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Muscle Relaxers for Back Spasms: What You Need to Know

For individuals who injure their neck or back, the muscles may spasm or seize up, making it difficult to get through the day, exercises, physical activities, etc. Can skeletal muscle relaxers help relieve pain and reduce frequency?

Back Spasms Muscle Relaxers

Back muscle spasms are common back pain that feels like a sudden tightness or contraction in the back muscles. They can range from minor twinges to severe pain.

Causes

  • Poor posture: Sitting or standing with bad posture can strain the back muscles.
  • Overuse: Picking something up, bending, or lifting can cause a spasm.
  • Dehydration: Not drinking enough water can cause electrolyte imbalances, leading to spasms.
  • Underlying conditions: A herniated disc or degenerative disc disease can cause back spasms.
  • Muscle imbalances: Weak muscles or muscles that are too tight can cause spasms.

Treatments

  • Home treatments: Apply heat or ice, take over-the-counter pain medication, try gentle stretching, or massage the area.
  • Exercise: Improve your back’s strength and flexibility with exercise or physical therapy.
  • Hydration and nutrition: Drink enough water and eat foods rich in magnesium and calcium.
  • Chiropractic Adjustments: These can realign the spine to the correct position and muscles to relax.
  • Non-surgical Decompression: Decompression of the spine will allow more blood and nutrients to heal painful areas.

Skeletal Muscle Relaxers

A healthcare provider may prescribe skeletal muscle relaxers. These medications are not available over the counter and must be prescribed by a healthcare provider.

  • Skeletal muscle relaxers will probably cause drowsiness.
  • Individuals should not drive, operate heavy machinery, or engage in other physical activities when taking back spasm muscle relaxers.
  • Skeletal muscle relaxers are not recommended for 65 or older because safer, effective alternatives exist.
  • Also, women who are pregnant or breastfeeding should not take these medications.
  • Discuss these issues with your healthcare provider.

Carisoprodol 

Carisoprodol is available generically and as Soma and Vanadom brands. It works by suppressing nerve impulses located in the brain and spinal cord. Healthcare providers prescribe this medication in combination with physical therapy for the healing release of any muscle spasm and management of musculoskeletal injuries and/or pain. (Witenko C. et al., 2014) It’s not about having to continue taking the medication to feel better but more as a jump start to help with the physical therapy program.

  • Back muscle spasms are a perfect example of a condition that may benefit from carisoprodol in the short term.
  • Carisoprodol can be habit-forming.
  • Be sure to talk to a healthcare provider before suddenly going off this medication.
  • Carisoprodol can cause side effects that may impair thinking or reactions.
  • Avoid drinking alcohol as it may increase drowsiness and dizziness that are often caused by carisoprodol. (Zacny J. P., Paice J. A., & Coalson D. W. 2012)
  • Inform your healthcare provider of any drug allergies, kidney disease, or liver disease, or if you get seizures.

Cyclobenzaprine

Cyclobenzaprine is available as Amrix and in generic form. Like other muscle relaxers, cyclobenzaprine may cause dizziness or drowsiness. The sedation effects are how it works on painful, tension-filled muscles. Cyclobenzaprine is used together with physical therapy to treat skeletal muscle-related conditions and/or injuries, especially when pain or spasm is involved. When used in conjunction with physical therapy, it can help expedite recovery.

  • Cyclobenzaprine is chemically related to tricyclic antidepressants.
  • Although it is considered a derivative of the tricyclic antidepressant class, it does not pose the same risk to liver health.
  • According to the National Institutes of Health, reasons not to take this medication include having a thyroid disorder, heart block, congestive heart failure, a heart rhythm disorder, or having recently had a heart attack. (Witenko C. et al., 2014)

Metaxalone

Skelaxin is the brand name for metaxalone. As with the other muscle relaxers, metaxalone is used in combination with physical therapy and rest when muscles get too tight. (Witenko C. et al., 2014) It works by suppressing nerve impulses in the brain and spinal cord. In addition to older individuals and pregnant women, metaxalone is usually not prescribed for those with kidney disease, liver disease, seizures, or blood disorders.

Injury Medical Chiropractic and Functional Medicine Clinic

Back spasms and muscle relaxers could help individuals, along with a personalized physical therapy treatment program. 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.

Thoracic Spine Pain

References

Witenko, C., Moorman-Li, R., Motycka, C., Duane, K., Hincapie-Castillo, J., Leonard, P., & Valaer, C. (2014). Considerations for the appropriate use of skeletal muscle relaxants for the management of acute low back pain. P & T: a peer-reviewed journal for formulary management, 39(6), 427–435.

Zacny, J. P., Paice, J. A., & Coalson, D. W. (2012). Subjective and psychomotor effects of carisoprodol in combination with oxycodone in healthy volunteers. Drug and alcohol dependence, 120(1-3), 229–232. https://doi.org/10.1016/j.drugalcdep.2011.07.006

By admin 0 Comments Acupuncture, Electroacupuncture , , , , , , , , , , , , , , , , ,

Healing with Needles: Acupuncture for Anxiety and Panic Disorders

Can acupuncture be an effective treatment for anxiety and panic disorders in addition to other treatments, like therapy and/or medication?

Acupuncture For Anxiety and Panic Disorders

Considered one of the most popular types of alternative medicine, acupuncture has grown in popularity as a way to treat a variety of mental health conditions, including depression, post-traumatic stress disorder (PTSD), and other anxiety disorders. With the growth in popularity, more research has been focused on treatment for panic and anxiety symptoms. (Pilkington K. 2010)

  • Acupuncture can enhance personal wellness.
  • Acupuncture is generally safe and has few side effects.
  • It can help reduce physical and mental symptoms like tension, pain, and rapid heart rate.

Other alternative medicine practices include yoga, therapeutic massage, herbal medicines, and aromatherapy.

Traditional Chinese Medicine

Acupuncture is a healing technique originating from traditional Chinese medicine (TCM). The practice is based on the concept that medical conditions and mental health disorders are caused by an imbalance in the energy and circulation of the body’s vital life energy, known as chi or qi (National Institute for Complementary and Integrative Health, 2022). When the body and mind function properly, energy flows optimally through the channels/meridians at certain points throughout the body. Like tight or spasming muscles, energy or circulation becomes congested in different meridian pathways, leading to disease or disorders. The goal of acupuncture is to restore the health and balance of these channels.

How It Works

During acupuncture treatment sessions, small needles are placed along specific body areas, known as acupuncture points. These areas are thought to be where energy blockage occurs. The needles, which come in various thicknesses and lengths, stimulate and open blocked energy channels. Experts have conceptualized acupuncture from a neuroscience perspective, where nerves, muscles, and connective tissues are stimulated, and neurochemicals are released.

  • Acupuncture can help regulate the nervous system.
  • It can stimulate the body’s feel-good hormones and reduce stress hormones.
  • It can help deactivate the analytical brain, which is responsible for anxiety and worries.

