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Chiropractic and Nurse Practitioner: Treatment Insights

By
Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP
-
With model of human spine. Two doctors are in the office.

What are the advantages of being both a chiropractor and a nurse practitioner in cases of personal injury and car accidents?

Chiropractic and Nurse Practitioner: Treatment Insights

Chiropractic and Nurse Practitioner On Auto Accidents

In the aftermath of a motor vehicle accident, both chiropractors and nurse practitioners play vital roles in managing injuries and promoting recovery. Chiropractors focus on manual therapies, such as adjustments and manipulations, to address musculoskeletal issues and restore mobility, while nurse practitioners provide comprehensive care, including assessments, diagnoses, treatment plans, and education, often collaborating with specialists to optimize patient outcomes. (Physicians Group, LLC. 2024)

Chiropractors

Chiropractors treat musculoskeletal ailments, such as back and neck discomfort, which are common in motor vehicle accidents. They frequently employ hands-on techniques to reduce pain and enhance mobility instead of drugs. Their extensive records and expert testimony can also be used to support personal injury lawsuits, demonstrating the severity of injuries. (Dies, S., & Strapp, J. W., 1992)

Diagnosis and Treatment of Musculoskeletal Conditions

  • Chiropractors can diagnose and treat spinal misalignments, muscle spasms, and soft tissue injuries that may occur following an accident. (The Neck and Back Clinics, 2025)

Pain Relief

  • Manual therapy, such as spine adjustments and soft tissue mobilization, can help relieve pain and inflammation.

Improved mobility

  • Chiropractors can assist in restoring range of motion and function by addressing joint and muscle limitations.

Holistic care

  • Chiropractors frequently examine the complete body and can advise on maintaining excellent posture, ergonomics, and overall health to avoid future accidents.

Collaboration with Other Healthcare Professionals

  • Chiropractors can collaborate with doctors, physical therapists, and other professionals to develop a holistic treatment plan for their patients. (Physicians Group, LLC, 2024)

Nurse practitioners

Nurse practitioners can offer complete care for motor vehicle accident injuries, such as: (Integrity Spine & Orthopedics, 2024)

Assessment and diagnosis

  • Nurse practitioners can do physical exams, interpret diagnostic tests, and treat injuries like whiplash, soft tissue injuries, and concussions.

Treatment Plans

  • They can create tailored treatment programs that include drugs, physical therapy, and other interventions to meet the patient’s specific requirements.

Patient Education

  • Nurse practitioners can help patients understand their injuries, the recovery process, and self-care practices to improve healing and avoid problems.

Coordination of Care

  • They can work with other professionals, such as surgeons, neurologists, and physical therapists, to provide a comprehensive approach to treatment.

Follow-Up Care

  • Nurse practitioners can track the patient’s progress, modify treatment programs as appropriate, and offer ongoing care throughout the healing process.

Personal injury cases, particularly those resulting from car accidents, sometimes entail complex medical and legal issues. Chiropractors and nurse practitioners, with their specific areas of practice, play critical roles in diagnosis, treatment, and documentation.

Both chiropractors and NPs provide distinct advantages to personal injury cases. Chiropractors specialize in musculoskeletal difficulties and provide non-invasive treatments, whereas NPs manage a wider range of medical needs, such as drug prescriptions and care coordination. Their collaboration can improve patient outcomes, as seen in settings such as the Accident Treatment and Treatment Center, where NPs and physicians monitor treatment and supplement chiropractic interventions. (Accident Care, 2025)

Legal sources indicate that both professionals’ paperwork is crucial for insurance claims and settlements. Chiropractors’ detailed reports on spinal injuries, along with NPs’ comprehensive medical records on overall health, can build a strong compensation case. This synergy is especially noticeable in auto accident cases, when patients may need both physical changes and medical supervision to fully recover. (Chiropractic Economics, 2023)

Injury Medical Chiropractic and Functional Medicine Clinic

Dr. Jimenez is a family practice nurse practitioner who uses both sophisticated medical knowledge and chiropractic care to treat a variety of illnesses. We use functional medicine, acupuncture, electro-acupuncture, and sports medicine to make personalized treatment programs that help people heal naturally, move better, and stay healthy for a long time. We help people do well, no matter their age or health problems, by focusing on flexibility, agility, and strength. We at El Paso’s Chiropractic Rehabilitation Clinic & Integrated Medicine Center are very dedicated to helping people recover from accidents and chronic pain conditions. We work with people of all ages and impairments to help them get better through programs that improve their flexibility, mobility, and agility. We make sure that every patient gets tailored care and good health outcomes by using both in-person and online health coaching and full care plans.

Don’t Ignore Your Post-Accident Pain

References

Physicians Group, LLC. (2024). The Role of Nurse Practitioners in Managing Auto Injuries. Physicians Group, LLC. https://physiciansgroupllc.com/the-role-of-nurse-practitioners-in-managing-auto-injuries/#:~:text=Nurse%20Practitioners%20are%20vital%20in,improved%20outcomes%20and%20patient%20satisfaction.

Dies, S., & Strapp, J. W. (1992). Chiropractic treatment of patients in motor vehicle accidents: a statistical analysis. The Journal of the Canadian Chiropractic Association, 36(3), 139–145.

The Neck and Back Clinics. (2025). Why Seeing a Chiropractor After a Car Accident Is Crucial for Long-Term Recovery. https://theneckandbackclinics.com/long-term-recovery/#:~:text=Reducing%20Inflammation%20and%20Pain,each%20patient%20for%20optimal%20recovery.

Integrity Spine & Orthopedics. (2024). The 9 Steps to Recovery After an Auto Accident. https://www.integrityspineortho.com/post/the-9-steps-to-recovery-after-an-auto-accident/#:~:text=CONTACT%20INTEGRITY%20SPINE%20AND%20ORTHOPEDICS%20AFTER%20A,concussions%2C%20soft%20tissue%20damage%20and%20spine%20damage.

Accident Care and Treatment Center, Inc. (2025). Comprehensive Therapies and Treatments in One Location. https://accidentcare.com/treatment/

Chiropractic Economics. (2023). Evidence-based chiropractic: the key to personal-injury cases. https://www.chiroeco.com/evidence-based-chiropractic-the-key-to-personal-injury-cases/

Whiplash: Impact on Daily Life and Recovery

By
Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP
-

Whiplash can lead to severe discomfort. Learn about its symptoms, effective treatments, and preventive measures you can take.

Introduction

A rapid impact, whether from a vehicle accident, sports injury, or fall, may cause devastating pain and functional impairment as well as what may first seem like a mild jolt. Whiplash is one such ailment that is often underestimated due to its intricacy. Whiplash is a complex injury that, although being often linked to rear-end crashes, may have long-term consequences for the cervical spine and musculoskeletal system if treatment is not received. Have you ever felt your shoulders and neck get rigid? Are you experiencing persistent headaches that won’t go away? Do you also feel as if your neck’s range of motion is limited? In today’s post, we’ll go over whiplash’s typical causes, symptoms, effects on the cervical spine and musculoskeletal system, and evidence-based therapy options to lessen the discomfort.

What Is Whiplash?

Whiplash is a type of neck injury associated with a rapid back-and-forth head-and-neck motion, mimicking the crack of a whip, hence the name. This causes persistent physical complaints and disability, and complaints when left untreated. (Mayou & Radanov, 1996) Medically, it is categorized under cervical acceleration-deceleration (CAD) injuries. This abrupt motion can damage muscles, ligaments, intervertebral discs, and even the neural structures of the cervical spine.

Common Causes Of Whiplash

While motor vehicle accidents are the most recognized cause, many mechanisms can precipitate a whiplash injury:

  • Rear-end car collisions
  • Contact sports (e.g., football, hockey, wrestling)
  • Physical assault or shaken trauma
  • Slips, trips, and falls
  • Roller coaster rides or sudden jolts

Even minor collisions at speeds as low as 5–10 mph can produce enough force to cause whiplash symptoms in vulnerable individuals.

