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Walking Backward to Alleviate Back Pain

Can walking backward on a treadmill aid in treating conditions and injuries, improving strength, gait, and mobility in the lower extremities and knee, hip, and ankle range of motion (ROM)?

Walking Backward On A Treadmill

Walking backward is often used in physical therapy to treat multiple conditions and injuries and help improve strength, gait, balance, and mobility in the lower extremities. It is also used to improve knee, hip, and ankle range of motion and lower back pain and burn calories.

The Difference Backward vs. Forward

The difference from forward walking is that certain motions are normal gait characteristics.

  • First, the leg swings through the air, and the heel lands on the ground.
  • Then, the straight knee bends slightly as you roll from heel to toe.
  • As this occurs, the opposite leg rolls from the toes and up into the air.
  • This heel-to-toe motion repeats, and normal walking takes place.

Reverse walking creates the opposite gait process.

  • The leg swings through the air and reaches backward with a bent knee.
  • The toes contact the ground, and the bent knee straightens as you roll from toe to heel.
  • Then, the heel leaves the ground with the knee straight, repeating the process.
  • The toe-to-heel gait can provide various benefits. (Cha H. G., Kim T. H., & Kim M. K. 2016)

Benefits

Walking backward on a treadmill benefits include:

  • Improved range of motion in the knee
  • Hamstring flexibility and mobility
  • Quadriceps strengthening

Walking backward also helps burn calories, improve heart function, and improve balance and stability. (Cha H. G., Kim T. H., & Kim M. K. 2016)

Knee Range of Motion

  • Reverse walking can help increase knee extension range of motion. (Zhang M. et al., 2022)
  • Individuals with knee injuries, surgeries, or arthritis may lose their knee extension or the knee’s ability to straighten.
  • The bent knee straightens fully when walking backward, moving from the toes onto the heel.
  • This helps to improve the range of motion into knee extension.

Quadriceps Function

  • Reverse walking can improve the function of the quadriceps muscles in the upper thighs. (Alghadir A. H. et al., 2019)
  • The quads are active when straightening the knee.
  • Exercises like quad sets, short arc quads, and straight leg raises increase quad strength.

Hamstring Flexibility

  • The hamstrings are located in the back of the upper thighs and work to bend the knees and extend the hips.
  • For individuals with tight hamstrings, a therapist may have you walk backward on the treadmill to improve the flexibility of the muscle group. (BBC, 2023)
  • When walking backward, the hamstring contracts to bend the knee as it swings through the air.
  • Then, the hamstring is stretched from the toe to heel movement, and the knee straightens.

Balance, Gait, and Mobility

  • Reverse walking can improve gait characteristics after an injury, surgery, or illness. (Balasukumaran T., Olivier B., & Ntsiea M. V. 2019)
  • Walking backward can help reset one’s gait and improve one’s ability to walk forward.
  • A study on stroke patients found that backward walking training was superior to standing balance training for improving balance and walking speed. (Rose, D. K. et al., 2018)

Burns Calories

  • Backward walking has been found to burn more calories than forward walking.
  • Walking backward uses up about 40% more calories per minute than forward walking at the same speed. (Cha H. G., Kim T. H., & Kim M. K. 2016)

Heart and Lung Function

  • Walking backward on a treadmill can also benefit heart and lung health.
  • Backward walking is more challenging and forces the individual to work harder.
  • Research shows it requires more oxygen and places more demands on the cardiovascular system. (Thomas K. S., Hammond M., & Magal M. 2018)
  • As a result, it improves heart and lung health better.

Conditions That Benefit

Individuals with a lower extremity impairment that results in loss of normal walking mobility may benefit from reverse walking. Common conditions that may help include: (BBC, 2023) (DelMastro H. M. et al., 2023)

  • Hamstring strain
  • Sciatica with tightness in hamstrings
  • Hip, knee or ankle surgery
  • Lower extremity fracture
  • Cerebral palsy
  • Multiple sclerosis
  • Parkinson’s disease
  • Stroke

A physical therapist will decide if an individual’s condition warrants reverse walking as part of a rehabilitation program.

Injury Medical Chiropractic and Functional Medicine Clinic

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

Control Foot Motion and Posture

References

Cha, H. G., Kim, T. H., & Kim, M. K. (2016). Therapeutic efficacy of walking backward and forward on a slope in normal adults. Journal of Physical Therapy Science, 28(6), 1901–1903. https://doi.org/10.1589/jpts.28.1901

Zhang, M., Pang, J., Lu, J., Kang, M., Chen, B., Jones, R. K., Zhan, H., & Liu, A. (2022). The Immediate Effect of Backward Walking on External Knee Adduction Moment in Healthy Individuals. Journal of Healthcare Engineering, 2022, 4232990. https://doi.org/10.1155/2022/4232990

Alghadir, A. H., Anwer, S., Sarkar, B., Paul, A. K., & Anwar, D. (2019). Effect of 6-week retro or forward walking program on pain, functional disability, quadriceps muscle strength, and performance in individuals with knee osteoarthritis: a randomized controlled trial (retro-walking trial). BMC musculoskeletal disorders, 20(1), 159. https://doi.org/10.1186/s12891-019-2537-9

BBC. (2023). Why walking backwards can be good for your health and brain. https://www.bbc.com/future/article/20231110-why-walking-backwards-can-be-good-for-your-health-and-brain

Balasukumaran, T., Olivier, B., & Ntsiea, M. V. (2019). The effectiveness of backward walking as a treatment for people with gait impairments: a systematic review and meta-analysis. Clinical Rehabilitation, 33(2), 171–182. https://doi.org/10.1177/0269215518801430

Rose, D. K., DeMark, L., Fox, E. J., Clark, D. J., & Wludyka, P. (2018). A Backward Walking Training Program to Improve Balance and Mobility in Acute Stroke: A Pilot Randomized Controlled Trial. Journal of Neurologic Physical Therapy: JNPT, 42(1), 12–21. https://doi.org/10.1097/NPT.0000000000000210

Thomas, K. S., Hammond, M., & Magal, M. (2018). Graded forward and backward walking at a matched intensity on cardiorespiratory responses and postural control. Gait & posture, 65, 20–25. https://doi.org/10.1016/j.gaitpost.2018.06.168

DelMastro, H. M., Ruiz, J. A., Simaitis, L. B., Gromisch, E. S., Neto, L. O., Cohen, E. T., Wong, E., Krug, R. J., & Lo, A. C. (2023). Effect of Backward and Forward Walking on Lower Limb Strength, Balance, and Gait in Multiple Sclerosis: A Randomized Feasibility Trial. International journal of MS care, 25(2), 45–50. https://doi.org/10.7224/1537-2073.2022-010

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Bicycle Stationary Conversion for Home Workouts

Can converting a bicycle into a stationary bike be a way for individuals to exercise more while still enjoying cycling?