Acupuncture is recognized by the National Institutes of Health (NIH) for treating pain management and other medical conditions. (National Institute for Complementary and Integrative Health, 2022)

Effectiveness

Clinical trials examining acupuncture for anxiety and panic disorders have shown some positive results. (Pilkington K. 2010) Acupuncturists and medical professionals are still not clear exactly why it may help with anxiety, but some research has noted that acupuncture appears to have a calming effect. More research studies are needed to prove the effectiveness of acupuncture for anxiety disorders. (Kim Y. K. 2019)

Getting Treated

What it can help with:

  • Agoraphobia
  • Generalized anxiety disorder (GAD)
  • Panic disorder
  • Phobias
  • Selective mutism
  • Separation anxiety disorder
  • Social anxiety disorder

If you are interested in treating your anxiety and panic symptoms through acupuncture, the first step is to consult your main healthcare provider. Professional acupuncture practitioners are on websites, including the National Certification Commission for Acupuncture and Oriental Medicine and the American Academy of Medical Acupuncture. The use of acupuncture continues to rise, making it more readily available. Since it has been evaluated for effectiveness and is available through many hospitals, some insurance policies may cover some acupuncture treatments.

Injury Medical Chiropractic and Functional Medicine Clinic

Acupuncture can help relieve symptoms of anxiety, stress, pain, discomfort, tightness, and poor circulation. Injury Medical Chiropractic and Functional Medicine Clinic can help individuals recover and build optimal health and wellness solutions with primary healthcare providers and specialists. 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.

Discovering The Benefits of Chiropractic Care

References

Pilkington K. (2010). Anxiety, depression, and acupuncture: A review of the clinical research. Autonomic neuroscience : basic & clinical, 157(1-2), 91–95. https://doi.org/10.1016/j.autneu.2010.04.002

National Institute for Complementary and Integrative Health. (2022). Acupuncture: Effectiveness and Safety. Retrieved from https://www.nccih.nih.gov/health/acupuncture-effectiveness-and-safety

Kim Y. K. (2019). Panic Disorder: Current Research and Management Approaches. Psychiatry investigation, 16(1), 1–3. https://doi.org/10.30773/pi.2019.01.08

By admin 0 Comments Chiropractic Care, Therapy , , , , , , , , , , , , , , , , , , ,

Exploring Nociceptors: Detecting and Reacting to Pain

Can understanding how nociceptors function and their role in processing pain signals help individuals who are managing injuries and/or living with chronic pain conditions?

Nociceptors

Nociceptors are nerve endings that detect harmful stimuli, such as extreme temperatures, pressure, and chemicals, and signal pain. They are the body’s first defense against potentially damaging environmental inputs.

  • Nociceptors are in the skin, muscles, joints, bones, internal organs, deep tissues, and cornea.
  • They detect harmful stimuli and convert them into electrical signals.
  • These signals are sent to the brain’s higher centers.
  • The brain interprets the signals as pain, which prompts the body to avoid the harmful stimulus.

Nociceptors, often called pain receptors, are free nerve endings all over the body. They play a pivotal role in how the body feels and reacts to pain. The main purpose of a nociceptor is to respond to damage to the body by transmitting signals to the spinal cord and brain. (Purves D, Augustine GJ, Fitzpatrick D, et al., editors. 2001) If you bang your foot, the nociceptors on the skin are activated, sending a signal to the brain via the peripheral nerves to the spinal cord. Pain resulting from any cause is transmitted this way. Pain signals are complex, carrying information about the stimuli’s location and intensity. This causes the brain to fully process the pain and send communication back to block further pain signals.

Classification

There are different classes of nociceptors, which are based on which type of stimuli they respond to (University of Texas McGovern Medical School, 2020)

Thermal

  • Thermal nociceptors respond to extreme hot or cold temperatures.
  • For instance, when touching a hot stove, the nociceptors, which signal pain, are activated immediately, sometimes before you know what you’ve done.

Mechanical

  • Mechanical nociceptors respond to intense stretching or strain, such as pulling a hamstring or straining a tendon.
  • The muscles or tendons are stretched beyond their ability, stimulating nociceptors and sending pain signals to the brain.

Chemical

  • Chemical nociceptors respond to chemicals released from tissue damage.
  • For example, prostaglandins and substance P or external chemicals like topical capsaicin pain creams.

Silent

  • Silent nociceptors must be first activated by tissue inflammation before responding to a mechanical, thermal, or chemical stimulus.
  • Most visceral nociceptors are located on organs in the body.

Polymodal

  • Polymodal nociceptors respond to mechanical, thermal, and chemical stimuli.

Mechano-thermal

  • Mechano-thermal nociceptors respond to mechanical and thermal stimuli.

Pain Transmission

Nociceptors are also classified by how fast they transmit pain signals. Transmission speed is determined by the type of nerve fiber known as an axon a nociceptor has. There are two main types.

  • The first type is A fiber axon, fibers surrounded by a fatty, protective sheath called myelin.
  • Myelin allows nerve signals/action potentials to travel rapidly.
  • The second type is C fiber axons, which are not surrounded by myelin and transmit slower. (University of Texas McGovern Medical School, 2020)

Because of the difference in transmission speed, the pain signals from the A fibers reach the spinal cord first. As a result, after an acute injury, an individual experiences pain in two phases, one from the A fibers and one from the C fibers. (Ngassapa D. N. 1996)

Pain Perception Phases

When an injury occurs, the stimulated nociceptors activate the A fibers, causing a person to experience sharp, prickling pain.

  1. This is the first phase of pain, known as fast pain, because it is not especially intense but comes right after the stimulus.
  2. During the second phase of pain, the C fibers are activated, causing an intense, burning pain that persists even after the stimulus has stopped.
  3. The fact that the C fibers carry burning pain explains why there is a short delay before feeling the sensation.
  4. The C fibers also carry aching, sore pain caused by organs within the body, such as a sore muscle or stomachache. (Ngassapa D. N. 1996)

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.

From Injury To Recovery With Chiropractic Care

References

Purves D, A. G., Fitzpatrick D, et al., editors. (2001). Nociceptors. In Neuroscience. 2nd edition. (2nd ed.). Sunderland (MA): Sinauer Associates. https://www.ncbi.nlm.nih.gov/books/NBK10965/

University of Texas McGovern Medical School. (2020). Chapter 6: Pain Principles. https://nba.uth.tmc.edu/neuroscience/m/s2/chapter06.html

Ngassapa D. N. (1996). Comparison of functional characteristics of intradental A- and C-nerve fibres in dental pain. East African medical journal, 73(3), 207–209.

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Wrist Sprain: Diagnosis and Treatment Options

Can knowing about wrist sprains—their types, symptoms, causes, and diagnoses—help develop an effective treatment program?

