Medicine Center, we passionately focus on treating patients after injuries and chronic pain syndromes. We focus on improving your ability through flexibility, mobility, and agility programs tailored for all age groups and disabilities. We use in-person and virtual health coaching and comprehensive care plans to ensure every patient’s personalized care and wellness outcomes.

Enhance Your Lifestyle Today with Chiropractic Care

References

Le Huec, J. C., Saddiki, R., Franke, J., Rigal, J., & Aunoble, S. (2011). Equilibrium of the human body and the gravity line: the basics. European spine journal: official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 20 Suppl 5(Suppl 5), 558–563. https://doi.org/10.1007/s00586-011-1939-7

NASA. Jet Propulsion Laboratory, California Institute of Technology. (2013). What is gravity? Retrieved from https://gracefo.jpl.nasa.gov/news/5/what-is-gravity/

Physiopedia. (2025). Centre of gravity. https://www.physio-pedia.com/Centre_of_Gravity

Hasegawa, K., Amabile, C., Nesme, M., & Dubousset, J. (2022). Gravity center estimation for evaluation of standing whole body compensation using virtual barycentremetry based on biplanar slot-scanning stereoradiography – validation by simultaneous force plate measurement. BMC musculoskeletal disorders, 23(1), 22. https://doi.org/10.1186/s12891-021-04948-5

Kim, D. H., Park, J. K., & Jeong, M. K. (2014). Influences of posterior-located center of gravity on lumbar extension strength, balance, and lumbar lordosis in chronic low back pain. Journal of Back and Musculoskeletal Rehabilitation, 27(2), 231–237. https://doi.org/10.3233/BMR-130442

By Dr. Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP 0 Comments Acupuncture, Chiropractic Care, Electroacupuncture , , , , , , , , , , , , , , , , , , ,

Paraspinal Muscle Tension: Understanding the Impacts

Can a paraspinal muscle spasm in the lower back create a chain reaction leading to hamstring spasms and potential sciatic nerve entrapment?

Paraspinal Muscle Spasm Chain Reaction

A paraspinal muscle spasm in the lower back can cause a cascade of events, including: (Cedars-Sinai, 2025)

  • Spasms in other lower back muscles
  • Hamstring spasms
  • Potential entrapment of the sciatic nerve

Leading to symptoms similar to sciatica: 

  • Pain
  • Sore, achy muscles
  • Weak muscles
  • Numbness
  • Tingling along the back of the leg

Possible Mechanisms

Triggering Muscle Spasms in the Lower Back

  • Paraspinal muscles are located along the spine and help to stabilize and support the lower back.
  • When these muscles spasm, they can become tense and painful, causing a chain reaction.
  • This tension can radiate down and affect other muscles in the lower back. (Noonan A. M., & Brown S. H. M., 2021)

Can Affect Lower Back Muscles and Cause Hamstring Spasms

  • Lower back muscles, including those like the quadratus lumborum, can be affected by paraspinal spasms. (Hospital for Special Surgery, 2024)
  • The spasms can cause these muscles to tighten or spasm, potentially pulling on the hamstring muscles.
  • This can lead to hamstring spasms and tightness, further contributing to pain and potential nerve irritation.

Entrapment of the Sciatic Nerve

  • Piriformis syndrome is a common condition where the piriformis muscle (located in the buttock) spasms and compresses the sciatic nerve. (Cedars-Sinai, 2025)
  • The sciatic nerve runs from the lower back down the back of the thigh and into the leg, making it vulnerable to compression by surrounding muscles.
  • If the paraspinal and hamstring spasms create enough tension on the piriformis muscle or surrounding tissues, it can lead to sciatic nerve entrapment. (Hospital for Special Surgery, 2024)

How acupuncture helps relieve sciatica

Acupuncture can help relieve sciatica pain by stimulating specific points on the body, which can trigger the release of endorphins, reduce inflammation, improve blood flow, and relax tight muscles that could be compressing the sciatic nerve. By modulating the nervous system and promoting the body’s natural healing processes, acupuncture can help alleviate pain and improve overall function. (Qin, Z. et al., 2015)

Releases endorphins

  • Acupuncture stimulates the nervous system, triggering the release of endorphins, the body’s natural painkillers.

Reduces inflammation

  • Acupuncture can help reduce inflammation in the area surrounding the sciatic nerve, which can contribute to pain and nerve irritation. (Natural Care Chiropractic, 2022)

Improves circulation

  • By increasing blood flow to the affected area, acupuncture can help deliver nutrients and oxygen to the sciatic nerve and surrounding tissues, promoting faster healing.

Relaxes tight muscles

  • Sciatica pain can be exacerbated by tight muscles compressing the nerve. Acupuncture can help relax these muscles, reducing pressure on the sciatic nerve and alleviating pain.

Regulates the nervous system

  • Acupuncture can help regulate the nervous system, positively impacting pain perception and overall well-being. (Qin, Z. et al., 2015)

Promotes regeneration

  • Some evidence suggests that acupuncture can promote sciatic nerve regeneration, potentially leading to long-term pain relief. (Natural Care Chiropractic, 2022)

Needling Types

Distal needling

  • Acupuncture can also involve using points that are further away from the site of pain, which can also help to reduce pain and inflammation. 

Local needling

  • Points are also selected on or near the sciatic nerve’s path, which can help directly address the source of pain and inflammation. (Qin, Z. et al., 2015)

Holistic approach

  • Acupuncture is often viewed as a holistic approach to pain management, addressing the symptoms of sciatica and the underlying causes and imbalances in the body.

Injury Medical Chiropractic and Functional Medicine Clinic

As a Family Practice Nurse Practitioner, Dr. Jimenez combines advanced medical expertise with chiropractic care to address various conditions. Our clinic integrates Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine to create customized care plans that promote natural healing, mobility, and long-term wellness. By focusing on flexibility, agility, and strength, we empower patients to thrive, regardless of age or health challenges. At El Paso’s Chiropractic Rehabilitation Clinic & Integrated Medicine Center, we passionately focus on treating patients after injuries and chronic pain syndromes. We focus on improving your ability through flexibility, mobility, and agility programs tailored for all age groups and disabilities. We use in-person and virtual health coaching and comprehensive care plans to ensure every patient’s personalized care and wellness outcomes.

Chiropractic and Integrative Healthcare

References

Cedars Sinai. (2025). Piriformis Syndrome. https://www.cedars-sinai.org/health-library/diseases-and-conditions/p/piriformis-syndrome.html#:~:text=Overview,can%20run%20through%20the%20muscle)

Noonan, A. M., & Brown, S. H. M. (2021). Paraspinal muscle pathophysiology associated with low back pain and spine degenerative disorders. JOR spine, 4(3), e1171. https://doi.org/10.1002/jsp2.1171

Hospital for Special Surgery. (2024). Sciatica. https://www.hss.edu/condition-list_sciatica.asp

Qin, Z., Liu, X., Wu, J., Zhai, Y., & Liu, Z. (2015). Effectiveness of Acupuncture for Treating Sciatica: A Systematic Review and Meta-Analysis. Evidence-based complementary and alternative medicine: eCAM, 2015, 425108. https://doi.org/10.1155/2015/425108

Natural Care Chiropractic, D. M. F. (2022). Acupuncture for Sciatica Pain Relief. https://www.naturalcarechiropractic.com/post/acupuncture-for-sciatica-pain-relief

By Dr. Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP 0 Comments Advanced Practice Registered Nurses (APRN), Chiropractic Care, Sleep Hygiene , , , , , , , , , , , , , , , , ,

Pseudoarthrosis After Spinal Fusion Surgery Explained

What is pseudoarthrosis of the cervical and lumbar spine?