Bicycle Stationary Conversion

Is your bike collecting dust in the garage? Do you miss riding, but the weather or temperatures keep you indoors?  Why not quickly and painlessly turn your bike into a stationary bike? An indoor stationary bike is a great way to maintain physical activity while avoiding inclement weather and outdoor elements. Plus, bicycle stationary conversion in your home, office, or garage is quick and straightforward. A bike trainer or roller is needed to convert a bicycle into a stationary bike. The bike is mounted onto the trainer stand, and its rear axle is replaced with a special axle provided with the trainer kit to secure it and hold the wheel in place while allowing you to pedal, creating resistance for indoor cycling.

Cycling

Bicycle stationary conversion isn’t only for die-hard cyclists. Research shows indoor cycling is a great way to stay healthy and consistent with your workouts. One study showed that indoor cycling improves aerobic capacity, blood pressure, lipid profile, and body composition. (Chavarrias, M. et al., 2019)

Stationary Bikes Types

For those who don’t have the space or know that they won’t regularly use a stationary bike, indoor bike trainers and rollers can provide convenient, economical, and compact options. Whether individuals want to exercise more, maintain a riding schedule, or train for an event, trainers and rollers can be highly effective tools for any cyclist. However, choosing between a bike trainer and rollers varies depending on the pros and cons. Selecting the right equipment depends on several factors, including:

  • Personal needs
  • Space – indoor or garage.
  • Cycling experience

Most cyclists, even hobbyists, prefer indoor cycling bikes over traditional stationary bikes because they are riding a real bicycle, including the positioning and pedaling, compared to upright, air, or recumbent bikes.

Trainer

A bike trainer is a stand that lets an individual ride a regular bicycle while stationary. Cyclists often use it to warm up before races, and it comes in handy when weather conditions or time constraints prevent riding outdoors. Most trainer stands can accommodate bicycles. Trainers are suitable for beginners and professional riders. There are two types of indoor bike trainers.

Direct-drive

  • Direct-drive trainers attach to the bike’s rear dropouts, replacing the wheel and providing a direct connection to the resistance unit.
  • These can cost more, but they’re worth the investment because they’re more accurate and deliver the highest resistance levels.

Friction

  • A small roller is installed against the rear wheel with friction trainers, which use magnetic or fluid resistance.
  • These are typically lighter and easier to transport than direct-drive trainers but are less accurate and provide less resistance.

Rollers

Rollers are the most basic type of indoor stationary bike but may not be the best option for individuals new to indoor cycling. This is because it requires advanced cycling techniques, such as balancing and keeping the front tire straight while riding. The cycle is on rollers instead of being fixed, allowing the resistance to range from zero to the equivalent of a direct-drive trainer. Rollers help refine pedaling technique and improve cycling form because you balance and stabilize while riding.

Conversion – What Is Needed

The most important equipment needed to convert the cycle is a bike stand, which will be the foundation of the stationary bike setup. (Bike To Work Day, 2025) There are two-piece stands and one-piece stands. (Bike To Work Day, 2025) Tools like an Allen wrench may be needed. Various bike trainer kits contain all the parts needed for this conversion, but extra standard tools may be required to remove the back wheel and replace the axle.

  • Choose the right trainer: Consider your bike type, desired resistance levels, and budget.
  • Install the trainer: Follow the manufacturer’s instructions to position and secure the trainer properly.
  • Mount the bike: Remove the rear wheel quick release, insert the trainer’s axle, and tighten it securely.
  • Adjust resistance: Most trainers have a knob or lever to control the difficulty level.
  • If you are uncertain whether your bike stand is set up correctly or having issues with the installation, contact a professional bike mechanic. They can help get the stationary bike up and running properly.

Considerations

  • Tire wear: Using a dedicated trainer tire for the rear wheel can minimize wear and tear.
  • Noise level: Some trainers can be noisy, especially wheel-on types.
  • Stability: Ensure the bike is properly secured on the trainer and your training area is stable.

Injury Medical Chiropractic and Functional Medicine Clinic

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to build optimal health and wellness solutions. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. The clinic can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.

Body In Balance: Chiropractic, Fitness, and Nutrition

References

Chavarrias, M., Carlos-Vivas, J., Collado-Mateo, D., & Pérez-Gómez, J. (2019). Health Benefits of Indoor Cycling: A Systematic Review. Medicina (Kaunas, Lithuania), 55(8), 452. https://doi.org/10.3390/medicina55080452

Bike To Work Day. (2025). How to turn a bike into a stationary bike: Things to know. https://biketoworkday.us/turn-a-bike-into-a-stationary-bike/#Setting_up_Your_Stationary_Bike

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Female Hernia: Insights into Diagnosis and Care

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

Female Hernia

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

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

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

Hernia Symptoms For a Woman

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

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

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

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

Emergency

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

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

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

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

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

Types

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

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

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

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

Other common hernias in women are:

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

Less common hernias include:

  • Hiatal hernia – diaphragm
  • Perineal hernia – pelvic floor

Risk Factors

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

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

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

  • Umbilical hernia
  • Ventral hernia
  • Inguinal hernia

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

Diagnosis

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

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

Misdiagnoses

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

  • Cysts in the reproductive organs
  • Endometriosis
  • Fibroid tumors

Treatment

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

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

Injury Medical Chiropractic and Functional Medicine Clinic

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

Lumbar Spine Injuries in Sports: Chiropractic Healing

References

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

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

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

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

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

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

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Straight Leg Test: Understanding Its Purpose

Can the straight leg test help find the cause of back or hamstring pain in individuals experiencing it?

Straight Leg Test

The straight leg raise test is often used to diagnose sciatica/radiculopathy, herniated discs, and other spinal problems. The healthcare provider giving the test performs most of the movement as they assess what’s causing the leg and/or back pain. The patient lies on their back with the legs straight. The provider will have the patient perform specific movements and inform them of how it feels. Then, they’ll raise the leg to see if and at what point symptoms begin to show. Providers often use this test alongside imaging studies.