Wrist Sprain

Wrist sprains are injuries that affect ligaments that attach bone to bone. They occur after a fall from work overuse, house tasks, during sports activities, or with other direct trauma. Symptoms of a wrist sprain include:

  • Pain
  • Swelling
  • Bruising
  • Decreased range of motion
  • Weakness
  • Tingling

The injury affects the ligaments and soft tissue structures connecting bone to bone. Mild wrist sprains typically heal within a few weeks; most heal without complications in six to 12 weeks. (National Health Service, 2020) However, severe injuries can require surgery, physical therapy, and months to recover fully.

Grades and Types

The three grades of sprains are graded by the severity of the injury (American Academy of Orthopaedic Surgeons, 2024)

Grade 1

  • Ligaments are stretched; this is considered a mild sprain.
  • The injury may heal in one to three weeks with standard care. (Mass General Brigham, 2025)

Grade 2

  • Ligaments are partially torn; this is considered a moderate sprain.
  • It may need a brace; healing can take three to six weeks. (Mass General Brigham, 2025)

Grade 3

  • Ligaments are torn completely or have pulled away from the bone.
  • Sometimes, a piece of bone comes off with it, a condition called an avulsion fracture.
  • This is considered a severe sprain. It can take months to heal completely. (Mass General Brigham, 2025)

The wrist is made up of three joints (American Society for Surgery of the Hand, 2017)

Distal radioulnar

  • This joint is between the two forearm bones.
  • The radius on the thumb side.
  • The ulna on the pinky side.

Radiocarpal

  • This joint is between the radius and three small bones in the base of the hand.
  • The scaphoid
  • The triquetrum
  • The lunate

Ulnocarpal

  • This joint is between the ulna and the articular disc and cushions it from the carpal bones, the lunate, and the triquetrum.

Wrist sprains can affect any of these joints but more commonly affect the ligament between the scaphoid and lunate bone or the triangular fibrocartilage complex/TFCC on the pinky side of the wrist.

Symptoms

The primary symptom of a wrist sprain is pain, especially when moving or touching the injured area. Other symptoms can include: (National Library of Medicine, 2021) (American Academy of Orthopaedic Surgeons, 2024)

  • Decreased range of motion
  • Swelling
  • Bruising
  • Feeling instability in the wrist 
  • Weakness
  • Numbness/tingling
  • Popping sensation
  • Warm skin

Causes

The common cause of wrist sprain is falling on an outstretched hand. (American Academy of Orthopaedic Surgeons, 2024) Other common causes include:

  • Repetitive overuse work injuries.
  • Housework and tasks.
  • Sports include skateboarding, gymnastics, basketball, snowboarding, hockey, and contact sports.

Diagnosis

A healthcare provider will diagnose a wrist sprain based on symptoms and injury causes. X-rays are the first imaging to rule out fractures. Other tests can include:

  • Magnetic resonance imaging – MRI
  • Computed tomography – CT scan
  • Arthrogram -X-rays with contrast dye

Treatment

Nonsteroidal anti-inflammatory drugs, such as Aleve, Advil, Motrin, and aspirin, can treat pain and inflammation. The severity of the wrist sprain determines whether additional treatment is needed. Sprains should initially be treated with the RICE protocol (American Academy of Orthopaedic Surgeons, 2024)

Rest

  • Minimize using the injured wrist for at least two days.
  • Wear a splint for support.
  • Avoid sudden movements.
  • Avoid placing too much pressure on the wrist.

Ice

  • Cold packs are recommended several times daily for 20 minutes to decrease pain and swelling.

Compression

  • Wrap the wrist with an elastic bandage or Kinesio tape to help reduce swelling.

Elevation

  • To decrease swelling, use pillows to elevate the wrist as much as possible above the level of your heart.
  1. Grade 1 sprains usually heal with basic care within a week or two.
  2. Grade 2 sprains often require wearing a brace for an extended period while the ligament heals, which can take up to six weeks. (American Society for Surgery of the Hand, 2018)
  3. The removable brace or splint should be worn when using the arm.
  4. It can be taken off at rest at night and when bathing. (National Health Service, 2020)
  5. Individuals may need the brace for a week or more.

A healthcare provider may also recommend stretching exercises to overcome stiffness and regain mobility. (American Academy of Orthopaedic Surgeons, 2024) Physical therapy, occupational therapy, or treatment by a certified hand therapist can also reduce pain and improve range of motion and strength.

Treatment for grade 3 sprains often requires surgery. Grade 3 sprains, including avulsion fractures, often require a six-week cast for bones to heal. In some cases, the bones might also need a screw or temporary wires to hold them in the proper position. (Vannabouathong, C. et al., 2018) Severe wrist sprains may also require surgery to repair the injured ligament. If the original ligament cannot be repaired, a piece of the tendon can be used to reconstruct it. (American Society for Surgery of the Hand, 2020)

Healing Time

Mild to moderate sprains usually recover within a few weeks without long-term complications. (American Society for Surgery of the Hand, 2018) The prognosis for severe wrist sprains improves with early diagnosis and treatment. After surgery, ligaments usually heal within eight to 12 weeks but can take six to 12 months for function to return to normal. (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 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 Path to Healing Personal Injury

References

National Health Service. (2020). Advice after spraining your wrist. https://www.ruh.nhs.uk/patients/patient_information/ORT_057_Advice_after_a_wrist_sprain.pdf

American Academy of Orthopaedic Surgeons. (2024). Wrist sprains. https://orthoinfo.aaos.org/en/diseases–conditions/wrist-sprains

Mass General Brigham. (2025). Wrist sprains. https://www.massgeneralbrigham.org/en/patient-care/services-and-specialties/sports-medicine/conditions/hand-arm/wrist-sprain

American Society for Surgery of the Hand. (2017). Anatomy 101: Wrist joints. https://www.assh.org/handcare/blog/anatomy-101-wrist-joints

National Library of Medicine. (2021). Wrist injuries and disorders. Retrieved from https://medlineplus.gov/wristinjuriesanddisorders.html

American Society for Surgery of the Hand. (2018). Sprained wrist. https://www.assh.org/handcare/condition/sprained-wrist

Vannabouathong, C., Ayeni, O. R., & Bhandari, M. (2018). A Narrative Review on Avulsion Fractures of the Upper and Lower Limbs. Clinical medicine insights. Arthritis and musculoskeletal disorders, 11, 1179544118809050. https://doi.org/10.1177/1179544118809050

American Society for Surgery of the Hand. (2020). Scapholunate torn ligament. https://www.assh.org/handcare/condition/scapholunate-torn-ligament

By admin 0 Comments Acupuncture, Electroacupuncture , , , , , , , , , , , , , , , , , ,

Pain-Free Acupuncture: Debunking the Misconceptions

Is acupuncture painful for individuals wanting to try acupuncture for various health conditions but aren’t sure?

Is Acupuncture Painful?