 

Symptoms of Whiplash

When individuals are experiencing whiplash, the symptoms can appear immediately or may be delayed for 24–72 hours post-injury. Additionally, whiplash injuries are considered soft tissue injuries to the neck with various clinical symptoms that vary in severity and may include: (Chen et al., 2009)

  • Neck pain and stiffness
  • Reduced range of motion
  • Shoulder and upper back pain
  • Headaches, especially originating at the base of the skull
  • Jaw pain or temporomandibular joint (TMJ) dysfunction
  • Dizziness or visual disturbances
  • Tingling or numbness sensations in the arms (cervical radiculopathy)
  • Fatigue and cognitive issues (“whiplash-associated disorders” or WAD)

 

How Whiplash Affects the Cervical Spine and Musculoskeletal System

Whiplash is more than just a soft tissue injury, as it impacts several interconnected systems:

1. Cervical Spine

The rapid motion during a whiplash injury can lead to:

  • Cervical facet joint irritation
  • Intervertebral disc compression or herniation
  • Muscle strain or ligamentous sprain
  • Altered cervical lordosis, leading to chronic postural imbalances

This causes pain, stiffness, and tenderness in the neck area due to injuries within the bony, muscular, and ligamentous regions. (Alektoroff & Papanagiotou, 2021)

 

2. Musculoskeletal Dysfunction

Whiplash often initiates a cascade of biomechanical issues:

  • Myofascial pain syndromes, especially in the trapezius, levator scapulae, and sternocleidomastoid muscles
  • Compensatory thoracic or lumbar strain
  • Poor proprioception and neuromuscular control
  • Chronic trigger points and fibrotic tissue development

The longer these musculoskeletal imbalances persist, the more likely they will evolve into chronic pain syndromes and central sensitization.

 

Why Choose Chiropractic?-Video

Why Choose Chiropractic? | El Paso, Tx (2023)

Diagnosing Whiplash

Diagnosis is largely clinical, supported by a thorough history and physical exam. Imaging may be required to rule out more severe pathology:

  • X-rays: To rule out fractures or malalignment
  • MRI: For soft tissue or disc pathology
  • CT scans: If fracture or serious trauma is suspected
  • Functional assessments: Range of motion, palpation, neurologic evaluation

Evidence-Based Treatments for Whiplash

Treatment for whiplash should be multimodal and individualized, focusing on restoring function, reducing inflammation, and promoting healing. (Bussieres et al., 2016)

 

1. Chiropractic Care

Chiropractic adjustments can offer significant benefits in managing whiplash-associated disorders:

  • Spinal manipulation therapy (SMT): Restores joint mobility, reduces cervical stiffness, and re-establishes biomechanical balance.
  • Myofascial release and soft tissue mobilization: Target muscle tension, trigger points, and fascial restrictions.
  • Postural retraining and ergonomic correction: Essential for long-term resolution.

Additionally, chiropractic patients experienced significant improvements in neck pain and function.

 

2. Physical Therapy

Individuals dealing with neck pain associated with whiplash can benefit from physical therapy to improve neck pain and disability. (Chrcanovic et al., 2022) Rehabilitative exercises are fundamental:

  • Neck range-of-motion drills
  • Isometric strengthening
  • Scapular stabilization and postural correction
  • Proprioceptive neuromuscular facilitation (PNF)

 

3. Functional Medicine Approach

From a functional medicine standpoint, addressing systemic inflammation, nutritional deficiencies, and stress response can enhance recovery:

  • Anti-inflammatory nutrition (e.g., omega-3s, curcumin)
  • Magnesium and B-complex supplementation for nerve healing
  • Sleep optimization and cortisol balance

 

4. Other Complementary Treatments

  • Acupuncture: Improves blood flow and pain modulation while alleviating pain and promoting relaxation. (Moon et al., 2014)
  • Gua Sha or cupping therapy: Relieves muscular tension
  • Dry needling: Effective for persistent trigger points
  • Manual lymphatic drainage: For patients experiencing edema or prolonged inflammation

 

Recovery and Prognosis

With consistent and proper treatment, many individuals recover within a few weeks. However, approximately 30–50% of individuals may develop chronic symptoms if not properly managed early on. Factors predicting prolonged recovery include:

  • High initial pain intensity
  • Poor coping mechanisms
  • History of prior neck injury
  • Psychosocial stressors

Early intervention using a holistic, integrative care model offers the best outcomes in preventing chronic whiplash-associated disorders.

 

Final Thoughts

Whiplash is a complicated neuromusculoskeletal condition that requires more consideration from patients and medical experts than just the “neck strain” classification. Effective diagnosis and treatment depend on an understanding of the complex effects on the musculoskeletal system, neurology, and cervical spine. As part of a personalized treatment strategy, combining non-surgical treatments may help minimize symptoms and improve the patient’s quality of life.

Injury Medical & Personal Injury Clinic

We associate certified medical providers who understand the importance of assessing individuals with whiplash associated with their necks. When asking important questions to our associated medical providers, we advise patients to incorporate customized treatment plans for their pain associated with whiplash. Dr. Alex Jimenez, D.C., uses this information as an academic service. Disclaimer

References

Alektoroff, K., & Papanagiotou, P. (2021). [Whiplash injury of the cervical spine]. Radiologe, 61(8), 710-713. https://doi.org/10.1007/s00117-021-00877-5 (Schleudertrauma der Halswirbelsaule.)

Bussieres, A. E., Stewart, G., Al-Zoubi, F., Decina, P., Descarreaux, M., Hayden, J., Hendrickson, B., Hincapie, C., Page, I., Passmore, S., Srbely, J., Stupar, M., Weisberg, J., & Ornelas, J. (2016). The Treatment of Neck Pain-Associated Disorders and Whiplash-Associated Disorders: A Clinical Practice Guideline. J Manipulative Physiol Ther, 39(8), 523-564 e527. https://doi.org/10.1016/j.jmpt.2016.08.007

Chen, H. B., Yang, K. H., & Wang, Z. G. (2009). Biomechanics of whiplash injury. Chin J Traumatol, 12(5), 305-314. https://www.ncbi.nlm.nih.gov/pubmed/19788851

https://www.sciencedirect.com/science/article/pii/S1008127509600651?via%3Dihub

Chrcanovic, B., Larsson, J., Malmstrom, E. M., Westergren, H., & Haggman-Henrikson, B. (2022). Exercise therapy for whiplash-associated disorders: a systematic review and meta-analysis. Scand J Pain, 22(2), 232-261. https://doi.org/10.1515/sjpain-2021-0064

Mayou, R., & Radanov, B. P. (1996). Whiplash neck injury. J Psychosom Res, 40(5), 461-474. https://doi.org/10.1016/0022-3999(95)00586-2

Moon, T. W., Posadzki, P., Choi, T. Y., Park, T. Y., Kim, H. J., Lee, M. S., & Ernst, E. (2014). Acupuncture for treating whiplash associated disorder: a systematic review of randomised clinical trials. Evid Based Complement Alternat Med, 2014, 870271. https://doi.org/10.1155/2014/870271

Disclaimer

Overcoming Histamine Intolerance in Daily Life

By
Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP
-

Learn about histamine intolerance and how it impacts your daily routine. Find solutions to help minimize its effects.

Introduction

How often, after eating, does your stomach hurt or feel like it’s burning? Does a certain cuisine make your skin feel heated and irritated? Or have you realized that you continually sneeze, which starts to hurt your upper muscles? Numerous people going through these circumstances may be suffering from a histamine assault that is impacting their immune systems and bodies. The function of histamine, its symptoms, the reasons of histamine intolerance, and thoughtful dietary changes that might lessen histamine-related bodily responses are all covered in today’s article.

 

 

When it comes to the human body, the immune system is the body’s first line of defense against any foreign invaders in the body. Histamine plays an essential role in the human body. As a chemical messenger, it helps regulate immune and inflammatory responses and stomach acid secretion and acts as a neurotransmitter in the brain. It’s naturally produced by mast cells, basophils, and certain neurons and is also found in many foods. Histamine binds to histamine receptors (H1, H2, H3, and H4) throughout the body. (Patel & Mohiuddin, 2025) These receptors mediate processes such as:

  • Vasodilation (widening of blood vessels)
  • Gastric acid secretion
  • Smooth muscle contraction
  • Neurological signaling
  • Immune system activation

In short, histamine is essential for maintaining homeostasis and defending against pathogens. However, balance is key. Excessive histamine—especially when the body can’t efficiently degrade it—leads to symptoms commonly mistaken for allergies, gastrointestinal disorders, or hormone imbalance.

 

What Is Histamine Intolerance

Histamine intolerance is not a true allergy. Instead, it refers to a reduced ability to break down histamine in the body, often due to insufficient levels of the enzymes diamine oxidase (DAO) or histamine-N-methyltransferase (HNMT), both of which are responsible for metabolizing histamine. (Comas-Baste et al., 2020) When these enzymes are impaired or overwhelmed, histamine accumulates and causes a cascade of symptoms that may be chronic, intermittent, or situational, depending on dietary intake, gut health, hormone levels, and environmental factors.