Purpose

The straight leg raise is one of the most common manual tests done during physical exams. The straight leg raise test seeks to reproduce the pain or other symptoms in a controlled fashion to provide clues to what’s happening. It is a manual exam, and the healthcare provider will:

  • Position the patient
  • Moves the patient
  • Create pressure to see how well the patient can resist it

This is often used alongside imaging tests, such as an X-ray or CT scan. (Allegri M. et al., 2016) Its goal is to check for nerve movement and sensitivity of nerve tissue to compression. The straight leg lift test is neurodynamic because it uses movement to diagnose nerve problems. (Baselgia L.T. et al., 2017)

During the Test

Expect to feel some pain during the test, as the whole point is to see what aggravates the symptoms. They may be caused by:

  • Tight hip or back muscles
  • Back muscle spasms
  • Slipped disc
  • Spinal instability

Most of the tests are passive, with the provider doing the lifting. The patient can help achieve the most accurate result by staying as relaxed as possible and being clear about what is felt. (Pande K. 2015) The procedure:

  • The patient lies on their back with their legs straight.
  • The provider will ask the patient to turn one of the legs in.
  • This tells them what hip position affects the lower back symptoms.
  • They’ll then ask you to bring the leg toward the body’s center.
  • Then, they’ll lift the straight leg until the patient experiences symptoms.
  • Pain suggests a herniated disc.
  • If there is no pain, this also provides valuable information.
  • The procedure is repeated with the other leg.

Modifications

It’s important to let the examiner know about any limitations. The straight leg raise test has modifications if the patient cannot lift their leg while it’s straight or if they have difficulty lying on their back, which can also help avoid an injury during the test.

Variations

The healthcare provider may repeat the test with the ankle in a dorsiflexed position/raising the foot. Then, they’ll have the patient do it with their chin tucked into their chest. (Young R. et al., 2013) These variations can help check for nerve involvement in specific locations, such as the spinal cord or the dura mater, the membrane covering the brain and spinal cord. (Venne G. et al., 2017) The spinal cord nerves are likely involved and affected if the usual pain is in the back or leg but not the chin, neck, or foot. (Camino Willhuber GO, Piuzzi NS. 2023)

Injury Medical Chiropractic and Functional Medicine Clinic

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

From Injury to Recovery with Chiropractic Care

References

Casiano, V. E., Sarwan, G., Dydyk, A. M., & Varacallo, M. A. (2025). Back Pain. In StatPearls. https://www.ncbi.nlm.nih.gov/pubmed/30844200

Pesonen, J., Shacklock, M., Suomalainen, J. S., Karttunen, L., Mäki, J., Airaksinen, O., & Rade, M. (2021). Extending the straight leg raise test for improved clinical evaluation of sciatica: validity and diagnostic performance with reference to the magnetic resonance imaging. BMC musculoskeletal disorders, 22(1), 808. https://doi.org/10.1186/s12891-021-04649-z

Allegri, M., Montella, S., Salici, F., Valente, A., Marchesini, M., Compagnone, C., Baciarello, M., Manferdini, M. E., & Fanelli, G. (2016). Mechanisms of low back pain: a guide for diagnosis and therapy. F1000Research, 5, F1000 Faculty Rev-1530. https://doi.org/10.12688/f1000research.8105.2

Baselgia, L. T., Bennett, D. L., Silbiger, R. M., & Schmid, A. B. (2017). Negative Neurodynamic Tests Do Not Exclude Neural Dysfunction in Patients With Entrapment Neuropathies. Archives of physical medicine and rehabilitation, 98(3), 480–486. https://doi.org/10.1016/j.apmr.2016.06.019

Pande K. (2015). The Use of Passive Straight Leg Raising Test: A Survey of Clinicians. Malaysian Orthopaedic Journal, 9(3), 44–48. https://doi.org/10.5704/MOJ.1511.012

Young, R., Nix, S., Wholohan, A., Bradhurst, R., & Reed, L. (2013). Interventions for increasing ankle joint dorsiflexion: a systematic review and meta-analysis. Journal of foot and ankle research, 6(1), 46. https://doi.org/10.1186/1757-1146-6-46

Venne, G., Rasquinha, B. J., Kunz, M., & Ellis, R. E. (2017). Rectus Capitis Posterior Minor: Histological and Biomechanical Links to the Spinal Dura Mater. Spine, 42(8), E466–E473. https://doi.org/10.1097/BRS.0000000000001867

Camino Willhuber, G. O., & Piuzzi, N. S. (2025). Straight Leg Raise Test. In StatPearls. https://www.ncbi.nlm.nih.gov/pubmed/30969539

By admin 0 Comments Exercises, Sleep Hygiene , , , , , , , , , , , , , , , , ,

Weight Resistance Training and Its Impact on Sleep Quality

For individuals looking to improve sleep, could weight training be the answer to increase healthy sleep?

Weight Resistance Training

Researchers found that resistance weight training improves sleep quality, among other methods like diet and sleep hygiene practices. Resistance training may improve sleep by reducing anxiety and stress, benefiting heart health, and promoting muscle recovery. Researchers examined non-medication methods of improving sleep in younger and middle-aged adults, comparing exercise, diet, and sleep hygiene practices. The findings showed that for adults under 65, resistance training is the best non-pharmacological way to improve sleep quality. (Hirohama, K. et al., 2024) These findings reinforce that sleep and exercise lead to improved restful sleep. Resistance training is highly effective compared to aerobic exercise (running or cycling) in improving sleep quality. The research shows that resistance exercise has more profound benefits than aerobic training alone.

Resistance Training and Improved Sleep

Resistance training, also called strength training or weight training, is intended to build muscle and strength using resistance. This can include:

  • Your body weight
  • Resistance bands
  • Free weights
  • Weight-lifting machines

The mechanisms by which exercise alters sleep are unknown. However, the researchers point out that weight training may improve sleep by improving mental health issues such as anxiety and depression. (Cunningham J. E. A., & Shapiro C. M. 2018) (Carbone E. A. et al., 2023) Other research on resistance training and sleep found that resistance training helped decrease anxiety and stress. (Alley J. R. et al., 2015) Resistance training can benefit heart health as it increases blood circulation. This means the heart’s vessels don’t have to work as hard during sleep when blood pressure should naturally drop, which is known as nocturnal dipping, which is great for individuals with high blood pressure.

Another reason this training may help with sleep is its impact on the body. Previous research on resistance training and sleep suggests that since weight training stresses muscle tissue, it could signal the brain that sleep is needed to repair the damage (Iowa State University, 2022). The hormone adenosine, which helps promote sleep, is a key factor in why exercise increases adenosine levels and helps the body doze off. (Roig M. et al., 2022)

How Much Resistance Training Is Needed?