Acupuncture is a procedure where extremely fine needles are inserted into pressure points in the body. A traditional Chinese medicine technique used to alleviate pain and enhance physical and emotional well-being. (Harvard Health, 2023) It can be beneficial for anyone dealing with persistent painful conditions, such as back pain, sciatica, arthritis-related discomfort, headaches, and post-surgery pain. It’s also a supportive option for individuals experiencing hot flashes and generalized inflammation, making it a versatile choice for holistic health. People undergoing acupuncture experience minimal pain, usually mild pressure or soreness during or after. However, choosing an experienced practitioner and communicating with them during the treatment is the best way to avoid increased pain.

When Performed Correctly, It Should Not Hurt

Many fear that acupuncture will be painful. However, this is not the case because the procedure uses extremely fine needles. One study of pediatric patients found that 87% reported minimal to no pain while having the treatment (Gold J. I. et al., 2023). Improper needle placement is one of the most common reasons that patients experience pain during or after treatment (Johns Hopkins Medicine, 2025). This is why it is important to be treated by a licensed practitioner who is well-versed in treating specific conditions.

Soreness After Treatment

It is relatively uncommon to experience pain after receiving acupuncture. About 10% of individuals experience minor soreness after the treatment (Kelly R. B. & Willis J. 2019). The soreness is typically felt in the areas where the needles were inserted.

Situations When Pain Can Present

A small group of those who undergo acupuncture may experience some pain. It is most frequently seen in the following: (Harvard Health, 2023)

  • The acupuncturist is inexperienced and inserts the needle incorrectly or not in the right area.
  • The needles are inserted more deeply than normal or with too much pressure.
  • The patient has a lower pain threshold and/or is more sensitive to needles.
  • The practitioner uses higher gauge/thicker needles.

It is important for individuals who have not had acupuncture before to discuss the procedure and any concerns with their provider beforehand. The acupuncturist may be able to perform a trial needle insertion to provide a preview of the treatment. During the initial session, they may use fewer needles or target a smaller area. Constantly communicate with the acupuncturist during the treatment. This allows them to adjust the needles causing soreness or discontinue the procedure if there is increased pain.

Acupuncture Process

Modern medicine explains acupuncture’s benefits. When the needles are inserted, they stimulate the release of endorphins, opioids, immune system cells, and neurohormones. These chemicals help reduce and relieve pain and modify how the body perceives it. They may also impact blood pressure, body temperature, and central nervous system function. (Harvard Health, 2023)

Pressure Points: Is Acupuncture Painful On Certain Body Parts?

Acupuncture can cause some increased soreness in certain body areas. This is especially true when needles are inserted into less muscle or fat regions. For example, hand or foot acupuncture can occasionally cause increased pain (Kaiser Permanente, 2021). Thin individuals with less soft tissue may also experience a stinging sensation as needles are inserted. Communication with the provider is the key to making the acupuncture sessions as comfortable as possible.

During A Session

The first acupuncture session may consist of the following:

  • The practitioner goes over medical history and current symptoms.
  • The practitioner examines the body and may also examine the tongue to assess for any present imbalances.
  • The patient will lie or sit on a table.
  • Sterilized needles are inserted into the affected areas one at a time.
  • In some situations, heat or electrical stimulation may also be used to enhance its effects. (Johns Hopkins Medicine, 2025)
  • A typical acupuncture session is about 20 to 30 minutes. (Kaiser Permanente, 2021)

Self-Care After Treatment

Most cases of soreness after treatment will resolve in one to three days. During this time, here are a few recommendations to alleviate any soreness symptoms:

  • Apply ice to the areas of soreness.
  • Gently stretch the sore areas.
  • Increase fluid intake.
  • Soak in a warm bath with Epsom salts or magnesium oil.
  • Perform light aerobic exercise.
  • Take over-the-counter anti-inflammatory medication if recommended by a physician. (University of Georgia, N.D.)

Find a Licensed Acupuncturist

Most states have an online directory of licensed acupuncturists that can help find a local provider. Some national acupuncture associations also maintain lists of members who are board-certified. For example, this directory searches for certified acupuncturists through the National Certification Commission for Acupuncture and Oriental Medicine. (National Certification Commission for Acupuncture and Oriental Medicine, 2024)

Injury Medical Chiropractic and Functional Medicine Clinic

Therefore, acupuncture is not painful and can help relieve symptoms such as anxiety, stress, pain, discomfort, tightness, and poor circulation. Injury Medical Chiropractic and Functional Medicine Clinic can help individuals recover and build optimal health and wellness solutions with primary healthcare providers and specialists. 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.

Beyond Adjustments: Chiropractic and Integrative Healthcare

References

Harvard Health Publishing. (2023). Acupuncture. https://www.health.harvard.edu/a_to_z/acupuncture-a-to-z

Gold, J. I., Kobylecka, M., Ngo, N. H., Lin, C. T., & Hurray, C. N. (2023). Does Acupuncture Hurt? A Retrospective Study on Pain and Satisfaction during Pediatric Acupuncture. Children (Basel, Switzerland), 10(11), 1774. https://doi.org/10.3390/children10111774

Johns Hopkins Medicine. (2025). Acupuncture. https://www.hopkinsmedicine.org/health/wellness-and-prevention/acupuncture

Kelly, R. B., & Willis, J. (2019). Acupuncture for Pain. American family physician, 100(2), 89–96.

Kaiser Permanente. (2021). Acupuncture 101: here’s what you can expect. https://healthy.kaiserpermanente.org/health-wellness/healtharticle.acupuncture-101

University of Georgia. (N.D.). Dry needling. https://healthcenter.uga.edu/healthtopics/dryneedling/

National Certification Commission for Acupuncture and Oriental Medicine. (2024). Directory: Feel Confident About Finding a Qualified Practitioner. https://directory.nccaom.org/#

By admin 0 Comments Chiropractic Care, Sporting , , , , , , , , , , , , , , , , ,

Key Exercises in the Treatment of Achilles Tendonitis: A Protocol

Can incorporating an exercise program like the Alfredson Protocol help athletes and individuals who have hurt their Achilles tendon find pain relief and healing so they can return to regular physical activities?

Exercise Protocol Achilles Tendonitis

Achilles tendonitis occurs when the tendon at the back of the ankle gets injured. It is common in runners. For individuals who have Achilles tendonitis, walking and running can be painful. You might have to stop engaging in exercise and physical activities like sports. Depending on your job, having the condition may make working harder. Here are a few of the signs and symptoms of the condition:

  • Pain in the back of the lower leg, just above the heel.
  • Pain with running, jumping, or pointing the toes.
  • A small lump on the Achilles tendon just above the heel.