 

Symptoms of Histamine Intolerance

Histamine intolerance affects multiple systems, often making it difficult to diagnose when individuals are undergoing treatment. This is because histamine is a potent inflammatory mediator associated with allergic reactions, causing vascular and tissue changes in the body. (Branco et al., 2018) Symptoms may vary from mild to severe and can include:

 

Dermatological:

  • Flushing or redness of the skin
  • Hives (urticaria)
  • Eczema or unexplained itching

Gastrointestinal:

  • Bloating, gas, or abdominal pain
  • Diarrhea or constipation
  • Nausea or vomiting
  • Heartburn (due to increased stomach acid)

Respiratory:

  • Nasal congestion or a runny nose
  • Asthma-like symptoms
  • Difficulty breathing (in severe cases)

Cardiovascular:

  • Low blood pressure
  • Dizziness or lightheadedness
  • Rapid or irregular heartbeat

Neurological:

  • Headaches or migraines
  • Anxiety
  • Insomnia or sleep disturbances
  • Brain fog or difficulty concentrating

Reproductive:

  • Menstrual irregularities
  • Worsened symptoms during estrogen surges (e.g., ovulation, PMS)

If symptoms improve with a low-histamine diet or DAO supplementation, this may point toward histamine intolerance.

Causes and Risk Factors of Histamine Intolerance

The most direct cause is a deficiency or dysfunction in the enzymes DAO (in the gut) or HNMT (in tissues), which are responsible for breaking down histamine.

2. Gut Dysbiosis

When the gut microbiome becomes imbalanced with environmental factors, it can lead to increased histamine production by certain bacteria and reduced DAO activity, especially in cases of:

  • Small Intestinal Bacterial Overgrowth (SIBO)
  • Inflammatory bowel disease (IBD)
  • Leaky gut syndrome

This is because gut bacteria play a crucial role in the body, providing food digestion and immune activation, and regulating the entero-endocrine signaling pathways to ensure the body works properly. (Dicks, 2022)

3. Genetic Polymorphisms

Variants in genes encoding DAO or HNMT enzymes may reduce their function, increasing susceptibility to histamine intolerance.

4. Nutritional Deficiencies

Vitamin B6, copper, and vitamin C deficiency—all cofactors for DAO activity—can impair histamine metabolism.

5. Medications

Several medications are known to block DAO or trigger histamine release, such as:

  • NSAIDs (ibuprofen, aspirin)
  • Antidepressants (SSRIs, MAO inhibitors)
  • Muscle relaxants
  • Diuretics
  • Certain antibiotics

6. Hormonal Fluctuations

Estrogen can inhibit DAO, which explains why many women experience worsened histamine symptoms during PMS, pregnancy, or estrogen-dominant conditions like PCOS or endometriosis.

 

Fighting Inflammation Naturally-Video

Fighting Inflammation Naturally | El Paso, Tx (2023)

High-Histamine Foods to Avoid

To manage histamine intolerance, a low-histamine diet is often a first-line approach. Common high-histamine or histamine-liberating foods include:

  • Aged cheeses (Parmesan, blue cheese)
  • Processed meats (salami, ham, bacon)
  • Fermented foods (sauerkraut, soy sauce, kombucha, yogurt)
  • Alcohol (especially red wine and beer)
  • Vinegar and pickled products
  • Tomatoes, eggplants, and spinach
  • Citrus fruits
  • Shellfish
  • Chocolate
  • Nuts (especially walnuts, cashews, peanuts)

This is because environmental factors like eating various foods can lead to food intolerances, thus causing histamine accumulation. (Jochum, 2024)

Foods That May Help Reduce Histamine Reactions

A well-structured anti-histamine diet should include foods that are low in histamine and support DAO activity and gut health.  A low histamine diet can reduce the chances of histamine reactions by eliminating foods that contain histamine and cause responses in the body. (Sanchez-Perez et al., 2021) Here are some food categories that may help minimize histamine burden:

1. DAO-Supportive Nutrients

  • Vitamin C: Bell peppers, broccoli, kiwi, strawberries
  • Vitamin B6: Bananas, turkey, sunflower seeds
  • Copper: Shiitake mushrooms, sesame seeds, cashews (with caution)

2. Natural Antihistamine Foods

These help stabilize mast cells and reduce histamine release:

  • Quercetin-rich foods: Apples (peeled), onions, kale, green tea
  • Turmeric: Contains curcumin, which has mast-cell-stabilizing properties
  • Ginger: Helps with nausea and inflammation
  • Holy basil (tulsi): Adaptogen and natural antihistamine

3. Gut-Healing Foods

  • Bone broth (if tolerated; avoid long cooking times to reduce histamine)
  • Fresh meats and poultry (cooked and eaten immediately)
  • Non-citrus fruits like pears, blueberries, and watermelon
  • Gluten-free whole grains (quinoa, rice, millet)

Functional Medicine Approach to Histamine Intolerance

When finding a holistic approach for reducing histamine intolerance, many healthcare professionals can devise a customized treatment plan to assess the individual.  Histamine intolerance often exists alongside broader systemic dysfunctions such as:

  • Chronic stress
  • Heavy metal toxicity
  • Hormonal imbalance
  • Environmental triggers
  • Autoimmune conditions

In addressing histamine intolerance, it’s important to:

  1. Identify underlying triggers using functional lab testing (e.g., gut microbiome panels, food sensitivity testing, genetic SNP analysis).
  2. Rebuild DAO capacity with nutrient repletion and, if necessary, temporary DAO supplementation.
  3. Support detoxification pathways, especially the liver and gut.
  4. Heal the gut barrier through probiotics (non-histamine producing), prebiotics, and anti-inflammatory foods.

Final Thoughts: Empowering Healing Through Nutrition and Insight

Although it is often misunderstood or ignored, histamine intolerance may have a significant impact on many people’s quality of life. Many people find great comfort by comprehending their symptoms, figuring out what causes them, and adopting thoughtful food and lifestyle adjustments. Just as with any chronic illness, bio-individuality is what counts. What irritates one individual could be quite harmless to another. Observation, trial and error, and even expert advice are all part of the healing process. To regain equilibrium and enhance their health from the inside out, people with histamine intolerance may get a personalized holistic treatment plan.

Injury Medical & Functional Medicine Clinic

We associate with certified medical providers who understand the importance of assessing individuals with histamine intolerances affecting their bodies. When asking important questions to our associated medical providers, we advise patients to incorporate small changes in their routine to reduce the chances of aggravating histamine symptoms from affecting the body. Dr. Alex Jimenez, D.C., uses this information as an academic service. Disclaimer.

References

Branco, A. C. C. C., Yoshikawa, F. S. Y., Pietrobon, A. J., & Sato, M. N. (2018). Role of Histamine in Modulating the Immune Response and Inflammation. Mediators of Inflammation, 2018, 1-10. https://doi.org/10.1155/2018/9524075

Comas-Baste, O., Sanchez-Perez, S., Veciana-Nogues, M. T., Latorre-Moratalla, M., & Vidal-Carou, M. D. C. (2020). Histamine Intolerance: The Current State of the Art. Biomolecules, 10(8). https://doi.org/10.3390/biom10081181

Dicks, L. M. T. (2022). Gut Bacteria and Neurotransmitters. Microorganisms, 10(9), 1838. https://doi.org/10.3390/microorganisms10091838

Jochum, C. (2024). Histamine Intolerance: Symptoms, Diagnosis, and Beyond. Nutrients, 16(8), 1219. https://doi.org/10.3390/nu16081219

Patel, R. H., & Mohiuddin, S. S. (2025). Biochemistry, Histamine. In StatPearls. https://www.ncbi.nlm.nih.gov/pubmed/32491722

Sanchez-Perez, S., Comas-Baste, O., Veciana-Nogues, M. T., Latorre-Moratalla, M. L., & Vidal-Carou, M. C. (2021). Low-Histamine Diets: Is the Exclusion of Foods Justified by Their Histamine Content? Nutrients, 13(5). https://doi.org/10.3390/nu13051395

Disclaimer

Bone Growth Stimulator: Enhancing Healing Processes

By
Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP
-
Contouring body with electro stimulation EMS Therapy. Salon therapist employs electrodes to refine and sculpt body contours for female clients.

Can bone growth stimulators help promote bone healing in cases where fractures or fusions fail to heal properly?