Sleep doctors advise patients to perform some form of daily movement or exercise to improve sleep. The amount of resistance training an individual needs depends on their circumstances, such as underlying conditions, injuries, fitness level, physical ability, and time.

  • General guidelines from the American Heart Association recommend strength training at least twice a week.
  • The guidelines for physical activity from the Department of Health and Human Services recommend adults do a muscle-strengthening activity at least two days each week in addition to at least 150 to 300 minutes of moderate-intensity aerobic activity.
  • The meta-analysis research found that a 55-minute resistance training session consisting of three sets of 10 to 12 exercises done three times a week positively affected sleep quality.
  • They added that higher intensity and frequency of training could have a greater effect on sleep.

In other research on exercise and sleep, study participants were grouped into resistance training, aerobic, and combination workouts – both resistance and aerobic exercise. Each group engaged in 60-minute training sessions three times a week, with the combination group doing 30 minutes of resistance training and 30 minutes of aerobic exercise each session. (Iowa State University, 2022) Resistance training increased sleep by an average of 40 minutes compared to about 23 minutes for those who did an hour of aerobic exercise. A combination of aerobic and resistance increased sleep by about 17 minutes. (American Heart Association, 2022)

Previous research on resistance training and sleep found that exercise at any time can improve sleep quality compared with no strength training. However, evening sessions tend to help individuals sleep a little better. (Alley J. R. et al., 2015) Resistance exercise may offer benefits regarding the ability to fall asleep and stay asleep for those with osteoporosis, sarcopenia, anxiety, or depression.

Strength Workouts

Resistance training that targets all the major muscle groups is the goal. The Iowa State University research had participants use 12 resistance machines to perform exercises, including: 

  • Leg presses
  • Chest presses
  • Lat pulldowns
  • Bicep curls
  • Abdominal crunches 
  • Participants performed three sets of eight to 12 reps at 50% to 80% of their one-rep max. (Iowa State University, 2022)
  • One of the studies had participants work out for 30 minutes using nine different resistance machines, completing three sets of 10 reps. (Alley J. R. et al., 2015)

However, individuals can also use dumbbells such as bicep curls or chest presses, barbells for deadlifts or back squats, resistance bands for lateral shoulder raises or leg extensions, or their body weight for movements such as chin-ups or push-ups.

Other Ways to Improve Sleep Without Meds

Other non-drug methods to improve sleep include a healthy diet, proper hydration, dietary changes, and stress management like meditation. Aerobic exercise is known to improve both sleep quantity and quality. (Kovacevic A. et al., 2018) Lifestyle behaviors outside exercise are also important for sleep. Sleep hygiene refers to having healthy sleep habits and behaviors at night. This includes optimizing pre-bedtime routines to prepare the mind and body for sleep and improving bedroom environments to ensure sleep support, meaning it is cool, dark, quiet, and free from distractions like phones. Another important method of improving sleep is listening to your body and not forcing yourself to stay up late when exhausted. Pushing the brain and body to stay up later leads to chronic sleep debt. Eating sugary and high-fat foods before bed can hinder sleep patterns. Drinking caffeine after dinner or close to bedtime can disrupt the sleep cycle, as well as alcohol consumption before bed can hurt sleep quality.

Injury Medical Chiropractic and Functional Medicine Clinic

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

Weight Loss Techniques

References

Hirohama, K., Imura, T., Hori, T., Deguchi, N., Mitsutake, T., & Tanaka, R. (2024). The effects of nonpharmacological sleep hygiene on sleep quality in nonelderly individuals: A systematic review and network meta-analysis of randomized controlled trials. PloS one, 19(6), e0301616. https://doi.org/10.1371/journal.pone.0301616

Cunningham, J. E. A., & Shapiro, C. M. (2018). Cognitive Behavioural Therapy for Insomnia (CBT-I) to treat depression: A systematic review. Journal of psychosomatic research, 106, 1–12. https://doi.org/10.1016/j.jpsychores.2017.12.012

Carbone, E. A., Menculini, G., de Filippis, R., D’Angelo, M., De Fazio, P., Tortorella, A., & Steardo, L., Jr (2023). Sleep Disturbances in Generalized Anxiety Disorder: The Role of Calcium Homeostasis Imbalance. International journal of environmental research and public health, 20(5), 4431. https://doi.org/10.3390/ijerph20054431

Alley, J. R., Mazzochi, J. W., Smith, C. J., Morris, D. M., & Collier, S. R. (2015). Effects of resistance exercise timing on sleep architecture and nocturnal blood pressure. Journal of strength and conditioning research, 29(5), 1378–1385. https://doi.org/10.1519/JSC.0000000000000750

Iowa State University. (2022). Pumping iron may improve sleep more than cardio workouts. https://www.news.iastate.edu/news/2022/03/03/resistance-exercise-sleep

Roig, M., Cristini, J., Parwanta, Z., Ayotte, B., Rodrigues, L., de Las Heras, B., Nepveu, J. F., Huber, R., Carrier, J., Steib, S., Youngstedt, S. D., & Wright, D. L. (2022). Exercising the Sleepy-ing Brain: Exercise, Sleep, and Sleep Loss on Memory. Exercise and Sport Sciences Reviews, 50(1), 38–48. https://doi.org/10.1249/JES.0000000000000273

American Heart Association. (2022). Resistance exercise may improve sleep more than aerobic exercise. https://www.heart.org/en/news/2022/03/03/resistance-exercise-may-improve-sleep-more-than-aerobic-exercise#:~:text=The%20results%20are%20considered%20preliminary,at%20night%2C%22%20Brellenthin%20said.

Kovacevic, A., Mavros, Y., Heisz, J. J., & Fiatarone Singh, M. A. (2018). The effect of resistance exercise on sleep: A systematic review of randomized controlled trials. Sleep medicine reviews, 39, 52–68. https://doi.org/10.1016/j.smrv.2017.07.002

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Pinched Nerve in the Neck: Managing Your Pain

Can physical therapy help individuals with a pinched nerve in the neck?

Pinched Nerve In The Neck

A pinched nerve in the neck can cause pain, numbness, and weakness that extends through the neck, shoulder, and arm. (American Academy of Orthopaedic Surgeons, 2024) Over-the-counter pain medications, resting the muscles, and gentle stretching can help. However, if you’re still in pain after a few days, see a healthcare provider. Common treatments include:

  • Rest
  • Over-the-counter (OTC) pain meds
  • Physical therapy
  • Steroid injections
  • Wearing a neck collar

Surgery is rarely needed, but it can provide relief if other treatments don’t help. Most of the time, a pinched nerve resolves within days or weeks.