Pseudoarthrosis of the cervical and lumbar spine

Individuals may need a spinal fusion to treat a fractured vertebra, scoliosis, or conditions like spinal stenosis, degenerative disc disease, and spondylolisthesis/slipped vertebrae. A spinal fusion reduces pain and stabilizes the spine by limiting movement between vertebrae. Pseudoarthrosis happens when the bones don’t heal after a fracture or bone surgery. When pseudoarthrosis affects the cervical or lumbar spine, it means that two vertebrae did not heal and grow together after spinal surgery to fuse them (spinal fusion). Reasons for a failed spinal fusion include:

  • Issues with the instruments used to stabilize the bone
  • Lack of bone growth
  • The number of vertebrae being fused.

The patient’s health and lifestyle play a role in failed fusions, which can include

  • Diabetes
  • Inflammatory health conditions increase the risk
  • Smoking
  • Long-term steroid use

In many cases, revision surgery is needed.

Surgery-Related

During a spinal fusion, surgeons insert a bone graft between two vertebrae and then apply spinal fixation hardware (instrumented spinal fusion) that includes:

  • Plates
  • Rods
  • Screws
  1. The bone graft promotes growth between the two bones.
  2. The hardware stabilizes the vertebrae and prevents movement while they fuse and grow together.
  3. The hardware goes inside, or internal fixation.
  4. Although rare, a severe spinal fracture or deformity may need external fixation.
  5. A rigid frame secured outside the body helps to stabilize the bones.

If the fusion fails, it could be caused by one or more of the following surgical issues:

Number of Vertebrae Being Fused

Hardware

  • The surgeon must carefully plan and use the right hardware.
  • The type of hardware used during a spinal fusion may influence bone healing.
  • The instruments can come loose or break, interfering with the fusion process.
  • Spinal osteoporosis, having thin, weak bones, can affect fixation.
  • Even with the optimal surgical preparedness, weak bones significantly increase the chance of the instruments loosening and pseudoarthrosis developing.

Bone Graft

  • The type of bone graft used may affect the fusion.
  • For example, in cervical/neck spinal fusions, an autograft, which uses a small piece of bone from the patient’s body, has a higher success rate. (Verla T. et al., 2021)
  • Other graft options include specialized steel cages that fit between vertebrae and contain bone growth factors.
  • The surgeon recommends the optimal bone graft for the type of surgery, the number of vertebrae involved, and risk factors.

Risk Factors

  • The patient’s overall health and lifestyle impact the results of spinal fusion. Smoking increases the risk. (Berman D. et al., 2017)
  • Nicotine restricts blood circulation, decreases bone density, reduces new bone formation, and delays bone healing. (Hernigou J., & Schuind F., 2019)

The risk of pseudoarthrosis increases if the individual has any of the following: (Scoliosis Research Society, 2023)

  • Previous pseudoarthrosis
  • Obesity
  • Chronic steroid use
  • Malnutrition
  • Inflammatory diseases

Inflammatory conditions that can lead to bone loss and non-optimal bone healing include: (Torres H. M. et al., 2023)

  • Diabetes (Jiao H, Xiao E, & Graves DT, 2015)
  • Inflammatory bowel disease
  • Psoriasis
  • Rheumatoid arthritis
  • Chronic obstructive pulmonary disease/COPD
  • Periodontitis
  • Systemic lupus erythematosus/SLE

Symptoms

  • The primary sign of pseudoarthrosis is pain in the same area as before the fusion surgery.
  • If the bones pinch a spinal nerve, one arm may experience pain, tingling, burning, or numbness.
  • Rarely does a pinched nerve affect both arms.
  • The pain may return shortly after the procedure.
  • The pain may develop gradually or not appear for many months.
  • However, it’s more likely to appear after several months when the individual returns to their usual activities.

Diagnosis

  • The healthcare provider will learn about symptoms and perform a physical exam to evaluate the back.
  • They’ll assess mobility and the type of movement that causes pain.
  • Then, they order diagnostic imaging to see the spine and identify the cause of pain.
  • Individuals may need a CT scan, MRI, and/or X-rays to evaluate the spinal structures and instrumentation fully.

Treatment

Treatment for pseudoarthrosis will likely start with:

  • Physical therapy
  • Pain management – especially in cases where it is important to rule out other sources of back or neck pain.
  • Medication
  • Injections
  • If symptoms don’t improve with conservative care or if there is severe pain, the healthcare provider may recommend revision surgery.
  • Revision surgery is another procedure to treat complications or correct issues that arise after the initial pseudoarthrosis surgery.

Injury Medical Chiropractic and Functional Medicine Clinic

As a Family Practice Nurse Practitioner, Dr. Jimenez combines advanced medical expertise with chiropractic care to address various conditions. Our clinic integrates Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine to create customized care plans that promote natural healing, mobility, and long-term wellness. By focusing on flexibility, agility, and strength, we empower patients to thrive, regardless of age or health challenges. At El Paso’s Chiropractic Rehabilitation Clinic & Integrated Medicine Center, we passionately focus on treating patients after injuries and chronic pain syndromes. We focus on improving your ability through flexibility, mobility, and agility programs tailored for all age groups and disabilities. We use in-person and virtual health coaching and comprehensive care plans to ensure every patient’s personalized care and wellness outcomes.

Enhancing Health Together

References

Boonsirikamchai, W., Wilartratsami, S., Ruangchainikom, M., Korwutthikulrangsri, E., Tongsai, S., & Luksanapruksa, P. (2024). Pseudarthrosis risk factors in lumbar fusion: a systematic review and meta-analysis. BMC musculoskeletal disorders, 25(1), 433. https://doi.org/10.1186/s12891-024-07531-w

Verla, T., Xu, D. S., Davis, M. J., Reece, E. M., Kelly, M., Nunez, M., Winocour, S. J., & Ropper, A. E. (2021). Failure in Cervical Spinal Fusion and Current Management Modalities. Seminars in plastic surgery, 35(1), 10–13. https://doi.org/10.1055/s-0041-1722853

Berman, D., Oren, J. H., Bendo, J., & Spivak, J. (2017). The Effect of Smoking on Spinal Fusion. International journal of spine surgery, 11(4), 29. https://doi.org/10.14444/4029

Hernigou, J., & Schuind, F. (2019). Tobacco and bone fractures: A review of the facts and issues that every orthopaedic surgeon should know. Bone & joint research, 8(6), 255–265. https://doi.org/10.1302/2046-3758.86.BJR-2018-0344.R1

Scoliosis Research Society. (2023). Pseudoarthrosis. https://www.srs.org/Patients/Conditions/Pseudoarthrosis

Torres, H. M., Arnold, K. M., Oviedo, M., Westendorf, J. J., & Weaver, S. R. (2023). Inflammatory Processes Affecting Bone Health and Repair. Current osteoporosis reports, 21(6), 842–853. https://doi.org/10.1007/s11914-023-00824-4

Jiao, H., Xiao, E., & Graves, D. T. (2015). Diabetes and Its Effect on Bone and Fracture Healing. Current osteoporosis reports, 13(5), 327–335. https://doi.org/10.1007/s11914-015-0286-8

By Dr. Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP 0 Comments Advanced Practice Registered Nurses (APRN), Chiropractic Care , , , , , , , , , , ,

Migraines & Neck Pain: Understanding the Connection

Find out how migraines and neck pain can disrupt your day and explore solutions to help you regain your comfort and peace.

