Microfragmented adipose tissue (MFAT) therapy uses your body’s own fat-derived tissue to support joint, soft tissue, and musculoskeletal healing. This regenerative approach is designed to help reduce pain, calm inflammation, and improve function without surgery.
A data center never truly sleeps. Servers keep running, alerts arrive at odd hours, and overnight teams keep essential systems online while most families sleep. For employees working those shifts, the challenge isn’t just productivity. It is coming home with enough comfort, patience, energy, and presence for the people who depend on you.
At ChiroMed, that family role matters. Providing for a household also means protecting your ability to move well, sleep deeply, think clearly, and stay engaged at home. Shift work can make those goals harder, but a thoughtful plan can help protect your health and family time.
Why 24/7 Work Can Follow You Home
Night and rotating shifts can disrupt the body’s normal sleep-wake rhythm. When sleep is shortened or irregular, fatigue may affect attention, reaction time, mood, and judgment. Research links shift work with disrupted sleep and higher metabolic risk, although individual risk varies with schedule, health history, activity, diet, and other factors (Khosravipour et al., 2021; National Institute for Occupational Safety and Health [NIOSH], 2026).
For data center employees, the physical side also matters. A shift may include console work, standing, device use, reaching into racks, carrying equipment, or crouching. A systematic review of IT professionals identified prolonged sitting, awkward posture, insufficient sleep, job demands, and overexertion among musculoskeletal risk factors (Prasetya et al., 2024).
Small stressors can stack up. A stiff neck follows ticket work. Tight hips can make the low back feel guarded. Fatigue makes balanced meals less convenient, while daytime sleep competes with the household schedule.
Protecting Your Back During the Shift
Your body benefits from variety. When possible, alternate sitting, standing, walking, and task positions. Keep frequently used screens near eye level. Bring work toward you instead of repeatedly reaching with rounded shoulders. When lifting equipment, keep the load close, use your hips and legs, and avoid twisting while carrying.
Short active breaks may help. Evidence suggests breaks involving postural change can reduce discomfort for some workers without necessarily reducing productivity (Waongenngarm et al., 2018). One person may benefit from a brief walk and chest-opening movement, while another needs hip mobility, trunk activation, or a change in workstation height.
Persistent pain deserves more than repeated stretching. New weakness, numbness, loss of coordination, severe pain after trauma, bowel or bladder changes, fever, unexplained weight loss, or progressive neurological symptoms should be medically evaluated promptly.
Sleep Is Part of the Family Budget
Shift workers often treat sleep as the flexible part of the schedule. Work is fixed. School drop-off is fixed. Bills, appointments, meals, and family responsibilities feel fixed. Sleep gets whatever time remains. Over time, that trade can become expensive.
Adequate sleep supports attention, recovery, and safety, yet night work can shorten or disrupt sleep (NIOSH, 2026). Daytime rest is often difficult because light, noise, messages, errands, and family routines signal that it is time to be awake.
Treat your sleep window like a protected appointment. Use blackout curtains or an eye mask, reduce noise, silence nonessential notifications, and keep the room cool. After a night shift, a predictable wind-down routine can separate work from rest. If caffeine helps, stop it far enough before sleep that it does not interfere with settling down.
Make the plan visible to your family. A shared calendar can show sleep, work, and priorities. Protecting sleep is not withdrawing from family life. It protects the energy you bring back.
Meals, Energy, and Metabolic Health
Overnight schedules can disrupt meal timing as easily as sleep. When healthy food is unavailable at 2:00 a.m., vending machines, energy drinks, or drive-through meals become easy defaults. Shift work has been associated with a modestly higher risk of metabolic syndrome, but association does not mean every shift worker will develop metabolic disease (Khosravipour et al., 2021).
Reduce decisions by packing food before the shift: protein, vegetables or fruit, a high-fiber carbohydrate, and water. Hydrate steadily rather than catching up at the end of the night. If you have diabetes, high blood pressure, abnormal cholesterol, gastrointestinal symptoms, or major weight changes, discuss meal timing with a clinician.
Integrated Care Looks at Structure and Physiology Together
A sore back and exhausted mornings may share the same demanding schedule, but they are not the same problem. Integrated care can evaluate both.
A chiropractic evaluation can assess spinal and extremity motion, posture, movement patterns, muscular imbalance, and mechanical contributors to neck or back symptoms. Spinal manipulation is one nonpharmacologic option included in major low-back-pain guidelines for appropriately selected patients, alongside exercise and other conservative care (Qaseem et al., 2017). Treatment should match your diagnosis, preferences, risks, and response.
Medical and nurse-practitioner evaluation can look at sleep quality, blood pressure, medications, fatigue patterns, nutrition, cardiometabolic history, and other symptoms. When clinically appropriate, laboratory testing may assess glucose control, lipids, liver enzymes, or other concerns. The goal is not to order tests; it is to choose information that may change care.
At ChiroMed, Dr. Alex Jimenez, DC, APRN, FNP-BC, CFMP, IFMCP, bridges physical medicine with functional diagnostics through chiropractic structural alignment, mechanical rehabilitation, metabolic assessment, and personalized functional medicine nutrition. He holds Texas Chiropractic License #TX5807, New Mexico Chiropractic License #NM-DC2182, Texas Advanced Practice Nursing License #1191402 with Prescriptive Authority #59628, and NPI #1205907805.
Dr. Maria G. Cardenas, MD, Board Certified in Internal Medicine, serves as Medical Director and Clinical Director, providing oversight for complex metabolic comorbidities, advanced laboratory panels, risk stratification, and internal medicine treatment coordination. She holds Texas Medical License #J2933 and NPI #1164426748.
Your Health Plan Should Fit Your Family
Beneficence means care should serve your well-being, not force you into a generic protocol. For a shift-working parent or family provider, improvement may mean less pain during rounds, safer lifting, steadier energy, better sleep after nights, or enough reserve to enjoy breakfast with your children instead of arriving home uncomfortable and depleted.
Autonomy matters just as much. You deserve to understand what is being assessed, why a treatment or test is suggested, what alternatives exist, and what you can do at home. Your schedule, family obligations, goals, culture, budget, and preferences should shape the plan.
Ask yourself: What symptom most interferes with work? What health issue follows you home? Which part of your schedule makes recovery hardest? What change would help your family feel the difference?
A Stronger Shift Can Support a Stronger Home
You may not control the 24/7 demands of the data center, but you can protect your body and family life. Movement habits, sleep, planned meals, hydration, and individualized care can reduce avoidable strain and reveal problems that deserve attention.
If neck or back tension, fatigue, poor sleep, or metabolic concerns are affecting work or family time, ChiroMed can evaluate both structural and medical factors. A collaborative DC-MD/NP approach can help you understand your options and choose a plan supporting safe movement, informed decisions, sustainable energy, and the people you provide for.
References
Khosravipour, M., Khanlari, P., Khazaie, S., Khosravipour, H., & Khazaie, H. (2021). A systematic review and meta-analysis of the association between shift work and metabolic syndrome: The roles of sleep, gender, and type of shift work. Sleep Medicine Reviews, 57, 101427. doi:10.1016/j.smrv.2021.101427
Prasetya, T. A. E., Al Mamun, A., Rahmania, A., Ahmed, M., Uddin, A. S. M. S., Nilamsari, N., & Wardani, R. W. K. (2024). Prevalence and associated risk factors of musculoskeletal disorders among information technology professionals: A systematic review. Narra J, 4(3), e1100. doi:10.52225/narra.v4i3.1100
Qaseem, A., Wilt, T. J., McLean, R. M., & Forciea, M. A. (2017). Noninvasive treatments for acute, subacute, and chronic low back pain: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 166(7), 514–530. doi:10.7326/M16-2367
Waongenngarm, P., Areerak, K., & Janwantanakul, P. (2018). The effects of breaks on low back pain, discomfort, and work productivity in office workers: A systematic review of randomized and non-randomized controlled trials. Applied Ergonomics, 68, 230–239. doi:10.1016/j.apergo.2017.12.003
National Institute for Occupational Safety and Health. (2026). Fatigue and work. Centers for Disease Control and Prevention.
Occipital neuralgia is a debilitating condition characterized by sharp, throbbing, or electric shock-like pain in the upper neck, back of the head, and behind the ears, often radiating to the scalp. This pain originates from the irritation or compression of the greater and lesser occipital nerves. In this educational post, I, Dr. Alex Jimenez, will take you on a journey to understand the physiological underpinnings of occipital neuralgia, exploring its causes, symptoms, and the latest in diagnostic and treatment strategies. We will delve into how our integrative practice combines evidence-based medicine with a holistic philosophy. A key component of our approach is the collaboration between me, with a background in chiropractic and functional medicine, and our esteemed Medical Director, Dr. Maria Guadalupe Cardenas, MD, a Board-Certified Internist with over four decades of experience. Together, we provide a multidisciplinary framework that integrates chiropractic care, medical oversight, functional medicine, and rehabilitative therapies to offer comprehensive, personalized solutions for patients with this painful condition. We will also examine a specific interventional technique—the occipital nerve block—and discuss how it fits within our broader, patient-centered treatment paradigm.
Hello, I’m Dr. Alex Jimenez. With my extensive training as a Doctor of Chiropractic (DC), Advanced Practice Registered Nurse (APRN), Family Nurse Practitioner (FNP-BC), and certifications in functional medicine (CFMP, IFMCP), I have dedicated my career to understanding and treating complex neuromusculoskeletal conditions. At Injury Medical Clinic PA, our mission is to provide a beacon of hope for those navigating the often-frustrating world of chronic pain.
A condition I frequently encounter in my clinical practice is occipital neuralgia. This isn’t just a simple headache; it’s a distinct neurological disorder that can severely impact one’s quality of life. The pain is often described as sharp, jolting, and unrelenting, stemming from the occipital nerves that run from the top of the spinal cord up through the scalp.
Our clinic uses a unique, powerful model of integrative care. I work closely with Dr. Maria Guadalupe Cardenas, MD. As a Board-Certified Internist with over 40 years of dedicated patient care (NPI #1164426749, Texas MD License #J2933), Dr. Cardenas serves as our Medical Director and Collaborative Physician. This partnership allows us to seamlessly blend the diagnostic precision and medical oversight of internal medicine with the holistic, biomechanical focus of chiropractic and functional medicine. This multidisciplinary approach ensures our patients receive a comprehensive, well-rounded treatment plan tailored to their individual needs, whether they are dealing with a personal injury, a chronic condition like occipital neuralgia, or are on a journey toward optimal wellness.
The Anatomy of Pain: What Are the Occipital Nerves?
To truly understand occipital neuralgia, we must first explore the anatomy involved. The primary culprits are the greater and lesser occipital nerves. These nerves are not part of the brain but are peripheral nerves that emerge from the upper cervical spine, specifically from the C2 and C3 nerve roots.
Greater Occipital Nerve: This is the larger of the two and originates from the C2 nerve root. It travels up through the deep muscles at the back of the neck, pierces the trapezius muscle, and then branches to provide sensation to most of the scalp on the back and top of the head.
Lesser Occipital Nerve: This nerve originates from the C2 and C3 nerve roots. It runs along the side of the neck, behind the ear, providing sensation to the skin in that area and the scalp just behind it.
When these nerves become inflamed, compressed, or injured anywhere along their path, they send distress signals that the brain interprets as intense pain. This is the essence of neuralgia—nerve pain.
Identifying the Root Cause of Occipital Neuralgia
Effective treatment depends on identifying the underlying cause of the nerve irritation. Occipital neuralgia is often secondary to another issue. Based on my clinical observations and leading research, common causes include:
Muscle Tension and Spasm: Chronic tension in the suboccipital muscles (the small muscles connecting the skull to the top of the spine) is a primary driver. Poor posture, such as “tech neck” from looking down at devices, can lead to hypertonicity in these muscles, effectively entrapping the occipital nerves as they pass through.
Trauma or Injury: Whiplash from a car accident, a direct blow to the back of the head, or even repetitive micro-trauma can injure the nerves or surrounding tissues, leading to inflammation and compression.
Cervical Spine Misalignments (Subluxations): From a chiropractic perspective, misalignments in the upper cervical vertebrae (atlas and axis) can directly irritate the C2 and C3 nerve roots from which the occipital nerves originate. This biomechanical dysfunction is a critical factor we address with chiropractic adjustments.
Degenerative Conditions: Osteoarthritis or degenerative disc disease in the upper cervical spine can lead to bone spurs or narrowing of the spaces where nerves exit the spinal column (foraminal stenosis), causing nerve compression.
Systemic Conditions: Less commonly, conditions like gout, diabetes, or infections can cause inflammation that affects the occipital nerves.
The Role of Integrative Chiropractic Care
This is where our integrative model truly shines. As a chiropractor, I focus on the biomechanical integrity of the spine and nervous system. When a patient presents with symptoms of occipital neuralgia, my assessment begins with a thorough examination of the cervical spine.
Chiropractic Adjustments: Using precise, gentle adjustments, I work to restore proper motion and alignment to the C1 (atlas) and C2 (axis) vertebrae. By correcting these vertebral subluxations, we can alleviate direct pressure on the nerve roots. This is not merely “cracking the neck”; it is a specific intervention designed to improve nerve function at its source (Taylor & Murphy, 2020).
Soft Tissue Mobilization: The nerves don’t exist in a vacuum. Muscles, fascia, and other soft tissues surround them. I utilize techniques like myofascial release, trigger point therapy, and instrument-assisted soft tissue mobilization (IASTM) to release tension in the suboccipital and trapezius muscles. This creates space for the nerve, reducing entrapment and inflammation.
Functional Rehabilitation: Treatment doesn’t end in the clinic. We empower patients with specific postural correction exercises, neck-muscle stretches, and strengthening exercises for the deep cervical flexors. This proactive approach helps prevent the recurrence of muscle tension and postural strain that often trigger occipital neuralgia.
This chiropractic foundation sets the stage for resolving the condition’s biomechanical triggers. However, for some patients, the inflammation and pain are so acute that they create a barrier to effective manual therapy. This is where medical intervention, under Dr. Cardenas’s guidance, becomes crucial.
Medical Intervention: The Occipital Nerve Block
For patients experiencing severe, intractable pain, an occipital nerve block can be a game-changer. This minimally invasive procedure serves both diagnostic and therapeutic purposes. It involves injecting a small amount of local anesthetic and a corticosteroid directly around the inflamed occipital nerves.
Let’s walk through the procedure, as performed in our clinic under my scope as a Family Nurse Practitioner, to understand the “why” behind each step.
Step 1: Precise Identification of Tender Points
The first and most critical step is locating the exact points of maximum tenderness. The patient’s feedback is paramount. I use my fingers to palpate the area where the occipital nerves emerge, just below the base of the skull (the occiput). I’ll ask, “Is that the spot?” When the patient confirms, “Yes, that’s it,” I know I’ve found a primary trigger point. Because we’re working in the hairline, I make a small indentation with a capped pen and a tiny ink mark just below it for reference. This ensures absolute precision.
Step 2: Aseptic Preparation
Patient safety is non-negotiable. I thoroughly cleanse the marked areas with alcohol swabs. In a hairy area like the scalp, this is a practical, effective way to prepare the skin and minimize infection risk.
Step 3: The Therapeutic Combination
The syringe contains a carefully measured mixture of two key components:
Lidocaine: This is a local anesthetic. It provides immediate pain relief by blocking sodium channels in nerve fibers. This stops pain signals from reaching the brain. The rapid relief it provides also serves a diagnostic function—if the pain disappears almost instantly, it confirms that the occipital nerve was indeed the source of the pain.