How a Pinched Nerve in the Neck Feels

The term for neck nerve pain is cervical radiculopathy (cervical spine pain). Common symptoms of a pinched nerve in the neck are: (American Academy of Orthopaedic Surgeons, 2024)

  • Sharp pain that extends into the shoulder and arm.
  • The pain worsens, or there is a shooting sensation when turning the head.
  • Tingling or feeling of pins-and-needles in the fingers or hand.
  • Weakness in the arm, shoulder, or hand.
  • Numbness or loss of feeling.

Often, these symptoms occur only on one side. Some find their pain less when they lift their hand onto their head, which can relieve pressure on the nerve.

Causes

The cervical spine is the spinal cord area around the neck. It’s made up of seven vertebrae. Nerves branch off the spinal cords in the spaces between the vertebrae. Nerve compression occurs when the space between two vertebrae is reduced, putting pressure on the nerve, pinching it, and causing pain. Pinched nerves develop from age because the spinal discs between the vertebrae become compressed over time. Age causes about 70% to 80% of nerve compression. Other factors that cause pinched nerves include: (Harvard Health Publishing, 2021)

  • Degenerative disc disease
  • A herniated disc
  • Injuries like car accidents falls, or other trauma to the spine
  • Spinal stenosis

Self-Care Relief

If you have nerve pain and think it is a pinched nerve, self-care can help (National Institute of Neurological Disorders and Stroke, 2025)

Rest

  • Find a comfortable position and try to allow the muscles in your neck to relax and rest.

Heat or Ice

  • Warmth and coolness can relieve pain and inflammation.
  • Use a warm or cool compress for 15 minutes at a time.

Over-The-Counter Pain Medications

  • Pain medications, including nonsteroidal anti-inflammatory drugs (NSAIDs), can help bring relief.

Treatment for Severe Symptoms

If pain doesn’t resolve within a few days, or if it is so bad that you can’t go about daily activities, it’s recommended to see a healthcare provider. They can diagnose a pinched nerve after a physical exam and may also recommend imaging, including an X-ray, CT scan, MRI, or EMG, to reveal what’s causing the symptoms. After diagnosing the condition, the healthcare provider will develop a personalized treatment plan, which may include the following (Harvard Health Publishing, 2021)

Physical Therapy

  • Physical therapy can help build strength and flexibility in the neck.
  • This is especially important if there is frequent nerve pain in the same spot.

Cervical Collar

  • A soft cervical collar is a brace that fits around the neck.
  • It supports your head so the neck muscles can relax, facilitating healing.
  • The collar can also keep the head from turning in painful ways.

Oral Corticosteroids

  • Oral steroids like prednisone can help reduce inflammation.
  • If inflammation or swelling in the neck puts more pressure on the nerve, they can help.

Steroid Injections

  • Steroid shots right into the painful tissue reduce inflammation right away.

Muscle Relaxers

  • These medications keep the muscles in the neck from seizing up.
  • As the muscles relax, this brings pain relief.

Narcotic Pain Medications

  • Narcotic pain medications can be used short-term by individuals who have severe pain.
  • A healthcare provider will inform the patient of the benefits and drawbacks of these medications, which include opiates.  

Neck Exercises

Gentle stretches can help alleviate the pain and strengthen the muscles. (National Health Service, 2025)

Chin to chest

  • Bring your chin toward your chest.
  • Hold for 20 seconds, then return to a neutral position.
  • Do this five times.

Eyes to Sky

  • Lean your head back and look toward the sky.
  • Hold for 20 seconds, then return to your starting position.
  • Do this five times.

Side to Side

  • Turn your head to the right as far as possible, bringing your chin in line with your shoulder.
  • Hold for 20 seconds, then turn as far as possible toward the left.
  • Repeat four times.

Ear to Shoulder

  • Bring your ear down toward your shoulder.
  • Hold for 20 seconds, then repeat the exercise on the other side.
  • Alternate between the right and left, stretching each side five times.

While it’s normal for exercises to hurt from stretching the muscles, they should never hurt more than a five on a pain scale of 1 to 10. If they do, stop exercising (National Health Service, 2025)

Healing Time

Healing and recovery depend on the severity of the injury. Some individuals find that the pain from a pinched nerve goes away in days, while for others, it can last for weeks. The pain goes away and then returns. If pain doesn’t go away with the conservative treatments or lasts more than a few days, talk with a healthcare provider or return for a second visit. Rarely do individuals need surgery to bring pain relief. The healthcare provider will discuss whether surgery is the best option and what to expect regarding pain relief. (American Academy of Orthopaedic Surgeons, 2024)

Injury Medical Chiropractic and Functional Medicine Clinic

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

Revitalize and Rebuild with Chiropractic

References

American Academy of Orthopaedic Surgeons. OrthoInfo. (2024). Cervical radiculopathy (pinched nerve). https://orthoinfo.aaos.org/en/diseases–conditions/cervical-radiculopathy-pinched-nerve/

Harvard Health Publishing. Publishing, H. H. (2021). Treating a pinched nerve. https://www.health.harvard.edu/pain/treating-a-pinched-nerve

National Institute of Neurological Disorders and Stroke. (2025). Pinched Nerve Definition. Retrieved from https://www.ninds.nih.gov/health-information/disorders/glossary-neurological-terms#-P-

National Health Service. Service, N. H. (2025). Exercises for neck problems. https://www.nhsinform.scot/illnesses-and-conditions/muscle-bone-and-joints/neck-and-back-problems-and-conditions/exercises-for-neck-problems

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Cheddar Cheese Nutritional Value Explained

While cheddar cheese’s high-calorie count and saturated fat content have nutritional drawbacks, can a moderate amount be an enjoyable part of a healthy diet?

Cheddar Cheese

Cheddar is a hard, cow’s milk cheese known for its dense, layered texture and nutty flavor. It is a favorite cheese served in quesadillas, mac and cheese, or on burgers. However, cheddar cheese nutrition isn’t considered ideal.

Nutrition

Nutrition information for 1 ounce/28 grams of cheddar cheese. (U.S. Department of Agriculture, 2019)

  • Calories – 120
  • Fat – 10 grams
  • Sodium – 190 milligrams
  • Carbohydrates – 0 grams
  • Fiber – 0 grams
  • Sugars – 1 grams
  • Protein – 7 grams
  • Calcium – 201.6 milligrams
  • Vitamin A – 95.7 micrograms
  • Vitamin B12 – 0.3 micrograms

Carbohydrates

  • Cheddar contains zero carbohydrates, meaning it has no fiber and little sugar.