Introduction

As a Nurse Practitioner with over 20 years of experience in physical and functional medicine, I’ve seen firsthand how chronic migraines—especially those linked with neck pain—can derail lives. Migraines are more than just severe headaches; they are complex neurological events often triggered by musculoskeletal dysfunction, stress, inflammation, and poor posture.

What’s often overlooked in traditional care models is the close relationship between cervical spine health and migraine activity. By integrating chiropractic care, postural retraining, and functional nutrition, we can significantly reduce migraine frequency and severity for many patients.

In this comprehensive post, we’ll explore:

  • The anatomical and physiological link between neck pain and migraines
  • The role of fibromyalgia in exacerbating migraine symptoms
  • Evidence-based chiropractic interventions
  • Postural and ergonomic corrections
  • Anti-inflammatory nutritional strategies

The Link Between Neck Pain and Migraines: Cervicogenic and Neurovascular Overlap

Patients often describe their migraine episodes beginning with a deep ache or stiffness in the neck, which gradually radiates toward the skull. This isn’t coincidental—it’s anatomical. Many migraines are cervicogenic in origin, meaning they arise from dysfunctions in the cervical spine.

The Cervical Trigeminovascular Connection

Cervicogenic headaches and migraines share overlapping pathways, particularly involving the trigeminocervical complex—a convergence of sensory nerves from the cervical spine and trigeminal nerve that transmits head and facial pain. Misalignment, muscular tension, or inflammation in this area can trigger the trigeminal-autonomic reflex, activating symptoms like:

  • Throbbing head pain
  • Light and sound sensitivity
  • Visual aura
  • Nausea

According to Vicente et al. (2023), activation of this reflex and extracranial autonomic involvement may underlie migraine generation when cervical structures are compromised. This suggests that structural or functional issues in the neck—such as joint hypomobility or myofascial tension—can act as primary migraine triggers.

Common Migraine-Associated Neck Pain Triggers

  • Cervical spine misalignment
  • Postural kyphosis and forward head posture
  • Muscular tension from occupational strain or emotional stress
  • TMJ dysfunction
  • Inadequate sleep or poor sleep posture

Fibromyalgia: An Amplifier of Migraines and Neck Pain

Patients with fibromyalgia are particularly susceptible to migraines due to central sensitization—a phenomenon in which the central nervous system becomes hypersensitive to stimuli.

In these patients, mitochondrial dysfunction plays a key role. As Janssen et al. (2021) highlight, both fibromyalgia and migraines are associated with impaired cellular energy metabolism. Symptoms in fibromyalgia patients often include:

  • Intensified migraine episodes
  • Musculoskeletal tenderness in the neck, trapezius, and occiput
  • Sleep disturbances and fatigue
  • Amplified pain response to touch (allodynia)

Understanding this connection allows for more targeted and effective treatment plans. Interventions must address not just musculoskeletal alignment but also systemic inflammation and nervous system regulation.

Tension Headaches Explained- Video

Holistic and Functional Interventions for Migraine Management

1. Chiropractic Care and Manual Therapy: Restoring Cervical Balance

Chiropractic interventions can be transformative for patients experiencing migraines related to neck dysfunction. Techniques such as cervical spine manipulation, soft tissue release, and muscle energy techniques (METs) help restore balance and reduce pain signaling.

Key Chiropractic Techniques:

  • Suboccipital Release: Alleviates deep muscle tension that compresses the greater occipital nerve
  • Cervical Mobilization: Increases joint range of motion and reduces localized inflammation
  • Myofascial Release: Targets the tight fascia and deep muscle layers in the upper back and neck
  • Instrument-Assisted Soft Tissue Mobilization (IASTM): Enhances blood flow and breaks down fibrotic tissue

Research by Mayo & Keating (2023) demonstrates that chiropractic spinal manipulation can significantly reduce migraine frequency and symptom duration, especially when combined with ergonomic education and exercise.

2. Postural Retraining and Ergonomics: Reducing Structural Strain

Modern lifestyle habits, such as prolonged screen use and poor workstation design, contribute significantly to cervical dysfunction and subsequent migraines.

Postural Interventions:

  • Craniocervical Flexion Exercises: Strengthen deep neck flexors and reduce forward head posture
  • Scapular Stabilization Routines: Reinforce shoulder and thoracic posture
  • Workstation Ergonomic Adjustments: Monitor elevation, lumbar support, and keyboard positioning

A 2021 study by de Almeida Tolentino et al. confirms that correcting head and neck posture can significantly reduce the frequency of migraines and improve functional disability scores in migraine sufferers.

3. Anti-Inflammatory Nutrition: Healing from Within

Nutritional strategies play a crucial role in modulating inflammation and stabilizing the nervous system. Many patients experience relief by identifying and avoiding dietary migraine triggers such as:

  • Aged cheeses
  • Processed meats (high in nitrates)
  • MSG, aspartame, and high-sugar foods
  • Alcohol, especially red wine

Functional Nutrition Recommendations:

  • Elimination Diets: Help identify food triggers and reduce systemic inflammation (Gazerani, 2020)
  • Magnesium Supplementation: Reduces cortical spreading depression and improves vascular tone (Shin et al., 2020)
  • Omega-3 Fatty Acids: Found in fatty fish, flaxseed, and chia, these combat neuroinflammation
  • Riboflavin (Vitamin B2): Shown to reduce the frequency of migraines when taken consistently
  • CoQ10: Improves mitochondrial function and energy production in the brain

Integrating these supplements and dietary shifts can offer long-term, sustainable relief by addressing underlying metabolic and neurological dysfunctions.

Integrated Care Planning: The Functional Medicine Model

In my clinical practice, treating migraines associated with neck pain involves more than adjusting the spine or prescribing a supplement—it requires a systems-based approach.

A Sample Care Plan May Include:

  • Initial chiropractic assessment and spinal X-rays (if indicated)
  • Trigger point mapping and musculoskeletal evaluation
  • Nutritional intake analysis with elimination diet guidance
  • Prescription of cervical mobility and posture exercises
  • Functional labs to assess inflammatory markers and micronutrient status
  • Co-management with neurologists for medication tapering (when appropriate)

The goal is to transition patients from episodic crisis management to proactive wellness, reducing reliance on pharmaceuticals and emergency interventions.

Empowering Patients Through Education and Collaboration

One of the most rewarding aspects of integrative care is educating patients about how their lifestyle, posture, diet, and spinal alignment interact to affect migraine frequency and severity.