The first line of treatment is to rest and ice the tendon. Anti-inflammatory medications can help reduce pain. (American Academy of Orthopaedic Surgeons, 2022) Physical therapy can include strengthening exercises, ultrasound heat therapy, and deep massage. Exercises stretching the nearby muscles will help gradually increase the stress the tendon can handle, eventually reducing inflammation and swelling. Stretching and flexibility exercises will help an Achilles tendon heal. (University of Michigan, 2023)

The only way to determine if an individual has injured their Achilles tendon is to see a doctor. If the injury is Achilles tendonitis, a physical therapist may be recommended. A physical therapist can train individuals on the Alfredson protocol, an exercise protocol program for those with Achilles tendonitis (tendinopathy) that research has shown is helpful for those with the condition. The therapist will train on how to exercise to strengthen the tendon. The exercises stretch the Achilles tendon to help it handle forces and stress, known as eccentric loading. (Stevens M., & Tan C. W. 2014)

Inflammation

Tendonitis is inflammation of a tendon. However, studies have shown that the tendon might not be inflamed in those with the condition. When an area of the body is inflamed, inflammatory cells are present. Individuals usually feel pain in the inflamed area. For those with Achilles tendonitis, the tendon will present with pain, but not necessarily because the tendon is inflamed. Under a microscope, researchers examined tissue from the tendons of those with Achilles tendonitis. They did not find inflammatory cells in the tissue. (Stevens M., & Tan C. W. 2014) This means that although individuals felt pain, they were not inflamed. If there are no inflammatory cells in the tendon, this could explain why those with Achilles tendonitis often do not find relief from the anti-inflammatory treatment of non-steroidal anti-inflammatory drugs (NSAIDs). Studies have shown that gentle exercise protocols for the tendon are more helpful. However, researchers are not sure why these exercises are so beneficial. (O’Neill S., Watson P. J., & Barry S. 2015)

Eccentric Exercise

A chiropractic physical therapy team can help individuals heal the injury with eccentric loading exercises. Eccentric loading exercises work the muscles and tendons to help them get stronger. Once healing has begun, they can help strengthen the tendon. Individuals start slowly with easy exercises and then work up to harder ones. They will have the patient lengthen or stretch out the muscle. As the patient moves, the muscles and tendons contract or shorten. The Alfredson protocol consists of eccentric loading exercises for the Achilles and the muscles that support it.

Alfredson Protocol

Before exercising, talk to a doctor or physical therapist to know if it’s safe. How to do the Alfredson protocol:

  1. First, stand on a small step or curb.
  2. Stand with the balls of your feet on the edge.
  3. Your heels should hang over the edge.
  4. Hold onto something for balance.
  5. Keep the knees straight.
  6. This will load a muscle part of the Achilles tendon called the gastrocnemius.
  7. Using both feet, lift the heels and rise onto the balls of the feet.
  8. Keep the foot with the painful Achilles tendon on the step.
  9. Lift the non-injured foot off the step.
  10. Slowly lower down using the injured ankle.
  11. The heel should move towards the floor.
  12. The ball of the foot should remain in contact with the edge of the step.
  13. Return the non-injured foot to the step.
  14. Repeat the exercise.

Do three sets of 15 reps with the knees straight. Then, do the Alfredson protocol again with the knees slightly bent. This will work a muscle called the soleus, which connects to the gastrocnemius. Perform three sets of 15 repetitions. Perform both exercises twice a day. This could be in the morning and the evening. The Alfredson protocol is most beneficial when done for about 12 weeks. (Stevens M., & Tan C. W. 2014)

Injury Medical Chiropractic and Functional Medicine Clinic

The Alfredson exercise protocol can be done at home with a step or raised platform to put the feet on safely. Individuals should consider working with a personal trainer to ensure safety and get the most out of the workouts. 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.

Functional Foot Orthotics Achieve Optimal Performance

References

American Academy of Orthopaedic Surgeons. OrthoInfo. (2022). Achilles Tendinitis. https://orthoinfo.aaos.org/en/diseases–conditions/achilles-tendinitis/

University of Michigan. (2023). Achilles Tendon Injury: Physical Therapy and Rehab. https://www.uofmhealth.org/health-library/tr2261

Stevens, M., & Tan, C. W. (2014). Effectiveness of the Alfredson protocol compared with a lower repetition-volume protocol for midportion Achilles tendinopathy: a randomized controlled trial. The Journal of orthopaedic and sports physical therapy, 44(2), 59–67. https://doi.org/10.2519/jospt.2014.4720

O’Neill, S., Watson, P. J., & Barry, S. (2015). WHY ARE ECCENTRIC EXERCISES EFFECTIVE FOR ACHILLES TENDINOPATHY?. International journal of sports physical therapy, 10(4), 552–562.

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Say Goodbye to Back Pain: Selecting the Perfect Mattress

What is the recommended way to choose a mattress for individuals with back pain?

Back Pain Mattress

When choosing a back pain mattress, one size does not fit all in selecting one for those with spine pain. Several other factors play a role, as well. However, whether a firm or soft mattress is the best option for individuals whose back pain keeps them up at night, most health experts say the choice is yours and that the mattress that makes you feel most comfortable is likely the best option. The research says that medium firmness seems to provide the most painless sleep. A review gathered information from 24 controlled trials where participants used soft, medium-firm, firm, or custom-inflated mattresses. The results showed that medium-firm and self-adjusted mattresses were best for sleep comfort, quality, and spinal alignment. (Radwan A. et al., 2015)

Medical Status

Selecting the back pain mattress best suited to your spinal condition is more than just how hard or soft the mattress is. Individuals and their healthcare providers should thoroughly review their medical history to tailor the mattress to their needs. Before purchasing a mattress, check the following:

  • Age
  • Medical history
  • Injuries current and past
  • Current diagnosis or diagnoses
  • Disease and/or Conditions
  • Sleeping preferences

For example, symptoms of spinal stenosis tend to present themselves when one is standing and walking but not when lying down. For this reason, mattress firmness is not a big issue only for people with spinal stenosis. However, it must be taken into consideration for those who have degeneration along with spinal stenosis.

Individuals with spinal arthritis without stenosis, disc problems, or non-specific back pain need to consider the relative firmness or softness of the back pain mattress. People with these conditions do better with more support, i.e., a firmer mattress. While everyone needs some back support when they sleep, those who have undergone multiple back surgeries often need less. The tissues have been altered and may be stiffer after several surgeries. In this case, a softer mattress may be more suitable and comfortable.

Mattress Age

Mattress springs break down over time, which makes the bed softer. This can aggravate the spine and back muscles. Based on this, investing in a new mattress makes sense, or pain and stiffness can worsen with the current one. While this will vary among individuals, medical research may help shed some light: A study measured the comfort and quality of sleep for 27 participants with low back pain and stiffness. The participants recorded their sleep comfort and quality in their beds for 21 days and then with a new prescribed mattress and bedding system, which they used for 12 weeks. The study found that the participants showed significant and progressive improvement in back pain and stiffness on the new mattresses and improved sleep quality significantly. (Jacobson B. H. et al., 2010)

Sleeping Position

The position usually slept in makes a difference in the support needed for the back pain mattress. Some recommendations for back sleepers, side and fetal position sleepers, and stomach sleepers:

Side Sleepers

  • Most people are side sleepers.
  • They sleep in the fetal position with their knees drawn up toward their chest.
  • This position tends to place pressure on the hips and shoulders.
  • For side and fetal sleepers, a slightly softer mattress is recommended.
  • The foam the mattress is made of conforms to the body, especially in the thoracic and lumbar regions of the spine.