Fats

  • Most health concerns focus on fat and saturated fat content. (Lordan R. et al., 2018)
  • Whole-milk cheddar is high in total fat – 10 grams per ounce.
  • Saturated fat – 6 grams per ounce.
  • Traditionally, nutrition recommendations have advised consuming a diet low in saturated fat to reduce the risk of cardiovascular disease.
  • However, research suggests saturated fat in whole foods like cheese may not harm heart health. (Astrup A., Geiker N. R. W., & Magkos F. 2019)
  • Further research is needed to determine the pros and cons of saturated fat in dairy. (Hirahatake K. M. et al., 2020)

Protein

  • It provides 7 grams per 1-ounce serving, and protein accounts for over 30% of cheddar’s calories.
  • This can significantly add to one’s daily intake.

Vitamins and Minerals

  • Calcium is a micronutrient at 200mg (or 20% of daily value) per ounce.
  • One ounce provides 10% daily vitamin A recommendation and 14% phosphorus, plus small amounts of zinc, selenium, and riboflavin.
  • Cheddar cheese can be relatively high in sodium at 190mg per ounce if trying to cut down on salt. (U.S. Department of Agriculture, 2019)

Health Benefits

Builds Healthy Bones

Builds Muscle

  • Protein performs a variety of functions in the body.
  • Protein helps build muscle; it’s necessary to produce enzymes, give structure to cells, maintain fluid balance, and more. (Carbone J. W., & Pasiakos S. M. 2019)

Calorie-Dense

  • Cheddar is calorie-dense, which increases its satisfaction factor.

May Help Weight Loss

  •  There is the belief that cheese causes weight gain; however, the full-fat dairy paradox, which goes against dietary guidelines, is the idea that full-fat dairy products may be healthier than low-fat or fat-free dairy,
  • Research now suggests removing fat from dairy products may make them more likely to cause weight gain, making full-fat the better choice for weight management. (Soltani S., & Vafa M. 2017)

Compatible With Keto and Low-Carb Diets

  • Because of cheddar’s high fat percentage, it’s compatible with high-fat nutrition plans.
  • With zero carbohydrates, cheddar also fits well in low-carb diets.

Low Lactose

  • Cheddar is one of the harder, aged cheeses that’s quite low in lactose.
  • This means lactose-intolerant individuals can often eat it without unpleasant symptoms like bloating, stomach upset, and gas.

Allergies

  • Although it is low in lactose, cheddar still contains casein and whey, two components that can trigger an immune response in individuals with a dairy allergy. (He, M. et al., 2017)

Storage and Safety

Cheddar does not technically require refrigeration. However, storing it in the fridge will help it last longer. According to the USDA, unopened cheddar can last up to six months in the refrigerator, and opened packages can last three to four weeks. Because it’s a hard cheese, cheddar even takes well to freezing, but this will not extend its life more than refrigeration. The USDA estimates cheddar can be frozen for about six months.

Preparation

Cheddar can be added to any number of cheesy dishes or, of course, served alone with crackers. It doesn’t require high heat to become nice and melty. Try adding a whole-grain base and veggies to increase the nutrients in dishes like cheesy casseroles, Mexican dishes, sandwiches, or pasta.

Injury Medical Chiropractic and Functional Medicine Clinic

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop highly effective treatment plans through an integrated approach for each patient and restore health and function to the body through nutrition and wellness, functional medicine, acupuncture, Electroacupuncture, and integrated medicine protocols. We focus on what works for you to relieve pain, restore function, prevent injury, and mitigate issues through adjustments that help the body realign itself. The clinic can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.

Osteoporosis

References

U.S. Department of Agriculture. FoodData Central. (2019). Cheddar Cheese. Retrieved from https://fdc.nal.usda.gov/food-details/494681/nutrients

Lordan, R., Tsoupras, A., Mitra, B., & Zabetakis, I. (2018). Dairy Fats and Cardiovascular Disease: Do We Really Need to be Concerned?. Foods (Basel, Switzerland), 7(3), 29. https://doi.org/10.3390/foods7030029

Astrup, A., Geiker, N. R. W., & Magkos, F. (2019). Effects of Full-Fat and Fermented Dairy Products on Cardiometabolic Disease: Food Is More Than the Sum of Its Parts. Advances in nutrition (Bethesda, Md.), 10(5), 924S–930S. https://doi.org/10.1093/advances/nmz069

Hirahatake, K. M., Astrup, A., Hill, J. O., Slavin, J. L., Allison, D. B., & Maki, K. C. (2020). Potential Cardiometabolic Health Benefits of Full-Fat Dairy: The Evidence Base. Advances in nutrition (Bethesda, Md.), 11(3), 533–547. https://doi.org/10.1093/advances/nmz132

Malmir, H., Larijani, B., & Esmaillzadeh, A. (2020). Consumption of milk and dairy products and risk of osteoporosis and hip fracture: a systematic review and Meta-analysis. Critical reviews in food science and nutrition, 60(10), 1722–1737. https://doi.org/10.1080/10408398.2019.1590800

Carbone, J. W., & Pasiakos, S. M. (2019). Dietary Protein and Muscle Mass: Translating Science to Application and Health Benefit. Nutrients, 11(5), 1136. https://doi.org/10.3390/nu11051136

Soltani, S., & Vafa, M. (2017). The dairy fat paradox: Whole dairy products may be healthier than we thought. Medical journal of the Islamic Republic of Iran, 31, 110. https://doi.org/10.14196/mjiri.31.110

He, M., Sun, J., Jiang, Z. Q., & Yang, Y. X. (2017). Effects of cow’s milk beta-casein variants on symptoms of milk intolerance in Chinese adults: a multicentre, randomised controlled study. Nutrition journal, 16(1), 72. https://doi.org/10.1186/s12937-017-0275-0

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Scaphoid Fracture Causes and Recovery Insights

Individuals who have fractured their scaphoid bone may experience pain and swelling in the wrist just below the thumb. Can immobilization with a cast and physical therapy help?

human hand and wrist pain

Scaphoid Fracture

A scaphoid fracture is a break in one of the wrist’s small or carpal bones. This type of fracture occurs most often after a fall onto an outstretched hand. Symptoms typically include swelling and pain in the wrist just below the base of the thumb. These fractures can be difficult to diagnose since they don’t always appear on an X-ray. If the X-ray is negative and the healthcare provider suspects a scaphoid fracture, an MRI may be necessary. Surgery may be required in more severe cases or when the injury is not healing correctly. (American Academy of Orthopaedic Surgeons, 2023)

A Break In The – Navicular Bone

The scaphoid is one of eight carpal bones in the wrist. It is located just below the thumb’s base and is shaped like a kidney bean. This bone can be identified by holding a thumbs-up position and feeling for the hollow between the two tendons below your thumb. The scaphoid is located at the base of the hollow. A break in the scaphoid bone most commonly occurs in the middle of the bone but can also happen at either end. A scaphoid fracture can be displaced or non-displaced (American Academy of Orthopaedic Surgeons, 2023)

Displaced Fracture

  • It is when the bone fragments have moved out of alignment.