By understanding the why behind their symptoms, patients are more empowered to:

  • Recognize and avoid migraine triggers
  • Adhere to treatment protocols
  • Participate in preventive strategies like exercise and stress reduction

When patients are viewed not just as symptoms but as whole individuals, outcomes dramatically improve. As we tailor care to their unique physiology and environment, we foster long-term healing—not just temporary relief.

Conclusion: Migraines and Neck Pain—An Opportunity for Functional Healing

The connection between migraines and neck pain is more than coincidental—it’s a deeply interwoven neurovascular and musculoskeletal relationship. As functional and physical medicine providers, we have the opportunity to address this relationship holistically.

Through chiropractic care, ergonomic corrections, anti-inflammatory nutrition, and nervous system regulation, we can guide patients toward a life with fewer migraines, improved neck mobility, and greater vitality.

By looking beyond the head and acknowledging the role of the cervical spine and systemic health, we not only reduce pain—we restore function, purpose, and quality of life.

Injury Medical & Functional Medicine Clinic

We associate with certified medical providers who understand the importance of assessing individuals dealing with neck pain associated with migraines. When asking important questions to our associated medical providers, we advise patients to incorporate numerous techniques to reduce migraines from reappearing and causing neck pain. Dr. Alex Jimenez, D.C., uses this information as an academic service. Disclaimer.

References

Aguilar-Shea, A. L., Membrilla Md, J. A., & Diaz-de-Teran, J. (2022). Migraine review for general practice. Aten Primaria, 54(2), 102208. https://doi.org/10.1016/j.aprim.2021.102208

Al Khalili, Y., Ly, N., & Murphy, P. B. (2025). Cervicogenic Headache. In StatPearls. https://www.ncbi.nlm.nih.gov/pubmed/29939639

de Almeida Tolentino, G., Lima Florencio, L., Ferreira Pinheiro, C., Dach, F., Fernandez-de-Las-Penas, C., & Bevilaqua-Grossi, D. (2021). Effects of combining manual therapy, neck muscle exercises, and therapeutic pain neuroscience education in patients with migraine: a study protocol for a randomized clinical trial. BMC Neurol, 21(1), 249. https://doi.org/10.1186/s12883-021-02290-w

Di Antonio, S., Arendt-Nielsen, L., & Castaldo, M. (2023). Cervical musculoskeletal impairments and pain sensitivity in migraine patients. Musculoskelet Sci Pract, 66, 102817. https://doi.org/10.1016/j.msksp.2023.102817

Gazerani, P. (2020). Migraine and Diet. Nutrients, 12(6). https://doi.org/10.3390/nu12061658

Janssen, L. P., Medeiros, L. F., Souza, A., & Silva, J. D. (2021). Fibromyalgia: A Review of Related Polymorphisms and Clinical Relevance. An Acad Bras Cienc, 93(suppl 4), e20210618. https://doi.org/10.1590/0001-3765202120210618

Jara Silva, C. E., Joseph, A. M., Khatib, M., Knafo, J., Karas, M., Krupa, K., Rivera, B., Macia, A., Madhu, B., McMillan, M., Burtch, J., Quinonez, J., Albert, T., & Khanna, D. (2022). Osteopathic Manipulative Treatment and the Management of Headaches: A Scoping Review. Cureus, 14(8), e27830. https://doi.org/10.7759/cureus.27830

Mayo, Z., & Keating, C. (2023). Manual Therapy and Exercise for the Management of Chronic Neck Pain With Multiple Neurovascular Comorbidities: A Case Report. Cureus, 15(3), e36961. https://doi.org/10.7759/cureus.36961

Shin, H. J., Na, H. S., & Do, S. H. (2020). Magnesium and Pain. Nutrients, 12(8). https://doi.org/10.3390/nu12082184

Vicente, B. N., Oliveira, R., Martins, I. P., & Gil-Gouveia, R. (2023). Cranial Autonomic Symptoms and Neck Pain in Differential Diagnosis of Migraine. Diagnostics (Basel), 13(4). https://doi.org/10.3390/diagnostics13040590

Disclaimer

By Dr. Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP 0 Comments Chiropractic Care, Electroacupuncture, Physio , , , , , , , , , , , , , ,

Supine Position Explained: Benefits and Uses

For individuals experiencing back pain, can lying in the supine position help bring relief?

Supine Position

The supine position describes the body’s position when lying on your back with your face up. The individual is flat on their back with no incline, arms at their sides or bent at a 90-degree angle. It’s commonly used in medical settings for examinations, surgeries, and procedures, particularly when access to the anterior/front of the body is needed. It can benefit certain conditions, like helping relieve pain, but exacerbate others, like acid reflux. The term is also used as a modifier for exercises and stretches that begin with the individual on their back. (ScienceDirect Topics, 2009)

Medical Uses

Examinations

  • Healthcare providers often use the supine position for physical examinations, including vital signs, palpation of the abdomen, and chest inspection. (Nurse.com, 2024)

Procedures

Surgery

  • Due to its accessibility to the front of the body, the supine position is frequently used for surgeries such as cardiac, abdominal, thoracic, and cranial procedures. 
  • It allows for easy access to the airway, facilitates anesthesia choices, and can be readily converted to an open procedure if necessary. ScienceDirect Topics, 2009)

Overall Health

Natural Position

  • Many individuals naturally fall asleep in the supine position, finding it comfortable and conducive to spinal alignment.

Back Pain Relief

  • Sometimes, lying supine with proper support can relieve back pain, particularly in individuals with lumbar spinal issues. (MedicalNewsToday, 2022)

Acid Reflux

  • However, the supine position can exacerbate acid reflux, as gravity allows stomach acid to travel up the esophagus. (MedicalNewsToday, 2022)

Sleep Apnea

  • The supine position can worsen sleep apnea in some individuals.

Clinical Uses

  • A physical therapist, trainer, or clinician may use supine to describe positions used for manual therapy or when having the patient do stretching and back exercises as part of a home exercise program.
  • If the therapist or personal trainer is training the individual on core stabilization exercises for the first time, the individual will most likely start in the supine position.
  • This is because when the body is supine, the muscles have the least work to do to maintain correct posture and position against the force of gravity.
  • Many bed exercises begin in this position for rehabilitation.

Back Care

Here are a few recommendations to relieve low back pain using the supine position.

  • First, individuals can release the tension in the back by assuming the hook-lying position, a modification of the supine position in which the knees are bent and the feet are resting flat on the floor (Aurora BayCare Medical Center, N.D.).
  • Start breathing and relaxing, allowing the tension to drain out of the muscles.
  • In a hook-lying position with the fingertips on the lower belly, inhale deeply, then exhale naturally and puff out the remaining air.
  • At that point, the fingertips should feel the transverse abdominal muscle engage.
  • Release and repeat 10 times.

After the body is warmed up, move on to actual exercise. For example, beginners may be given hip stretches to help relieve back pain. These might be done to maintain or prevent back pain. Individuals can do yoga for their back while in the supine position. As with any exercise program, not all yoga poses involve lying on the back, but many beginners and restorative ones do.

For example, the supine spinal twist involves lying on the back, bending the knees, and gently placing them to one side. The idea is to stay in that position for a few moments—and breathe—to allow the oblique abdominal and back muscles to release.