Cortisone: This is a powerful anti-inflammatory steroid. While lidocaine provides short-term relief, cortisone targets the underlying inflammation. It suppresses the local inflammatory response, reduces swelling around the nerve, and provides longer-lasting pain relief that can last for weeks or even months (Govindappagari & V, 2022). The goal is to break the pain-inflammation cycle.
Step 4: The Injection Process
Using a fine-gauge needle (a 25-gauge in this case) to minimize discomfort, I perform the injection. I always alert the patient, saying, “You’re going to feel a little stick.” I advance the needle until it is near the occiput, in the vicinity of the nerve.
Before injecting, I perform an aspiration. This means I gently pull back on the plunger to ensure the needle tip is not inside a blood vessel. If blood were to enter the syringe, it would indicate an intravascular position, and injecting the steroid there could lead to systemic side effects. Seeing no blood on aspiration confirms we are in the correct tissue plane. I then slowly inject the solution, bathing the nerve in the anesthetic and anti-inflammatory medication. I repeat this for each identified trigger point.
Step 5: Immediate Post-Procedure Assessment
Immediately after the injection, I gently massage the area to help disperse the medication. Then comes the moment of truth. I apply pressure to the same spots that were excruciatingly painful just moments before. I ask, “Does that hurt right there?” The typical response is one of relief: “It feels better.” or “I just feel pressure now.”
This immediate feedback is invaluable. The patient’s significantly reduced pain confirms the block’s success. This relief, even if temporary from the anesthetic, breaks the cycle of pain and muscle guarding. It opens a crucial “window of opportunity” to apply our other therapies more effectively. With pain diminished, the patient can better tolerate chiropractic adjustments and engage in the necessary rehabilitative exercises.
A True Integrative Framework: Tying It All Together
The occipital nerve block is not a standalone cure; it is a strategic tool within our comprehensive care plan. Here is how the pieces fit together:
Initial Crisis Management: The occipital nerve block, overseen medically by Dr. Cardenas and performed by me as an FNP, provides rapid, significant pain relief. This calms the hypersensitive nervous system.
Restoring Biomechanical Function: During the pain-free window created by the block, I implement integrative chiropractic care. This includes targeted upper cervical spinal adjustments and soft tissue work to release muscular entrapment of the occipital nerves.
Addressing Systemic Drivers: As a functional medicine practitioner, I also look deeper. Is there a systemic inflammatory issue at play? We may use advanced lab testing to investigate nutritional deficiencies, food sensitivities, or metabolic imbalances that could be contributing to chronic inflammation. A pro-inflammatory diet can certainly worsen conditions like neuralgia.
Rehabilitation and Empowerment: Our physical therapy and rehabilitation team guides the patient through exercises to correct posture, strengthen supporting muscles, and improve overall spinal health, empowering them to maintain their results and prevent future flare-ups.
This cyclical, mutually reinforcing process is the heart of our practice. Medical intervention makes chiropractic care more effective, and chiropractic care addresses the root biomechanical issues to provide a long-term solution. Dr. Cardenas’s internal medicine expertise ensures we identify and manage any underlying systemic health issues, providing a complete safety net for the patient’s overall health.
By weaving together the latest evidence-based research and techniques from multiple disciplines, we create a patient journey that is not just about managing symptoms, but about restoring function, health, and quality of life. If you are struggling with head and neck pain, know that there are comprehensive, integrative solutions available that go beyond a simple prescription.
Taylor, R. S., & Murphy, F. (2020). Cervical spine manipulation for the treatment of headache: A case series. Chiropractic & Manual Therapies, 28(1), 25. https://doi.org/10.1186/s12998-020-00311-5
Hello, I’m Dr. Alex Jimenez. Welcome to our educational corner, where we delve into the latest advancements in musculoskeletal health. My extensive background, holding titles like DC, APRN, FNP-BC, and multiple functional medicine certifications, allows me to bridge various disciplines to offer comprehensive, evidence-based care.
In this post, we will explore percutaneous tenotomy, a groundbreaking, minimally invasive procedure for treating chronic tendinopathies such as tennis elbow, plantar fasciitis, and Achilles tendinopathy. We will detail the two leading techniques, Tenex (ultrasonic emulsification) and TenJet (hydroresection), explain their physiological mechanisms, and show how they remove diseased tendon tissue while preserving healthy structures. This discussion is grounded in the latest evidence-based research from leading experts in the field.
Furthermore, I will explain how our unique multidisciplinary practice in El Paso, Texas, integrates these advanced procedures. At Injury Medical Clinic, I work alongside our Medical Director, Dr. Maria Guadalupe Cardenas, MD. With over 40 years of experience as a Board-Certified Internist, Dr. Cardenas provides essential medical oversight, ensuring a safe, effective, collaborative environment. Together, we combine functional medicine, rehabilitative science, and integrative chiropractic care to create a holistic treatment journey that resolves pain, restores optimal function, and prevents recurrence.
Join me as we explore the science behind percutaneous tenotomy and discover how this innovative treatment, combined with a patient-centered, integrative framework, is transforming outcomes for those with chronic tendon pain.
Understanding the Challenge of Chronic Tendinopathy
As a clinician with decades of experience, I’ve seen countless patients struggle with tendinopathy, a condition often mislabeled as “tendinitis”. The key difference is that tendinitis implies active inflammation, whereas tendinopathy describes a degenerative state of the tendon. In tendinopathy, the tendon’s collagen fibers become disorganized, weakened, and filled with abnormal, painful tissue and sometimes microcalcifications. This is not an inflammatory problem but a structural failure of the tissue.
Conditions like lateral epicondylosis (tennis elbow), patellar tendinopathy (jumper’s knee), Achilles tendinopathy, and plantar fasciitis can be notoriously difficult to treat. Traditional conservative measures like rest, ice, and physical therapy are often effective for acute injuries but may fall short once the condition becomes chronic. In these cases, the degenerative tissue itself prevents healing, creating a cycle of pain and dysfunction. This is where modern, targeted interventions become essential.
Introducing Percutaneous Tenotomy: A Minimally Invasive Revolution
One of the most exciting advancements in musculoskeletal medicine is percutaneous tenotomy, an FDA-approved, ultrasound-guided procedure designed to debride, or remove, diseased tendon tissue. The term “percutaneous” simply means “through the skin,” highlighting its minimally invasive nature. This procedure represents a significant leap forward, offering a more definitive solution than conservative care but far less invasive than traditional open surgery.
The beauty of percutaneous tenotomy lies in its precision. Using real-time ultrasound imaging, we can guide a specialized instrument directly to the damaged tissue. This lets us selectively remove the degenerative, pain-generating portions of the tendon while leaving the surrounding healthy tissue intact. This precision is critical for promoting a robust healing response.
Two primary technologies dominate this field: Tenex and TenJet. Both are now accessible to appropriately trained primary care and specialty providers, allowing these procedures to be performed safely and effectively in the office.
The Tenex Health TX System: Ultrasonic Debridement
At our clinic, we utilize the Tenex Health TX system. This technology is a marvel of bioengineering, leveraging the principles of phacoemulsification—a technique famously used in modern cataract surgery.
How It Works: The Tenex system uses a handheld device connected to a console. The key component is an 18-gauge, double-lumen needle. When activated by a foot pedal, the needle tip vibrates at an ultrasonic frequency (around 20,000 Hz). This ultrasonic energy precisely emulsifies, or liquefies, the targeted degenerative tendon tissue.
The Double-Lumen Design: The Tenex probe’s ingenuity lies in its dual functionality. While the vibrating tip breaks down the pathologic tissue, a second, parallel lumen within the same needle simultaneously irrigates the area with saline and suctions the emulsified debris away. This “cut and remove” action is performed in a single, efficient step.
The Procedure: The procedure is performed under sterile conditions. After administering a local anesthetic, I use an ultrasound probe (covered in a sterile sheath) to visualize the damaged tendon. I insert the Tenex needle through the skin and guide it in real time to the area of tendinopathy. I then activate the device and methodically move the needle tip back and forth through the diseased tissue. The entire debridement process, or “cutting time,” is remarkably short, typically lasting between 30 and 90 seconds. The patient hears a humming sound but feels no pain due to the local anesthetic.
The TenJet System: A High-Velocity Saline Jet
The primary alternative to Tenex is the TenJet system. While the goal is the same—to remove diseased tendon tissue—the mechanism is different.
How It Works: TenJet uses a technology called hydroresection. Instead of ultrasonic energy, it employs a highly pressurized, high-velocity jet of sterile saline that shoots out from the tip of its specialized needle. This powerful fluid stream acts like a water knife, cutting and excising soft, degenerative tissue.
Simultaneous Aspiration: Like Tenex, the TenJet wand has a built-in suction feature that immediately removes resected tissue and excess saline, keeping the operative field clear and preventing pressure buildup.
Comparison: Both Tenex and TenJet are excellent tools. The choice between them often comes down to physician preference, training, and the specific characteristics of the tendon being treated. Both offer a significant advantage over traditional surgery by minimizing tissue trauma and accelerating recovery.
The Power of Integrative Care: Our Multidisciplinary Model
Performing an advanced procedure like percutaneous tenotomy is only one piece of the puzzle. True, lasting healing requires a comprehensive, integrative approach that addresses the patient as a whole. This is the core philosophy of our practice at Injury Medical Clinic.
My unique qualifications as a Doctor of Chiropractic (DC), an Advanced Practice Registered Nurse (APRN), a Family Nurse Practitioner (FNP-BC), and a certified Functional Medicine practitioner allow me to view health through multiple lenses. This is further strengthened by our collaborative structure with Dr. Maria Guadalupe Cardenas, MD, our esteemed Medical Director.
Dr. Cardenas is a Board-Certified Internist with an NPI of #1164426749 and Texas Medical License #J2933. With over four decades of clinical experience, she provides invaluable medical oversight for our practice. This multidisciplinary setup, where an MD and a DC work in tandem, ensures that our patients receive care that is both holistic and medically sound. We integrate the following services to create a powerful, synergistic treatment plan:
Medical Oversight and Diagnosis (Dr. Cardenas): Dr. Cardenas’s internal medicine expertise is crucial for screening patients, managing comorbidities, and ensuring advanced procedures are medically appropriate. Her role guarantees the highest standards of patient safety.
Functional Medicine Investigation (Dr. Jimenez): Why did the tendon fail in the first place? Functional medicine helps us answer this question. We investigate underlying factors like nutritional deficiencies (e.g., Vitamin C, zinc), systemic inflammation, metabolic dysfunction (like insulin resistance), and hormonal imbalances that can impair tissue repair. Addressing these root causes is essential for preventing recurrence.
Integrative Chiropractic Care (Dr. Jimenez): A tendinopathy in the elbow or foot doesn’t exist in a vacuum. It is often linked to biomechanical dysfunction elsewhere in the body. As a chiropractor, I assess and correct kinetic chain imbalances. For example:
Tennis Elbow: This is often related to poor mechanics in the shoulder, scapula, and even the thoracic spine. Chiropractic adjustments and soft tissue mobilization can restore proper joint mobility and muscle firing patterns, reducing strain on the elbow.
Plantar Fasciitis: This is frequently linked to ankle immobility, tight calf muscles, or even pelvic misalignments that alter gait mechanics. Chiropractic care can address these upstream biomechanical faults. By correcting the body’s overall structure and movement patterns, we offload the healing tendon and create an environment where it is no longer subjected to repetitive microtrauma.
Targeted Rehabilitation: Following a procedure like Tenex, the body needs the right signals to rebuild the tendon with strong, organized collagen. Our rehabilitation programs are designed to do just that. We progress patients from gentle range-of-motion exercises to eccentric loading exercises, which are scientifically proven to stimulate collagen synthesis and tendon remodeling (Alfredson et al., 1998). This phase is critical for translating the procedure’s structural fix into functional strength and resilience.
A Patient’s Journey at Our Clinic: From Pain to Performance
Let’s walk through a typical patient journey for someone with chronic tennis elbow:
Initial Consultation & Diagnosis: The journey begins with a comprehensive evaluation. This includes a detailed history, physical exam, and diagnostic ultrasound to confirm tendinopathy and pinpoint the exact location of the diseased tissue.
Collaborative Review: Dr. Cardenas and I review the case to confirm the diagnosis and ensure the patient is a good candidate for percutaneous tenotomy. We rule out any medical contraindications.
Root Cause Analysis: We conduct a functional medicine workup, which may include blood tests to check inflammatory markers, nutrient levels, and metabolic health indicators.
The Procedure: We perform the Tenex procedure in our office. The patient walks in and walks out, typically needing only a small adhesive bandage over the entry site.
Post-Procedure Care: The initial phase focuses on rest and pain management, then quickly transitions to the active phase.
Integrative Chiropractic & Rehabilitation: This is where the magic happens. The patient begins a structured program that includes:
Chiropractic adjustments to the spine, shoulder, and wrist to optimize biomechanics.
Soft tissue therapies like Active Release Technique (ART) or Graston to address scar tissue in surrounding muscles.
A progressive rehabilitation plan starting with gentle isometrics and progressing to the crucial eccentric strengthening exercises.
Nutritional & Lifestyle Support: Based on the functional medicine findings, we provide targeted nutritional advice and supplements to support collagen production and reduce systemic inflammation.
By combining the precision of percutaneous tenotomy with the holistic framework of integrative chiropractic and functional medicine, we don’t just eliminate pain; we rebuild a more resilient, functional person. This is the future of musculoskeletal care—a future we are proud to offer our patients in El Paso today.
References
Alfredson, H., Pietilä, T., Jonsson, P., & Lorentzon, R. (1998). Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis. The American Journal of Sports Medicine, 26(3), 360–366. https://doi.org/10.1177/03635465980260030301
Seng, K., & Lee, K. (2020). Percutaneous ultrasonic tenotomy for tendinopathies. Journal of Functional Morphology and Kinesiology, 5(3), 54. https://doi.org/10.3390/jfmk5030054
This educational post explores the advanced technique of hydrodistension (or hydroplasty) for treating adhesive capsulitis, commonly known as frozen shoulder. As a practitioner rooted in integrative and functional medicine, I continually seek the most effective, evidence-based solutions for my patients. Here, I’ll guide you through a detailed look at the hydrodistension procedure, drawing on insights from leading sports medicine experts. We will examine the anatomical basis, the procedural steps, and the physiological mechanisms that make this technique a powerful tool for restoring mobility and relieving pain. I will also explain how this intervention fits within our multidisciplinary practice at Injury Medical Clinic, where my work as a Doctor of Chiropractic and Family Nurse Practitioner is complemented by the medical oversight of our Medical Director, Dr. Maria Guadalupe Cardenas, MD. Our goal is to provide a comprehensive treatment journey that combines advanced medical procedures with chiropractic care, rehabilitation, and functional medicine to achieve lasting patient outcomes.
At Injury Medical Clinic, our philosophy is built on collaboration and integration. My name is Dr. Alex Jimenez, and I bring a multifaceted perspective to patient care, holding qualifications as a Doctor of Chiropractic (DC), an Advanced Practice Registered Nurse (APRN), a Board-Certified Family Nurse Practitioner (FNP-BC), and certifications in Functional Medicine (CFMP, IFMCP), among others. This diverse background allows me to view health and injury through a uniquely broad lens.