Non-displaced Fracture

  • It is when the fragments are still in their normal location in the hand.

The scaphoid’s blood supply comes from a small vessel that enters the most distant part of the bone and flows back through the bone. Because of this one small blood supply, a fracture in the center can stop the circulation to the proximal portion of the bone. Because of this, scaphoid fractures need immediate diagnosis and treatment.

Symptoms

Pain or deep aching on the thumb-side of the wrist, typically after a fall on an outstretched arm, could be a scaphoid fracture. Other symptoms experienced include: (American Academy of Orthopaedic Surgeons, 2023)

  • Tenderness at the base of the hollow area.
  • Pain at the base of the hollow area.
  • Swelling in the wrist
  • Difficulty gripping objects

Pain can become worse from: (American Academy of Orthopaedic Surgeons, 2023)

  • Grasping
  • Pulling
  • Pushing
  • Pinching

Diagnosis

A healthcare provider will evaluate the hand for tenderness and pain in the hollow and/or the bone. If a break is suspected, they will order an X-ray. (Clementson M., Björkman A., & Thomsen N. O. B. 2020) Many patients are diagnosed with a wrist sprain when they have a fracture. Diagnosis can be difficult because the fracture often doesn’t appear on X-rays until weeks after the healing process starts. Physicians commonly treat a wrist injury as a scaphoid fracture initially and then repeat X-rays within two weeks. (American Academy of Orthopaedic Surgeons, 2023) If the injury doesn’t show on an X-ray, the provider may order an MRI, as these fractures can be easier to see on an MRI. An MRI can help ensure appropriate treatment immediately. (Wong S. B. S., & Peh W. C. G. 2019)

Treatment

If a wrist fracture is diagnosed, the wrist will be immobilized in a cast. However, a healthcare provider may also put the wrist in a cast if the X-ray is negative but they suspect a fracture. This will stabilize the injury until an MRI can be performed. With immobilization and follow-up treatment, scaphoid fractures often heal without surgery. Repeat X-rays are taken over several weeks or months so the provider can make sure the injury is healing correctly. If it is not healing correctly, surgery may be recommended. (Clementson M., Björkman A., & Thomsen N. O. B. 2020) If the fracture is displaced, healing correctly may be a challenge. In this case, a physician may recommend initial surgery to reposition the bones. (Clementson M., Björkman A., & Thomsen N. O. B. 2020) This type of surgery involves pinning the bone in place with screws.

Healing Time

Recovery

With the wrist in a cast, individuals will be instructed on activities to avoid placing even a small amount of strain (American Academy of Orthopaedic Surgeons, 2023)

  • Lifting
  • Pushing
  • Pulling objects that weigh more than one pound.
  • Sports activities
  • Throwing
  • Climbing
  • Using tools or machinery that vibrate.

Rehabilitation is an important part of healing because immobilization takes a long time. Wrist range-of-motion exercises can be started, followed by strengthening exercises for the wrist flexors and extensors. Supination, pronation, and grip exercises are also part of physical therapy.

Complications

Scaphoid fractures can lead to serious complications, especially when not properly treated. These include: (American Academy of Orthopaedic Surgeons, 2023) (Almigdad A. et al., 2024)

Nonunion

  • This describes a fracture that fails to heal.

Carpal Collapse

  • This is a form of degenerative arthritis.

Osteoarthritis

  • This condition causes degeneration of the cartilage in the joint.

Avascular Necrosis

  • This is when the blood supply to the bone is reduced or cut off, causing the bone to die.

Injury Medical Chiropractic and Functional Medicine Clinic

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

Skateboarding Injury Treatment

References

American Academy of Orthopaedic Surgeons. (2023). Scaphoid fracture of the wrist. https://orthoinfo.aaos.org/en/diseases–conditions/scaphoid-fracture-of-the-wrist

Clementson, M., Björkman, A., & Thomsen, N. O. B. (2020). Acute scaphoid fractures: guidelines for diagnosis and treatment. EFORT open reviews, 5(2), 96–103. https://doi.org/10.1302/2058-5241.5.190025

Wong, S. B. S., & Peh, W. C. G. (2019). The role of magnetic resonance imaging in the evaluation of scaphoid fractures. Journal of Medical Radiation Sciences, 66(1), 3–4. https://doi.org/10.1002/jmrs.316

Almigdad, A., Al-Zoubi, A., Mustafa, A., Al-Qasaimeh, M., Azzam, E., Mestarihi, S., Khair, Y., & Almanasier, G. (2024). A review of scaphoid fracture, treatment outcomes, and consequences. International orthopaedics, 48(2), 529–536. https://doi.org/10.1007/s00264-023-06014-2

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Cauda Equina Syndrome: Symptoms and Treatments

Cauda equina syndrome/CES is a rare condition in which the nerves in the lower back are compressed. It can include sciatica as one of its symptoms. Individuals presenting with symptoms that could be CES are advised to see a healthcare provider as soon as possible, as delaying treatment can lead to permanent damage.

Cauda Equina Syndrome

A cluster of nerve roots called the cauda equina, Latin for horse’s tail, sends and receives messages to the legs, bladder, and other body parts. Cauda equina syndrome is a rare condition in which nerve roots in the lower spinal cord are compressed. This compresses the nerves and disrupts motor and sensory function in the bladder and lower extremities. The most common cause is a ruptured or herniated disc in the lumbar area. This usually occurs when a severe disc herniation compresses the nerve bundle at the base of the spinal cord, causing significant neurological dysfunction like bladder/bowel issues and numbness in the saddle area. If found early, it is treated with surgery within 24 to 48 hours of symptom onset.