Stomach Sleepers

  • For the stomach sleeper, soft mattresses can irritate the back.
  • A soft mattress encourages the abdomen to sink into the bed.
  • The resulting position is known to increase the arch in the lower back and cause pain.
  • A medium-firm surface is good for stomach sleepers.
  • The idea is to derive support from the chosen mattress without the abdominal sinking.
  • The sinking effect is amplified if you have a large abdomen.
  • For thin individuals, sinking may not be as much of an issue.

Back Sleepers

  • For support, place a thin, rolled towel or pillow under the knees and lower back of those who sleep on their backs.
  • A pillow/s under these areas will help support them and provide more comfort.

Researchers divided the participants according to their usual sleep position. They were assigned to a medium-firm mattress with foam and latex layering based on their preferred sleep position. The participants rated their sleep comfort and quality daily for three months. The researchers found that the new mattresses improved back pain and stiffness. For this reason, they concluded that sleep surfaces relate to sleep discomfort and that replacing a mattress with one uniquely suitable to your spinal condition can reduce and relieve pain. (Jacobson B. H. et al., 2010)

Injury Medical Chiropractic and Functional Medicine Clinic

Choosing the right back pain mattress ultimately comes down to personal preference. Individuals should try various mattresses and see which one they like best. Individuals who struggle with sleep or other sleep disorders that impact their ability to get restful sleep should consult with their healthcare provider about getting an assessment and treatment. Injury Medical Chiropractic and Functional Medicine Clinic can help individuals recover and regain the benefits of quality rest through healthy sleep practices and lifestyle accommodations. We build optimal health and wellness solutions with primary healthcare providers and specialists. 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.

Chiropractic Care Can Transform Pain Into Relief

References

Radwan, A., Fess, P., James, D., Murphy, J., Myers, J., Rooney, M., Taylor, J., & Torii, A. (2015). Effect of different mattress designs on promoting sleep quality, pain reduction, and spinal alignment in adults with or without back pain; systematic review of controlled trials. Sleep health, 1(4), 257–267. https://doi.org/10.1016/j.sleh.2015.08.001

Jacobson, B. H., Boolani, A., Dunklee, G., Shepardson, A., & Acharya, H. (2010). Effect of prescribed sleep surfaces on back pain and sleep quality in patients diagnosed with low back and shoulder pain. Applied ergonomics, 42(1), 91–97. https://doi.org/10.1016/j.apergo.2010.05.004

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Deep Sleep Guaranteed: Discover the Benefits of Sleep Sounds

Can listening to sleep sounds help achieve and maintain healthy sleep patterns for individuals having trouble sleeping?

Sleep Sounds

Sleep sounds include white, pink, green, or brown noise, binaural beats, ASMR, nature, and ambient sounds. Each has different benefits and can potentially improve sleep. (Ebben M. R., Yan P., & Krieger A. C. 2021) Sound has no color, but it follows a spectrum. The color of a sound refers to the power spectrum of a particular noise signal. Each color has different qualities.

  • White noise, such as an untuned radio or television, is the most well-known background noise and is often used as a sleep aid.
  • Green noise features more powerful mid-range frequencies.
  • Brown noise is a more low-frequency rumble deeper than green and white noise.
  • Pink noise combines white noise softened by brown and could be the most effective option for improving sleep.

White noise is a sound that includes all the audible frequencies at equal volume, like a continuous hiss. One study found that adults fell asleep faster while listening to white noise. (Messineo L. et al., 2017)

Green noise, which features more powerful mid-range frequencies, is similar to natural sounds like ocean waves, rainfall, and rustling leaves. It’s more soothing than white noise and can help individuals with anxiety sleep better.

Brown noise, also known as red noise, has a deeper tone than white noise and is similar to the hum of an airplane. It can help mask lower-pitched sounds and may be especially helpful for individuals with ADHD, as it aids in productivity and concentration. Brown noise mimics sounds found in nature but with a low-frequency rumble. Examples include heavy rainfall, thunder, or loud waves.

Pink Noise

While further scientific research on sleep noise is needed, evidence has begun to suggest that pink noise may be the most effective option for improving sleep. (Ong J. L. et al., 2016) Pink noise is softer and more soothing than the other colored sleep sounds. It combines white noise softened by brown noise and is considered more relaxing because of its lower pitch. It has a pleasant-sounding, balanced volume across frequencies, making it calming to the human ear. Pink noise includes digital recreations of natural sounds such as a gently flowing stream, soft rain falling, wind rustling through trees, or calm waves lapping at the shore.

In a study, adults over 60 were given intermittent bursts of pink noise while sleeping, similar to rushing water. (Papalambros N. A. et al., 2017) The following morning, participants were given memory tests, which indicated that retention levels were approximately three times greater than those of the control group not exposed to the pink noise. Another study found that steady pink noise significantly reduced brain wave complexity during sleep while improving stable sleep time with less fragmentation and fewer wake periods. (Zhou, J. et al., 2012)

Injury Medical Chiropractic and Functional Medicine Clinic

Choosing the right sound for you ultimately comes down to personal preference. Individuals can try each color and see which one they like best. Individuals who struggle with sleep or other sleep disorders that impact their ability to get restful sleep should consult with their healthcare provider about getting an assessment and treatment to restore health. Individuals can recover and regain the benefits of quality rest through healthy sleep practices and lifestyle accommodations. 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.

Beyond Medicine: The Power of Chiropractic Care

References

Ebben, M. R., Yan, P., & Krieger, A. C. (2021). The effects of white noise on sleep and duration in individuals living in a high noise environment in New York City. Sleep medicine, 83, 256–259. https://doi.org/10.1016/j.sleep.2021.03.031

Messineo, L., Taranto-Montemurro, L., Sands, S. A., Oliveira Marques, M. D., Azabarzin, A., & Wellman, D. A. (2017). Broadband Sound Administration Improves Sleep Onset Latency in Healthy Subjects in a Model of Transient Insomnia. Frontiers in neurology, 8, 718. https://doi.org/10.3389/fneur.2017.00718

Ong, J. L., Lo, J. C., Chee, N. I., Santostasi, G., Paller, K. A., Zee, P. C., & Chee, M. W. (2016). Effects of phase-locked acoustic stimulation during a nap on EEG spectra and declarative memory consolidation. Sleep medicine, 20, 88–97. https://doi.org/10.1016/j.sleep.2015.10.016

Papalambros, N. A., Santostasi, G., Malkani, R. G., Braun, R., Weintraub, S., Paller, K. A., & Zee, P. C. (2017). Acoustic Enhancement of Sleep Slow Oscillations and Concomitant Memory Improvement in Older Adults. Frontiers in human neuroscience, 11, 109. https://doi.org/10.3389/fnhum.2017.00109

Zhou, J., Liu, D., Li, X., Ma, J., Zhang, J., & Fang, J. (2012). Pink noise: effect on complexity synchronization of brain activity and sleep consolidation. Journal of theoretical biology, 306, 68–72. https://doi.org/10.1016/j.jtbi.2012.04.006

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Understanding the Relationship Between Eating Habits and Insomnia

Insomnia is a condition with causes that vary from person to person and can be a result of stress, caffeine, and excessive screen time. Can modifying eating habits help reduce episodes and improve sleep patterns?