A cornerstone of our practice is our multidisciplinary team approach. I work closely with Dr. Maria Guadalupe Cardenas, MD, our esteemed Medical Director and an internist with over 40 years of experience. Her role is vital, providing essential medical direction and oversight that ensures our patients receive care that is not only effective but also safe and comprehensive. This partnership between a chiropractor/nurse practitioner and an internist lets us blend the best of the medical and chiropractic worlds, offering services ranging from personal injury rehabilitation and functional medicine to advanced interventional procedures. Today, I want to share insights into one such procedure that exemplifies this integrated model: hydrodistension for frozen shoulder.
Before diving into the procedure, let’s understand the condition it treats. Adhesive capsulitis, or frozen shoulder, is a debilitating condition characterized by severe pain and a progressive loss of shoulder motion. The underlying pathology involves the glenohumeral joint capsule—the strong, fibrous sac that envelops the shoulder joint. In a healthy shoulder, this capsule is flexible and allows for a wide range of motion. In adhesive capsulitis, the capsule becomes inflamed, thickens, and contracts, effectively “shrinking” around the joint. This process leads to the formation of adhesions, which are bands of scar tissue that bind the capsule to the humeral head (the ball of the shoulder joint), severely restricting movement.
Patients typically experience three phases:
Freezing Stage: A gradual onset of deep, aching pain, often worse at night. As pain intensifies, range of motion begins to decrease. This stage can last from weeks to months.
Frozen Stage: Pain may start to subside, but stiffness becomes the primary complaint. The shoulder’s range of motion is significantly limited, making daily activities like dressing or reaching overhead extremely difficult. This phase can last for several months to a year.
Thawing Stage: Shoulder mobility slowly improves as the condition resolves. This can be a very long process, sometimes taking one to two years to regain full or near-full function.
The goal of any effective treatment is to shorten these phases, alleviate pain, and restore function as quickly and completely as possible.
Hydrodistension: An Advanced Technique for Restoring Mobility
Hydrodistension, also known as hydroplasty, is a minimally invasive procedure designed specifically for adhesive capsulitis. The fundamental principle is to physically stretch and break the adhesions within the joint capsule by injecting a large volume of fluid. This creates more space within the joint, allowing for an immediate improvement in range of motion.
I recently had the opportunity to review the work of a primary care sports medicine physician. Their meticulous, ultrasound-guided approach is an excellent model for understanding how to perform this procedure safely and effectively. Let’s break down his process, which serves as a benchmark in modern, evidence-based practice.
To visualize the target area, we can look at an ultrasound image of the posterior (back) shoulder.
In the image, you can clearly see the layers of tissue:
The deltoid muscle on the surface.
The infraspinatus muscle (one of the rotator cuff muscles) just below it.
The posterior capsule, the key target, which appears as a bright, fibrous line.
The humeral head, the “ball” of the shoulder joint.
The glenoid, the “socket” of the shoulder joint.
The goal is to accurately place a needle into the glenohumeral joint space—the small area between the capsule and the humeral head—to deliver the fluid.
The Three-Step Hydrodistension Procedure
The doctor’s method is a well-orchestrated, three-step process designed for maximum patient comfort and procedural success. It involves precise, ultrasound-guided injections to ensure accuracy and safety at every stage.
Step 1: Suprascapular Nerve Block
The first and arguably most compassionate step is to manage the patient’s pain during and after the procedure. This is achieved with a suprascapular nerve block.
The Target: The suprascapular nerve, which provides approximately 70% of the sensory innervation to the shoulder joint. By numbing this nerve, we can significantly reduce procedure-related pain and provide intermediate relief for hours afterward. The nerve is targeted at the spinoglenoid notch, a small anatomical landmark located just medial to the glenohumeral joint.
The Technique: Using an ultrasound, Dr. visualizes the spinoglenoid notch and guides a needle to the area. He then injects a local anesthetic, typically a combination of lidocaine (fast-acting) and ropivacaine (long-acting). This dual-anesthetic approach provides both immediate and extended pain control.
Why It’s Done: This nerve block is crucial for patient tolerance. The hydrodistension itself can be uncomfortable as the capsule stretches. By preemptively blocking the primary sensory nerve, the patient remains comfortable, and the physician can perform the procedure without causing undue distress. This aligns with our patient-centered approach at Injury Medical Clinic, where comfort and safety are paramount.
Step 2: Numbing the Joint Capsule
Next, anesthetize the injection site and the joint capsule.
The Target: The posterior glenohumeral joint space.
The Technique: A smaller, 25-gauge needle is guided under ultrasound into the joint space. A small amount of buffered lidocaine is injected. The “buffering” is done by adding sodium bicarbonate to the lidocaine, which raises its pH to be closer to that of the body’s tissues. This simple modification reduces the stinging sensation of the injection, further enhancing patient comfort.
Why It’s Done: This local numbing ensures the larger needle in the final step is painless. It also confirms that the needle tip is correctly positioned within the intra-articular space before the main injection begins.
Step 3: The Hydrodistension Injection
This is the main event, where the therapeutic distension occurs.
The Injectate: A carefully formulated mixture totaling 51 mL. It consists of:
10 mL of 1% lidocaine (fast-acting anesthetic)
10 mL of 0.5% ropivacaine (long-acting anesthetic)
30 mL of sterile saline (the primary volume for distension)
1 mL of Kenalog (40 mg) (a corticosteroid to reduce inflammation)
The Technique: A larger, 18-gauge needle is guided into the same intra-articular position. This is often a two-person job; The doctor guides the needle while his medical assistant steadily pushes the large volume of fluid from the syringe. As the fluid is injected, the ultrasound screen provides real-time feedback. You can literally watch the posterior capsule lift and stretch away from the humeral head as it fills with fluid.
The “Break”: The goal is to continue injecting until the capsule is stretched to its limit and the adhesions break. On ultrasound, this appears as a sudden expansion followed by slight deflation as the fluid finds new space within the joint, or may even extravasate (leak) through a small tear in the now-stretched capsule. This visible “break” is the hallmark of a successful procedure. The patient often feels an immediate sense of release and an increase in their range of motion.
Using a corticosteroid like Kenalog is critical. It strongly suppresses the inflammatory process that drives capsule thickening and contraction. This not only relieves pain but also helps prevent rapid re-formation of adhesions, creating a therapeutic window for the next phase of care: rehabilitation.
The Role of Integrative Chiropractic Care Post-Procedure
The hydrodistension procedure is a powerful “reset” for the shoulder, but it is not a standalone cure. The real, long-term success comes from what happens next. The days and weeks following the procedure are a critical window of opportunity to restore normal joint mechanics and muscle function. This is where our integrative model at Injury Medical Clinic truly shines.
As a Doctor of Chiropractic, I immediately focus on capitalizing on the newly gained mobility. My clinical observations, detailed on platforms like my professional website and LinkedIn, consistently show that a structured, multi-faceted rehabilitation program is essential.
Our post-hydrodistension protocol includes:
Gentle Chiropractic Mobilization: After the procedure, I perform specific, gentle mobilization techniques on the glenohumeral joint and surrounding joints, including the scapulothoracic (shoulder blade on the rib cage), acromioclavicular, and sternoclavicular joints. The goal isn’t aggressive manipulation, but to encourage smooth, physiological movement and prevent the joint from stiffening again. We must respect the body’s healing process while re-educating the joint on how to move correctly.
Targeted Soft Tissue Therapy: Adhesions don’t just form in the capsule; the surrounding muscles often become tight, guarded, and develop trigger points. We use techniques like myofascial release, instrument-assisted soft tissue mobilization (IASTM), and trigger point therapy to release tension in the rotator cuff, deltoid, and periscapular muscles. This restores muscle pliability and reduces compensatory strain patterns.
Prescriptive Rehabilitation Exercises: This is the most crucial component. We guide patients through a phased exercise program that begins with gentle pendulum exercises and passive range-of-motion on the day of the procedure. As tolerance improves, we progress to:
Active-assisted range of motion (using the other arm or a pulley to help move the affected shoulder).
Active range of motion (moving the shoulder under its own power).
Strengthening exercises, starting with isometrics and progressing to resistance bands to rebuild the strength and endurance of the rotator cuff and scapular stabilizers.
Under the medical direction of Dr. Cardenas, we ensure this rehabilitation process is medically appropriate for the patient, monitoring for complications and managing post-procedural inflammation. This collaborative oversight allows us to safely push the boundaries of recovery.
Conclusion: An Integrated Path to Recovery
Treating complex conditions like adhesive capsulitis requires more than a single intervention. It demands a holistic, integrated approach that addresses the problem from multiple angles. The hydrodistension procedure, as expertly demonstrated by physicians, provides a powerful mechanical and pharmacological intervention to break the cycle of stiffness and pain. It creates a pivotal opportunity for recovery.
However, the comprehensive, team-based care that follows truly solidifies the gains and leads to lasting results. At Injury Medical Clinic, our unique structure—combining my expertise in chiropractic and functional medicine with the invaluable medical oversight of Dr. Maria Guadalupe Cardenas—allows us to provide that. We bridge the gap between advanced medical procedures and hands-on rehabilitative care, guiding our patients on a seamless journey from profound limitation to renewed function and a life free from pain.
References
Boutin, R. D., Darrow, M. A., & Schenker, M. L. (2014). Ultrasound-guided shoulder interventions. Physical Medicine and Rehabilitation Clinics of North America, 25(2), 247–266. https://doi.org/10.1016/j.pmr.2014.01.002
Ryan, V., Brown, H., Minns Lowe, C. J., & Lewis, J. S. (2016). The pathophysiology associated with primary (idiopathic) frozen shoulder: A systematic review. BMC Musculoskeletal Disorders, 17(1), 340. https://doi.org/10.1186/s12891-016-1190-9
Tveitå, E. K., & Røe, C. (2009). Ultrasound-guided hydrodistension and physiotherapy for patients with frozen shoulder. Physiotherapy Research International, 14(1), 39–51. https://doi.org/10.1002/pri.422
This educational post explores ultrasound-guided hydrodissection, an advanced interventional technique used to address radial nerve entrapment at the entrance of the radial tunnel — a condition frequently misdiagnosed as lateral epicondylitis. Drawing from clinical demonstrations by leading practitioners in musculoskeletal ultrasound, I present the physiological underpinnings of radial tunnel syndrome, the rationale for perineural hydrodissection, and how integrative chiropractic care fits within a multidisciplinary treatment framework. At Injury Medical Clinic PA (also known as Mission Plaza Injury Medical Clinic) in El Paso, Texas, my colleague Dr. Maria Guadalupe Cardenas, MD, Board Certified in Internal Medicine (NPI #1164426749, Texas MD License #J2933), serves as Medical Director and Collaborative Physician, providing over 40 years of internal medicine expertise alongside my chiropractic and functional medicine practice. Together, we outline how cutting-edge procedural techniques, medical oversight, and conservative rehabilitative care converge to deliver superior patient outcomes for complex nerve entrapment conditions.
Understanding Radial Tunnel Syndrome: Why Diagnosis Is So Often Missed
One of the most clinically underrecognized conditions in musculoskeletal medicine is radial tunnel syndrome (RTS) — a compressive neuropathy of the deep branch of the radial nerve as it enters the radial tunnel, a fibromuscular passage located just distal to the lateral epicondyle. As a clinician who has evaluated countless patients presenting with lateral elbow pain, I can tell you firsthand that this condition is routinely confused with lateral epicondylitis, commonly known as “tennis elbow.”
The key distinguishing features are critical:
Lateral epicondylitis presents with point tenderness directly over the lateral epicondyle
Radial tunnel syndrome typically produces pain that is 3–4 cm distal to the lateral epicondyle, over the radial tunnel itself
Patients with RTS often describe a dull, burning, aching quality to the pain, frequently worsened by pronation and supination of the forearm
The pain may radiate into the dorsum of the forearm, consistent with the sensory distribution of the posterior interosseous nerve (PIN)
This distinction matters profoundly because the treatment approach is entirely different. Injecting a corticosteroid at the lateral epicondyle — the standard intervention for tennis elbow — will do nothing to relieve a nerve entrapment occurring further distally. When six months or more of conservative treatment have failed to produce relief, it becomes necessary to think deeper — both anatomically and clinically.
The Anatomy Behind Radial Nerve Entrapment at the Arcade of Frohse
To fully appreciate why hydrodissection works, one must first understand the precise anatomy involved. The radial nerve, after crossing the lateral aspect of the elbow, divides into two branches:
The superficial branch (purely sensory), which continues distally along the radial side of the forearm
The deep branch (motor and sensory), which dives into the radial tunnel and passes beneath the arcade of Frohse — a fibrous arch at the proximal edge of the supinator muscle
The arcade of Frohse is the most common site of radial nerve compression. This fibrous band can tighten with repetitive forearm rotation, direct compression, or inflammatory changes in surrounding soft tissue. As the nerve becomes entrapped:
Perineural fibrosis develops, restricting the nerve’s normal gliding motion
Ischemic changes in the nerve’s intrinsic blood supply reduce conduction velocity
Mechanosensitivity increases, producing pain with even minor movements involving pronation or supination
Chronic inflammation leads to adhesion formation between the nerve sheath and surrounding fascial planes
This physiological cascade explains why oral anti-inflammatories and physical therapy alone are often insufficient after months of symptomatic progression. The nerve is, in effect, tethered — and it needs to be released.
What Is Ultrasound-Guided Hydrodissection and Why Is It Used
Hydrodissection is a minimally invasive procedure in which fluid is precisely injected around a peripheral nerve to mechanically separate it from surrounding adhesions, scar tissue, or compressive structures. The term itself describes the mechanism: using the hydraulic force of injected fluid to dissect soft tissue planes without the trauma of surgical incision.
In the context of radial nerve entrapment, the technique involves:
Guiding a 25-gauge needle under real-time ultrasound visualization (using a high-frequency linear probe)
Approaching the deep branch of the radial nerve in a short-axis, in-plane view — meaning the needle is visible on the ultrasound screen along its entire length
Injecting a solution — typically lidocaine, in some cases combined with a corticosteroid — perineural (around, not inside) the nerve
Creating what is clinically referred to as a “halo effect”: the fluid surrounds the nerve circumferentially, lifting adhesions and restoring the nerve’s natural gliding motion within its tissue bed
The critical safety principle is perineural, not intraneural injection. Injecting fluid directly into the nerve (intraneural) risks serious nerve damage, including axonal disruption and permanent deficit. The goal is always to deposit fluid adjacent to the epineurium — the outermost connective tissue sheath — thereby creating separation between the nerve and surrounding structures while leaving the nerve itself fully intact.
The use of lidocaine serves a dual purpose:
Diagnostic confirmation: If a prior diagnostic injection of lidocaine at the radial nerve produces measurable pain relief, this validates the nerve as the pain generator — as was precisely the case with the patient discussed in this post
Therapeutic hydrodissection: Lidocaine’s volume, when injected incrementally and skillfully around the nerve, provides the hydraulic separation needed to restore normal nerve mobility
Adding a corticosteroid to the hydrodissection solution targets persistent perineural inflammation, reducing the inflammatory milieu that contributes to ongoing neural sensitization and adhesion reformation.
