Platelet Fibrin Plasma therapy is a regenerative treatment that uses healing factors from your blood to support tissue repair. It is used for joint pain, soft tissue injuries, and non-surgical musculoskeletal recovery. Often used to support tendon and ligament healing in areas affected by overuse, strain, or injury. PFP therapy may help support injured or worn joints by delivering concentrated healing factors to the targeted area. This regenerative option is often used to promote comfort, mobility, and tissue recovery. By using your body’s own natural repair components, this therapy is designed to encourage recovery and improve function.

Percutaneous Tenotomy for Chronic Tendinopathy: An Integrative Approach

Abstract

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

September 8, 2026

Unlocking Frozen Shoulder: Hydrodistension and Integrative Care

Abstract

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.

Understanding Adhesive Capsulitis (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

September 4, 2026

Radial Tunnel Hydrodissection for Nerve Entrapment

Abstract

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.

References

September 3, 2026

Tendon Healing: High-Volume Injections for Tendinopathy

Abstract

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

August 31, 2026

Head and Neck Injury Nutrition Care in El Paso

Abstract

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:

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.

Laser therapy cannot replace neurological evaluation.

Exercise cannot correct every metabolic problem.

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.

References

Aghakhani, N. (2022). Relationship between mild traumatic brain injury and the gut microbiome: A scoping review. Journal of Neuroscience Research, 100(3), 827–834. Relationship Between Mild Traumatic Brain Injury and the Gut Microbiome

Centers for Disease Control and Prevention. (2025). Symptoms of mild TBI and concussion. Symptoms of Mild TBI and Concussion

ChiroMed Integrated Medicine. (2026). About us. Meet the ChiroMed Integrated Medicine Team

ChiroMed Integrated Medicine. (2026). Integrated injury care in El Paso, TX. Integrated Injury Care in El Paso, Texas

Cleveland Clinic. (2023). The gut-brain connection. The Gut-Brain Connection

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

Finnegan, E., Daly, E., Pearce, A. J., & Ryan, L. (2022). Nutritional interventions to support acute mTBI recovery. Frontiers in Nutrition, 9, 977728. Nutritional Interventions to Support Acute Mild Traumatic Brain Injury Recovery

Gwak, M.-G., & Chang, S.-Y. (2021). Gut-brain connection: Microbiome, gut barrier, and environmental sensors. Immune Network, 21(3), e20. Gut-Brain Connection: Microbiome, Gut Barrier, and Environmental Sensors

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

Jimenez, A. (2026). The gut-brain connection. Dr. Alex Jimenez: The Gut-Brain Connection

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

August 28, 2026

Break the Wait-and-See Injury Cycle in El Paso

Abstract

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.

References

Berrigan, W., Tao, F., Kopcow, J., Park, A. L., Allen, I., Tahir, P., Reddy, A., & Bailowitz, Z. (2024). The effect of platelet dose on outcomes after platelet rich plasma injections for musculoskeletal conditions: A systematic review and meta-analysis. Current Reviews in Musculoskeletal Medicine, 17(12), 570–588.

Bussières, A. E., Stewart, G., Al-Zoubi, F., et al. (2016). The treatment of neck pain-associated disorders and whiplash-associated disorders: A clinical practice guideline. Journal of Manipulative and Physiological Therapeutics, 39(8), 523–564.e27.

ChiroMed. (2026a). Integrated injury care in El Paso, TX.

ChiroMed. (2026b). Regenerative medicine and chiropractic care in El Paso, TX.

ChiroMed. (2026c). From injury to compensation: How chiropractors and nurse practitioners support personal injury recovery after car accidents.

Clijsen, R., Brunner, A., Barbero, M., Clarys, P., & Taeymans, J. (2017). Effects of low-level laser therapy on pain in patients with musculoskeletal disorders: A systematic review and meta-analysis. European Journal of Physical and Rehabilitation Medicine, 53(4), 603–610.

Farahi Law Firm Team. (2025, February 18). 5 ways a delay in treatment can devalue your injury case.

Integrated Health & Injury Center. (2026, March 6). How chiropractic documentation strengthens your personal injury case.

Tavrn. (2026, August 8). Personal injury medical records request: A legal guide.

Texas Department of Insurance, Division of Workers’ Compensation. (2026). Workers’ compensation insurance glossary.

U.S. Food and Drug Administration. (2026). Certain bulk drug substances for use in compounding that may present significant safety risks.

August 27, 2026

Second Opinion for Spine and Nerve Pain in El Paso

Abstract

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.

References

Advanced Orthopaedics & Sports Medicine. (n.d.). Radiculopathy.

Butler, B. (2026). Nerve Pain vs. Joint Pain: Understanding the Differences and Finding Proper Relief.

ChiroMed – Integrated Medicine. (2026). ChiroMed – Integrated Medicine Holistic Healthcare in El Paso, TX.

ChiroMed – Integrated Medicine. (2026). Integrated Injury Care in El Paso, TX.

ChiroMed – Integrated Medicine. (2026). Personal Injury and Work Injury Recovery in El Paso.