Eating Habits and Insomnia

Insomnia is a common sleep disorder characterized by persistent difficulty falling asleep, staying asleep, and/or both. Individuals often experience daytime sleepiness, mood disturbances, or cognitive impairments. There are two types:

  • Primary insomnia, which is not linked to other health conditions.
  • Secondary insomnia is associated with other health issues like asthma, depression, or heartburn. (National Library of Medicine, 2024)

While there are various causes of insomnia, researchers have recently learned more about its impact on eating habits. New data has found that an individual’s dietary pattern may impact sleep habits. (Gan Z. H. et al., 2024)

Risk Factors

Chronic insomnia is linked to negative health outcomes, including an increased risk of high blood pressure, diabetes, obesity, depression, heart attack, and stroke. (Chalet F. X. et al., 2023) (Marie-Pierre St-Onge et al., 2016) Researchers recruited over five thousand participants who did not have insomnia and evaluated their eating habits and insomnia incidence. (Gan Z. H. et al., 2024) Results showed that 464 of the participants developed insomnia, and of those, the risk was lower in vegetarians than those who ate more meat. Males who followed a more plant-based diet had a reduced incidence of insomnia; however, this relationship was not seen among females. The research suggests that a diet with more vegetables may positively affect sleep. Many plant-based foods are rich sources of sleep-supporting compounds, such as melatonin. Treating and preventing insomnia is important for restoring health and daily functioning.

Past nutritional data highlights the relationship between healthy sleep and a diet rich in fruits, vegetables, legumes, and other sources of tryptophan and melatonin. (Zuraikat F. M. et al., 2021) Prior research also shows how vegetarian diets can help reduce chronic inflammation, positively impacting sleep. (Dzierzewski J. M. et al., 2020) Specifically, the Mediterranean diet, known for its anti-inflammatory effects, is linked to improved sleep and reduced insomnia. (Zaidalkilani A. T. et al., 2021) Also, data links a vegetarian diet to improved mood, which might enhance the quality of sleep by moderating mental health, including depression condition. (Wang X. et al., 2023)

Support Quality Sleep

According to dieticians, looking at an individual’s eating habits during the day is crucial in determining why they can’t sleep at night. Often, making a few small dietary adjustments is enough to help with better sleep. Some steps to try include:

  • Increase magnesium by adding more leafy greens, nuts, and seeds.
  • Incorporating melatonin-rich foods like walnuts rather than relying on melatonin supplements.
  • Easing off caffeine, alcohol, and refined carbohydrates can help improve sleep quality.

Dietary changes should not be the only way to combat insomnia. Cognitive behavioral therapy (CBT-I) is a recommended first-line treatment rather than sleeping medications, along with learning healthy sleep habits and using the right mattress. This therapy can help improve sleep habits and behaviors by rethinking sleep and current practices that could affect an individual’s ability to sleep well. Combining CBT-I with a healthy diet and regular physical activity can significantly impact overall health and sleep patterns.

Injury Medical Chiropractic and Functional Medicine Clinic

Individuals who struggle with insomnia or other sleep disorders that impact their ability to get restful sleep should consult with their healthcare provider about getting an assessment and treatment to avoid deprivation side effects and restore health. A chiropractic therapy team can assess your condition and develop a customized treatment plan. 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 heal.

Revolutionizing Healthcare

References

National Library of Medicine: MedlinePlus. (2024). Insomnia. Retrieved from https://medlineplus.gov/insomnia.html

Gan, Z. H., Chiu, T. H. T., Lin, C. L., Lin, M. N., & Kuo, P. H. (2024). Plant-based dietary patterns and risk of insomnia: a prospective study. European journal of clinical nutrition, 78(3), 228–235. https://doi.org/10.1038/s41430-023-01380-x

Chalet, F. X., Saskin, P., Ahuja, A., Thompson, J., Olopoenia, A., Modi, K., Morin, C. M., & Wickwire, E. M. (2023). The Associations between Insomnia Severity and Health Outcomes in the United States. Journal of clinical medicine, 12(6), 2438. https://doi.org/10.3390/jcm12062438

St-Onge, M. P., Grandner, M. A., Brown, D., Conroy, M. B., Jean-Louis, G., Coons, M., Bhatt, D. L., & American Heart Association Obesity, Behavior Change, Diabetes, and Nutrition Committees of the Council on Lifestyle and Cardiometabolic Health; Council on Cardiovascular Disease in the Young; Council on Clinical Cardiology; and Stroke Council (2016). Sleep Duration and Quality: Impact on Lifestyle Behaviors and Cardiometabolic Health: A Scientific Statement From the American Heart Association. Circulation, 134(18), e367–e386. https://doi.org/10.1161/CIR.0000000000000444

Zuraikat, F. M., Wood, R. A., Barragán, R., & St-Onge, M. P. (2021). Sleep and Diet: Mounting Evidence of a Cyclical Relationship. Annual review of nutrition, 41, 309–332. https://doi.org/10.1146/annurev-nutr-120420-021719

Dzierzewski, J. M., Donovan, E. K., Kay, D. B., Sannes, T. S., & Bradbrook, K. E. (2020). Sleep Inconsistency and Markers of Inflammation. Frontiers in neurology, 11, 1042. https://doi.org/10.3389/fneur.2020.01042

Zaidalkilani, A. T., Alhaj, O. A., Serag El-Dine, M. F., Fekih-Romdhane, F., AlRasheed, M. M., Jahrami, H. A., & Bragazzi, N. L. (2021). Arab Women Adherence to the Mediterranean Diet and Insomnia. Medicina (Kaunas, Lithuania), 58(1), 17. https://doi.org/10.3390/medicina58010017

Wang, X., Song, F., Wang, B., Qu, L., Yu, Z., & Shen, X. (2023). Vegetarians have an indirect positive effect on sleep quality through depression condition. Scientific reports, 13(1), 7210. https://doi.org/10.1038/s41598-023-33912-7

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The Importance of the Long Thoracic Nerve in Shoulder Function

Can understanding the anatomy and function of the long thoracic nerve help individuals make informed healthcare decisions after an injury to the nerve?