Initial Signs

Symptoms can occur acutely, in hours, or gradually over weeks or months. One of the first signs and most common symptoms is urinary retention, where the bladder fills, but there is no normal sensation or urge to urinate. (American Association of Neurological Surgeons, 2024) Other symptoms include: (Gardner A., Gardner E., & Morley T. 2011)

  • Severe low back pain
  • Sciatica
  • Pain, numbness, or weakness in one or both legs
  • Saddle anesthesia, which is numbness or other nerve sensations around the anus and the area that sits.
  • A loss of reflexes in the extremities
  • Sexual dysfunction that comes suddenly
  • Loss of bowel control
  • Overflow urination

There are two stages based on urinary symptoms (Fairbank J., & Mallen C. 2014)

CES-Incomplete CES-I

CES-Retention CES-R

  • Bladder control is completely lost.

Causes

The most common cause is a ruptured or herniated disc in the lumbar area. Other possible causes may include: (American Association of Neurological Surgeons, 2024)

Trauma or injury to the spine

  • that leads to fractures or dislocations (gunshots, falls, auto accidents)

Tumors or Infections

  • It can compress the cauda equina nerve bundle.

Spinal Stenosis

  • Narrowing of the spinal column can be either congenital or acquired.

Bone Spurs

Tuberculosis or Pott’s Paralysis

  • Pott’s paralysis is a neurological complication of tuberculosis (TB) of the spine.
  • TB is a bacterial infection that usually affects the lungs but can spread to the spine.

Iatrogenic Side Effects

  • Injuries or illnesses that result from medical or surgical treatment

Spinal Lesions or Malignant Tumors

  • A spinal lesion refers to any abnormal growth or damage within the spine.
  • It can include benign (noncancerous) and malignant (cancerous) tumors.
  • A malignant tumor is a cancerous growth within the spine; essentially, a malignant tumor is a type of spinal lesion with the potential to spread to other parts of the body.

Spinal Infection, Inflammation, Hemorrhage, or Fracture

  • A spinal infection refers to a bacterial, fungal, or viral infection that occurs within the bones of the spine (vertebrae) or the surrounding tissues, potentially causing pain, inflammation, and, in severe cases, neurological complications like weakness or paralysis;
  • Spinal inflammation is a general term for swelling or irritation within the spinal column.
  • Spinal hemorrhage” indicates bleeding within the spinal canal.
  • A spinal fracture refers to a break in one or more of the vertebrae in the spine.

Spinal Arteriovenous Malformations (AVMs)

  • A spinal arteriovenous malformation (AVM) is a rare condition in which the arteries and veins in the spinal cord tangle abnormally.
  • This can damage the spinal cord over time.

Complications from Lumbar Surgery

  • Lumbar surgery can have several complications, including infections, blood clots, nerve damage, and spinal fluid leaks.

Spinal Anesthesia

  • Spinal anesthesia is a regional anesthesia that blocks pain and sensation in the lower body.
  • It involves injecting a local anesthetic medication into the subarachnoid space surrounding the spinal cord.
  • The exact cause is not fully understood, but it can involve direct nerve root injury from the needle, inflammation caused by the anesthetic, or a spinal hematoma compressing the nerve roots.

Spinal Birth Defects

Diagnosis

Diagnosis requires a medical history of symptoms, general health, activity level, and a physical exam to assess strength, reflexes, sensation, stability, alignment, and motion. (​American Association of Neurological Surgeons, 2024) Testing includes: 

Blood Tests

  • These test for infections.

MRI

  • These yield three-dimensional images of the spinal cord, nerve roots, and surrounding areas.

Myelography

  • X-ray or computerized tomography (CT) imaging is enhanced by the injection of contrast material into the cerebrospinal fluid spaces, which can show displacement of the spinal cord or spinal nerves.

Specialized Nerve Testing

  • This could be nerve conduction velocity tests and testing electrical activity in muscles or electromyography.

Treatment

The extent of urinary problems can determine treatment protocols. A CES diagnosis is usually followed by emergency surgery within 24 to 48 hours to relieve compression of the nerves. Moving quickly is essential to prevent permanent complications such as nerve damage, incontinence, or leg paralysis. (American Association of Neurological Surgeons, 2024)

  • Depending on the cause, corticosteroids also may be prescribed to reduce swelling.
  • Antibiotics may be needed if an infection is responsible for CES.
  • For situations in which a tumor is the cause, surgery to remove it may be necessary, followed by chemotherapy and/or radiation.
  • The outcome with CES-I during surgery is generally favorable.
  • Those whose CES has deteriorated to CES-R tend to have a less favorable prognosis.

Post Surgery Therapy

After surgery, CES can be challenging to deal with. If bladder function has been impaired, recovery of control can take time.

  • It may be necessary to use a catheter or to wear disposable underwear. (American Association of Neurological Surgeons, 2024)
  • Frequent urinary infections are also a potential complication.
  • Loss of bladder or bowel control can be psychologically distressing, impacting social life, work, and relationships.
  • Sexual dysfunction can also occur, contributing to relationship difficulties or depression.

Therapy with a mental health professional may be recommended. When damage is permanent, it will be important to include family and friends in the adjustment to living with a chronic condition. Psychological counseling and/or a support group can be helpful. Other specialists who can help include: (American Academy of Orthopaedic Surgeons, 2024)

  • Occupational therapist
  • Physical therapist
  • Physiotherapist
  • Sex therapist
  • Social worker

Injury Medical Chiropractic and Functional Medicine Clinic

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

Disc Herniation

References

American Association of Neurological Surgeons. (2024). Cauda Equina Syndrome. https://www.aans.org/patients/conditions-treatments/cauda-equina-syndrome/

Gardner, A., Gardner, E., & Morley, T. (2011). Cauda equina syndrome: a review of the current clinical and medico-legal position. European Spine Journal: official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 20(5), 690–697. https://doi.org/10.1007/s00586-010-1668-3

Fairbank, J., & Mallen, C. (2014). Cauda equina syndrome: implications for primary care. The British journal of general practice: the journal of the Royal College of General Practitioners, 64(619), 67–68. https://doi.org/10.3399/bjgp14X676988

American Academy of Orthopaedic Surgeons. (2024). Cauda equina syndrome. https://orthoinfo.aaos.org/en/diseases–conditions/cauda-equina-syndrome

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Peroneal Tendon Injuries and Their Symptoms

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

Peroneal Tendon Injuries

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

Anatomy and Function

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

Tendonitis

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

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

Typical treatment of peroneal tendonitis is accomplished by:

Ice application

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

Rest

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

Anti-inflammatory Medications

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

Physical Therapy

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

Cortisone Injections

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

Tendon Tears

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

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

Tendon Debridement and Repair

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

Tenodesis

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

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

Injury Medical Chiropractic and Functional Medicine Clinic

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

The Difference of Using Custom Foot Orthotics

References

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

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

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

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