Cleveland Clinic. (2022). Complex Regional Pain Syndrome (CRPS).

Dallas Spine Surgery. (2026). What Causes Nerve Compression in the Spine?.

Jimenez, A. (n.d.). Dr. Alex Jimenez: El Paso Chiropractor and Integrative Healthcare Provider.

Jimenez, A. (n.d.). Dr. Alex Jimenez Professional Profile. LinkedIn.

Kansas Pain Management. (2026). Is Your Back Pain Coming From Nerves, Muscles, or Joints?.

Manipal Hospitals. (n.d.). Spine Problems Affect the Vertebrae, Discs, Nerves, and Surrounding Muscles [Video].

YouTube. (n.d.). Spinal Joint and Nerve Pain Educational Resource [Video].

YouTube. (n.d.). Spine and Nerve Pain Educational Resource [Video].

August 26, 2026

Sports Neuropathy Treatment: An Integrated Approach in El Paso

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.

References

Fu, H., & Wang, C. (2025). Micro-fragmented adipose tissue—An innovative therapeutic approach: A narrative review. Medicine, 104(9), e41724. Micro-fragmented adipose tissue—An innovative therapeutic approach

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

Senk, A. M., & Carlson, A. (2026). Ankle and foot neuropathies and entrapments. PM&R KnowledgeNow. Ankle and foot neuropathies and entrapments

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

ChiroMed – Integrated Medicine. (2026). Regenerative therapies for athletes in El Paso, TX. Regenerative therapies for athletes in El Paso, TX

ChiroMed – Integrated Medicine. (2026). Regenerative medicine and chiropractic care in El Paso, TX. Regenerative medicine and chiropractic care in El Paso, TX

August 18, 2026

Overlooked Injuries After Car and Workplace Accidents

Hidden Injury Warning Signs

Abstract

After a car accident or workplace injury, it is possible to have pain even when standard X-rays look normal. X-rays are excellent for finding many fractures and bone problems, but they do not show most muscles, ligaments, spinal discs, joint capsules, fascia, or mild brain injuries in detail.

Some commonly overlooked injuries include small ligament injuries, annular tears in spinal discs, facet joint capsule trauma, myofascial trigger points, concussions, and repetitive workplace injuries.

At ChiroMed in El Paso, Texas, an integrative approach looks beyond the location of pain. The goal is to identify how an injury affects movement, muscles, joints, nerves, and normal function. Chiropractic care, medical oversight, rehabilitation, functional medicine, and other supportive treatments can work together to address both mechanical problems and biological tissue healing.

Why Some Accident Injuries Are Easy to Miss

After a motor vehicle accident, fall, lifting injury, or workplace accident, many people visit an emergency room, urgent care center, or primary care office.

These evaluations are important. The first goal is usually to identify serious problems such as:

Major fractures
Internal bleeding
Spinal cord injuries
Brain bleeding
Dislocations
Other medical emergencies

However, not every injury is visible on a basic X-ray.

Soft-tissue injuries may affect the:

Muscles
Ligaments
Tendons
Spinal discs
Joint capsules
Fascia

These structures can become stretched, torn, compressed, or irritated during an accident.

Advantage Healthcare Systems explains that soft-tissue injuries may be harder to identify immediately after a collision. Pain and stiffness can also become more noticeable as inflammation develops during the hours or days after the accident (Advantage Healthcare Systems, 2025).

This is why a person may leave an emergency department with no broken bones but still experience significant neck pain, back pain, headaches, or limited movement.

A Normal X-Ray Does Not Always Mean There Is No Injury

A normal X-ray can be reassuring, but it doesn’t always tell the whole story.

Standard X-rays are mainly designed to show bones and alignment. They provide much less information about discs, ligaments, muscles, nerves, and other soft tissues.

At ChiroMed, the clinical examination is important because it helps determine whether pain could be coming from structures that are difficult to see on a plain X-ray.

Small Spinal Ligament Injuries

Ligaments are strong bands of connective tissue that hold bones together and help control joint movement.

During a collision or workplace accident, the neck or lower back can move very quickly.

For example, the spine may be:

Bent forward
Forced backward
Twisted
Compressed
Pulled beyond its usual range

These forces can stretch or injure spinal ligaments.

Possible symptoms include:

Neck stiffness
Lower back pain
Pain with turning
Muscle tightness
Headaches
Pain after prolonged sitting
Pain while lifting or bending

Small ligament injuries usually do not show clearly on a standard X-ray.

When symptoms, examination findings, or neurologic changes suggest a more complex injury, MRI or another form of imaging may sometimes be considered. The American College of Radiology notes that MRI can provide more information about soft tissues in selected spinal trauma cases (American College of Radiology [ACR], n.d.).

Annular Tears and Disc Injuries

The bones of the spine are separated by intervertebral discs.

Each disc contains:

A soft inner center
A tougher outer layer called the annulus fibrosus

During a motor vehicle accident, the spine can experience compression, twisting, bending, and sudden movement.

These forces may contribute to small tears or fissures in the annulus.