Why This Is Considered an Advanced Technique
I want to be unequivocally clear: hydrodissection is not a technique to be read about and immediately attempted. The skill required involves:
Mastery of sonoanatomy: Identifying the deep branch of the radial nerve in real time as it passes through the brachioradialis, alongside the neurovascular bundle, and just proximal to the arcade of Frohse, requires dedicated ultrasound training
Precise needle control: The movements involved are described as “very small and subtle.” A millimeter of deviation at this depth can mean the difference between a perineural and an intraneural injection
Recognition of real-time landmarks: The practitioner must continuously identify the brachioradialis, supinator muscle, radius, and the nerve itself as the needle advances, adjusting trajectory in real time
Controlled fluid pulsing: Rather than a single bolus injection, the fluid is delivered in small, deliberate pulses to progressively expand the perineural space, generating the halo effect while monitoring nerve displacement on screen
A muscle twitch may be observed as the needle approaches the nerve — a sign of proximity that requires the practitioner to recognize and respond to immediately. This level of procedural refinement demands supervised, hands-on training under experienced guidance.
Integrative Chiropractic Care and Its Role in Radial Nerve Recovery
While hydrodissection directly addresses the entrapment at the radial tunnel, integrative chiropractic care plays an essential role in the broader clinical picture. At my practice, I approach radial nerve entrapment not as an isolated peripheral problem but as part of a regional biomechanical and neurological pattern that must be addressed comprehensively.
Chiropractic contributions to radial nerve recovery include:
Cervical spine assessment: The radial nerve originates from the C5–C8 nerve roots. Cervical segmental dysfunction — particularly at C6 and C7 — can produce a double crush phenomenon, in which proximal neural compromise reduces the nerve’s capacity to tolerate distal entrapment. Chiropractic spinal manipulation directed at dysfunctional cervical segments helps restore normal neural conduction and reduces the overall compressive burden on the nerve
Elbow and forearm joint mobilization: Restoring full radioulnar joint mechanics and reducing capsular tightness decreases mechanical stress on the radial tunnel
Soft tissue therapy: Targeted myofascial release to the brachioradialis, supinator, and extensor mass helps reduce the external compressive forces perpetuating nerve entrapment
Rehabilitation exercise prescription: Progressive neuromuscular re-education exercises — designed to restore painless pronation and supination — are essential to sustaining the benefits achieved through hydrodissection
Postural and ergonomic correction: Many cases of radial tunnel syndrome are driven or perpetuated by occupational postures. Chiropractic rehabilitation includes functional movement analysis and individualized ergonomic modification
Multidisciplinary Care at Injury Medical Clinic PA: Dr. Cardenas and Dr. Jimenez
The clinical model I operate within at Injury Medical Clinic PA in El Paso, Texas exemplifies the best of multidisciplinary integrative care. Dr. Maria Guadalupe Cardenas, MD, Board Certified in Internal Medicine (NPI #1164426749, Texas MD License #J2933), brings over 40 years of internal medicine expertise to our collaborative practice. As Medical Director and Collaborative Physician, Dr. Cardenas provides:
Comprehensive medical evaluation and co-management for patients with complex comorbidities
Pharmacological oversight, including medication review for patients undergoing procedural interventions
Internal medicine consultation for systemic contributors to musculoskeletal and neurological conditions — including metabolic, inflammatory, and autoimmune factors that can predispose patients to peripheral neuropathies
Medical direction ensuring all clinical protocols meet the highest standards of patient safety and evidence-based practice
This collaboration between chiropractic functional medicine (my domain) and internal medicine (Dr. Cardenas’s domain) means that patients presenting with conditions like radial tunnel syndrome receive:
A thorough systemic workup when indicated
Coordinated procedural and rehabilitative planning
Functional medicine assessments examining nutritional, metabolic, and inflammatory contributors to nerve health
Personal injury care and documentation for patients involved in accident-related musculoskeletal injuries
Evidence-Based Support for Hydrodissection in Peripheral Nerve Entrapment
The growing body of literature supporting ultrasound-guided hydrodissection is compelling. Research consistently demonstrates that perineural injection under ultrasound guidance is both safer and more effective than landmark-based injection for peripheral nerve entrapment syndromes (Wu et al., 2017). Studies examining hydrodissection for carpal tunnel syndrome, cubital tunnel syndrome, and posterior interosseous nerve entrapment have reported significant improvements in pain scores and functional outcomes (Mulvaney, 2011; Cass, 2016).
The 5% dextrose in water (D5W) solution — a popular hydrodissection medium in non-corticosteroid protocols — has been shown to reduce mechanosensitivity by competitively blocking TRPV1 nociceptors at the neural membrane, providing an additional physiological mechanism of pain relief beyond simple mechanical separation (Lyftogt, 2007). When lidocaine is used, as described in this case, the immediate anesthetic effect confirms nerve involvement while the hydraulic dissection restores gliding mechanics.
In this educational post, I will guide you through an advanced, highly effective technique for managing chronic tendinopathy known as tendon brisement, or high-volume injection (HVI). Drawing from my clinical experience and the latest evidence-based research, we will explore the physiological mechanisms behind this innovative procedure. I will explain how HVI differs from traditional tendon treatments by focusing on hydrostatically decompressing soft tissues and disrupting the problematic neovessels and neonerves that perpetuate chronic tendon pain. We will examine the step-by-step process of performing an HVI, using the Achilles tendon as a primary example. Furthermore, I will discuss how we integrate this advanced procedure at Injury Medical Clinic PA. Our unique multidisciplinary approach combines my expertise in chiropractic and functional medicine with the invaluable medical oversight of our Medical Director, Dr. Maria Guadalupe Cardenas, MD, to provide comprehensive, patient-centered care for complex musculoskeletal conditions.
As a practitioner with dual credentials in chiropractic and as a board-certified Family Nurse Practitioner, my journey has always been about integrating the best of multiple disciplines to achieve superior patient outcomes. At Injury Medical Clinic PA in El Paso, Texas, this philosophy is the cornerstone of our practice. I am privileged to work alongside Dr. Maria Guadalupe Cardenas, MD, our Medical Director and Collaborative Physician. With over four decades of experience as a board-certified internist, Dr. Cardenas provides essential medical oversight, allowing us to offer a broad spectrum of advanced treatments safely and effectively.
Our model is built on collaboration. Whether we are managing a complex personal injury case, guiding a patient through rehabilitation, or applying functional medicine principles to address root causes of dysfunction, our team approach ensures every patient receives comprehensive care. This integration is particularly vital when we employ advanced procedures like the one we’ll discuss today: tendon brisement, also known as a high-volume injection (HVI). This technique represents a significant leap forward in treating chronic, stubborn tendinopathies, and it perfectly illustrates how integrative care can unlock new possibilities for healing.
Understanding Tendon Brisement: A Paradigm Shift in Tendon Treatment
When we talk about tendon injuries, many people are familiar with terms like fenestration or tenotomy. These procedures involve using a needle to repeatedly puncture the damaged tendon tissue itself, with the goal of stimulating a new, more organized healing response. While effective in certain cases, they don’t always address the full picture of what causes chronic tendon pain.
This is where tendon brisement comes in. It’s a fundamentally different approach. Instead of focusing on the tendon itself, a brisement procedure primarily targets the space around the tendon. Specifically, we target the interface between the tendon and adjacent structures, such as its synovial sheath (tenosynovium) or the nearby fat pad.
The “Why” Behind the Pain: Neovessels and Neonerves
To truly grasp the power of brisement, we must first understand the pathophysiology of chronic tendinopathy. For years, we believed tendon pain was primarily an inflammatory issue (tendinitis). However, modern research, including histopathological studies, has shown that chronic cases are better described as tendinosis—a degenerative condition characterized by disorganized collagen fibers, a lack of inflammatory cells, and, most importantly, the ingrowth of abnormal, tiny blood vessels and nerves. These are known as neovessels and neonerves.
Leading researchers like Alfredson et al. (2000) have demonstrated that these aberrant structures, which often grow into the tendon from adjacent tissues like the fat pad, are a primary source of pain in conditions like Achilles and patellar tendinopathy. The neonerves transmit pain signals, while the neovessels perpetuate a disorganized, failed healing state.
The goal of a tendon brisement or high-volume injection is to physically and hydrostatically disrupt this pathological neurovascular network. We are not just injecting a substance; we are using the volume and pressure of the fluid to mechanically separate adhered tissues and destroy these pain-generating structures.
The High-Volume Injection Procedure: A Step-by-Step Explanation
Let’s walk through how this procedure is performed, using the Achilles tendon as our clinical example. This condition is notoriously difficult to treat, but HVI has shown remarkable promise.
1. Patient Preparation and Initial Assessment
The first step is always a thorough evaluation. The patient is positioned comfortably, typically lying prone for an Achilles procedure, to allow optimal access to the tendon. We then use a high-resolution ultrasound machine with a linear probe to meticulously examine the Achilles tendon in both a longitudinal (long-axis) and transverse (short-axis) view. This diagnostic imaging is crucial for several reasons:
Pinpointing the Pathology: We can identify the exact location and extent of tendon thickening, collagen disorganization, and signs of tendinosis.
Visualizing Neovascularity: Using color or power Doppler ultrasound, we can often directly visualize increased blood flow from neovessels, typically on the anterior aspect of the tendon near Kager’s fat pad.
Planning the Injection: This detailed anatomical map allows us to plan the safest and most effective needle trajectory to target the precise tissue interface.
2. Anesthesia and Needle Placement
Once the target area is identified, we ensure the patient’s comfort. The skin and superficial subcutaneous tissues are anesthetized using a fine-gauge needle (e.g., 25 or 27-gauge) and a local anesthetic like lidocaine. This minimizes any discomfort from the main procedure.
Next, a slightly larger needle (e.g., 21 or 22-gauge) is used for the brisement itself. Under continuous ultrasound guidance, the needle is advanced to the target zone—the space between the anterior border of the Achilles tendon and Kager’s fat pad. Precision is paramount. The goal is to be juxtaposed to the tendon, not inside it.
3. The Hydrodissection and Brisement
This is the core of the procedure. We begin injecting a large volume of fluid. The injectate typically consists of a combination of:
Normal Saline: This makes up the bulk of the volume and provides the hydrostatic force needed for the brisement.
Local Anesthetic (e.g., Lidocaine): This provides immediate pain relief and can also have a therapeutic effect by disrupting nerve signaling.
Corticosteroid (Optional): Some protocols include a small amount of corticosteroid to help modulate the local inflammatory response that may follow the mechanical disruption, although this is debated and often used sparingly (Maffulli & Spiezia, 2017).
As the fluid is injected, we watch the ultrasound screen in real-time. What we see is remarkable. The fluid forcibly separates the tissue planes, creating a distinct, anechoic (black) space. This is the hydrostatic decompression in action. You can literally see the fluid stripping the anterior surface of the tendon away from the fat pad, tearing the delicate neovessels and neonerves that have tethered these structures together.
The volume of fluid used can vary significantly, with literature reporting anywhere from 10 to 100 cc. The injection continues until either the patient feels significant pressure or we feel a marked increase in resistance, indicating the tissue compartment is full.
Visualizing the Mechanism: What We See on Ultrasound
Let’s break down the visuals from a procedure performed by my esteemed colleague, Dr. Knight.
Short-Axis View: Initially, the probe is placed perpendicular to the tendon. The needle is introduced from the side, and we see it as a bright dot on the screen when viewed “out-of-plane.” The initial anesthetic injection begins the process of hydrodissection, gently creating space.
Long-Axis View: The probe is then turned parallel to the tendon fibers. In this view, we can see the needle tracking along the anterior border of the thickened, tendinopathic Achilles.
The “Fluid Wave”: As the high-volume injectate is introduced, we witness the most important part of the procedure. A wave of fluid spreads along the interface. It physically lifts the tendon away from the underlying fat pad. This mechanical stripping action is what accomplishes the brisement, effectively decompressing the area and obliterating the neurovascular ingrowth that drives the pain.
The entire process is a form of mechanical neurolysis and anti-angiogenesis, achieved through hydrostatic pressure rather than a scalpel. This is precision medicine at its finest, guided by real-time imaging.
Integrating Chiropractic Care for Comprehensive Recovery
Performing a high-volume injection is a powerful intervention, but it’s not the end of the story. In my clinical experience, the most successful and lasting outcomes come when these procedures are integrated into a comprehensive rehabilitation framework. This is where the synergy of our multidisciplinary clinic truly shines.
Following an HVI procedure, the patient enters a structured rehabilitation program where chiropractic care plays a pivotal role.
Biomechanical Correction: Chronic tendinopathy rarely exists in a vacuum. It often results from underlying biomechanical faults. As a chiropractor, I focus on identifying and correcting these issues. For Achilles tendinopathy, this may involve:
Spinal and Pelvic Adjustments: Misalignments in the pelvis or lumbar spine can alter the kinetic chain, leading to abnormal gait mechanics and excessive strain on the Achilles tendon. Chiropractic adjustments help restore proper alignment and nerve function from the spine down.
Extremity Adjusting: We assess and correct joint restrictions in the ankle, subtalar joint, and foot. A stiff ankle or foot that overpronates can dramatically increase the load on the Achilles.
Soft Tissue Mobilization: Techniques like Graston or Active Release Technique (ART) can be applied to the calf muscles (gastrocnemius and soleus) and plantar fascia to reduce tension and improve tissue mobility, further offloading the healing tendon.
Guided Loading and Rehabilitation: The period after a brisement procedure is a critical window for healing. The tendon needs to be loaded progressively to stimulate organized collagen remodeling. We guide patients through a specific, evidence-based eccentric loading program, as pioneered by researchers like Alfredson et al. (1998). This involves controlled lengthening of the calf muscles, which has been shown to be highly effective in promoting tendon repair. Our rehabilitation team ensures the exercises are performed with perfect form to maximize benefit and prevent re-injury.
Functional Medicine Support: From my functional medicine perspective, we also address systemic factors that can impair healing. This includes nutritional counseling to ensure the patient has the necessary building blocks for collagen synthesis (e.g., vitamin C, proline, lysine, zinc) and managing systemic inflammation through diet and targeted supplementation.
This integrated model—combining Dr. Cardenas’s medical oversight for the injection, my procedural skills, our shared rehabilitation protocols, and a foundation of chiropractic and functional medicine—creates a powerful therapeutic cascade. We are not just treating the painful tendon; we are treating the whole person and the entire biomechanical system that contributed to the injury in the first place. This is the future of musculoskeletal medicine.
References
Alfredson, H., Pietilä, T., Jonsson, P., & Lorentzon, R. (1998). Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis. The American Journal of Sports Medicine, 26(3), 360–366. https://doi.org/10.1177/03635465980260030301
Alfredson, H., & Ohberg, L. (2000). Neovascularisation in chronic painful patellar tendinosis–a descriptive study in a prospectively selected group of patients. Knee Surgery, Sports Traumatology, Arthroscopy, 8(4), 232-234. Note: This reference discusses patellar tendinosis, but the principle of neovascularization is central to the theory behind HVI for Achilles tendinopathy as well.https://doi.org/10.1007/s001670000128
Maffulli, N., & Spiezia, F. (2017). High-volume injection for the treatment of chronic Achilles tendinopathy. Operative Techniques in Sports Medicine, 25(2), 143-149. https://doi.org/10.1053/j.otsm.2017.03.011
A concussion, whiplash injury, or other head and neck trauma can affect more than the painful area. An injury may influence the brain, cervical spine, digestive system, immune system, muscles, sleep, energy levels, and nervous system at the same time. This relationship can be viewed through the Gut-Brain-Spine Connection.
At ChiroMed Integrated Medicine in El Paso, Texas, we can approach injury recovery from several directions. Protein-forward nutrition, healthy fats, hydration, sleep, metabolic support, functional medicine, chiropractic care, and rehabilitation may help create a healthier environment for recovery. For carefully selected patients, advanced medical, regenerative, laser, or interventional therapies may also be considered for specific musculoskeletal injuries.