Variations

Lawn Chair Position

  • This variation involves slightly bending the hips and knees and elevating them above the heart, which can help relieve lower back pain.

Frog-Leg Position

  • The frog-leg position involves lying on the back with bent knees pushed out to the sides, providing access to the groin and perineum. (Steris Healthcare, 2025)

Injury Medical Chiropractic & 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.

Thoracic Spine Pain

References

ScienceDirect. (2009). Supine Position. Morrey’s The Elbow and Its Disorders (Fourth Edition), 567-577. https://doi.org/https://doi.org/10.1016/B978-1-4160-2902-1.50042-5

Nurse.com. (2024). What Is Supine Position? https://www.nurse.com/nursing-resources/definitions/what-is-supine-position/#:~:text=During%20routine%20physical%20examinations%2C%20the,easier%20to%20perform%20comprehensive%20assessments.

STERIS. (2025). The Complete Guide to Patient Positioning. https://www.steris.com/healthcare/knowledge-center/surgical-equipment/complete-guide-to-patient-positioning#:~:text=The%20most%20common%20position%20used,and%20elevating%20the%20sternal%20notch.

MedicalNewsToday. (2022). What is the supine position? https://www.medicalnewstoday.com/articles/supine-position

Aurora BayCare Medical Center. (N.D.). Lumbar stabilization hooklying position. https://ahc.aurorahealthcare.org/fywb/baycare/x06913bc.pdf

By Dr. Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP 0 Comments Chiropractic Care, Therapy , , , , , , , , , , , , , , , , ,

Understanding Nerve Conduction Velocity in Health Care

Should individuals experiencing nerve pain or various sensations get a nerve conduction velocity study to examine nerve health and function?

Nerve Conduction Velocity

A nerve conduction velocity (NCV) is a noninvasive test that measures the speed and strength of nerve stimulation using electrical probes placed on the skin. It’s used to diagnose nerve damage or disease, often alongside an EMG (electromyogram) to differentiate between nerve and muscle problems. It can also evaluate sensory issues, pain, and weakness of the extremities.

  • This test involves safe electrical shocks that can be slightly uncomfortable but not painful.
  • Nerve conduction velocity (NCV) measures the speed at which electrical impulses travel along a nerve fiber, which measures how quickly electrical signals travel through a nerve.
  • This information indicates nerve health and function.
  • Electromyography (EMG) is a nerve test that involves placing tiny needles into the muscles.
  • A slower NCV can indicate nerve injury or dysfunction.

Test Uses

Generally, the test is ordered to assess peripheral nerve diseases, those that connect from the muscles, organs, and skin to the spinal cord or brain. It can help identify the type and location of nerve damage.

  • Peripheral nerve conditions typically cause pain, sensory loss, tingling, or burning.
  • Mild weakness and diminished reflexes can be detected during a neurological examination.

Conditions

Nerve conduction studies are performed to help diagnose conditions.

  • Herniated disc disease
  • Sciatic nerve problems
  • Carpal tunnel syndrome
  • Guillain-Barré syndrome
  • Nerve damage (neuropathy), such as from diabetes, chemotherapy, or autoimmune disorders
  • Charcot-Marie-Tooth disease

Nerve compression

  • Many different conditions, including trauma, inflammation, and tumors, can compress one or more nerves.

Radiculopathy

  • Often described as a pinched nerve, radiculopathy can affect an arm or a leg, causing pain and weakness.

Peripheral Neuropathy

  • This nerve damage begins in the most distal nerves, those farthest from the center of the body, such as the toes and fingers. It is often due to chronic alcohol misuse, uncontrolled diabetes, nutritional deficits, and inflammatory diseases. (Ferdousi M. et al., 2020)

Carpal Tunnel Syndrome

  • Commonly caused by inflammatory diseases or overuse of the wrists, such as from assembly line work, carpal tunnel syndrome causes numbness, pain, and weakness of the fingers and hands. (Tada K. et al., 2022)

Ulnar neuropathy

  • This common condition causes arm pain and sensory changes, usually due to repetitive movements or a prolonged position that causes pressure on the ulnar nerve.

Guillain-Barré syndrome (GBS)

  • This inflammatory condition causes demyelination, or loss of the insulating covering around nerves, which results in leg weakness.
  • It begins in the motor nerves, which send signals to muscles in the legs. (Shibuya K. et al., 2022)
  • The inflammation travels to nerves of the upper body, often affecting the muscles that control breathing.
  • Respiratory support is necessary until the condition improves.

Chronic Demyelinating Polyneuropathy (CIDP)

  • This condition is a chronic, recurrent form of GBS that usually affects the legs and causes episodes of weakness.

ICU neuropathy

  • Metabolic changes, severe illness, and not moving enough can cause nerves to develop a pattern of weakness and sensory loss.

Myasthenia gravis (MG)

  • This autoimmune condition affects the junction between the nerves and the muscles.
  • Myasthenia gravis causes drooping eyelids and weakness of the arms and shoulders.

Amyotrophic lateral sclerosis (ALS)

  • ALS is a serious, degenerative disease affecting the spinal cord’s motor neurons.
  • Amyotrophic lateral sclerosis progresses rapidly, resulting in substantial weakness of muscles throughout the body.

How it’s Done

  • Surface electrodes are placed on the skin over nerves, and a small electrical current is applied to stimulate the nerve.
  • The time it takes for the electrical signal to travel between the electrodes is measured, and this time is used to calculate the NCV.

Values

Normal NCV values are generally between 50 and 70 meters per second. However, these values can vary depending on the nerve and the individual.

NCV Factors

Various factors can influence NCV.

  • Age
  • Sex
  • Medical conditions like diabetes

Interpretation

  • A slower NCV can indicate nerve damage or demyelination (loss of the myelin sheath, which insulates nerve fibers), while an EMG can help determine if the problem is with the nerve or the muscle.

Results

The results of NCV testing can be used to determine the type, severity, and location of nerve damage. The results will be ready in report form about a week after the test.

  • The test measures velocity (how fast a nerve transmits signals) and amplitude (how many nerve fibers were activated). (Tavee J. 2019)
  • The measurements are transmitted to a computer and shown as waves and numerical values.
  • The values are compared to a standard measurement based on the tested nerve.
  • The distance between the electrodes.
  • The person’s age.

Compared to the standard, the NCV results can identify certain patterns of nerve damage. (Tada K. et al., 2022) Outcomes include: (Tavee J. 2019)

  • If one or more nerves are affected.
  • If motor nerves (control movement), sensory nerves (transmit sensory signals), or both are affected.
  • Whether a nerve is blocked or damaged.
  • The severity of the damage.
  • The type of nerve damage
  • Axonal (damage to the nerve itself)
  • Demyelination (damage to the protective fatty layer around the nerve)

The results can help point to certain diagnoses.

Preparation Before the Test

Individuals will not need to change their diet before having an NCV. However, patients will be asked to avoid lotions or creams on their skin before the test. Individuals who are also having an EMG at the time of their NCV might be asked to stop taking medications or supplements that increase the risk of bleeding and bruising. If a healthcare provider says not to stop taking the medicines for health reasons, the patient might be warned that they could have some bruising after the EMG test.