Possible symptoms can include:

Deep back or neck pain
Pain when sitting
Pain when bending
Muscle spasms
Pain that spreads into the arm
Pain that spreads into the leg

Annular tears cannot normally be seen on standard X-rays.

Some disc injuries can be seen on MRI. Studies have described MRI findings associated with annular tears and disc-related pain, although imaging findings must always be compared with the patient’s symptoms and physical examination (Lam et al., 2000; Saifuddin et al., 1999).

It is also important to remember that not every disc abnormality is caused by an accident. Some changes can develop with age or normal wear.

This is why the patient’s history matters.

Clinicians may consider:

When the pain started
Whether symptoms existed before the accident
How the accident occurred
What movements increase the pain
Whether numbness or weakness is present

Facet Joint Capsule Injuries

The spine contains small joints called facet joints.

Facet joints help control movement between the spinal bones.

Each facet joint is surrounded by a capsule. This capsule contains connective tissue and nerve endings that can become irritated after trauma.

During whiplash, the facet joint capsule may be stretched very quickly.

Research has identified cervical facet joint structures as possible sources of pain after whiplash injuries (Chen et al., 2009).

Facet-related pain may become worse with:

Looking upward
Turning the head
Twisting the back
Standing for long periods
Repeated bending
Certain sleeping positions

Facet joint capsule injuries may not be obvious on a standard X-ray.

This is one reason why orthopedic testing, range-of-motion testing, and a complete musculoskeletal examination can be important after an accident.

Muscle Injuries and Myofascial Trigger Points

Muscles commonly tighten after an injury.

This is sometimes called muscle guarding.

The body may tighten muscles around an injured area to protect it from further movement.

However, prolonged muscle guarding can lead to additional pain and stiffness.

Sensitive areas called myofascial trigger points can develop within muscles and fascia.

These trigger points may cause pain in the injured area or refer pain to another location.

For example, neck trigger points may contribute to pain in the:

Head
Upper back
Shoulder
Arm

Trigger points in the lower back may cause pain near the:

Hip
Buttock
Pelvis

These problems do not appear on standard X-rays.

They are usually identified through the patient’s history, examination, muscle testing, movement testing, and palpation.

Mild Concussion After an Accident

Not every hidden injury involves the spine.

A person may experience a mild traumatic brain injury, commonly called a concussion, after:

A car accident
A fall
A workplace accident
A sudden blow to the body
Rapid acceleration and deceleration

The head does not always need to strike an object for a concussion to occur.

Possible symptoms include:

Headache
Dizziness
Nausea
Brain fog
Trouble concentrating
Memory problems
Light sensitivity
Noise sensitivity
Balance problems
Sleep changes

The Centers for Disease Control and Prevention explains that some concussion symptoms may appear immediately, while others can develop later (Centers for Disease Control and Prevention [CDC], 2025a).

A CT scan or standard MRI can also appear normal in a person with a mild traumatic brain injury.

Imaging is often used to look for serious problems such as bleeding rather than to diagnose every concussion (CDC, 2025b; Shenton et al., 2012).

Any worsening neurological symptoms after a head injury require medical evaluation.

Workplace Injuries Can Build Over Time

Not every workplace injury happens during one major event.

Some injuries develop slowly because of repeated physical stress.

This may happen with:

Repetitive lifting
Repeated twisting
Long periods of sitting
Poor workstation position
Overhead work
Repetitive gripping
Tool use
Vibration
Frequent bending
Awkward body positions

This type of injury may be described as cumulative trauma.

Stern and Cohen explain that cumulative trauma injuries can develop because of repeated movements, physical stress, or long-term overuse (Stern & Cohen, 2025).

Examples can include:

Tendinitis
Carpal tunnel syndrome
Chronic low back pain
Shoulder injuries
Repetitive strain injuries

Because these conditions can develop slowly, a detailed work history may be important.

A clinician may ask:

What does the patient lift?
How often does the patient bend?
Does the patient sit most of the day?
Does the job involve repetitive hand movements?
Does the patient work overhead?
Does the job involve heavy tools or vibrating equipment?

These questions may help identify the source of ongoing physical stress.

Why the Physical Examination Matters at ChiroMed

Imaging can be useful, but it is only one part of an injury evaluation.

At ChiroMed, a complete evaluation may look at how the body moves and functions after the injury.

Depending on the patient’s condition, the examination may include:

Range-of-motion testing
Orthopedic testing
Neurological examination
Muscle strength testing
Reflex testing
Sensory testing
Posture assessment
Gait evaluation
Joint movement
Functional movement testing
Review of the accident
Review of symptoms

This information helps the clinical team decide what type of care may be appropriate.

It may also help determine whether the patient needs:

MRI
CT imaging
Electrodiagnostic testing
Specialist referral
Further medical evaluation

How Integrative Chiropractic Care Fits Into Recovery

At ChiroMed, chiropractic care isn’t focused only on the area that hurts.

Accidents can change the way a person moves.

For example, a patient with neck pain may start turning their entire body instead of just their neck.