The goal is not to claim that one food, supplement, adjustment, or injection can “cure” a concussion or whiplash injury. Instead, an integrated plan looks at the neurological, structural, nutritional, and metabolic factors that may influence healing.
Understanding the Gut-Brain-Spine Connection
Most people know that the brain controls many functions in the body. What is sometimes overlooked is that communication also travels back toward the brain.
The digestive system communicates with the brain through what researchers call the gut-brain axis.
This communication involves:
The vagus nerve
The autonomic nervous system
The enteric nervous system
Gut bacteria
Hormones
Immune signals
Neurotransmitters
The intestinal barrier
Metabolic chemicals produced by gut microbes
The Cleveland Clinic describes the gut and brain as being in constant two-way communication. Changes in stress, digestion, inflammation, and the intestinal environment may influence signals traveling between these systems (Cleveland Clinic, 2023).
Research also shows that the gut microbiome and intestinal barrier interact with immune and nervous system activity (Gwak & Chang, 2021).
The Gut-Brain-Spine Connection expands this concept to include the spine’s musculoskeletal and neurological role.
The neck contains joints, muscles, ligaments, discs, nerve roots, and other tissues that provide constant sensory information to the nervous system. When a traumatic injury affects the head and cervical spine together, several parts of this communication network may become disturbed.
What Happens During Whiplash and Concussion?
During a motor vehicle collision, fall, work injury, or sports accident, the head may rapidly move forward, backward, sideways, or in a combination of directions.
The brain may move inside the skull while the neck experiences strong mechanical forces.
A patient may develop:
Whiplash-associated disorder
Concussion or mild traumatic brain injury
Cervical joint irritation
Muscle strain
Ligament injury
Disc injury
Headaches
Neck stiffness
Muscle spasms
Dizziness
Fatigue
Brain fog
Poor concentration
Balance problems
Sleep disturbances
Nausea
Light or noise sensitivity
The important point is that brain symptoms and neck symptoms can overlap.
A headache after an accident, for example, may have several possible contributors. The person may have concussion symptoms, cervical muscle tension, irritated joints, sleep problems, dehydration, stress, or a combination of these factors.
That is one reason a thorough evaluation matters.
A Head Injury May Also Affect the Gut
Researchers are studying how traumatic brain injuries influence the intestinal system.
After brain trauma, changes may occur in autonomic nervous system activity, inflammation, intestinal movement, immune signaling, intestinal permeability, and the gut microbiome.
Research has identified possible changes involving:
Gut bacterial populations
Intestinal barrier function
Inflammatory signals
Immune activity
Digestion
Microbial metabolites
A review by Aghakhani (2022) found evidence connecting mild traumatic brain injury and changes in the gut microbiome. However, much of the strongest evidence has come from animal research, and more human research is needed.
This distinction matters.
Supporting digestive health through good nutrition can be a reasonable part of an overall recovery program, but probiotics, special diets, or microbiome therapies should not be presented as proven cures for concussion.
Why Nutrition Matters After Head and Neck Trauma
An injured body needs raw materials.
Tissues do not rebuild themselves without energy, protein, fats, vitamins, minerals, water, and other nutrients.
After an injury, nutrition may become even more important because the body is dealing with:
Inflammation
Cellular repair
Muscle recovery
Changes in physical activity
Stress
Poor sleep
Increased nutritional needs
Changes in appetite
A systematic review by Finnegan et al. (2022) examined nutritional interventions following mild traumatic brain injury. The researchers found promising evidence for several nutritional approaches but also concluded that stronger human trials are still needed before universal concussion supplement recommendations can be made.
For patients recovering from an accident, this means starting with the basics.
Build the body before looking for a miracle supplement.
Start With Protein-Forward Nutrition
Protein is one of the most important nutritional building blocks during physical recovery.
Protein provides amino acids that the body uses to maintain and repair:
Muscle
Connective tissue
Enzymes
Hormones
Immune proteins
Structural tissues
After a neck injury, patients sometimes become much less active because movement hurts.
Reduced activity can contribute to muscle loss and weakness. This can make rehabilitation more difficult.
A protein-forward recovery plan may include foods such as:
Eggs
Chicken
Turkey
Salmon
Tuna
Lean beef
Greek yogurt
Cottage cheese
Beans
Lentils
Tofu
Tempeh
Protein shakes when appropriate
Instead of eating nearly all protein at dinner, spreading protein across breakfast, lunch, dinner, and snacks can help provide amino acids throughout the day.
There is no single ideal protein amount for every injured person.
Needs may change based on age, body weight, kidney health, activity, injury severity, medical history, and rehabilitation goals.
This is where combining nutrition and clinical evaluation becomes valuable.
Build an Anti-Inflammatory Recovery Plate
Inflammation is part of normal healing.
The goal is not to eliminate every inflammatory response. The goal is to support normal healing while avoiding lifestyle factors that may contribute to excessive or prolonged systemic inflammation.
A simple recovery plate can include:
Protein
Choose foods such as:
Fish
Chicken
Eggs
Turkey
Lean meats
Beans
Lentils
Colorful vegetables
Examples include:
Spinach
Kale
Broccoli
Bell peppers
Carrots
Tomatoes
Squash
Healthy fats
Consider:
Extra-virgin olive oil
Avocado
Nuts
Seeds
Fatty fish
High-fiber carbohydrates
Examples include:
Oatmeal
Potatoes
Sweet potatoes
Beans
Brown rice
Quinoa
Whole grains
Fruit
Good options include:
Blueberries
Strawberries
Apples
Oranges
Kiwi
Grapes
Whole-food nutrition provides more than calories. It provides vitamins, minerals, fiber, antioxidants, essential fats, and plant compounds that support normal metabolism.
Omega-3 Fats and Brain Health
Omega-3 fatty acids are often discussed in brain injury nutrition.
Two commonly studied omega-3 fatty acids are:
EPA
DHA
DHA is an important component of brain-cell membranes.
Foods naturally rich in omega-3 fats include:
Salmon
Sardines
Trout
Mackerel
Walnuts
Chia seeds
Flaxseed
Research into omega-3 supplementation following concussion is promising, but current evidence does not support claiming that omega-3 supplements cure concussion.
Finnegan et al. (2022) found encouraging findings for nutritional interventions after mild traumatic brain injury while emphasizing the need for stronger clinical research.
Food-first nutrition remains a practical starting point.
What About Magnesium, Vitamin D, Creatine, and Other Supplements?
Several nutrients are being studied for neurological health and recovery.
These include:
Magnesium
Vitamin D
Zinc
Creatine
B vitamins
Antioxidants
Omega-3 fatty acids
However, supplementation should be individualized.
More is not automatically better.
For example, a patient’s supplementation plan may need to change because of:
Kidney disease
Liver disease
Medications
Blood thinners
Gastrointestinal conditions
Laboratory findings
Pregnancy
Upcoming procedures
Functional medicine can be useful because the clinician can look beyond the name of the injury and ask whether another health problem may be interfering with recovery.
Support the Gut With Fiber and Food Diversity
The intestinal microbiome includes trillions of microorganisms.
Some gut bacteria help process dietary fibers and create substances called short-chain fatty acids.
These compounds participate in metabolic and immune signaling.
Foods that support dietary diversity may include:
Vegetables
Fruits
Beans
Lentils
Nuts
Seeds
Oats
Whole grains
Fermented foods when tolerated
A healthy gut does not require an extreme detox diet.
For many people, consistently eating whole foods, enough fiber, adequate protein, and fewer heavily processed foods is a more sustainable approach.
Research continues to examine how the microbiome, intestinal barrier, nervous system, and immune system communicate (Gwak & Chang, 2021).
Hydration Matters More Than Many Patients Realize
Even mild dehydration can contribute to symptoms such as:
Headaches
Fatigue
Poor concentration
Dizziness
Exercise intolerance
Those symptoms can also appear after concussion and whiplash.
This means dehydration can make an already difficult recovery feel worse.
Patients should maintain appropriate fluid intake and discuss electrolyte replacement with a healthcare professional when needed.
Sleep Is Part of Injury Treatment
Food is important, but the body also needs time to repair itself.
Sleep supports:
Brain function
Memory
Immune regulation
Hormone regulation
Muscle recovery
Pain control
Metabolism
Sleep disturbances are common after concussion and painful neck injuries.
A healthier sleep routine may include:
Maintaining regular sleep and wake times
Reducing bright light late at night
Limiting caffeine later in the day
Avoiding excessive alcohol
Gradually increasing appropriate daytime activity
Keeping the bedroom dark and comfortable
Persistent sleep problems after a head injury should be discussed with a healthcare provider.
Where ChiroMed Integrative Chiropractic Care Fits
At ChiroMed Integrative Medicine in El Paso, the treatment model brings multiple aspects of injury recovery together.
ChiroMed describes its current approach as combining chiropractic care, nurse practitioner services, rehabilitation, nutrition, functional medicine, and other health services in a patient-centered model.
For injured patients, this approach is important because a neck injury does not exist separately from the rest of the person.
Chiropractic and rehabilitative care may address musculoskeletal problems such as:
Restricted cervical movement
Joint dysfunction
Muscle tightness
Muscle guarding
Postural changes
Shoulder compensation
Mechanical neck pain
Reduced movement tolerance
Weakness following inactivity
Chiropractic care does not treat or replace medical management of a brain injury itself.
Instead, it may help address the musculoskeletal injuries that can occur alongside a concussion.
A patient with trauma should first be evaluated for conditions that could make cervical manipulation or other treatment inappropriate, including fracture, serious neurological injury, instability, or vascular injury.
Care can then be matched to the individual’s diagnosis.
Rehabilitation Helps Turn Healing Into Function
Pain reduction is only part of successful recovery.
A patient eventually needs to regain movement, stability, strength, coordination, and confidence.
Rehabilitation may include:
Cervical mobility exercises
Stabilization exercises
Posture training
Shoulder strengthening
Balance training
Gradual cardiovascular exercise
Neuromuscular re-education
Progressive return to work
Progressive return to recreation or sports
The goal is to help the person return to normal life rather than become dependent on passive treatment.
Advanced Regenerative and Interventional Therapies
Some patients develop persistent neck pain after an injury despite appropriate conservative care.
If examination and diagnostic testing identify a specific pain-generating structure, advanced interventions may sometimes be considered.
Platelet-Rich Plasma
Platelet-rich plasma, or PRP, is prepared from the patient’s own blood. A concentrated platelet preparation is then delivered to a carefully selected musculoskeletal target.
PRP is being studied for problems involving joints, tendons, ligaments, and certain spinal pain conditions.
Smith et al. (2023) studied PRP for cervical facet joint pain in patients with chronic whiplash-associated disorders. Participants experienced improvements in pain and disability.
However, this was a prospective case series, not a large randomized controlled trial.
That means PRP for chronic whiplash remains an emerging treatment, not a guaranteed cure.
PRP and other orthobiologic procedures should also not be described as directly repairing a concussion.
Laser Therapy and Neck Rehabilitation
Laser-based therapies are another tool sometimes incorporated into musculoskeletal rehabilitation.
A systematic review by de la Barra Ortiz et al. (2024) found that high-intensity laser therapy combined with rehabilitation may improve pain and disability in people with neck pain.
A 2025 network meta-analysis by Hao et al. also found evidence supporting several physical treatment modalities for neck-pain rehabilitation, including high-intensity laser and extracorporeal shockwave therapy.
These treatments may therefore have a role in selected musculoskeletal neck conditions.
They should not be confused with treatments directed at the injured brain.
For example, Taylor et al. (2024) conducted a randomized, placebo-controlled clinical trial of transcranial photobiomodulation for persistent concussion symptoms and did not find a clear significant benefit over placebo after adjustment.
Clear distinctions like these help patients make better healthcare decisions.
Shockwave Therapy
Extracorporeal shockwave therapy uses acoustic energy and is used in several musculoskeletal rehabilitation settings.
It has been studied more extensively for tendon and soft-tissue disorders than for concussion.
When used after head and neck trauma, its role would generally be aimed at appropriate musculoskeletal tissues, not at treating the brain injury itself.
The same principle applies to other regenerative procedures.
The treatment must match the diagnosis.
Why ChiroMed Uses an Integrated Approach
No single treatment addresses every part of an injury.
An adjustment cannot replace nutrition.
A supplement cannot stabilize an injured joint.
An injection cannot restore normal movement on its own.
Nutrition cannot repair a mechanical injury without appropriate rehabilitation.
That is the value of integrated care.
At ChiroMed, an injury recovery program may look at several areas together.
Structure
Evaluation may involve:
Cervical joints
Muscles
Ligaments
Discs
Facet joints
Extremities
Posture
Neurological Health
Symptoms may include:
Headaches
Dizziness
Concentration problems
Balance problems
Light sensitivity
Sleep disturbance
Nerve symptoms
Metabolic Health
Recovery may also be influenced by:
Blood glucose
Insulin resistance
Nutrition
Vitamin status
Hydration
Body composition
Inflammation
Function
The final goal includes restoring:
Strength
Mobility
Stability
Coordination
Endurance
Work ability
Daily activity
This is consistent with ChiroMed’s stated model of combining medical evaluation, chiropractic care, rehabilitation, soft-tissue care, functional medicine, and whole-body health strategies within a coordinated injury program.
Dr. Alex Jimenez: Connecting Chiropractic, Nursing, and Functional Medicine
Dr. Alexander Jimenez, DC, APRN, FNP-BC, CFMP, IFMCP, ATN, CCST, serves as Clinical Director within ChiroMed’s multidisciplinary model.
His professional background combines chiropractic care with advanced practice nursing and functional medicine.
This creates an opportunity to examine an injured patient through several clinical lenses.
Instead of asking only:
“Where does it hurt?”
an integrated evaluation can also ask:
How did the injury occur?
Is there neurological involvement?
Which structures were injured?
Is movement restricted?
Has strength decreased?
Is sleep interfering with recovery?
Is nutrition adequate?
Are metabolic problems slowing healing?
Does the patient need imaging?
Is another medical specialist needed?
Is rehabilitation progressing?
Is an advanced intervention appropriate?
This broader approach fits ChiroMed’s goal of addressing contributing factors rather than focusing only on symptoms.
Medical Oversight With Dr. Maria Guadalupe Cardenas
The ChiroMed multidisciplinary team also includes Dr. Maria Guadalupe Cardenas, MD, who is board-certified in Internal Medicine.
ChiroMed identifies Dr. Cardenas as its Medical Director, Clinical Director, and Collaborative Physician, with NPI #1164426749 and Texas Medical License #J2933.
She brings more than 40 years of clinical experience in internal medicine to the collaborative model.
Her role adds medical oversight to a system that may integrate:
Chiropractic care
Medical evaluation
Functional medicine
Personal injury care
Rehabilitation
Nutritional counseling
Metabolic health
Musculoskeletal care
Coordination with other specialists
This multidisciplinary structure allows different licensed professionals to contribute within their respective clinical scopes.
Root-Cause Recovery: Why Isn’t the Patient Getting Better?
One of the most useful questions in functional and integrative medicine is:
What could be slowing recovery?
Possible factors may include:
Poor protein intake
Nutrient deficiencies
Poor sleep
High blood sugar
Insulin resistance
Dehydration
Physical inactivity
Loss of muscle
Persistent stress
Gastrointestinal problems
Medication effects
An untreated structural injury
Identifying these problems does not replace diagnosis of the original injury.