  • NCV may advise against getting the test for those with electrical device implants.
  • Make sure your healthcare providers are aware of your whole medical history.

Injury Medical Chiropractic & 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.

Peripheral Neuropathy and Chiropractic Care

References

Ferdousi, M., Kalteniece, A., Azmi, S., Petropoulos, I. N., Worthington, A., D’Onofrio, L., Dhage, S., Ponirakis, G., Alam, U., Marshall, A., Faber, C. G., Lauria, G., Soran, H., & Malik, R. A. (2020). Corneal confocal microscopy compared with quantitative sensory testing and nerve conduction for diagnosing and stratifying the severity of diabetic peripheral neuropathy. BMJ open diabetes research & care, 8(2), e001801. https://doi.org/10.1136/bmjdrc-2020-001801

Tada, K., Murai, A., Nakamura, Y., Nakade, Y., & Tsuchiya, H. (2022). In Carpal Tunnel Syndrome, Sensory Nerve Conduction Velocities Are Worst in the Middle Finger Than in the Index Finger. Frontiers in Neurology, 13, 851108. https://doi.org/10.3389/fneur.2022.851108

Shibuya, K., Tsuneyama, A., Misawa, S., Suzuki, Y. I., Suichi, T., Kojima, Y., Nakamura, K., Kano, H., Ohtani, R., Aotsuka, Y., Morooka, M., Prado, M., & Kuwabara, S. (2022). Different patterns of sensory nerve involvement in chronic inflammatory demyelinating polyneuropathy subtypes. Muscle & Nerve, 66(2), 131–135. https://doi.org/10.1002/mus.27530

Tavee J. (2019). Nerve conduction studies: Basic concepts. Handbook of Clinical Neurology, 160, 217–224. https://doi.org/10.1016/B978-0-444-64032-1.00014-X

By Dr. Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP 0 Comments Chiropractic Care, Therapy , , , , , , , , , , , , , , , , , ,

Bone Density Test and Its Importance for Health

What is a bone density test, how is it performed, and what do the results mean?

Bone Density Test

A bone density test examines bone mass, which indicates overall bone strength. Assessing bone density or mass is necessary for diagnosing osteopenia or osteoporosis, conditions that increase the risk of broken bones. The scan is performed through dual-energy X-ray absorptiometry (DEXA), which examines the thickness of the bones. Results from DEXA scans are compared to standardized values to determine whether bone density is lower than normal and whether osteopenia or osteoporosis is present.

Examination

The procedure examines bone density, or bone mass. The bones’ density, or mass, is an overall indicator of bone strength. The greater the bone density, the thicker and stronger the bones are. The test is used to diagnose osteoporosis, a condition characterized by brittle bones at risk of breaking due to significantly low bone density. A bone density test can also diagnose osteopenia, a condition characterized by lower than normal bone mass that can lead to osteoporosis. (National Institute of Arthritis and Musculoskeletal and Skin Diseases, 2025) It is recommended that all women aged 65 and older and all men aged 70 and older have a bone density scan to screen for bone loss to help prevent fractures. (Kling J. M., Clarke B. L., & Sandhu N. P. 2014)

  • Bone density scans can establish a baseline level of bone density and track changes over time.
  • For individuals with osteoporosis or osteopenia, a bone density scan can help track how well their bones respond to treatment.

Procedure

The most common bone density test is a dual-energy X-ray absorptiometry, or DEXA, scan. A DEXA scan is similar to getting an X-ray taken, but it uses two beams to produce a more detailed and sensitive reading. (National Institute of Arthritis and Musculoskeletal and Skin Diseases, 2025)

  • During a DEXA scan, the patient will lie on their back on a table with their legs elevated on a padded platform.
  • An X-ray scanner will pass over the spine and hips while another scans beneath.
  • While the scan takes place, the patient will be asked to hold very still to obtain an accurate image.
  • The scan will obtain bone density readings from the spine and hip, the two most commonly fractured bones, and generally takes less than 30 minutes.

Results

A DEXA scan measures bone density in grams per centimeter squared (g/cm²). This number indicates how densely bone cells are packed together in a specific area of bone. This bone density reading is then compared to a standardized value to determine if bone density is within a normal range or lower than average.

For postmenopausal women and men aged 50 and older, bone density values are given a T score. The T-scores are then compared to a standardized bone density level of a healthy 30-year-old adult with peak bone density levels. (Kling J. M., Clarke B. L., & Sandhu N. P. 2014) Scores indicate the following: (Kling J. M., Clarke B. L., & Sandhu N. P., 2014)

  • Equal to minus 1.0 or above: Normal bone density
  • Between minus 1.0 and minus 2.5: Low bone density (osteopenia)
  • Equal to minus 2.5 or below: Osteoporosis
  1. Bone density values are reported as a Z score for women who have not undergone menopause and men under 50 years old.
  2. Z scores are compared to bone density levels of individuals of the same age and sex.
  3. A Z score of minus 2.0 or lower indicates low bone density, which can be caused by factors other than aging, such as medication side effects, nutritional deficiencies, or thyroid problems.

Arthritis Diagnosis 

Because a DEXA scan only measures the thickness of bones, it doesn’t work to diagnose arthritis. An X-ray of the affected joint is currently the most accurate way to diagnose arthritis. The Kellgren-Lawrence classification system categorizes the extent of arthritis based on the severity of joint damage seen on an X-ray. According to this system, arthritis can be classified as: (Kohn M. D., Sassoon A. A., & Fernando N. D. 2016)

Grade 1 (minor)

  • Minimal or no joint space narrowing, with possible bone spur formation.

Grade 2 (mild)

  • Possible joint space narrowing, with definite bone spur formation.

Grade 3 (moderate)

  • Definite joint space narrowing, moderate bone spur formation, mild sclerosis (abnormal thickening of bone), and possible deformation of bone ends.

Grade 4 (severe)

  • Severe joint space narrowing, large bone spur formation, marked sclerosis, and definite deformation of bone ends.

Injury Medical Chiropractic & Functional Medicine Clinic

Exercise can be incredibly beneficial for improving bone density, joint mobility, and the strength of surrounding muscles, which support and protect joints and bones. Talk to a healthcare provider to learn what interventions and available treatment options would be the most effective. 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.

Osteoporosis

References

National Institute of Arthritis and Musculoskeletal and Skin Diseases. (2025). Bone mineral density tests: what the numbers mean. Retrieved from https://www.niams.nih.gov/health-topics/bone-mineral-density-tests-what-numbers-mean

Kling, J. M., Clarke, B. L., & Sandhu, N. P. (2014). Osteoporosis prevention, screening, and treatment: a review. Journal of women’s health (2002), 23(7), 563–572. https://doi.org/10.1089/jwh.2013.4611

Kohn, M. D., Sassoon, A. A., & Fernando, N. D. (2016). Classifications in Brief: Kellgren-Lawrence Classification of Osteoarthritis. Clinical orthopaedics and related research, 474(8), 1886–1893. https://doi.org/10.1007/s11999-016-4732-4

By Dr. Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP 0 Comments Chiropractic Care, Physio , , , , , , , , , , , , , , , , , ,

Postural Assessment for Optimal Movement Efficiency

Can postural assessments help identify problems with how a person stands or sits, which can lead to various musculoskeletal issues?