A patient with lower back pain may place more weight on one leg.

A shoulder injury can also change posture and upper-back movement.

These compensations may place additional stress on other muscles and joints.

Integrative chiropractic care may include:

Chiropractic adjustments when appropriate
Joint mobilization
Soft-tissue treatment
Mobility exercises
Corrective exercises
Stabilization training
Rehabilitation
Posture training
Movement retraining

The goal is to improve movement while reducing unnecessary stress on injured tissues.

Clinical practice guidelines support exercise and selected manual therapies for certain forms of neck and lower-back pain when they are properly matched to the patient’s condition (George et al., 2021).

Combining Mechanical Recovery With Biological Healing

Accident recovery can involve two major areas:

Mechanical restoration and biological tissue healing.

Mechanical recovery focuses on how the body moves.

This may include improving:

Joint movement
Muscle function
Posture
Stability
Balance
Strength
Flexibility

Biological healing focuses on how damaged tissues repair themselves.

Some patients may also be evaluated for regenerative or supportive treatments when medically appropriate.

For example, platelet-rich plasma, or PRP, uses concentrated components from a patient’s own blood. Platelets contain signaling proteins that are involved in normal healing processes.

Regenerative treatments are being studied for various tendon, ligament, and joint conditions, but outcomes can vary depending on the patient, injury, and treatment method (Cohn, n.d.).

These treatments should not be described as guaranteed cures.

Instead, the goal is to create a treatment plan based on the patient’s specific condition.

An Integrated Medical and Chiropractic Model

ChiroMed supports a multidisciplinary approach to injury care in El Paso.

Dr. Alexander Jimenez, DC, APRN, FNP-BC, CCST, CFMP, IFMCP, ATN, incorporates chiropractic, physical medicine, functional medicine, rehabilitation, and personal injury care into a coordinated clinical model.

His clinical observations emphasize looking beyond the painful body part.

An injury can affect:

muscles → joints → ligaments → discs → nerves → posture → movement

Understanding these connections can help guide treatment and rehabilitation.

Dr. Jimenez also works under the medical oversight of Dr. Maria Guadalupe Cardenas, MD, a board-certified internal medicine physician with more than 40 years of clinical experience.

Dr. Cardenas serves as a medical director and collaborative physician within Injury Medical Clinic PA.

This type of integrated arrangement brings chiropractic and medical care together while allowing each clinician to work within the appropriate professional scope.

Medical oversight may help with:

General medical evaluation
Medication considerations
Chronic medical conditions
Clinical safety
Medical coordination
Appropriate referrals

Dr. Jimenez’s role may include:

Chiropractic care
Musculoskeletal evaluation
Functional medicine
Personal injury care
Rehabilitation
Movement assessment
Care coordination

This collaborative model can be especially useful when a patient has several health concerns after an accident.

The ChiroMed Approach to Hidden Injuries

The most important lesson is simple:

Pain after an accident should not be ignored only because an X-ray is normal.

A complete injury evaluation looks beyond bones.

The clinical team may need to examine the:

Ligaments
Muscles
Spinal discs
Facet joints
Nerves
Posture
Balance
Movement patterns
Neurological function

At ChiroMed, the goal is to identify problems that interfere with normal movement and recovery.

From there, the care plan can focus on reducing pain, restoring movement, rebuilding strength, and supporting healing.

A clear recovery path often follows these steps:

Identify the injury
Rule out serious conditions
Reduce pain and inflammation
Restore healthy movement
Support tissue healing
Rebuild strength and stability
Return the patient to daily activity

For many accident and workplace injury patients, recovery is not about treating one painful spot.

It is about helping the body function as a connected system again.

References

Advantage Healthcare Systems. (2025). The hidden soft-tissue injuries most people miss after a car accident.

American College of Radiology. (n.d.). ACR Appropriateness Criteria: Acute spinal trauma.

Centers for Disease Control and Prevention. (2025a). Symptoms of mild TBI and concussion.

Centers for Disease Control and Prevention. (2025b). About mild TBI and concussion.

Chen, H., Yang, K. H., & Wang, Z. (2009). Biomechanics of whiplash injury. Chinese Journal of Traumatology, 12(5), 305–314.

Cohn, J. (n.d.). Regenerative orthopedics: PRP, stem cells, and healing from within.

George, S. Z., et al. (2021). Interventions for the management of acute and chronic low back pain: Revision 2021. Journal of Orthopaedic & Sports Physical Therapy, 51(11), CPG1–CPG60.

Jimenez, A. (2026). MVA joint trauma: Comprehensive chiropractic approaches.

Jimenez, A. (2026). How regenerative medicine and chiropractic care work together. LinkedIn.

Jimenez, A. (2026). Regenerative medicine and integrative chiropractic strategies.

Lam, K. S., Carlin, D., & Mulholland, R. C. (2000). Lumbar disc high-intensity zone: The value and significance of provocative discography in the determination of the discogenic pain source. European Spine Journal, 9, 36–41.

Morgan & Morgan. (2025). 15 work injuries you may not know about.