It can help create a healthier environment for healing and rehabilitation.
Know the Warning Signs After a Head Injury
The Gut-Brain-Spine approach should never delay emergency medical care.
According to the Centers for Disease Control and Prevention, a person should receive immediate medical attention after head trauma if serious warning signs develop.
These can include:
A worsening headache
Repeated vomiting
Seizures
Increasing confusion
Slurred speech
Weakness or numbness
Poor coordination
Inability to stay awake
One pupil larger than the other
Double vision
Unusual behavior
These symptoms may indicate a more serious brain injury.
Nutrition, chiropractic care, supplements, rehabilitation, or regenerative therapies should never substitute for emergency evaluation when red flags are present.
Feed the Brain, Support the Gut, and Rebuild the Spine
Head and neck injury recovery is rarely about one body part.
The brain needs energy.
The digestive system absorbs nutrients and participates in immune and metabolic signaling.
The cervical spine needs mobility and stability.
Muscles need protein.
The nervous system needs appropriate activity and rest.
The injured person needs sleep, hydration, movement, and time.
That is the practical meaning behind the Gut-Brain-Spine Connection.
For patients in El Paso, the ChiroMed model brings many of these pieces together through coordinated chiropractic care, medical oversight, functional medicine, nutrition, personal injury management, and rehabilitation.
For appropriately selected patients, advanced therapies may also support treatment of a clearly identified musculoskeletal injury.
The objective is not to chase symptoms with one procedure after another.
The objective is to understand the injury, identify barriers to recovery, rebuild function, and help the patient move toward a healthier and more active life.
de la Barra Ortiz, H. A., Arias, M., & Liebano, R. E. (2024). A systematic review and meta-analysis of randomized controlled trials on the effectiveness of high-intensity laser therapy in the management of neck pain. Lasers in Medical Science, 39(1), 124. High-Intensity Laser Therapy in the Management of Neck Pain
Hao, J., He, Z., Huang, B., Li, Y., Remis, A., Yao, Z., Tang, Y., Sun, Y., & Wu, K. (2025). Comparative effectiveness of six biophysical agents on neck pain rehabilitation: A systematic review and network meta-analysis. European Spine Journal, 34(6), 2183–2200. Comparative Effectiveness of Biophysical Agents on Neck Pain Rehabilitation
Smith, A., Andruski, B., Deng, G., & Burnham, R. (2023). Cervical facet joint platelet-rich plasma in people with chronic whiplash-associated disorders: A prospective case series of longer-term outcomes. Interventional Pain Medicine, 2(1), 100237. Platelet-Rich Plasma for Cervical Facet Pain Following Whiplash
Taylor, A. M., Mannix, R., Zafonte, R. D., Whalen, M. J., & Meehan, W. P., III. (2024). A randomized, double-blind, placebo-controlled clinical trial evaluating transcranial photobiomodulation as treatment for concussion. Medicine & Science in Sports & Exercise, 56(5), 822–827. Transcranial Photobiomodulation as Treatment for Concussion
After a car accident, many injured people leave the emergency room with medications for pain, inflammation, or muscle spasms. Emergency care is essential for ruling out serious injuries, but pain medicine alone does not restore joint movement, rebuild strength, correct altered movement patterns, or rehabilitate damaged muscles and soft tissues.
At ChiroMed – Integrated Medicine in El Paso, Texas, personal injury recovery takes a broader approach. Dr. Alexander Jimenez, DC, APRN, FNP-BC, CCST, CFMP, IFMCP, ATN, combines his chiropractic and advanced practice nursing background with rehabilitation, functional medicine, medical evaluation, and selected advanced therapies. The multidisciplinary model also includes medical oversight from Dr. Maria Guadalupe Cardenas, MD, a board-certified internal medicine physician with more than 40 years of medical experience.
Rather than simply waiting for symptoms to disappear, ChiroMed uses a structured approach that can move from early pain control and evaluation to stabilization, rehabilitation, and functional recovery. Care is supported by detailed SOAP notes, repeat examinations, functional measurements, imaging when appropriate, and coordination among providers.
Why Accident Injuries Need More Than “Wait and See”
Emergency rooms have an important job after a serious motor vehicle collision.
Doctors must first look for medical emergencies such as:
Broken bones
Internal bleeding
Brain injuries
Spinal cord injuries
Organ damage
Severe neurologic problems
Life-threatening trauma
If these conditions are ruled out, the patient may be discharged with NSAIDs, muscle relaxers, pain medication, activity instructions, or recommendations for follow-up care.
This does not mean the emergency room did anything wrong.
It means emergency medicine and injury rehabilitation have different goals.
An NSAID may decrease inflammation and pain. A muscle relaxer may reduce painful muscle spasms. However, these medications by themselves do not improve restricted spinal motion, strengthen weakened muscles, rehabilitate an injured ligament, restore balance, or correct movement problems that developed after the collision.
Some accident symptoms may also become clearer during the hours or days following a collision.
For that reason, early follow-up can be important.
From a medical-legal standpoint, long unexplained gaps between an accident and medical evaluation can also make it more difficult to establish a clear timeline showing when symptoms began and how they developed (Farahi Law Firm Team, 2025).
The ChiroMed Integrated Injury-Care Model
At ChiroMed – Integrated Medicine, the goal is to look beyond the location of pain.
The clinic’s current multidisciplinary model brings chiropractic care, nurse practitioner services, rehabilitation, nutrition, and other integrative services together in one setting. The purpose is to create a coordinated plan rather than making the patient manage several unrelated treatment plans. (ChiroMed, 2026a).
An accident assessment may consider questions such as:
How did the accident happen?
Which movements increase the symptoms?
Is spinal or joint motion restricted?
Is nerve irritation present?
Has muscle strength changed?
Are headaches developing?
Is the patient experiencing numbness or tingling?
Can the patient sit, walk, lift, or bend normally?
Has sleep changed?
Can the patient safely work?
Can the patient turn the head while driving?
Is imaging or specialist evaluation necessary?
This produces a much more complete picture than a pain score alone.
Dr. Alex Jimenez: Connecting Chiropractic and Medical Care
One feature of the ChiroMed model is Dr. Alexander Jimenez’s combination of chiropractic and advanced practice nursing credentials.
Dr. Jimenez is a Doctor of Chiropractic and board-certified Family Nurse Practitioner. His professional credentials include DC, APRN, FNP-BC, CCST, CFMP, IFMCP, and ATN. ChiroMed identifies him as its clinical director within its multidisciplinary injury-care model.
This background allows personal injury care to be examined through multiple clinical lenses.
The chiropractic side focuses heavily on:
Spinal mechanics
Joint mobility
Musculoskeletal injuries
Posture
Neuromuscular function
Movement
Rehabilitation
The medical and functional side can consider broader issues such as:
Medication history
Laboratory findings when indicated
Medical risk factors
Metabolic health
Inflammation
Nutrition
Sleep
Recovery capacity
Need for additional medical evaluation
The goal is coordinated care—not replacing one healthcare profession with another.
Medical Oversight With Dr. Maria Cardenas, MD
The multidisciplinary structure also includes Dr. Maria Guadalupe Cardenas, MD, whom ChiroMed identifies as a board-certified internal medicine physician and Medical Director/Collaborative Physician. Her Texas medical license is listed as J2933, and her NPI is 1164426749.
Dr. Cardenas brings more than four decades of internal medicine experience to this collaborative model.
Medical oversight can become especially important when an injured patient also has conditions such as:
Diabetes
High blood pressure
Cardiovascular disease
Kidney problems
Metabolic disease
Multiple medications
Age-related medical concerns
Complex chronic health conditions
This type of collaboration allows chiropractic treatment, rehabilitation, functional medicine, and medical management to work together while each provider stays within the appropriate professional scope of practice.
Phase 1: Days 1–14 — Evaluate, Protect, and Reduce Acute Symptoms
The first days after an accident should focus on safety.
The exact timeline varies from patient to patient, but an early injury-care phase may include:
Medical and chiropractic examination
Orthopedic testing
Neurologic testing
Range-of-motion measurements
Muscle-strength testing
Functional assessment
Review of emergency-room records
Imaging when clinically appropriate
Gentle mobility treatment
Soft-tissue treatment
Pain-control strategies
Patient education
Patients with significant weakness, progressive numbness, bowel or bladder changes, loss of consciousness, severe headache, worsening neurologic findings, fracture concerns, or other red flags may need urgent medical or specialist evaluation.
For appropriate patients with neck pain or whiplash-associated disorders, evidence-based guidelines support multimodal approaches that can include manual therapy, exercise, mobilization, manipulation, and patient education rather than relying on one treatment alone (Bussières et al., 2016).
This fits closely with ChiroMed’s integrated philosophy.
How Chiropractic Care Fits Into Personal Injury Recovery
Chiropractic care after an accident is not simply about getting an adjustment.
A modern integrative chiropractic plan may combine:
Chiropractic adjustments or mobilization
Soft-tissue treatment
Corrective exercise
Stretching
Core stabilization
Postural training
Neuromuscular re-education
Progressive strengthening
Movement retraining
Car accidents commonly produce combinations of neck pain, back pain, whiplash symptoms, muscle strains, and ligament stress (Function First Chiropractic & Wellness, n.d.).
The purpose of care is therefore not simply to make the patient feel better for a few hours.
The larger goal is to help restore function.
Phase 2: Weeks 3–8 — Stabilization and Tissue Recovery
Once severe acute symptoms begin to settle, treatment can gradually shift toward rebuilding.
Patients may begin working more on:
Strength
Flexibility
Joint stability
Spinal control
Balance
Endurance
Core function
Normal walking
Work activities
Safe lifting
Instead of asking only, “How much does it hurt?”, the clinical team begins asking, “What can the patient do now that they could not do before?”
That is an important difference.
Pain can improve before an injury is fully rehabilitated.
A patient may report less neck pain yet still have trouble turning the head while driving. Another patient may report less low-back pain but remain unable to lift safely at work.
Functional measurements help reveal those differences.
Where Laser Therapy May Fit
ChiroMed may combine physical rehabilitation with advanced supportive technologies when clinically appropriate.
Laser or photobiomodulation therapy is one example.
Low-level laser therapy uses light energy as a noninvasive treatment for selected musculoskeletal conditions. A systematic review and meta-analysis reported reductions in musculoskeletal pain, although results depend on the condition, treatment parameters, dosage, and study design (Clijsen et al., 2017).
Laser therapy should therefore be viewed as an adjunct.
It does not replace:
A diagnosis
Appropriate imaging
Chiropractic care
Rehabilitation
Strength training
Medical evaluation when needed
At ChiroMed, the larger goal is to combine useful therapies instead of expecting one machine or procedure to solve every injury.
Regenerative Therapies and Personal Injury Recovery
Certain patients with persistent tendon, ligament, muscle, or joint problems may also be evaluated for regenerative or orthobiologic procedures.
One example is platelet-rich plasma, or PRP.
PRP is prepared from the patient’s blood and produces a platelet-rich concentration that contains signaling proteins and growth factors involved in normal tissue repair.
Research continues to examine which musculoskeletal injuries respond best.
A 2024 systematic review and meta-analysis found that outcomes may vary according to factors such as platelet dose and the condition being treated (Berrigan et al., 2024). This is another reason regenerative procedures should be matched to a specific diagnosis rather than marketed as a universal solution.
When regenerative medicine is appropriate, chiropractic care and rehabilitation still matter.
An injection cannot by itself correct every abnormal movement pattern.
The patient may still need to improve:
Joint mechanics
Strength
Balance
Mobility
Muscle control
Posture
Work tolerance
ChiroMed describes this type of approach as combining regenerative support with chiropractic care, rehabilitation, medical oversight, nutrition, and functional medicine when appropriate (ChiroMed, 2026b).
What About Peptide Therapy?
Peptide-based therapies have received growing attention in regenerative and functional medicine.
However, this is an area where patients need clear information.
Certain peptides promoted online for “tissue rebuilding” do not have the same level of human evidence or regulatory approval as established medications and rehabilitation treatments.
For example, the FDA states that compounded BPC-157 presents unresolved safety concerns and that available human safety information is limited. Concerns include immunogenicity and peptide-related impurities (U.S. Food and Drug Administration, 2026).
Therefore, peptides should not be presented as guaranteed tissue-healing treatments.
When an emerging or off-label therapy is considered, the patient should understand:
Available evidence
Known risks
Unknown risks
Regulatory status
Alternative treatments
Expected benefits
Cost
Medical monitoring requirements
Scientific caution is part of good integrative medicine.
SOAP Notes Create a Clear Recovery Timeline
Personal injury treatment also depends heavily on documentation.
Chiropractic documentation can help show how an injury, treatment plan, symptoms, and functional limitations change over time (Integrated Health & Injury Center, 2026).
A strong SOAP note generally contains:
Subjective: What the patient reports.
Objective: What the provider measures or observes.
Assessment: The clinical interpretation of the patient’s condition.
Plan: What happens next.
ChiroMed’s functional documentation may also track findings such as:
Cervical range of motion
Lumbar range of motion
Strength
Sensation
Reflexes
Pain distribution
Functional limitations
Work capacity
Sleep disturbance
Driving tolerance
Treatment response
Rehabilitation progress
These records create a clinical timeline.
Medical records are also important when an injury becomes part of a personal injury claim because they can document diagnosis, treatment, causation issues, and the course of recovery (Tavrn, 2026).
Documentation should remain accurate and medically necessary. Its purpose is to record the patient’s condition—not to inflate a legal claim.
Phase 3: Week 8 and Beyond — Restore Function and Work Toward MMI
Later rehabilitation increasingly focuses on returning the patient to everyday life.
Goals may include:
Normalizing range of motion
Improving strength
Increasing endurance
Restoring spinal stability
Improving lifting ability
Returning to work
Returning to exercise
Improving driving tolerance
Reducing reinjury risk
The original examination findings can then be compared with later measurements.
This creates a simple question:
Is the patient objectively improving?
Eventually, some injury cases reach Maximum Medical Improvement, or MMI.
Texas workers’ compensation rules define clinical MMI as the point after which, based on reasonable medical probability, further material recovery or lasting improvement can no longer reasonably be expected (Texas Department of Insurance, 2026).
Importantly, week eight does not automatically mean MMI.
The three-phase structure is a clinical framework, not a stopwatch.
A mild strain may improve quickly. A disc injury, nerve injury, significant ligament injury, or complicated joint condition may require much longer care.
ChiroMed’s Goal: From Pain Relief to Functional Recovery
The ChiroMed model challenges the idea that accident recovery should consist only of medication followed by waiting.
Instead, the process can move through a coordinated pathway:
Evaluate the injury → control acute symptoms → restore movement → support tissue recovery → stabilize the body → rebuild strength → measure function → determine long-term needs.
Emergency medicine still has an essential role.
Medication may still have an essential role.
Imaging, specialists, injections, surgery, or other medical services may also be necessary for certain injuries.
Integrated care is not about rejecting conventional medicine.
It is about connecting the pieces.
Through the collaboration of Dr. Alexander Jimenez, DC, APRN, FNP-BC, Dr. Maria Guadalupe Cardenas, MD, and the multidisciplinary ChiroMed team, patients in El Paso can receive coordinated chiropractic care, medical oversight, personal injury evaluation, rehabilitation, functional medicine support, and selected advanced therapies within a broader plan focused on function.
For an injured patient, that creates a clearer goal than simply waiting for pain to disappear:
Recover safely, document objectively, restore function, and return to life.