Bone Growth Stimulator: Enhancing Healing Processes

Bone Growth Stimulator

Individuals who sustain broken bones typically heal the fracture with appropriate treatment, which may include casts, realignment, and surgery. This type of surgery is performed on the spine and joints throughout the body; typically, the bone heals without a problem. Bone healing is a natural process, as bones are constantly replaced with new ones, and after an injury, the body can heal the damage to the bone. However, bone healing sometimes does not happen correctly and/or completely. Bone healing can take a long time, which is known as a delayed union, or it may not occur at all, or a nonunion. This is when a healthcare provider could recommend bone growth stimulation.

How They Work

Bone growth stimulators apply external or implanted electrical or ultrasonic energy to the fracture or fusion site, stimulating bone growth. These devices are often used when a fracture doesn’t heal within the expected timeframe (a nonunion fracture) or when a spinal fusion has not successfully fused. (FDA, 2022)

  • They come in various shapes, sizes, and technologies depending on the location of the fracture.
  • The most commonly used bone stimulators in orthopedics are electrical and ultrasound stimulators.
  • The stimulator emits a pulsed electromagnetic or ultrasonic impulse to the area where bone healing should occur.
  • Most modern bone stimulators are attached near the fracture site or fused with a small battery pack and worn for a period each day that may last minutes or hours.

Electrical Stimulation

  • Devices deliver low-level electrical pulses to the fracture site, which can stimulate bone cells to create new bone tissue.

Ultrasound Stimulation

  • They emit low-intensity pulsed ultrasound waves, which are absorbed by the bone and can promote bone healing.

Implantable vs. External

  • Some stimulators are surgically implanted, providing constant stimulation directly at the fracture site, while others are external and worn over the skin or cast.

The goal is to activate a series of receptors in the body to encourage a healing response. (Childs, S. G. 2003) The stimulator activates a pathway that releases chemicals within the body to promote fracture healing. This type of process in the body is called a cascade, and it happens when one signal stimulates another method, and so on until healing is complete. The bone stimulator ensures this cascade continues until the healing process is complete.

Effectiveness

Studies of bone stimulator effectiveness suggest two benefits:

  1. Less pain is associated with the bone healing process.
  2. Faster fracture healing.

However, these studies haven’t shown that these differences lead to improved patient functional outcomes. It would seem that if there is less pain and faster healing, then the patient should recover without complications. However, some researchers have suggested this is probably because the differences in pain and healing times are small and not necessarily noticeable. (Aleem, I. S. et al., 2016)

  • While bone growth stimulators can be effective, the results can vary, and their effectiveness is still under investigation.
  • Some studies have shown that stimulators can reduce pain and speed up healing time, while others have shown mixed results.
  • It’s important to discuss the benefits and risks of bone growth stimulation with a doctor to determine if it’s the right treatment option.

When Stimulation is Necessary

Bone stimulators are currently not used for routine fracture healing. It is certainly possible that bone healing stimulators will be used routinely in the future. They seem to show some benefit in non-healing fractures or fractures that are likely troublesome to heal. Some reasons individuals may have problems healing fractures are injuries to the blood supply to and around the fracture, injuries to specific bones, and overuse-related fractures. (Victoria, G. et al., 2009) These injuries may include (FDA, 2022)

Nonunion Fractures

  • When a fracture doesn’t heal within the expected timeframe.
  • Open fractures
  • Stress fractures
  • Scaphoid bone fractures
  • Talus fractures

Failed Fusions

  • When a spinal fusion hasn’t been successful.

High-Risk Patients

  • For individuals with factors that can hinder bone healing, such as smoking, diabetes, or certain medications

Bone healing typically proceeds without much problem. However, there are situations where people have issues healing after fractures or surgery. Bone stimulators are not used for routine bone healing but in situations where steps may be needed to help stimulate the body. While the improvement may be small, it may be critical if it is the difference between healing and nonhealing.

Injury Medical Chiropractic and Functional Medicine Clinic

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

From Injury to Recovery with Chiropractic Care

References

U.S. Food & Drug Administration. (2022). AccelStim Bone Growth Stimulator – P210035. Retrieved from https://www.fda.gov/medical-devices/recently-approved-devices/accelstim-bone-growth-stimulator-p210035#:~:text=What%20is%20it?,the%20transducer%20to%20the%20fracture

Childs, S. G. (2003). Stimulators of bone healing. Biologic and biomechanical. Orthopedic nursing, 22(6), 421–428. https://doi.org/10.1097/00006416-200311000-00010

Aleem, I. S., Aleem, I., Evaniew, N., Busse, J. W., Yaszemski, M., Agarwal, A., Einhorn, T., & Bhandari, M. (2016). Efficacy of Electrical Stimulators for Bone Healing: A Meta-Analysis of Randomized Sham-Controlled Trials. Scientific Reports, 6, 31724. https://doi.org/10.1038/srep31724

Victoria, G., Petrisor, B., Drew, B., & Dick, D. (2009). Bone stimulation for fracture healing: What’s all the fuss?. Indian Journal of Orthopaedics, 43(2), 117–120. https://doi.org/10.4103/0019-5413.50844

Sauerkraut: A Superfood for Gut Health

By
Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP
-
The preparation process fermentation preservation Sauerkraut on the table a light background. Processing of the autumn harvest. Natural rustic style. Canned vegetarian healthy food concept.

Can incorporating sauerkraut into one’s diet help promote healthy gut bacteria?

Sauerkraut: A Superfood for Gut Health

Sauerkraut

Sauerkraut, a fermented cabbage food, is a great source of probiotics and fiber, both of which can contribute to gut health. It’s a living food containing various microbial strains and can help improve digestion, reduce inflammation, and improve overall gut health. (Shahbazi R. et al., 2021)

Fermented foods like sauerkraut have live cultures that promote the growth of beneficial probiotics, bacteria that provide powerful health benefits. Probiotics also help make foods more digestible, increasing the gut’s ability to absorb the vitamins and minerals they contain. A study found that fermented cabbage may help protect intestinal cells from inflammatory damage more than raw cabbage. (Wei L., & Marco M. L., 2025)

Homemade sauerkraut likely contains more live cultures than store-bought since processing may destroy some of the healthy bacteria. (National Institutes of Health Office of Dietary Supplements, 2023) Depending on which supplement is chosen, sauerkraut may have a greater diversity of probiotic strains. This is because an oral supplement has a known quantity and strain of probiotics. Individuals who want to add probiotics to their diet for potential gut health benefits should take a food-first approach, which is generally recommended over oral supplements. (National Institutes of Health, 2025)

Look at the Benefits

Probiotics

  • Sauerkraut contains lactic acid bacteria, which are beneficial bacteria that can help support the immune system and reduce inflammation. (Healthline, 2023)

Fiber

  • Sauerkraut is a robust source of fiber, which aids in digestion and can help you feel full longer.

Digestion

Anti-inflammatory

Gut Microbiome

  • Sauerkraut can help diversify and improve the composition of the gut microbiome, leading to various health benefits. (Healthline, 2023)

IBS symptoms

How to incorporate sauerkraut into one’s diet

Check the Ingredients

Option for unpasteurized

  • Look for sauerkraut that is labeled raw or naturally fermented to ensure it contains live probiotics.

Try to Eat Regularly

  • Aim to include sauerkraut in your diet a few times a week to reap the benefits. (Healthline, 2023)

Pair with Other Gut-Healthy Foods

  • Sauerkraut can be eaten alone or paired with other fermented foods, such as yogurt, kimchi, or chard, to promote gut health.

What to consider

Cabbage Allergy

  • Individuals who have a cabbage allergy or histamine intolerance should avoid sauerkraut.

Sodium

MAOI Medications

  • Consult with a doctor before adding sauerkraut to your diet if you are taking monoamine oxidase inhibitors (MAOIs).

Start small and learn how you like to eat sauerkraut, which can be as a condiment, side dish, or sandwich ingredient.

Injury Medical Chiropractic and Functional Medicine Clinic

As a Family Practice Nurse Practitioner, Dr. Jimenez combines advanced medical expertise with chiropractic care to address various conditions. 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.