Saifuddin, A., Mitchell, R., & Taylor, B. A. (1999). Extradural inflammation associated with annular tears: Demonstration with gadolinium-enhanced lumbar spine MRI. European Spine Journal, 8(1), 34–39.

Shenton, M. E., et al. (2012). A review of magnetic resonance imaging and diffusion tensor imaging findings in mild traumatic brain injury. Brain Imaging and Behavior, 6, 137–192.

Stern & Cohen. (2025). Workplace cumulative trauma and your right to compensation.

August 17, 2026

Regenerative Therapies for Athletes in El Paso, TX

PRP, PFP, MFAT, IV Infusions, Peptides, and Integrative Chiropractic Care

Abstract

Athletes in El Paso, Texas, often want to recover from injuries, return to training, and protect their long-term performance. Regenerative therapies such as platelet-rich plasma (PRP), platelet-fibrin products (PFP), micro-fragmented adipose tissue (MFAT), IV infusions, and peptide therapies are becoming more common in sports and wellness care.

At ChiroMed in El Paso, an integrative approach can combine chiropractic care, medical oversight, functional medicine, rehabilitation, and regenerative medicine support. Instead of focusing only on pain, the goal is to identify the injured tissue, improve movement, restore strength, and help the athlete return to activity as safely as possible.

This article explains how these therapies may fit into an athlete’s recovery plan, how integrative chiropractic care can support movement and rehabilitation, and why competitive athletes must also consider anti-doping rules before using certain IV treatments or peptide products.

Why Athletes in El Paso Are Looking at Regenerative Medicine

Athletes place repeated stress on their muscles, joints, tendons, ligaments, and connective tissues. Running, jumping, lifting, throwing, tackling, and sudden changes in direction can all create injuries.

Common sports problems may include:

Tendon irritation or tearing
Ligament sprains
Muscle strains
Shoulder injuries
Knee injuries
Ankle and foot injuries
Hip pain
Joint degeneration
Cartilage damage
Back and neck pain
Repetitive-use injuries

For many athletes, the main question is simple:

How can I heal while losing as little training time as possible?

Regenerative medicine may be one part of that answer for selected injuries. However, treatment should always begin with a proper diagnosis. The right therapy depends on the tissue involved, the injury’s severity, the athlete’s health, and the demands of the sport.

PRP, rehabilitation, and other regenerative approaches are increasingly used in sports medicine, but results vary depending on the condition being treated (de Sire et al., 2025; Reagan Integrated Sports Medicine, 2022).

What Is PRP Therapy?

Platelet-rich plasma, or PRP, is made from the patient’s own blood.

A healthcare professional draws a small blood sample and places it into a centrifuge. The centrifuge separates different parts of the blood and creates a preparation with a higher concentration of platelets.

Platelets are known for their role in blood clotting, but they also contain proteins and signaling molecules involved in the body’s normal repair process.

PRP may be considered for certain:

Tendon injuries
Ligament injuries
Muscle injuries
Joint problems
Knee osteoarthritis
Elbow tendinopathy
Rotator cuff conditions
Patellar tendon problems

Sports medicine clinics have used PRP as one option when an injury is slow to improve with more basic conservative care (Dunn, n.d.; OrthoEdge Orthopedics and Sports Medicine, n.d.).

However, PRP should not be presented as a guaranteed cure.

Research shows that the results can differ depending on the injury. A systematic review of PRP use in athletes found possible pain and functional benefits in some conditions, but researchers also noted that higher-quality studies are still needed (de Sire et al., 2025).

This makes individualized care important.

Instead of simply asking, “Does PRP work?”, athletes should ask:

“Is PRP supported for my specific type of injury?”

What Are PFP Treatments?

Another option discussed in regenerative medicine is PFP, or platelet-fibrin products.

PFP treatments use blood-derived material containing platelets along with fibrin. Fibrin is part of the body’s normal clotting and healing process and can form a supportive framework around platelets.

This framework may help keep platelets and biological signaling factors near the treatment area for a period of time.

PFP is sometimes discussed for:

Tendon injuries
Ligament problems
Joint injuries
Soft-tissue injuries
Areas that have been slow to recover

One important point is that platelet and fibrin products can be prepared in different ways.

The term PFP is not completely standardized across all clinics and researchers. Athletes should ask exactly what type of product is being used and why the healthcare provider believes it fits the injury.

Clear communication helps the patient understand whether the treatment is PRP, PRF, PFP, or another platelet-based preparation.

What Is MFAT?

MFAT stands for micro-fragmented adipose tissue.

Adipose tissue is body fat. In an MFAT procedure, a small amount of the patient’s own adipose tissue is collected and mechanically processed into smaller fragments.

The processed tissue may then be placed into an injured or arthritic joint.

MFAT is being studied in areas such as knee osteoarthritis and joint degeneration.

Research has shown encouraging results for some patients with knee osteoarthritis. A systematic review and meta-analysis found that both MFAT and PRP produced improvements in patients with knee osteoarthritis, although more research is needed to determine which patients are most likely to benefit (Park et al., 2025).