Postural Assessment

Proper posture is an exercise in which the muscles support the skeleton in a comfortable, stable, and efficient alignment. Healthy posture is present when the body is still and when moving. However, numerous factors can affect and hinder posture. These include daily wear and tear, injury, illness, or a condition. A posture assessment is a process that identifies posture issues and their root causes, often using visual and palpation techniques, and can help determine appropriate treatment or exercises. (Science Direct, 2007)

Visual Assessment

  • Observing the body’s alignment and symmetry from different angles (anterior, posterior, and lateral views).

Palpation

Movement Analysis

  • Assessing how a person moves and if there are any limitations or compensations. (Physiopedia, 2025)

Importance and Benefits

Early Identification

  • Helps identify potential problems early, before they become more serious.

Targeted Treatment

  • Allows for the development of personalized treatment plans to address specific postural issues.

Injury Prevention

  • It can help prevent injuries by addressing underlying postural imbalances.

Postural Assessment Tools

Some tools used include:

Basic Assessment

Stand Upright

  • The patient stands with their feet shoulder-width apart, arms relaxed at their sides, and looks straight ahead. (Science Direct, 2007)

Alignment Observation

  • Head: Is the head aligned over the shoulders, forward, or tilted?
  • Shoulders: Are the shoulders level, or are they rounded forward?
  • Back: Is the back straight, or is there excessive curvature (kyphosis or lordosis)?
  • Pelvis: Is the pelvis level or tilted forward or backward?
  • Knees: Are the knees straight or slightly bent?
  • Feet: Are the feet flat on the ground, or is there excessive arch or pronation?

Palpate for Muscle Imbalances

Consider the Patient’s Activity Level and History

Wall Test

  • The patient stands against a wall with their feet shoulder-width apart and heels about 6 inches from the baseboard.
  • If they have good posture, their ears will be vertically aligned with their shoulders, and their head will be no more than three finger widths from the wall. (Physiopedia, 2025)

Postural Issues Examples

Rounded Shoulders (Hyperkyphosis)

  • Forward rounding of the upper back.

Forward Head Posture

  • Head positioned too far forward.

Lordosis

  • Excessive inward curve of the lower back.

Flat Back

  • Reduced natural curve of the lower back.

Muscle Imbalances

Professionals Who Can Perform a Posture Assessment

Physiotherapists

  • Professionals trained in assessing and treating musculoskeletal problems.

Chiropractors

  • Professionals who focus on the spine and nervous system.

Fitness Professionals

  • Personal trainers or other fitness professionals can use posture assessments to help clients improve their posture and movement.

Ergonomists

  • Professionals who specialize in designing workspaces and environments to promote good posture and reduce strain.

Injury Medical Chiropractic & Functional Medicine Clinic

Talk to a healthcare provider to learn what interventions would help the most. 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.

Multidisciplinary Evaluation and Treatment

References

ScienceDirect. (2007). Postural Assessment – an Overview. Evidence-Based Manual Medicine, 2007. https://www.sciencedirect.com/topics/medicine-and-dentistry/postural-assessment#recommended-publications

Singla, D., & Veqar, Z. (2014). Methods of postural assessment used for sports persons. Journal of clinical and diagnostic research: JCDR, 8(4), LE01–LE4. https://doi.org/10.7860/JCDR/2014/6836.4266

Du, S. H., Zhang, Y. H., Yang, Q. H., Wang, Y. C., Fang, Y., & Wang, X. Q. (2023). Spinal posture assessment and low back pain. EFORT open reviews, 8(9), 708–718. https://doi.org/10.1530/EOR-23-0025

Physiopedia. (2025). Sports Screening: Postural Assessment. https://www.physio-pedia.com/Sports_Screening:_Postural_Assessment#:~:text=Postural%20assessment%20as%20part%20of,tone%20can%20cause%20postural%20faults.

By Dr. Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP 0 Comments Chiropractic Care, Therapy , , , , , , , , , , , , , , , , , , ,

Hamstring Syndrome Relief for Sciatic Nerve Pain

Individuals dealing with pain in the buttocks and in the back of the thigh, along with numbness and tingling down to the bottom of the foot, may be experiencing hamstring syndrome, a condition caused by pressure on the sciatic nerve. What is the recommended treatment?

Hamstring-Syndrome Relief

The hamstrings are three muscles in the back of the thigh, extending from the pelvis or upper thigh across the back of the knee to the leg. This muscle group is important for bending the knee, straightening the hip, and stabilizing the knee. The sciatic nerve is a large nerve that runs from the lower back down the legs. It usually passes near or through these muscles, and the pelvis then runs under these muscles in the thigh. Hamstring syndrome refers to pain in the buttock and back of the thigh, often radiating down the leg, caused by compression or irritation of the sciatic nerve at the hamstring-insertion point on the ischial tuberosity, typically due to tight or scarred tissue. (Sakari Orava, 1997)

Pain Location

The pain is primarily felt in the buttock and back of the thigh, sometimes extending down the leg. It’s characterized by pressure on the sciatic nerve, which runs through the buttock and into the back of the thigh, where it supplies the hamstring muscles. (Kaiser Permanente, 2024)

Mechanism

This pressure can occur due to: (Sakari Orava, 1997) (Kaiser Permanente, 2024)

Fibrotic Bands

  • Tight, tendon-like, or scarred bands of tissue at the hamstring’s insertion point/ischial tuberosity can irritate the sciatic nerve.

Compression

  • These bands can compress the nerve, especially when sitting or during activities that involve hip flexion and knee extension.

Traction

  • The sciatic nerve can also be stretched or irritated by the hamstring tendons.

Symptoms

  • Pain in the buttock and back of the thigh may radiate down the leg.
  • Pain that is worse when sitting, stretching the hamstrings, or during activities like running. (Puranen J. & Orava S. 1988)
  • Numbness or tingling in the back of the leg

Differential Diagnosis

It’s important to differentiate hamstring syndrome from other conditions that could be causing similar symptoms, including:

  • Piriformis syndrome
  • Ischiogluteal bursitis
  • Hamstring muscle strains

Treatment

Hamstring syndrome relief may consist of the following:

Conservative

  • Initial treatment focuses on rest, ice, stretching, and over-the-counter pain relievers.

Physical Therapy

Injections

  • In some cases, injections with cortisone and numbing medicine may be used to reduce nerve inflammation and pain. (Lower Limb Surgery, 2024)

Surgery

  • In severe cases, surgery may be necessary to release the compressing bands and free the sciatic nerve. (Lower Limb Surgery, 2024)

Injury Medical Chiropractic & Functional Medicine Clinic

Talk to a healthcare provider about what interventions would help the most. 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.

Sciatica: Causes, Symptoms and Tips

References

Orava, Sakari. (1997). Hamstring syndrome. Operative Techniques in Sports Medicine, 5(3). https://doi.org/https://doi.org/10.1016/S1060-1872(97)80035-4.