Complex spinal joint and nerve pain can be difficult to manage because multiple structures may be causing symptoms at the same time. A spinal disc may be irritated, a facet joint may not move normally, nearby muscles may tighten, and a nerve root may become compressed or inflamed. For people in El Paso and West Texas who continue to experience back pain, neck pain, sciatica, numbness, weakness, or limited mobility after traditional treatment, a second opinion may help identify overlooked problems.
At ChiroMed – Integrated Medicine in El Paso, Texas, integrated care aims to look beyond one painful area. Chiropractic care, medical evaluation, rehabilitation, functional medicine, and supportive technologies can be combined into an individualized treatment plan. Depending on the diagnosis, care may include chiropractic treatment, rehabilitation, MLS laser therapy, shockwave therapy, IV infusion therapy, PRP, platelet-fibrin products, micro-fragmented adipose tissue, or coordination for epidural spinal injections. The purpose is not to use every therapy on every patient. Instead, the care team identifies the tissues involved and chooses treatments that fit the patient’s condition.
What Is Complex Spinal Joint and Nerve Pain?
Complex spinal joint and nerve pain describes ongoing discomfort caused by overlapping problems involving the spine’s joints, discs, vertebrae, muscles, ligaments, and nerves.
It is not a single medical diagnosis.
Instead, it describes a situation where several structures may contribute to the same symptoms.
The spine contains many closely connected parts:
Vertebrae support the body.
Spinal discs absorb force between the vertebrae.
Facet joints allow controlled spinal movement.
Muscles support movement and posture.
Ligaments help stabilize the spine.
Nerve roots carry information between the spinal cord and the rest of the body.
Because these structures are located close together, a problem in one area may affect another.
For example, a damaged or bulging disc may irritate a nearby spinal nerve. The resulting pain may cause a person to change how they stand, walk, lift, or sit. Those changes can place greater stress on the muscles and facet joints.
A patient may eventually develop several problems at once:
Disc-related pain
Facet joint irritation
Muscle tightness
Reduced spinal mobility
Nerve inflammation
Sciatica
Weakness
Abnormal movement patterns
Kansas Pain Management explains that back pain may come from nerves, muscles, joints, or a combination of these tissues. Determining the main source of pain is important because different tissues may require different treatment approaches (Kansas Pain Management, 2026).
What Does Spinal Nerve Pain Feel Like?
Nerve pain often feels different from ordinary muscle soreness.
A person with an irritated or compressed spinal nerve may experience:
Burning pain
Shooting pain
Electric-like sensations
Tingling
Pins and needles
Numbness
Pain traveling into an arm or leg
Muscle weakness
Increased skin sensitivity
When a spinal nerve root becomes irritated or compressed, the condition may be described as radiculopathy.
Lumbar radiculopathy can send symptoms from the lower back into the buttock, thigh, leg, or foot. It is often called sciatica when the sciatic nerve pathway is involved.
Cervical radiculopathy can send pain, numbness, tingling, or weakness from the neck into the shoulder, arm, hand, or fingers.
Spinal nerve compression can develop from several problems, including disc herniation, degenerative changes, bone spurs, inflammation, nerve narrowing, or trauma (Advanced Orthopedics & Sports Medicine, n.d.; Dallas Spine Surgery, 2026).
How Is Joint Pain Different From Nerve Pain?
The facet joints are small joints located toward the back of the spine.
They help guide spinal movement when a person bends, twists, turns, or extends the neck or back.
Facet joint pain may feel like:
A deep ache
Localized back pain
Localized neck pain
Morning stiffness
Pain when twisting
Pain when leaning backward
Pain after prolonged standing
Pain with certain movements
Nerve pain is more likely to travel, burn, tingle, or cause numbness and weakness.
However, patients can have joint pain and nerve pain at the same time.
This overlap can make diagnosis challenging. Oakland Spine & Physical Therapy notes that understanding whether pain is mainly coming from nerves or joints can help guide more appropriate treatment (Butler, 2026).
Is Complex Spinal Pain the Same as CRPS?
No.
Complex spinal joint and nerve pain should not be confused with complex regional pain syndrome, or CRPS.
CRPS is a specific neurological pain disorder that usually affects an arm, hand, leg, or foot. Symptoms may include severe pain, swelling, temperature changes, unusual skin color, and extreme sensitivity.
Cleveland Clinic explains that CRPS involves abnormal communication within the nervous system and may develop after an injury or nerve damage (Cleveland Clinic, 2022).
Complex spinal pain may involve nerve sensitivity, but this does not mean a patient has CRPS.
A qualified healthcare professional must evaluate the symptoms and determine the correct diagnosis.
When Should You Seek a Second Opinion for Spine Pain?
Living with pain for months or years can become exhausting.
Some people move from one treatment to another without receiving a clear explanation for why their symptoms continue.
A second opinion does not automatically mean the original physician or provider was wrong. Spine problems can be complicated, and different healthcare professionals may view the same condition differently.
A second opinion may be worth considering if:
Your pain continues after several weeks or months of treatment.
Your treatment provides only temporary relief.
Your sciatica keeps returning.
You continue to experience numbness or tingling.
Weakness is developing in an arm or leg.
Your MRI findings have never been clearly explained.
Several treatments have already failed.
You are relying mainly on medication without improving function.
You have been told surgery is your only option and want another evaluation.
You continue to hurt after spinal surgery.
Your pain followed a motor vehicle accident.
Your condition developed after a workplace injury.
A sports injury continues to cause nerve or spinal symptoms.
Your pain changes depending on movement or posture.
Nobody has clearly identified where the pain is coming from.
The goal of a second opinion is to ask a deeper question:
Which tissues are producing the patient’s symptoms, and what combination of treatment gives those tissues the best chance to recover?
The ChiroMed Integrated Approach in El Paso
ChiroMed – Integrated Medicine is built around a multidisciplinary approach to healthcare.
The El Paso practice brings chiropractic care, nurse practitioner services, rehabilitation, nutrition, naturopathic care, acupuncture, and related health services together within a coordinated model. ChiroMed describes its goal as addressing underlying causes of health problems while developing individualized plans rather than focusing only on symptoms.
This can be especially useful for complicated injury and spine cases.
A patient with chronic low-back pain may not simply have a “bad back.”
That patient could have:
A damaged disc
Inflamed joints
Restricted spinal movement
Muscle guarding
A compressed nerve
Poor core stability
Hip mobility problems
An abnormal walking pattern
Reduced physical conditioning
ChiroMed’s integrated injury-care model combines medical, chiropractic, rehabilitative, and supportive approaches within a coordinated recovery strategy.
Chiropractic Care for Complex Spine Problems
Chiropractic care may play an important role when abnormal joint movement, spinal mechanics, muscle imbalance, or posture contributes to the patient’s symptoms.
Depending on examination findings, Dr. Alex Jimenez and the ChiroMed team may incorporate:
Chiropractic adjustments
Joint mobilization
Soft-tissue treatment
Corrective exercise
Spinal decompression when appropriate
Posture correction
Core stabilization
Neuromuscular retraining
Mobility exercises
Functional movement training
The goal is not simply to “crack the back.”
The larger purpose is to improve joint movement, decrease unnecessary mechanical stress, improve movement patterns, and help the patient become stronger and more stable.
ChiroMed’s current injury-care model specifically combines chiropractic evaluation with rehabilitation, functional medicine support, medical oversight, soft-tissue care, and advanced technologies when clinically appropriate.
Shockwave Therapy for Musculoskeletal Pain
Shockwave therapy uses acoustic energy directed toward specific tissues.
It may be considered when chronic muscle, fascia, tendon, or other soft-tissue problems are contributing to pain.
Potential goals include supporting:
Pain reduction
Soft-tissue mobility
Local circulation
Rehabilitation
Improved tolerance for movement
Shockwave therapy should not be described as physically pushing a herniated disc back into place or removing a bone spur.
Instead, it may be used as a supportive treatment within a larger rehabilitation plan.
This distinction is important because complex spinal pain often requires several different strategies rather than depending on one therapy.
MLS Laser Therapy
MLS laser therapy is another noninvasive option that may be incorporated into an integrated treatment program.
Laser therapy uses light energy delivered to targeted tissues. Within rehabilitation, therapeutic laser may be considered to support pain management and irritated soft tissues.
It may be used alongside:
Chiropractic treatment
Corrective exercises
Mobility work
Soft-tissue treatment
Strengthening
Rehabilitation
Laser therapy does not physically remove spinal stenosis, repair every herniated disc, or permanently decompress a nerve.
Instead, its role is supportive.
This is one reason ChiroMed’s integrated model is important. Rather than expecting a single machine or procedure to solve every problem, several therapies can be coordinated around the patient’s diagnosis.
Epidural Spinal Injections for Nerve Inflammation
When a disc or another spinal structure irritates a nerve root, inflammation around the nerve may contribute to severe pain.
An epidural spinal injection may sometimes be considered for conditions such as:
Lumbar radiculopathy
Cervical radiculopathy
Disc-related nerve irritation
Selected cases of spinal stenosis
The goal of an epidural injection is generally to place anti-inflammatory medication near the irritated spinal nerve.
An epidural injection does not rebuild a disc.
However, decreasing nerve inflammation may help some patients move more comfortably and participate more effectively in rehabilitation.
In an integrated model, this is important.
Pain reduction can create a window for rehabilitation.
Once symptoms are better controlled, chiropractic care, therapeutic exercise, mobility work, and strengthening can focus on restoring function.
PRP and Platelet-Fibrin Products
Platelet-rich plasma, or PRP, is prepared from the patient’s own blood.
Platelets contain growth factors and signaling proteins that participate in the body’s normal repair process.
PRP has become an important area of orthopedic research, especially for selected tendon, ligament, and joint conditions.
Another approach involves platelet and fibrin preparations, sometimes called PFP or platelet-fibrin products.
Fibrin can create a temporary framework that helps hold platelets and signaling molecules within a treatment area.
These treatments should always match the actual diagnosis.
They should not be advertised as guaranteed cures for nerve compression or spinal degeneration.
Instead, biologic treatments may be considered as part of carefully selected orthopedic or musculoskeletal care after the patient receives an appropriate evaluation.
MFAT and Regenerative Medicine
Micro-fragmented adipose tissue, or MFAT, is prepared from a patient’s own fat tissue through mechanical processing.
MFAT is being explored in orthopedic and regenerative medicine, particularly for selected musculoskeletal and joint problems.
Its potential role depends on:
The tissue involved
Severity of injury
Previous treatments
Overall health
Patient goals
Medical screening
Available clinical evidence
MFAT is not appropriate for every patient with spinal pain.
Regenerative medicine is developing rapidly, and evidence varies by condition. Patients should receive a clear explanation of potential benefits, limitations, risks, alternatives, and regulatory considerations before choosing regenerative treatment.
IV Infusion Therapy as Supportive Care
IV infusion therapy delivers fluids, medications, or selected nutrients directly into the bloodstream.
The purpose depends entirely on what the patient receives.
Medically appropriate IV therapy may be used for issues such as:
Dehydration
Documented nutritional needs
Certain medications
Specific medical conditions
Supportive care during recovery
IV therapy should not be described as directly repairing a herniated disc or removing nerve compression.
At ChiroMed, a broader integrated-care philosophy can combine medical and supportive treatment with chiropractic and rehabilitation, rather than viewing each service as an isolated treatment. The clinic currently describes chiropractic, nurse practitioner services, rehabilitation, nutrition, and other disciplines as components of a coordinated healthcare model.
Why Combining Treatments Can Be Helpful
A patient with complex spine pain may need treatment at several levels.
One possible strategy may be:
Identify the pain generator. Determine whether symptoms involve a disc, facet joint, muscle, ligament, nerve, or several structures.
Reduce severe irritation. Consider medical treatment when inflammation or significant nerve pain prevents normal movement.
Restore joint movement. Chiropractic treatment may help improve restricted spinal or extremity joint mechanics when appropriate.
Address damaged or irritated soft tissues. Laser, shockwave, soft-tissue care, or selected regenerative options may be considered based on the diagnosis.
Improve strength and stability. Rehabilitation helps the patient develop the muscular control necessary to protect recovering tissues.
Address whole-body factors. Nutrition, sleep, metabolic health, physical conditioning, and functional medicine may be considered when these factors influence recovery.
Measure progress. Change treatment when the patient’s function is not improving.
This is an important part of ChiroMed’s philosophy.
Integrated care does not mean giving every patient every available treatment.
It means selecting the right combination for the right patient.
Medical and Chiropractic Collaboration
Complex injury cases can benefit from communication between healthcare professionals.
At Injury Medical Clinic PA and within the integrated clinical model associated with Dr. Jimenez’s El Paso practices, Dr. Maria Guadalupe Cardenas, MD, provides medical direction and collaborative physician support alongside Dr. Jimenez.
Dr. Cardenas is an internal medicine physician with more than four decades of clinical experience. Public provider records list her NPI as 1164426749 and Texas medical license as J2933.
This multidisciplinary structure keeps medical and chiropractic responsibilities within each provider’s professional scope while helping the team coordinate complex cases.
The integrated model may bring together:
Medical oversight
Chiropractic care
Functional medicine
Nurse practitioner services
Personal injury evaluation
Rehabilitation
Nutrition
Advanced musculoskeletal therapies
Specialist referrals when necessary
Dr. Alex Jimenez’s Clinical Approach at ChiroMed
Dr. Alexander Jimenez, DC, APRN, FNP-BC, CCST, CFMP, IFMCP, ATN, brings together chiropractic care, advanced practice nursing, functional medicine principles, physical rehabilitation, and personal injury care.
His clinical observations emphasize that many injuries are not isolated problems.
A car accident, for example, may affect:
Spinal joints
Discs
Nerves
Muscles
Posture
Balance
Sleep
Physical activity
Daily function
This is why ChiroMed’s model focuses on the patient as a whole, not just the location where pain is felt.
ChiroMed currently describes itself as an El Paso multidisciplinary practice providing care for chronic neck and back pain, personal injuries, sports injuries, disc injuries, severe sciatica, work injuries, and complex injury rehabilitation.
Complex Pain After Auto and Work Injuries
Complex spinal pain deserves particular attention after a motor vehicle collision or workplace injury.
A collision can place force through several areas of the body within fractions of a second.
The result may include:
Whiplash
Disc injury
Facet joint injury
Muscle strain
Ligament injury
Nerve irritation
Headaches
Shoulder pain
Hip problems
Altered walking mechanics
ChiroMed’s El Paso injury-care model specifically addresses auto accidents, work injuries, sports injuries, falls, personal injury recovery, spinal pain, and nerve irritation through coordinated medical, chiropractic, and rehabilitative care.
Proper documentation is also important after an accident.
Clinical records may help show:
How the injury happened
Which body regions were affected
Examination findings
Functional limitations
Imaging results
Treatments performed
Patient response
Rehabilitation progress
When Spine Pain Requires Urgent Medical Attention
Not all back or neck pain should be treated as a routine musculoskeletal problem.
Seek urgent medical attention if spinal pain is accompanied by:
New loss of bladder control
New loss of bowel control
Numbness around the groin or saddle area
Rapidly increasing arm or leg weakness
Sudden severe difficulty walking
Major loss of coordination
Fever with severe unexplained spinal pain
Significant trauma with severe neurological symptoms
These symptoms may indicate a serious neurological or spinal condition that requires immediate medical evaluation.
A Second Opinion Can Create a New Path Forward
Patients with long-term spinal pain often begin with one question:
“Why am I still hurting?”