MFAT should not be described as a guaranteed way to regrow cartilage or rebuild a completely damaged joint.

At ChiroMed, regenerative therapies can be considered as part of a broader plan that also looks at:

Joint mechanics
Strength
Flexibility
Weight-bearing patterns
Muscle balance
Previous injuries
Functional movement
Rehabilitation needs

The goal is to treat the athlete as a whole rather than focusing only on one painful area.

How Much Downtime Is Needed After Regenerative Therapy?

This is one of the most common questions athletes ask.

“When can I train again?”

There is no single recovery timeline.

The answer depends on:

The type of injury
The location of the injury
The treatment performed
The severity of tissue damage
The athlete’s age
Medical conditions
Fitness level
Training demands
Healing response
Rehabilitation progress

An athlete who receives an injection into a knee may have a different recovery plan than someone receiving treatment for an elbow or shoulder tendon.

Regenerative treatment is also not the same as instant pain relief.

Some therapies are intended to support the body’s repair response, which may take time.

Early recovery may include:

Reduced activity
Gentle movement
Controlled range-of-motion exercises
Gradual weight bearing
Progressive strengthening
Functional exercises
Sport-specific training

Athletes should not return to full activity based only on how many days have passed.

A better return-to-sport plan looks at strength, movement quality, balance, pain, stability, and sport-specific function.

How Integrative Chiropractic Care Supports Athletes

An injection may address an injured tissue, but it does not automatically fix the movement problem that contributed to the injury.

For example, an athlete with chronic knee pain may also have:

Limited ankle mobility
Weak hip muscles
Poor pelvic control
Abnormal running mechanics
Muscle imbalance
Restricted joint motion
Poor landing mechanics

These problems can continue placing stress on the recovering tissue.

That is why integrative chiropractic care at ChiroMed can be an important part of the overall recovery plan.

Depending on the athlete’s condition, care may include:

Chiropractic adjustments
Joint mobilization
Soft-tissue treatment
Corrective exercise
Mobility training
Core stabilization
Strengthening
Functional movement testing
Balance training
Sport-specific rehabilitation
Posture and movement correction

Chiropractic adjustments should not be described as directly regenerating torn tendons or cartilage.

Instead, chiropractic treatment can help support mobility, joint function, movement mechanics, and rehabilitation participation.

This can help athletes move better while the injured tissues recover.

Dr. Alex Jimenez’s Integrative Approach at ChiroMed

At ChiroMed, Dr. Alexander Jimenez, DC, APRN, FNP-BC, CCST, CFMP, IFMCP, ATN, brings together chiropractic care, functional medicine, injury evaluation, rehabilitation, and multidisciplinary care.

His clinical approach considers more than the painful body part.

A sports injury may involve problems with:

Muscle coordination
Joint mobility
Strength
Balance
Posture
Gait
Flexibility
Training volume
Nutrition
Sleep
Recovery habits

Dr. Jimenez’s clinical observations often focus on two important questions:

What tissue has been injured?

and

What movement problem is continuing to place stress on that tissue?

This approach can help create a more complete rehabilitation plan.

Instead of treating only symptoms, the goal is to understand the athlete’s movement patterns and determine what may need to change before returning to full training.

Medical Oversight With Dr. Maria Guadalupe Cardenas, MD

An important part of the multidisciplinary model used alongside Dr. Jimenez’s practice is the medical oversight of Dr. Maria Guadalupe Cardenas, MD, a board-certified Internal Medicine physician with more than 40 years of experience.

Dr. Cardenas serves as Medical Director and Collaborative Physician at Injury Medical Clinic PA in El Paso.

Her role adds medical evaluation and oversight to an integrative care system that includes chiropractic and rehabilitation services.

This type of collaboration can be useful because an athlete’s recovery may be affected by more than the injury itself.

Medical issues that may influence treatment include:

Prescription medications
Heart and blood pressure conditions
Diabetes or metabolic problems
Hormonal concerns
Blood disorders
Infection
Kidney problems
Liver conditions
Nutritional deficiencies

By combining chiropractic care with medical oversight, the care team can consider both musculoskeletal and general medical factors.

The multidisciplinary model may include:

Chiropractic care
Internal medicine oversight
Functional medicine
Sports injury care
Personal injury care
Rehabilitation
Regenerative medicine support
Wellness services

This type of coordinated care can help guide athletes through different stages of recovery.

What About IV Infusions for Athletes?

IV infusion therapy is often discussed in sports recovery and wellness clinics.

IV fluids may be appropriate when a patient needs direct fluid or medication administration.

However, athletes should not assume that every IV marketed for recovery is necessary or supported for every situation.

An IV treatment may contain:

Fluids
Electrolytes
Vitamins
Minerals
Medications
Other ingredients

Athletes should know exactly what they are receiving.

Competitive athletes must be especially careful.

Under World Anti-Doping Agency rules, IV infusions or injections totaling more than 100 mL during a 12-hour period are generally prohibited, unless they are received during certain hospital treatments, surgical procedures, clinical diagnostic investigations, or meet another accepted medical exemption.