Body In Balance: Chiropractic, Fitness, and Nutrition

References

Shahbazi, R., Sharifzad, F., Bagheri, R., Alsadi, N., Yasavoli-Sharahi, H., & Matar, C. (2021). Anti-Inflammatory and Immunomodulatory Properties of Fermented Plant Foods. Nutrients, 13(5), 1516. https://doi.org/10.3390/nu13051516

Healthline. (2023). 8 Surprising Benefits of Sauerkraut (Plus How to Make It). https://www.healthline.com/nutrition/benefits-of-sauerkraut#nutrients

Medical News Today. (2023). What are the benefits of eating sauerkraut? https://www.medicalnewstoday.com/articles/health-benefits-of-sauerkraut

Wei, L., & Marco, M. L. (2025). The fermented cabbage metabolome and its protection against cytokine-induced intestinal barrier disruption of Caco-2 monolayers. Applied and environmental microbiology, e0223424. Advance online publication. https://doi.org/10.1128/aem.02234-24

National Institutes of Health Office of Dietary Supplements. (2023). Probiotics. Retrieved from https://ods.od.nih.gov/factsheets/Probiotics-Consumer/

National Institutes of Health. (2025). Probiotics. Retrieved from https://ods.od.nih.gov/factsheets/Probiotics-HealthProfessional/

U.S. Department of Agriculture. (2018). Sauerkraut, canned, solids and liquids. Retrieved from https://fdc.nal.usda.gov/food-details/169279/nutrients

Perimenopause and Its Common Symptoms Explained

By
Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP
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Discover the realities of perimenopause and how to cope with the changes for a smoother experience during this time.

Introduction

When it comes to their health and well-being, many people often recognize that their bodies are changing on their own. This may include hormonal changes in both men and females as well as normal skeletal degradation inside the joints. Males have andropause, a decrease in their testosterone hormone levels. The normal decline of estrogen and progesterone hormones in females marks the beginning of the menopause, a stage of aging. Perimenopause, on the other hand, starts before women experience menopause. The definition of perimenopause, its symptoms, its impact on the musculoskeletal system, and strategies for managing these symptoms will all be covered in today’s post.

 

What Is Perimenopause?

Do you experience mental fogginess, where you can’t remember what you were doing? How often do your joints ache after doing a simple errand? Or how frequently does your bladder feel full that you constantly need to go to the bathroom? Many of these issues are associated with hormonal changes within the body. For women, perimenopause is a transformative menopausal stage that usually occurs in women in their 40s and early 50s, which is widely recognized for hormonal shifts and reproductive changes in the body.

Functional Medicine Doctor for Women's Hormones | El Paso, TX Chiropractor

Additionally, perimenopause usually starts when a woman is dealing with a persistent difference in their menstrual cycle length after 12 months. (Lega & Jacobson, 2024) This is due to the ovarian hormone production of estrogen and progesterone fluctuating unpredictably.

 

Common Symptoms Of Perimenopause

When it comes to perimenopause, it can affect women differently with its symptoms. Since hormones during perimenopause fluctuate unpredictably. This is because for women, ovarian hormones like estrogen play an important role in maintaining health and homeostasis by modulating the body’s nervous, endocrine, and immune function. (Priyanka & Nair, 2020) Some of the other symptoms that are included with perimenopause are:

  • Vasomotor symptoms: Hot flashes, night sweats
  • Sleep disturbances: Insomnia, early waking
  • Mood changes: Irritability, anxiety, depression
  • Cognitive difficulties: Brain fog, memory lapses
  • Urogenital symptoms: Vaginal dryness, urinary urgency
  • Menstrual irregularities: Skipped, prolonged, or heavy periods

Additionally, since perimenopausal symptoms vary from woman to woman, perimenopause can also affect the musculoskeletal system in the body.

 

Assessing Hormone Therapy- Video

Assessing Hormones *THERAPY* | El Paso, Tx (2022)

How Perimenopause Affects The Musculoskeletal System

The musculoskeletal system’s various muscles, tissues, and ligaments allow the body to be mobile and flexible without pain. However, environmental factors like physical inactivity, poor dietary habits, and chronic issues affect the musculoskeletal system, leading to overlapping risk profiles affecting the body. For perimenopausal women, their musculoskeletal system is affected by fluctuating estrogen hormone levels. When it comes to perimenopause, the musculoskeletal system will begin to develop various issues that can affect the body over time. When a woman is going through perimenopause, their bone mineral density is reduced as well as their muscle mass due to the decline of estradiol. (Wright et al., 2024) This causes the musculoskeletal system to develop:

  • Increased joint stiffness (especially in the morning) and muscle pain
  • Osteopenia and osteoporosis
  • Sarcopenia (loss of muscle mass)

This is due to hormones being associated with inflammation. When a woman has low or fluctuating estrogen hormone levels, it can lead to developmental changes in their pain perception in their muscles. The hormone estrogen is responsible for inhibiting the actions of inflammatory mediators in osteoblasts and stromal cells to ensure that bone mass is reabsorbed into the skeletal system. When perimenopause naturally occurs in the body, estrogen levels decline, and the development of musculoskeletal issues starts to appear.

 

Managing Perimenopausal Symptoms

Now, when it comes to managing perimenopausal symptoms, many women can start researching non-surgical treatments and incorporating various techniques to help manage the symptoms and reduce any pain from musculoskeletal issues associated with perimenopause. Below are some therapeutic options for perimenopausal women to manage their symptoms and restore their musculoskeletal system.

 

Hormone Therapy

For many women, hormone replacement therapy remains the gold standard for treating moderate to severe vasomotor and musculoskeletal symptoms. Hormone therapy for perimenopausal women can help restore estrogen production to the body and accelerate skeletal growth. (Moustakli & Tsonis, 2023) Estrogen therapy can:

  • Reduce joint and muscle pain
  • Slow bone density loss
  • Improve overall well-being

Note: HRT is not suitable for everyone, particularly those with a history of breast cancer, thromboembolic disease, or certain cardiovascular conditions. Always conduct a thorough risk-benefit analysis.

 

Exercise & Nutrition

For perimenopausal women, proper nutrition and exercise can help manage the perimenopausal symptoms and maintain muscle tone. Incorporating nutritional foods with high protein, calcium, and vitamin D can help maintain skeletal muscle mass and regulate proper hormone functioning. (Erdélyi et al., 2023) Combined with exercises, it can help strengthen weak muscles, improve bone density, and promote flexibility while retaining the joint’s range of motion. Exercises like tai chi are excellent for perimenopausal women as they combine meditation through slow and gentle movements that can lower fracture risk, improve muscle strength, and restore balance functionality. (Li et al., 2023)

 

Manual Therapies

Many women find relief with:

  • Acupuncture: Shown to help reduce chronic pain affecting the joints and provide anti-inflammatory effects to the musculoskeletal system. (Zhao et al., 2023)
  • Mind-body therapies: Meditation, cognitive-behavioral therapy (CBT) to address mood swings and insomnia
  • Chiropractic and physical therapy: Effective in managing musculoskeletal discomfort

 

Final Thoughts

People often become aware of their bodies’ natural changes in terms of their health and well-being. Male and female hormone fluctuations as well as normal skeletal deterioration inside the joints might be examples of this. Known as andropause, guys experience a decrease in their testosterone hormone levels. The menopause, a stage of aging, begins for women when their levels of the hormones progesterone and estrogen gradually decline. However, perimenopause starts before women experience menopause. We will examine the definition and symptoms of perimenopause, its impact on the musculoskeletal system, and strategies for coping with these symptoms in today’s post.

 

Injury Medical & Functional Wellness Clinic

We associate with certified medical providers who understand the importance of assessing individuals dealing with musculoskeletal issues related to perimenopause. When asking important questions to our associated medical providers, we advise patients to incorporate numerous techniques to reduce pain-like symptoms related to the musculoskeletal system. Dr. Alex Jimenez, D.C., uses this information as an academic service. Disclaimer.