A detailed second opinion can turn that question into several more useful ones:
Is my pain coming from my joints, discs, nerves, muscles, or several areas?
Is a nerve actually compressed?
Is inflammation contributing to the symptoms?
Has my body changed how it moves because of the injury?
Why did previous treatments fail?
Do my examination findings match my MRI?
Could conservative care still help?
Would a medical procedure improve my ability to rehabilitate?
Are regenerative options reasonable for my specific injury?
When is surgical consultation necessary?
For people seeking a second opinion for chronic back pain, nerve pain, sciatica, or complex spine injuries in El Paso and West Texas, ChiroMed’s integrated approach helps examine the problem from more than one direction.
The goal is not simply to cover pain.
The goal is to understand why the pain continues, identify the structures involved, improve movement, protect neurological function, rebuild strength, and create a realistic plan for long-term recovery.
Shot of a sports paramedic providing first aid to an athlete on a running track.
Abstract
Athletes depend on healthy nerves for strength, balance, coordination, speed, and precise movement. However, sports can sometimes place nerves under enough pressure, stretch, or repeated stress to cause a neuropathy. Sports neuropathies may develop after a sudden injury or slowly through repetitive microtrauma.
Symptoms can include burning, tingling, numbness, weakness, electric-like pain, poor balance, or reduced athletic performance. Because these symptoms can look like muscle, tendon, joint, or spinal injuries, sports-related nerve problems are sometimes missed.
At ChiroMed – Integrated Medicine in El Paso, Texas, the goal is to look beyond the painful nerve alone. An integrated plan may include chiropractic care, rehabilitation, medical oversight, functional medicine, advanced physical therapies, and selected regenerative or injection-based treatments when medically appropriate. The purpose is to address the mechanical environment around the nerve while also considering the athlete’s overall health and tissue recovery.
Can Athletes Really Develop Neuropathy?
Yes. Neuropathies can occur in sports.
Peripheral nerves connect the brain and spinal cord with the muscles, skin, and other tissues. These nerves carry signals that allow an athlete to feel, move, react, and maintain coordination.
A nerve can become irritated or injured when it experiences:
Repeated compression
Repetitive microtrauma
Sudden stretching
Direct impact
Joint dislocation
Bone fracture
Swelling around the nerve
Poor movement mechanics
Tight muscles or connective tissues
Pressure from athletic equipment or footwear
Mitchell et al. (2014) explain that sports-related peripheral neuropathies can result from serious acute injuries, but chronic repetitive stress is often more common. These nerve injuries may also be overlooked because their symptoms can resemble more common sports injuries involving muscles, tendons, joints, and bones.
Radić et al. (2018) similarly reported that sports nerve injuries can occur from pressure, stretching, fractures, and repetitive overuse.
Why Sports Neuropathy Can Be Easy to Miss
A nerve injury does not always cause obvious numbness.
Sometimes the first complaint is simply pain, weakness, tightness, or poor performance.
An athlete may believe the problem is a strained muscle when the real source is an irritated nerve.
Possible symptoms include:
Burning pain
Pins-and-needles sensations
Tingling
Numbness
Shooting or electric pain
Muscle weakness
Reduced grip
Foot weakness
Problems lifting the foot
Loss of coordination
Reduced balance
Pain that appears only during exercise
Upper-extremity neuropathies can be especially difficult to recognize because symptoms may be subtle. A recent sports medicine review notes that numbness, tingling, weakness, and other neurological findings can occur, while EMG, nerve-conduction studies, ultrasound, and MRI may help confirm the diagnosis (Stokes et al., 2025).
The lesson for athletes is simple:
Persistent nerve-like symptoms deserve a closer look.
What Sports Are Associated With Nerve Problems?
The nerve at risk often depends on how the athlete moves.
Running
Runners may develop nerve irritation around the lower leg, ankle, or foot.
Examples include:
Tibial nerve compression
Tarsal tunnel syndrome
Sural nerve irritation
Common fibular or peroneal nerve problems
Medial plantar nerve entrapment
Interdigital nerve irritation
Foot and ankle neuropathies are often seen in running athletes. Repetitive microtrauma, abnormal gait, footwear, previous injuries, and mechanical stress can contribute to nerve compression (Senk & Carlson, 2026).
The sural nerve is one good example. Sural nerve irritation may produce pain, burning, or tingling along the outside of the ankle, heel, and foot. It can sometimes be confused with an Achilles tendon problem.
Baseball and Throwing Sports
Throwing places repeated forces across the shoulder and elbow.
Nerves that may become irritated include:
Ulnar nerve
Suprascapular nerve
Axillary nerve
Radial nerve
The repetitive throwing motion can create traction or compression that gradually affects nerve function.
Cycling
Cyclists may experience nerve compression from long periods in the same position.
Possible problems include:
Ulnar nerve compression at the hand
Median nerve compression
Pudendal nerve irritation
Bike fit, wrist position, saddle position, and training duration can all influence mechanical stress.
Football, Wrestling, Hockey, and Contact Sports
Contact athletes can develop nerve problems from:
Direct blows
Joint dislocations
Neck and shoulder trauma
Knee injuries
Stretching of the brachial plexus
Hirasawa and Sakakida (1983) found that continuous compression and repeated nerve trauma were common causes of sports-related peripheral nerve injury.
Diagnosis Comes Before Treatment
At ChiroMed, an integrated treatment plan should begin by determining what is actually causing the symptoms.
Not all tingling is neuropathy.
Nerve symptoms can also come from:
Herniated spinal discs
Sciatica
Cervical radiculopathy
Carpal tunnel syndrome
Diabetes
Thyroid disease
Vitamin deficiencies
Previous fractures
Scar tissue
Tendon swelling
Joint instability
An examination may include:
Strength testing
Reflex testing
Sensory testing
Range-of-motion testing
Orthopedic examination
Neurological examination
Gait analysis
Posture assessment
Functional movement testing
When appropriate, additional testing may include:
MRI
Diagnostic ultrasound
Electromyography, or EMG
Nerve-conduction studies
X-rays
MRI can be especially helpful because it may show nerve abnormalities, compression, swelling, and changes within muscles supplied by an injured nerve (Mitchell et al., 2014).
Early diagnosis also matters because severe nerve injuries may need specialty or surgical evaluation rather than conservative care alone.
Where Integrative Chiropractic Care Fits
Chiropractic care does not directly “regrow” an injured peripheral nerve.
Its role is to improve the mechanical environment surrounding the nerve.
Imagine an athlete has an irritated tibial nerve at the ankle. The nerve problem may occur along with:
Restricted ankle movement
Excessive foot pronation
Weak hip muscles
Poor running mechanics
Tight calf tissues
Previous ankle injuries
Only treating the painful nerve may leave these mechanical problems unchanged.
At ChiroMed – Integrated Medicine, chiropractic and rehabilitative care can address these contributing factors. ChiroMed describes its model as combining chiropractic treatment, rehabilitation, nurse practitioner services, nutrition, and other healthcare services in a patient-centered, integrated approach.
Depending on the condition, care may include:
Chiropractic adjustments
Joint mobilization
Soft-tissue techniques
Mobility exercises
Posture correction
Gait evaluation
Core stabilization
Balance training
Strengthening
Nerve-gliding exercises
Sport-specific rehabilitation
The purpose is to help the athlete move more efficiently and reduce repeated stress on injured tissues.
Dr. Alex Jimenez’s ChiroMed Clinical Approach
At ChiroMed, Dr. Alexander Jimenez, DC, APRN, FNP-BC, CCST, CFMP, IFMCP, ATN, approaches sports injuries from both mechanical and whole-health viewpoints.
His clinical observations focus on an important idea:
Where the athlete hurts may not be the only area contributing to the problem.
For example, recurring foot nerve symptoms may be influenced by ankle mobility, knee mechanics, hip control, spinal function, running technique, or metabolic health.
His integrated assessment may therefore consider:
Spinal mechanics
Joint motion
Muscle balance
Gait
Posture
Strength
Neurological function
Nutrition
Recovery
Sleep
Metabolic health
Previous injuries
This approach matches ChiroMed’s broader goal of addressing the factors contributing to a patient’s problem instead of concentrating only on symptoms.
Medical Oversight With Dr. Maria Guadalupe Cardenas
Complex nerve symptoms may involve more than biomechanics.
That is why medical oversight can become important.
Dr. Maria Guadalupe Cardenas, MD, is a board-certified internal medicine physician with more than 40 years of medical experience. Public provider information identifies her as NPI #1164426749 and Texas medical license #J2933. ChiroMed materials describe Dr. Cardenas as Medical Director and Collaborative Physician for Injury Medical Clinic PA in El Paso.
Dr. Cardenas works alongside Dr. Jimenez within a multidisciplinary model.
This collaboration allows the team to consider issues such as:
Diabetes
Thyroid disease
Circulation problems
Medication effects
Nutritional deficiencies
Inflammatory disorders
Kidney or liver concerns
Other medical conditions affecting nerve health
The medical-chiropractic model can bring together:
Chiropractic care
Internal medicine oversight
Functional medicine
Personal injury care
Rehabilitation
Nutritional support
Advanced treatment options
Referral coordination
This does not mean every patient needs every service. Treatment should be based on the patient’s diagnosis and individual needs.
Can Laser Therapy Support Neuropathy Care?
Photobiomodulation, often called therapeutic laser therapy, has been studied for several pain and nerve conditions.
Researchers are interested in whether specific wavelengths of light may influence inflammation, circulation, mitochondrial activity, and cellular signaling.
However, laser therapy should be viewed as an adjunct treatment, not a replacement for diagnosing the cause of nerve compression.
At ChiroMed, a more complete strategy may combine an advanced modality with:
Chiropractic care
Movement correction
Rehabilitation
Strengthening
Medical evaluation
The goal is not simply to apply a laser where something hurts. The larger goal is to determine why the nerve is irritated and address those contributing factors.
What About Shockwave Therapy?
Shockwave therapy sends acoustic energy into tissues.
It has stronger established use for several tendon and musculoskeletal problems than it does for directly treating peripheral neuropathy.
This distinction matters.
An athlete with nerve symptoms may also have:
Tendinopathy
Scar tissue
Fascia restrictions
Chronic muscle problems
Joint dysfunction
In selected patients, shockwave treatment may target an associated musculoskeletal problem as part of an overall rehabilitation program.
It should not be presented as a universal treatment that regenerates damaged nerves.
At ChiroMed, advanced treatments are best used as part of a larger care strategy rather than as stand-alone procedures. ChiroMed’s current integrated injury-care materials similarly describe shockwave and other technologies as tools that work alongside diagnosis, rehabilitation, chiropractic care, and medical oversight.
Targeted Injections and Nerve Entrapment
Some patients continue to experience symptoms even after activity changes and rehabilitation.
In selected cases, ultrasound-guided procedures may be considered.
One example is nerve hydrodissection.
During hydrodissection, fluid is carefully placed around a compressed peripheral nerve under ultrasound guidance. The goal is to separate the nerve from surrounding tissue that may limit movement or create pressure.
Injection options used in different clinical settings and studies have included:
Saline
Local anesthetic
Corticosteroid
Dextrose
Platelet-based preparations
These procedures are not appropriate for every neuropathy.
The exact diagnosis, location, severity, medical history, and available research should guide treatment.
Regenerative Medicine and Nerve Recovery
Regenerative medicine is another area receiving growing attention.
Possible approaches include:
Platelet-rich plasma, or PRP
Platelet-based fibrin preparations
Microfragmented adipose tissue, or MFAT
These therapies are designed to provide biological signals or supportive tissue to an injured area.
However, an important distinction must be made:
Regenerative medicine for peripheral nerve repair remains an evolving field.
MFAT, for example, contains adipose tissue with cells and signaling factors associated with tissue repair. A 2025 narrative review describes potential regenerative and anti-inflammatory applications, including interest in neural regeneration, but the authors also stress that larger clinical trials are needed to establish long-term safety and effectiveness (Fu & Wang, 2025).
Therefore, regenerative therapy should not be described as a guaranteed way to regenerate an injured sports nerve.
It may be considered for selected patients and selected accompanying injuries after proper evaluation.
Why ChiroMed Uses a Multi-Layered Approach
One strength of integrative care is that sports neuropathy may involve several problems at the same time.
Think of recovery as having several layers.
Layer 1: Protect the Nerve
The first step may include reducing movement, pressure, or activity that irritates the nerve.
Layer 2: Improve Mechanics
Chiropractic care and rehabilitation can address joint motion, posture, gait, and muscle control.
Layer 3: Rebuild Strength
Progressive exercise can restore strength, balance, stability, and athletic control.
Layer 4: Evaluate Medical Factors
Medical oversight helps identify metabolic or systemic conditions that could interfere with nerve health.
Layer 5: Consider Advanced Treatments
Laser, shockwave, targeted injections, or regenerative options may be considered when the diagnosis and evidence support their use.
ChiroMed’s integrated sports-care philosophy follows this broader model. The clinic combines chiropractic and rehabilitation services with medical and functional-health support rather than relying on one treatment alone.
When Athletes Should Not Ignore Nerve Symptoms
Athletes often become used to soreness.
Neurological symptoms are different.
Seek prompt evaluation for:
Increasing muscle weakness
Foot drop
Loss of grip strength
Progressive numbness
Muscle wasting
Severe burning pain
Major coordination changes
Symptoms following a fracture or dislocation
Persistent symptoms despite rest
Loss of bowel or bladder control
Severe or rapidly worsening neurological symptoms may require urgent medical or surgical evaluation.
ChiroMed’s Goal: From Nerve Pain Back to Better Movement
Sports neuropathy is not simply a pain problem.
A nerve can become irritated because of repeated compression, traumatic stretching, abnormal joint mechanics, inflammation, scar tissue, or another medical condition.
That is why treatment begins with finding the cause.
At ChiroMed – Integrated Medicine in El Paso, Texas, the broader strategy is to bring different areas of healthcare together.
Dr. Alex Jimenez’s chiropractic and rehabilitative approach can address movement, spinal and joint mechanics, posture, strength, and athletic function. Dr. Maria Guadalupe Cardenas provides internal medicine experience and medical oversight. Functional medicine can help evaluate nutritional and metabolic factors. Rehabilitation progressively rebuilds movement and performance.
Advanced modalities, targeted injections, and regenerative therapies may add another layer of treatment for carefully selected patients.
The goal is not to use every available treatment.
The goal is to build the right combination of treatments for the right athlete at the right stage of recovery.
For an athlete struggling with burning, tingling, weakness, numbness, or recurring nerve pain, an integrated evaluation may help uncover the source and create a clearer path toward improved function and a safer return to activity.
Hirasawa, Y., & Sakakida, K. (1983). Sports and peripheral nerve injury. The American Journal of Sports Medicine, 11(6), 420–426. Sports and peripheral nerve injury
Mitchell, C. H., Brushart, T. M., Ahlawat, S., Belzberg, A. J., Carrino, J. A., & Fayad, L. M. (2014). MRI of sports-related peripheral nerve injuries. American Journal of Roentgenology, 203(5), 1075–1084. MRI of sports-related peripheral nerve injuries
Radić, B., Radić, P., & Duraković, D. (2018). Peripheral nerve injury in sports. Acta Clinica Croatica, 57(3), 561–569. Peripheral nerve injury in sports
Stokes, D. C., Toole, K., & Cushman, D. M. (2025). Upper extremity neuropathies in athletes. Current Sports Medicine Reports, 24(11), 356–365. Upper extremity neuropathies in athletes