Before an IV, competitive athletes should ask:

What is in the IV?
What is the total volume?
Why is the IV medically needed?
Is every ingredient allowed by my sport?
Does my sports organization follow WADA rules?
Do I need a Therapeutic Use Exemption?

Athletes should check anti-doping requirements before receiving treatment, not afterward.

Peptide Therapy and Athletic Recovery

Peptide therapies are receiving more attention in functional and regenerative medicine.

Peptides are short chains of amino acids that can act as biological signals in the body.

Some clinics market peptides for goals involving:

Recovery
Body composition
Sleep
Hormonal support
Tissue repair
Inflammation

However, athletes should approach peptide therapy carefully.

Many peptides promoted for sports recovery lack strong human clinical evidence for treating sports injuries.

Some compounded peptides have also raised safety concerns with the U.S. Food and Drug Administration.

Examples that athletes may hear about include:

BPC-157
CJC-1295
Ipamorelin
TB-500-related compounds
Growth hormone-related peptides

The FDA has identified safety concerns or limited human data for several compounded peptide substances.

This does not mean every peptide is the same, but it does mean athletes should avoid assuming that “peptide therapy” automatically means safe, proven, or approved.

Peptides and Anti-Doping Rules

Competitive athletes need to be especially cautious.

Some peptides are prohibited under anti-doping rules.

For example, BPC-157 is prohibited under the World Anti-Doping Agency Prohibited List.

Growth hormone-releasing compounds and certain related peptides may also be prohibited.

A substance can violate anti-doping rules even when:

A clinic offers it legally
A healthcare professional recommends it
It comes from a compounding pharmacy
It is marketed as natural
The athlete did not intend to cheat

Athletes who compete in tested sports should check their organization’s current rules before using any peptide, supplement, hormone, medication, or injection.

Combining Regenerative Medicine and Chiropractic Rehabilitation

The strongest treatment plan is often not built around a single procedure.

An athlete may receive PRP or another regenerative treatment, but recovery still requires proper rehabilitation.

At ChiroMed, an integrative plan may move through several stages.

Phase 1: Evaluate the Injury

The first goal is to understand what happened.

This may include:

Medical history
Physical examination
Orthopedic testing
Neurological testing
Movement assessment
Imaging when appropriate

Phase 2: Reduce Stress on the Injured Area

Early treatment may involve:

Activity modification
Joint care
Soft-tissue therapy
Pain management
Mobility work

Phase 3: Support Tissue Recovery

Depending on the diagnosis, the care team may discuss regenerative or medically directed options such as:

PRP
Platelet-fibrin products
MFAT
Other appropriate treatments

Phase 4: Rebuild Movement

Athletes may begin:

Corrective exercise
Strength training
Stability work
Balance training
Mobility exercises

Phase 5: Return to Sport

Training gradually becomes more demanding.

The athlete may work on:

Running
Jumping
Cutting
Lifting
Throwing
Sport-specific movements
Speed
Power
Endurance

The purpose is to help the athlete return to competition with better movement and a lower risk of repeating the same injury.

Questions Athletes Should Ask Before Treatment

Before receiving a regenerative procedure, athletes should ask their healthcare team:

What is my exact diagnosis?
What tissue is injured?
Do I need imaging?
What treatments should I try first?
What evidence supports this therapy?
Is PRP appropriate for this injury?
What exactly is the PFP product being used?
Is MFAT appropriate for my condition?
What are the possible risks?
What does rehabilitation involve?
When can I begin training again?
What tests will determine my return to sport?
Does this treatment follow my sport’s anti-doping rules?
Who is providing medical oversight?

An informed athlete is better prepared to make decisions about treatment and recovery.

A More Complete Sports Recovery Approach in El Paso

Regenerative medicine can help with selected sports injuries, but it should not replace careful diagnosis, rehabilitation, or appropriate medical treatment.

At ChiroMed in El Paso, Texas, the goal of integrative sports injury care is to look at the complete athlete.

That means considering:

The damaged tissue
Joint movement
Muscle strength
Training mechanics
Nutrition
Recovery
Medical conditions
Rehabilitation needs
Long-term performance goals

PRP, PFP, MFAT, IV infusions, peptide discussions, functional medicine, chiropractic care, and rehabilitation should each have a clear purpose.

The goal is not simply to help an athlete feel better for a few days.

The larger goal is to restore function, improve movement, support healthy recovery, and create a safer path back to sport.

References

de Sire, A., et al. (2025). Efficacy of platelet-rich plasma injection for pain relief in athletes: A systematic review. PubMed.

Dunn, J. (n.d.). Regenerative medicine for sports injuries.

Indian Trail Chiropractic & Rehab. (n.d.). Functional movement program.

Jimenez, A. (2026). PRP, PFP, MFAT, and epidural injections after injuries: Benefits. PushAsRx Athletic Training Centers.

Jimenez, A. (2026). El Paso chiropractor Dr. Alex Jimenez: Functional medicine, injury care, and rehabilitation.