References

Erdélyi, A., Pálfi, E., Tűű, L., Nas, K., Szűcs, Z., Török, M., Jakab, A., & Várbíró, S. (2023). The Importance of Nutrition in Menopause and Perimenopause—A Review. Nutrients, 16(1), 27. https://doi.org/10.3390/nu16010027

Lega, I. C., & Jacobson, M. (2024). Perimenopause. CMAJ, 196(34), E1169. https://doi.org/10.1503/cmaj.240337

Li, J., Guo, J., Wang, X., Zhang, X., Zhang, Y., Bu, M., Yao, X., & She, Y. (2023). Efficacy and safety of tai chi exercise on bone health: An umbrella review. Osteoporos Int, 34(11), 1853-1866. https://doi.org/10.1007/s00198-023-06830-7

Moustakli, E., & Tsonis, O. (2023). Exploring Hormone Therapy Effects on Reproduction and Health in Transgender Individuals. Medicina (Kaunas, Lithuania), 59(12). https://doi.org/10.3390/medicina59122094

Priyanka, H. P., & Nair, R. S. (2020). Neuroimmunomodulation by estrogen in health and disease. AIMS Neurosci, 7(4), 401-417. https://doi.org/10.3934/Neuroscience.2020025

Wright, V. J., Schwartzman, J. D., Itinoche, R., & Wittstein, J. (2024). The musculoskeletal syndrome of menopause. Climacteric, 27(5), 466-472. https://doi.org/10.1080/13697137.2024.2380363

Zhao, F.-Y., Zheng, Z., Fu, Q.-Q., Conduit, R., Xu, H., Wang, H.-R., Huang, Y.-L., Jiang, T., Zhang, W.-J., & Kennedy, G. A. (2023). Acupuncture for comorbid depression and insomnia in perimenopause: A feasibility patient-assessor-blinded, randomized, and sham-controlled clinical trial. Frontiers in Public Health, 11. https://doi.org/10.3389/fpubh.2023.1120567

Disclaimer

Muscles Retighten After Treatment: What Happens

By
Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP
-
Specialist massages a woman neck during a manual therapy session, the patient lies on the massage table

Why do the muscles retighten days or weeks later for individuals who have received massage or chiropractic adjustments?

Muscles Retighten After Treatment: What Happens

Muscles Retighten

Muscles can retighten again days or weeks after chiropractic treatment and/or a massage. A few factors may cause this.

  • Muscle memory: The body’s natural tendency to return to its previous state of tension.
  • This includes all the unhealthy postures/positioning
  • Delayed inflammatory response.
  • The body’s natural healing process
  • How muscles respond to manipulation
  • The need for ongoing maintenance of muscle health

After a massage, muscles can experience a temporary increase in soreness or tightness as the body heals from any minor damage or inflammation caused by the massage. Additionally, if the underlying issue causing muscle tightness is not addressed, the muscles may revert to their original state over time. (Cleveland Clinic, 2024)

Causes

Causes for muscles to retighten.

Underlying Issues

  • If the root cause of the muscle tightness is not addressed, such as unhealthy posture, injuries, repetitive motions, or muscle imbalances, it can lead to further complications.
  • In that case, the muscles may return to their original state after a few days or weeks.

Delayed Onset Muscle Soreness (DOMS)

  • For example, muscles feel sore after intense exercise, and individuals can also experience DOMS after a massage, especially if they are particularly tight or if it’s been a while since their last massage. (Healthline, 2020)

Delayed Inflammatory Response

  • Massage can sometimes cause microscopic tears or inflammation in muscle tissue, which triggers the body’s natural healing process.
  • This response can cause soreness and temporary tightness, as the body repairs the damaged tissue even after the initial massage. (Essential Chiropractic, 2025)

Muscle Memory

  • The body tends to revert to habitual patterns of muscle tension, especially if the underlying cause of the tightness isn’t addressed.
  • Muscles can retain how they were manipulated during the massage and may revert to their original tightness if they haven’t been consistently relaxed.

Muscle Guarding

  • The individual and body can subconsciously tense muscles to avoid pain or soreness, even after the massage.
  • This muscle guarding can counteract the benefits of the massage and lead to a renewed cycle of tension. (Bhimani R. H., & Soomar D. 2019)

Muscle Health Maintenance

  • Regular Maintenance
  • Muscles need consistent care to maintain their optimal state of health and function.
  • Regular massages and other lifestyle changes, such as stretching and strengthening exercises, can help maintain muscle flexibility and reduce the likelihood of muscle tightness returning.

Individual Variation

  • Factors like the type of massage received, the frequency of massages, and individual body responses can all influence how long a massage’s benefits last. (Cleveland Clinic, 2024)

Massage Treatment

Muscles can retighten after a massage due to the body’s response to the pressure and manipulation during the treatment. This can include individual sensitivity to massage, the type of massage, and hydration levels, which can also play a role.

Type of Massage

  • Deep tissue massage, which focuses on specific muscle groups and applies deeper pressure, may cause more soreness than other types of massage.
  • Some individuals may be more sensitive to massage and experience soreness, even with a gentle massage. (Cleveland Clinic, 2024)

Muscle Fiber Manipulation

  • Deep tissue massage can break down spasms or microtears in muscle fibers, leading to soreness.
  • This is similar to the microscopic tears that occur during exercise, which are necessary for muscle repair and growth.

Dehydration

  • Individuals who are not adequately hydrated may experience increased soreness after a massage. (Cleveland Clinic, 2024)

Lactic Acid Buildup

  • During an intense massage, particularly deep tissue, lactic acid can build up in the muscles, leading to soreness and tightness.
  • (Healthline, 2020)

Muscle Tensions

  • If the muscles were particularly tense or knotted before the massage, the manipulation could lead to soreness as the knots get worked out.

Injury Medical Chiropractic and Functional Medicine Clinic

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

Secrets of Optimal Wellness

References

Cleveland Clinic. (2024). How to Relieve Muscle Soreness After a Massage. https://health.clevelandclinic.org/why-does-my-body-feel-worse-after-a-massage

Healthline. (2020). How to Relieve Sore Muscles After a Massage. https://www.healthline.com/health/sore-after-massage#causes-of-soreness

Essential Chiropractic and Physiotherapy. (2025). Muscle Ache After Massage: Common Causes and Relief. https://essentialchiropractic.co.uk/muscle-ache-after-massage-common-causes-and-relief/#:~:text=Post%2Dmassage%20soreness%20is%20a,hours%20as%20the%20muscles%20recover.

Bhimani, R. H., & Soomar, D. (2019). Understanding Symptoms of Muscle Tightness, Weakness, and Rigidity From a Nursing Perspective. Rehabilitation Nursing: The Official Journal of the Association of Rehabilitation Nurses, 44(5), 271–281. https://doi.org/10.1097/rnj.0000000000000151

Pace Running: Improving Speed and Endurance

By
Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP
-
Group of friends running in city street in morning.

Can pace running help runners concentrate on other things, like breathing, form, or mental toughness?

Pace Running: Improving Speed and Endurance

Pace Running

Running is a sport many participate in and doesn’t require any equipment—only quality running shoes. Running in races comes with various physical and mental challenges. Some runners enjoy running in races and marathons but want to perfect their abilities and techniques, become more consistent, finish in a certain time, or pass a personal record. This is where pace running or working with a pace runner can help achieve those goals.

What is a Pace Runner?

A pace runner, or pacer, is an experienced runner who can run at a set pace for a long time. The pacer sets the speed so the runner can focus on running. Pacers run in races or marathons to help set the pace for a runner or runners. There are different reasons why professional and amateur runners work with a pace runner. Professional runners often use pace runners to work on techniques and help reach new levels in their running, while amateur runners can work on improving their overall running abilities. There are three typical types of pacers.

Race Pacer

  • Pacers wear or carry signs to make it easier for the runners and can often run split times.
  • A split time is the time it takes to run a certain distance.
  • Typically, these pacers will run at an even pace.
  • Many marathons will have pace groups that run at a specific speed or pace throughout the race.
  • The pace groups will have runners running a set time so other runners can key off these runners.
  • There are typically set paces for a 3-hour marathon time up to a 6-hour marathon time.
  • Runners can use pacers to help them reach their goals without relying on technology, such as a smartwatch or GPS, to determine if they maintain the correct speed throughout the race.

Distance Pacer

  • Professional and non-professional runners who run long distances or ultramarathons may also use a pace runner to set a specific tempo.
  • Ultramarathons are any race with a distance longer than the standard marathon of 26.2 miles.
  • Because some ultramarathons can be as long as 50 to 100 miles, runners who choose to have a pacer often have several pacers at different sections to motivate them and help set the rhythm.

Record Pacer or Rabbit

  • A record pacer, also known as a rabbit, is a pacer who helps a professional runner set a new record.
  • A rabbit often leads the race for a predetermined distance at a predetermined pace.
  • Some races have multiple pacers at various distances.

How Are Pacers Used?

There are different reasons for having a pacer, but they are based on the runner’s goals.

  • A runner being paced runs directly behind a pacer or pacers.
  • A pacer can run any pace requested, but typically, the pace groups run at an even pace or with a slight negative split.
  • A negative split is when a runner runs the race’s second half faster than the first half.

How Do They Help?

  • A pacer can be helpful because it takes more energy to lead a race than to sit back and follow another runner.
  • The pacer is responsible for timing and establishing the tempo so runners only have to focus on running.
  • A pacer does more work setting the pace, which allows the runner being paced to relax and not stress about hitting the pace.