Long Thoracic Nerve

Also referred to as the posterior thoracic nerve, the long thoracic nerve/LTN is a thin superficial nerve that runs from the cervical spine to the chest wall side of the trunk. It supplies motor function to the thorax’s serratus anterior muscle, helping stabilize the shoulder blade. Injury to this nerve can cause limited or abnormal shoulder and shoulder blade motion, including difficulty raising the arm during overhead reaching.

Anatomy

The long thoracic nerve originates from the ventral rami of cervical nerves C5, C6, and C7. (Waxenbaum JA, Reddy V, Bordoni B. 2023) In some individuals, the root from C7 is absent; in others, a small nerve root branches from C8. The nerve roots from C5 and C6 go through the medial scalene muscle to join the C7 nerve. It travels behind the brachial plexus axillary artery and vein and courses down the lateral side of the thorax. The long thoracic nerve terminates at the lower portion of the serratus anterior muscle, sending small nerve tendrils to each muscle’s projections, which attach to the ribs. Because the long thoracic nerve is located on the lateral side of the chest, it is vulnerable to injury during sports or surgical procedures. The nerve also has a smaller diameter than other cervical and brachial plexus nerves, which increases its potential for injury.

Function

The long thoracic nerve attaches to the underside of the shoulder blade and inserts as muscular slips into the ribs. It supplies motor function to the serratus anterior muscle, essential for normal shoulder motion. When it contracts, it pulls the shoulder blade against the ribs and thorax, helping to move and stabilize the arm as it moves forward and up during shoulder motions. Injury to the long thoracic nerve causes a condition called scapular winging. This occurs when the serratus anterior muscle becomes weakened or paralyzed after injury. (Lung K, St Lucia K, Lui F. 2024)

Susceptibility to Injury

The LTN is relatively unprotected and can be damaged by several things, including:

  • Heavy backpacks
  • Sports
  • Activities the body is not used to, like digging
  • Using crutches

Conditions

Injury to the long thoracic nerve may occur as a result of trauma, lifting heavy weights above the shoulder, or a surgical procedure. Surgical procedures that may place the nerve at risk for injury may include: (Lung K, St Lucia K, Lui F. 2024)

  • Axillary lymph node dissection
  • Improperly placed intercostal drains
  • Chest tube placements
  • Mastectomy
  • Thoracotomy

The long thoracic nerve is protected during these procedures by the surgeon and proper surgical technique, but occasionally, difficulties arise during surgery, and the nerve may become injured. Individuals may also have an anatomical variance that places their nerves in varying positions. The surgeon may not see it and accidentally injure their nerves during surgery.

The superficial long thoracic nerve may also be injured during sports or trauma to the trunk. A blow to the side or a sudden overhead stretch to the shoulder may be enough to damage the nerve, paralyzing the serratus anterior muscle.

Weakness or paralysis of the serratus anterior muscle will result in a winged scapula. To test for this:

  • Stand about two feet from a wall, facing it.
  • Place both hands on the wall and gently push against it.
  • If one of the shoulder blades sticks out abnormally, it could be a winged scapula.
  • Have a family member or friend stand behind you and check the shoulder blade position.
  • If you suspect a winged scapula, visit a physician who can assess the condition and determine if there is a long thoracic nerve injury.

Winging the scapula may result in difficulty lifting the arm overhead. The serratus anterior muscle works with other scapular stabilizers, such as the upper trapezius and levator scapula, to properly position the shoulder blade when lifting the arm. Failure of the serratus to stabilize the shoulder blade may make lifting the arm impossible.

Clinical examination is usually used to diagnose a long thoracic nerve injury. X-rays and MRIs cannot show the nerve injury directly, although an MRI can show some secondary signs to help confirm the diagnosis. An electromyographic or EMG test may also be performed to examine the function of the long thoracic nerve.

Treatment and Rehabilitation

Treatment for LTN pain and reduced movement may include:

  • Rest
  • Heat or ice
  • Anti-inflammatory pain medication
  • Neck support or a pillow
  • Avoiding strenuous activity and driving

If the long thoracic nerve is severely injured and the serratus anterior is completely paralyzed, the best course of action is to be active and monitor the condition. Full recovery of arm function can take one to two years. If permanent nerve injury has occurred, surgery may be an option to restore shoulder motion and function. Several different kinds of surgery can be used to address winged scapula. (Vetter M. et al., 2017)

  • One involves transferring the pectoralis major tendon to the scapula (Vetter M. et al., 2017) so it functions as the serratus.
  • Often, the tendon has to be lengthened, which may be done using part of the hamstring tendon.
  • After surgery, individuals will likely wear a sling on their arm for a few weeks, and then gentle range-of-motion exercises will be initiated.
  • After eight to ten weeks, gentle progressive strengthening of the new tendon can begin.
  • Full shoulder motion and strength recovery are expected six to 12 months after surgery.

Physical therapy may be used to help improve serratus anterior functions. (Berthold J. B., Burg T. M., & Nussbaum R. P. 2017) Exercises to strengthen serratus function may include:

Supine Punches

  • Lie on your back and raise both arms toward the ceiling.
  • Make a fist and punch up toward the ceiling.
  • Ensure the motion is steady and deliberate, and keep the elbow straight.
  • Hold the position for three seconds, then slowly lower the arm to the starting position.
  • Perform 10 to 15 repetitions.
  • Holding a small dumbbell in your hands can make the exercise more challenging.

Pushup

  • Lie on your stomach and place your hands flat on the ground by your shoulders as if you were going to perform a pushup.
  • Perform a pushup and press further, allowing the shoulder blades to wrap around the thorax.
  • Hold this position for three seconds, and slowly release.
  • Perform 10 to 15 reps.
  • If this is too difficult, perform the pushup against a wall to reduce the effect of gravity on the exercise.

Scapular Winging in Depth

References

Waxenbaum, J. A., Reddy, V., & Bordoni, B. (2024). Anatomy, Head and Neck: Cervical Nerves. In StatPearls. https://www.ncbi.nlm.nih.gov/pubmed/30844163

Lung, K., St Lucia, K., & Lui, F. (2024). Anatomy, Thorax, Serratus Anterior Muscles. In StatPearls. https://www.ncbi.nlm.nih.gov/pubmed/30285352

Vetter, M., Charran, O., Yilmaz, E., Edwards, B., Muhleman, M. A., Oskouian, R. J., Tubbs, R. S., & Loukas, M. (2017). Winged Scapula: A Comprehensive Review of Surgical Treatment. Cureus, 9(12), e1923. https://doi.org/10.7759/cureus.1923

Berthold, J. B., Burg, T. M., & Nussbaum, R. P. (2017). Long Thoracic Nerve Injury Caused by Overhead Weight Lifting Leading to Scapular Dyskinesis and Medial Scapular Winging. The Journal of the American Osteopathic Association, 117(2), 133–137. https://doi.org/10.7556/jaoa.2017.025