Ling, S. K. K., Mak, C. T. K., Lo, J. P. Y., & Yung, P. S. H. (2024). Effect of platelet-rich plasma injection on the treatment of Achilles tendinopathy: A systematic review and meta-analysis. Orthopaedic Journal of Sports Medicine, 12(11).

OrthoEdge Orthopedics and Sports Medicine. (n.d.). Platelet-rich plasma (PRP) therapy.

Park, Y. B., Lee, S. K., Kim, K. I., Yoo, J. H., Jung, T., & Kim, J. H. (2025). Microfragmented adipose tissue as an alternative to platelet-rich plasma for intra-articular injection in knee osteoarthritis: A systematic review and meta-analysis of randomized controlled trials. The American Journal of Sports Medicine.

QC Kinetix. (2025). Regenerative therapy aftercare: Best practices and exercises for long-term pain relief.

Reagan Integrated Sports Medicine. (2022). How platelet-rich plasma therapy helps athletes.

U.S. Anti-Doping Agency. (n.d.). IV infusion: Explanatory note.

U.S. Food and Drug Administration. (2026). Certain bulk drug substances for use in compounding that may present significant safety risks.

World Anti-Doping Agency. (2026). The 2026 Prohibited List.

Category: Platelet Fibrin Plasma Therapy (PFP)

Abstract

Understanding the Challenge of Chronic Tendinopathy

Introducing Percutaneous Tenotomy: A Minimally Invasive Revolution

The Tenex Health TX System: Ultrasonic Debridement

The TenJet System: A High-Velocity Saline Jet

The Power of Integrative Care: Our Multidisciplinary Model

A Patient’s Journey at Our Clinic: From Pain to Performance

References

Abstract

Understanding Adhesive Capsulitis (Frozen Shoulder)

Hydrodistension: An Advanced Technique for Restoring Mobility

The Three-Step Hydrodistension Procedure

Step 1: Suprascapular Nerve Block

Step 2: Numbing the Joint Capsule

Step 3: The Hydrodistension Injection

The Role of Integrative Chiropractic Care Post-Procedure

Conclusion: An Integrated Path to Recovery

References

Abstract

Understanding Radial Tunnel Syndrome: Why Diagnosis Is So Often Missed

The Anatomy Behind Radial Nerve Entrapment at the Arcade of Frohse

What Is Ultrasound-Guided Hydrodissection and Why Is It Used

Why This Is Considered an Advanced Technique

Integrative Chiropractic Care and Its Role in Radial Nerve Recovery

Multidisciplinary Care at Injury Medical Clinic PA: Dr. Cardenas and Dr. Jimenez

Evidence-Based Support for Hydrodissection in Peripheral Nerve Entrapment

References

Abstract

Understanding Tendon Brisement: A Paradigm Shift in Tendon Treatment

The High-Volume Injection Procedure: A Step-by-Step Explanation

Visualizing the Mechanism: What We See on Ultrasound

Integrating Chiropractic Care for Comprehensive Recovery

References

Abstract

Understanding the Gut-Brain-Spine Connection

What Happens During Whiplash and Concussion?

A Head Injury May Also Affect the Gut

Why Nutrition Matters After Head and Neck Trauma

Build the body before looking for a miracle supplement.

Start With Protein-Forward Nutrition

Build an Anti-Inflammatory Recovery Plate

Protein

Colorful vegetables

Healthy fats

High-fiber carbohydrates

Fruit

Omega-3 Fats and Brain Health

What About Magnesium, Vitamin D, Creatine, and Other Supplements?

Support the Gut With Fiber and Food Diversity

Hydration Matters More Than Many Patients Realize

Sleep Is Part of Injury Treatment

Where ChiroMed Integrative Chiropractic Care Fits

Rehabilitation Helps Turn Healing Into Function

Advanced Regenerative and Interventional Therapies

Platelet-Rich Plasma

Laser Therapy and Neck Rehabilitation

Shockwave Therapy

Why ChiroMed Uses an Integrated Approach

Structure

Neurological Health

Metabolic Health

Function

Dr. Alex Jimenez: Connecting Chiropractic, Nursing, and Functional Medicine

Medical Oversight With Dr. Maria Guadalupe Cardenas

Root-Cause Recovery: Why Isn’t the Patient Getting Better?

Know the Warning Signs After a Head Injury

Feed the Brain, Support the Gut, and Rebuild the Spine

References

Abstract

Why Accident Injuries Need More Than “Wait and See”

The ChiroMed Integrated Injury-Care Model

Dr. Alex Jimenez: Connecting Chiropractic and Medical Care

Medical Oversight With Dr. Maria Cardenas, MD

Phase 1: Days 1–14 — Evaluate, Protect, and Reduce Acute Symptoms

How Chiropractic Care Fits Into Personal Injury Recovery

Phase 2: Weeks 3–8 — Stabilization and Tissue Recovery

Where Laser Therapy May Fit

Regenerative Therapies and Personal Injury Recovery

What About Peptide Therapy?