A study focused on elite athletes who used pacers. It found that running together at a realistic speed helped optimize and achieve finishing time goals. (Casado A. et al., 2021) However, not all elite events allow pacers to participate. Some championship events, like the Olympics and NCAA Championships, do not allow pacer runners.

Benefits

Benefits of running with a pacer.

Prevent Running Too Fast

  • When a race begins, runners can take off and start too fast.
  • Starting too quickly can negatively impact the runners, like losing energy and stamina.
  • A pacer can help start the race with a steady pace, keeping them from going out too fast or expending too much energy.

Maintain an Even Pace

  • Maintaining an even pace can be difficult throughout a long race or a marathon.
  • Having a pacer can relieve some stress and pressure.
  • A pacer can keep the runners on an even pace or negative splits versus going out too fast and losing energy.

Focus on the Race

  • Pacers help the runners stay focused on the race without worrying about how they are running or maintaining the right speed.
  • A pacer can help keep runners relaxed.

Motivating

  • Pacers can help motivate runners.
  • The pace runners may encourage individuals along the way and help them stay motivated to keep working toward their goal, especially when the hard parts come.

Disadvantages

Running with a pacer can sometimes be more stressful than beneficial, especially for amateur runners. A pacer or pace group can be helpful, but it also can create more stress for some amateur runners.

  • Sometimes, individuals realize the pacer is running too quickly for what they can handle.
  • Anxiety can present as not being able to keep up.
  • Other times, runners underestimate their abilities and run more slowly than their bodies can handle.
  • However, runners don’t have to stay with a pace group just because they started with them.
  • Individuals can run ahead.
  • Or if the group is too fast, the runner can slow down and join the slower-paced group behind them.
  • The key is to listen to your body and do what feels right.

Becoming a Pacer

An experienced runner who wants to be a pacer for a race can contact a running organization about becoming a pace runner.

  • Individuals need to be able to have consistent racing times.
  • Be able to run at a set speed for a long duration.
  • Most pacers will contact the race organization to apply for a certain pace.
  • Some pacers enjoy the thrill of running in a race and helping other runners meet their goals.
  • The runner’s goals and the type of event also influence who the pacer is.

Injury Medical Chiropractic & Functional Medicine Clinic

Individuals can talk to local running experts or a running coach. 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. We can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.

The Difference of Using Custom Foot Orthotics

References

Casado, A., Hanley, B., Jiménez-Reyes, P., & Renfree, A. (2021). Pacing profiles and tactical behaviors of elite runners. Journal of Sport and Health Science, 10(5), 537–549. https://doi.org/10.1016/j.jshs.2020.06.011

Center of Gravity: Impact on Movement and Stability

By
Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP
-
Physiotherapist, man and recovery on fitness bench with exercise, help and progress at clinic. Peop.

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

Center of Gravity: Impact on Movement and Stability

 

Center of Gravity

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

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

Key aspects of the COG

Location

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

Shifting COG

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

Balance Impact

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

Variations

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

Biomechanics

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

The Human Center

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

  • Arms up/down
  • Leaning
  • Turning

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

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

Chronic Lower Back Pain

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

Injury Medical Chiropractic and Functional Medicine Clinic

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

Enhance Your Lifestyle Today with Chiropractic Care

References

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

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

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

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

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

Cornstarch Substitutes: Flour Replacement Options

By
Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP
-
Fresh corn on the cob and a heap of white corn starch isolated on white background

How can cornstarch be used instead of flour in recipes for individuals on a gluten-free diet who are looking for a flour alternative due to celiac disease or non-celiac gluten sensitivity?

Cornstarch Substitutes: Flour Replacement Options

Cornstarch Substitute

Flour is often used as a thickener or a coating in recipes. Pure cornstarch (made from corn) is a gluten-free flour substitute (Rai S., Kaur A., & Chopra C.S., 2018). However, some brands are not considered gluten-free.

Substitute for Flour

It’s easy to substitute cornstarch for flour when the recipe calls for a thickener, such as in gravies, sauces, pies, or coatings for fried foods. If flour is unavailable or individuals want to try a gluten-free alternative, cornstarch has a similar effect in these cooking applications.

However, individuals should be aware that it cannot be used as a substitute for flour in baked goods.

As a Thickener

Cornstarch can be a thickener in sauces, gravy, and pie fillings. (Bob’s Red Mill, 2020)

  • There is no taste of cornstarch.
  • However, foods will be more translucent.
  • This is because it is pure starch, while flour contains some protein.
  1. Cornstarch is not a 1:1 substitute for flour.
  2. Individuals should generally use one tablespoon for each 1 1/2 to 2 cups of flour for sauce/gravy for medium thickness. (The Denver Post, 2016)

When using cornstarch as a thickener:

  • Bring the mixture to a full boil for 1 minute, which allows the granules to swell to their maximum.
  • Reduce the heat as it thickens.
  • Overcooking can cause mixtures to thin when cooled.
  • Cook over medium-low to medium heat, as high heat can cause lumping.
  • Stir gently
  • Stirring vigorously can break down the mixture.
  • If more ingredients are needed, remove the pot from the heat and stir them quickly and gently.
  • Avoid freezing sauces or gravies since they won’t freeze well. (Cook’s Info, 2008)

How To Use

  • Use half as much cornstarch as you would flour.
  • For example, if the recipe calls for two tablespoons of flour, use one tablespoon of cornstarch.
  • If the recipe calls for 1/4 cup of flour, use 1/8 cup of cornstarch.
  • This is true for other starches, including arrowroot, potato, and tapioca. (Taste of Home, 2023)
  • Adding the cornstarch directly will cause it to clump and form lumps in the sauce that will be difficult to dissolve.
  • To avoid this, mix the cornstarch with cold water (1 tablespoon of cornstarch to 1 tablespoon of cold water) until it is dissolved.
  • Then pour the water/starch mixture/slurry into the mix.
  • Keep stirring as the mixture thickens. (Bon Appetit, 2020)

Cornstarch is not as effective as flour when thickening acidic sauces. It doesn’t work well with tomato, vinegar, or lemon juice sauces. It is also less effective than flour when thickening sauces made with fat, including butter or egg yolks. (The BC Cook Articulation Committee, 2015)

If the mixture contains too little liquid, the starch granules cannot absorb. This is also the case when there is more sugar than liquid, in which case, more liquid is needed to firm up the mixture.

Fried Dishes

Individuals can use cornstarch instead of flour to coat fried chicken, fish, or other fried dishes. It creates a crisper coating that better withstands sauces and absorbs less frying oil, resulting in a lower-fat meal. Tips for frying:

  • Try a 50/50 blend of cornstarch and gluten-free flour for a coating closer to wheat flour. (Bon Appetit, 2016)
  • Ensure there is a light, even cornstarch coating on the food.
  • Heavier coatings can get gummy.

Injury Medical Chiropractic and Functional Medicine Clinic

When cooking gluten-free, individuals may be able to continue to enjoy some of their favorite sauces by learning how to use cornstarch and other gluten-free thickeners instead of flour. As a Family Practice Nurse Practitioner, Dr. Jimenez combines advanced medical expertise with chiropractic care to address various conditions. 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.

From Consultation to Transformation: Assessing Patients in a Chiropractic Setting

References

Rai, S., Kaur, A., & Chopra, C. S. (2018). Gluten-Free Products for Celiac-Susceptible People. Frontiers in Nutrition, 5, 116. https://doi.org/10.3389/fnut.2018.00116

Bob’s Red Mill. (2020). Baking with cornstarch: Everything you need to know. https://www.bobsredmill.com/articles/baking-with-cornstarch-everything-you-need-to-know

Denver Post. (2016). Cornstarch a good way to thicken gravy lightly. https://www.denverpost.com/2010/11/20/cornstarch-a-good-way-to-thicken-gravy-lightly/

Cook’s Info. (2008). Thickeners. https://www.cooksinfo.com/thickeners/

Taste of Home. (2023). Cornstarch vs. flour vs. arrowroot – when should you use which thickener? https://www.tasteofhome.com/article/best-thickener/

Bon Appetit. (2020). Cornstarch is a powerful tool that must be used responsibly. https://www.bonappetit.com/story/the-power-of-almighty-cornstarch

The BC Cook Articulation Committee. (2015). Understanding Ingredients for the Canadian Baker
Types of thickening agents. https://opentextbc.ca/ingredients/chapter/types-of-thickening-agents/

Bon Appetit. (2016). 4 brilliant ways to cook with cornstarch. https://www.bonappetit.com/story/cornstarch-uses-sauce-crispy-meat

Cauliflower: Your Guide to Cooking and Nutrition

By
Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP
-

Discover delicious recipes featuring cauliflower and understand the nutritional advantages of including cauliflower in your diet.