Kaiser Permanente. (2024). Hamstring Syndrome: Care Instructions. https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.hamstring-syndrome-care-instructions.abr3618

Puranen, J., & Orava, S. (1988). The hamstring syndrome. A new diagnosis of gluteal sciatic pain. The American Journal of Sports Medicine, 16(5), 517–521. https://doi.org/10.1177/036354658801600515

Zion Physical Therapy. (2023). Hamstring Tendinitis Vs. Hamstring Syndrome. https://www.zionpt.com/post/hamstring-tendinitis-vs-hamstring-syndrome

Lower Limb Surgery. (2024). Hamstring Syndrome. https://www.lowerlimbsurgery.com/hamstring syndrome#:~:text=General%20Treatment%20Considerations,%E2%80%8B

By Dr. Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP 0 Comments Chiropractic Care, Physio , , , , , , , , , , , , , , , , ,

Leg Cramp Causes Explained: Your Guide

Can understanding how leg cramps feel, their causes, and prevention help individuals with treatment options?

Leg Cramp Causes

A leg cramp is an involuntary contraction of the muscles in the leg, typically the calf muscle. It causes a sudden, sharp, and painful tightening of the muscle. They commonly occur from

  • Dehydration
  • Muscle overexertion
  • They can be a symptom of an underlying health condition, such as type 2 diabetes or kidney failure.
  • They can also be a side effect of certain medications.

Sensation

Leg cramps typically cause sudden, severe pain in the affected muscle. Individuals may also feel a hard knot or twitching of the muscle. The calf muscles are the most common site. (Harvard Health Publishing, 2024)

Causes

The underlying cause of leg cramps isn’t always known. However, work, lifestyle factors, and medical conditions can play a role. Common causes include:

  • Muscle fatigue from overuse
  • Electrolyte imbalances (e.g., potassium, magnesium)
  • Dehydration
  • Poor circulation
  • Nerve damage
  • Certain medications (e.g., statins, diuretics)

Lifestyle Risk Factors

Certain lifestyle factors and other physical characteristics can increase the risk of leg cramps and can include: (Harvard Health Publishing, 2024) (National Library of Medicine, 2020)

  • Age (those 60 and over are affected more often than younger individuals)
  • Exercising in a hot environment
  • Exercising for extended periods
  • Obesity
  • Pregnancy

Medical Factors

Leg cramps are also associated with certain medical conditions and treatments for illness. Examples include: (Maughan R. J. & Shirreffs S. M. 2019) (Garrison, S. R. et al., 2020)

  • Pinched nerves in the lower back
  • Decreased blood circulation in the legs
  • Spinal cord injury
  • Certain medications (such as statins and diuretics)
  • Allergies
  • Gastrointestinal disease (digestive tract disorders)
  • Cardiovascular disease
  • Liver failure
  • Cancer
  • Dialysis – treatment to remove excess fluid from the blood when kidneys fail.
  • Respiratory diseases of the lungs and airways
  • Amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease, a neurological condition affecting the brain, nerves, and muscles)

Self-Care

Leg cramps often go away on their own after a few minutes. However, other self-care can help. Recommendations: (Harvard Health Publishing, 2024)

Change Body Positions

  • Moving can help relieve tension and pain.
  • If the leg cramps happen at night, stand up and take a few steps.

Massage

  • Gently rubbing the cramped muscle can help it relax.

Stretch

  • Stretching the cramping muscle can help it relax.

Apply Heat

  • If the leg cramp lasts more than a few minutes, apply a heating pad or take a warm shower to increase blood circulation to and around the muscle to help it relax.

Treatment

There are no medications specifically for treating leg cramps. However, if symptoms are caused by another medical condition, treating the underlying condition might help reduce cramp frequency. Dehydration or low electrolytes can cause leg cramps; in these cases, drinking water or electrolyte-infused beverages can help. If cramps are related to overexercising, consider reducing the intensity of your activity or exercising in a cooler environment. (Maughan R. J. & Shirreffs S. M. 2019) Magnesium supplements are usually marketed to relieve muscle cramps; they are not proven to alleviate them. (Garrison, S. R. et al., 2020)

Exercises and Stretches

Knowing which muscle to target when stretching the leg is important. If the cramp does not resolve after the first stretch attempt, try again.

Hamstring Muscle

Pain in the back of the thigh. Here’s how to stretch the hamstrings (American Academy of Orthopaedic Surgeons, 2018)

  • Lie on your back.
  • Bend both knees and rest your feet on the ground or mattress if the cramp occurs at night.
  • On the leg that is cramping, bring the knee toward your chest.
  • Interlock the fingers behind your knee.
  • Slowly straighten the knee and pull your leg toward your head until you feel a stretching sensation along the back of the thigh.
  • Hold for 30 to 60 seconds.

Calf Muscle

The calf muscle is the most common for leg cramps. To stretch the calf muscle (American Academy of Orthopaedic Surgeons, 2018)

  • Stand facing a wall.
  • Place palms flat against the wall at shoulder height.
  • Step the cramping leg away from the wall around 12 to 18 inches.
  • Keep your heels flat on the floor.
  • Keeping the back leg straight, bend the front knee slowly and lean forward until you feel a stretch along the calf.
  • Hold for 30 to 60 seconds.

Prevention

They can’t always be prevented. However, if they are related to dehydration or other lifestyle factors, individuals may be able to prevent them from occurring or decrease the frequency. Try the following: (Harvard Health Publishing, 2024)

  • Drink plenty of water.
  • Stretch the leg muscles before you go to bed.
  • Try drinking a beverage with electrolytes for longer workouts or activities in hot weather.
  • Warm up before exercise, such as with a slow jog, before getting into more intense exercises.
  • Properly cool down after a workout.
  • Stretch the leg muscles before and after exercising.
  • Maintain a healthy body weight.

Contact a Healthcare Provider

Leg cramps can sometimes signify something more serious than a Charley horse. See a healthcare provider if any of the following symptoms present (National Library of Medicine, 2020)

  • Change in skin color, including redness or a deeper tone than normal
  • Cramps that last more than a few minutes or occur frequently
  • Muscle weakness
  • Severe pain from the cramps
  • Swelling
  • Warm skin

Injury Medical Chiropractic & Functional Medicine Clinic

Talk to a healthcare provider about leg cramps to learn what interventions would help the most. 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.

Is Motion Key to Healing?

References

Harvard Health Publishing. (2024). How to get rid of muscle cramps in your legs. https://www.health.harvard.edu/pain/how-to-get-rid-of-muscle-cramps-in-your-legs

National Library of Medicine. (2020). Muscle cramps. Retrieved from https://medlineplus.gov/musclecramps.html

Maughan, R. J., & Shirreffs, S. M. (2019). Muscle Cramping During Exercise: Causes, Solutions, and Questions Remaining. Sports Medicine (Auckland, N.Z.), 49(Suppl 2), 115–124. https://doi.org/10.1007/s40279-019-01162-1

Garrison, S. R., Korownyk, C. S., Kolber, M. R., Allan, G. M., Musini, V. M., Sekhon, R. K., & Dugré, N. (2020). Magnesium for skeletal muscle cramps. The Cochrane database of systematic reviews, 9(9), CD009402. https://doi.org/10.1002/14651858.CD009402.pub3

American Academy of Orthopaedic Surgeons. (2018). Knee conditioning program. https://orthoinfo.aaos.org/en/recovery/knee-conditioning-program/