Introduction

Many people all around the globe want to include wholesome meals in their quest toward health and wellbeing. Many individuals find that eating a lot of fruits and vegetables is one of the greatest methods to do this. Numerous vitamins and minerals included in fruits and vegetables are vital for the body and may help alleviate recurring pain-like sensations that can lead to the development of chronic problems. When environmental variables become a part of a person’s daily routine, issues with the intestines, muscles, and essential organs start to play a part, leading to symptoms that resemble pain. Therefore, a lot of people look for non-surgical therapies that include a personalized treatment plan and nutritional component to assist them transition to a healthy lifestyle. One of them is eating cauliflower, a kind of vegetable. What cauliflower is, its nutritional worth, how it supports the body, and simple dishes to include in a tasty, healthful diet are all covered in today’s post.

 

What Is Cauliflower?

Known for being a humble vegetable with its pale appearance, the cauliflower is a powerhouse full of nutrients. It can become the most versatile vegetable to be added to any diet. As part of the Brassicaceae family, cauliflower falls in line with cruciferous vegetables like broccoli, Brussels sprouts, kale, and cabbage that contribute a significant amount of dietary intake to human health due to being low in calories while providing a diverse range of macronutrients. (Zhang et al., 2025) Additionally, cauliflower can come in various colors and be filled with multiple nutrients that benefit the body, including white, green, purple, and orange.

 

Nutritional Value of Cauliflower

Whether people want to improve their health, lose weight, or add more plant-based variety to their meals, cauliflower deserves a prominent place on their plate. One cup of chopped cauliflower, which is about 107 grams, includes:

  • Calories: 27
  • Total Carbohydrates: 5 g
    • Dietary Fiber: 2.1g
  • Sugar: 2 g
  • Protein: 2.1 g
  • Total Fat: 0.3 g
    • Saturated Fat: 0.1g
    • Trans Fat Regulation: 0g
  • Cholesterol: 0g
  • Sodium: 32mg
  • Potassium: 320mg
  • Vitamin C: 85% of the Daily Value (DV)
  • Iron: 2% of DV
  • Vitamin B6: 10% of DV
  • Magnesium: 4% of DV
  • Calcium: 2% of DV

Additionally, cauliflower is rich in phytonutrients, particularly glucosinolates and sulforaphane, which have neuroprotective and anticancer agents that can reduce neuroinflammation in the body. (Otoo & Allen, 2023)

 

Eating Right To Feel Better- Video

Eating Right to Feel Better | El Paso, Tx (2023)

How Cauliflower Helps The Body

When it comes to the body, cauliflower can provide various nutrients that the body needs to provide energy and help with normal functioning. Incorporating cauliflower into a healthy diet can help reduce overlapping risk profiles like obesity and hypertension, which can cause individuals to experience pain and discomfort. (Madsen et al., 2023)

 

Supports Immune Function & Digestive Health

Cauliflower has a high vitamin C content that can help boost the immune defense response by being an antioxidant to protect against cell damage within the body. Since cauliflower is a cruciferous vegetable, it has many phytochemicals, including vitamins, carotenoids, fibers, and other nutrient compounds, to protect the body against reactive oxygen species (ROS) damage. (Ahmed & Ali, 2013) Additionally, with its nutrient components, cauliflower can help support gut health by aiding regular bowel movements. As a cruciferous vegetable, it feeds the beneficial gut bacteria to promote a healthy microbiome balance. This is due to cauliflower containing glucosinolates (GLS), a chemical compound in plants in the Brassicaceae family. GLS, when served in various dishes, contains anti-obesity effects and pro-healthy compounds to benefit the body’s gut system. (Sikorska-Zimny & Beneduce, 2021)

 

Reduces Inflammation & Oxidative Stress

When inflammation and oxidative stress occur in the body, many people don’t often realize that many environmental factors play a part in their development. While inflammation is the body’s natural response, chronic inflammation can correlate with oxidative stress, causing the body to develop musculoskeletal and gut issues. When oxidative stress is associated with chronic inflammation, it can impact the body’s central nervous system, causing the neuron signals to affect the gut system by increasing bad bacteria in the gastrointestinal system. (Shandilya et al., 2022) Consuming cauliflower in various dishes can help reduce the oxidative damage and inflammation correlated with chronic body issues.

 

Simple & Delicious Cauliflower Recipes

Since cauliflower has a mild flavor and versatile texture, it can be easily incorporated into numerous dishes that are not only delicious but also nutritious. Below are a few simple and easy recipes that many people can try:

 

Cauliflower Rice

Cauliflower rice is a low-carb, grain-free substitute for rice

  • How to make:
    • Start by grating raw cauliflower with a grater or pulse it in the food processor until it resembles rice grains.
    •  Then, for 5 minutes, add olive oil, garlic, salt, and pepper to the cauliflower grains and sauté in a pan.
    •  You can use various sauces and herbs to enhance the cauliflower rice for extra flavor.

 

Cauliflower Pizza Crust

 Individuals with gluten allergies or sensitivity can make this pizza crust with cauliflower.

  • How to make:
    • Start by steaming and mashing a head of cauliflower, transferring it to cheesecloth, and squeezing out the excess water.
    •  Then, add one egg, shredded mozzarella, seasoning, and cauliflower to a mixing bowl and mix. This should resemble dough.
    • Take the cauliflower dough and shape it into a crust.
    • Bake at 400°F (200°C) for at least 15 minutes, then remove it from the oven.
    • Then add your favorite toppings on the cauliflower pizza crust, and bake again.

 

Cauliflower Buffalo Bites

As a healthier alternative to chicken wings, they can be perfect for your next party.

  • How to make:
    • Toss cauliflower florets in flour and spices, and bake at 425°F (220°C) for 20 minutes.
    • Toss in buffalo sauce and bake for another 10 minutes. Serve with celery and light ranch.

 

Final Thoughts

Beyond being a simple white vegetable, cauliflower is a superfood that can be used in a variety of recipes and readily included into different diets due to its nutrients and antioxidants. Including cauliflower in a nutritious diet may provide the body with the vital minerals, vitamins, and antioxidants it needs to function at its best. Incorporating this cruciferous vegetable into a nutritious cuisine may be a great way to give the body the energy it needs.

 

Injury Medical & Functional Medicine Clinic

We associate with certified medical providers who understand the importance of assessing individuals and incorporating cauliflower into their dietary needs. When asking important questions to our associated medical providers, we advise patients to incorporate numerous vegetables like cauliflower into their foods to provide energy and nutrients to their bodies in their customized treatment plan. Dr. Alex Jimenez, D.C., uses this information as an academic service. Disclaimer.

References

Ahmed, F. A., & Ali, R. F. M. (2013). Bioactive Compounds and Antioxidant Activity of Fresh and Processed White Cauliflower. BioMed Research International, 2013, 1-9. https://doi.org/10.1155/2013/367819

Madsen, H., Sen, A., & Aune, D. (2023). Fruit and vegetable consumption and the risk of hypertension: a systematic review and meta-analysis of prospective studies. Eur J Nutr, 62(5), 1941-1955. https://doi.org/10.1007/s00394-023-03145-5

Otoo, R. A., & Allen, A. R. (2023). Sulforaphane’s Multifaceted Potential: From Neuroprotection to Anticancer Action. Molecules, 28(19), 6902. https://doi.org/10.3390/molecules28196902

Shandilya, S., Kumar, S., Kumar Jha, N., Kumar Kesari, K., & Ruokolainen, J. (2022). Interplay of gut microbiota and oxidative stress: Perspective on neurodegeneration and neuroprotection. J Adv Res, 38, 223-244. https://doi.org/10.1016/j.jare.2021.09.005

Sikorska-Zimny, K., & Beneduce, L. (2021). The Metabolism of Glucosinolates by Gut Microbiota. Nutrients, 13(8), 2750. https://doi.org/10.3390/nu13082750

Zhang, X., Jia, Q., Jia, X., Li, J., Sun, X., Min, L., Liu, Z., Ma, W., & Zhao, J. (2025). <i>Brassica</i> vegetables—an undervalued nutritional goldmine. Horticulture Research, 12(2). https://doi.org/10.1093/hr/uhae302

 

Disclaimer

Paraspinal Muscle Spasms and Their Effects

By
Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP
-
electroacupuncture with the needle connection machine. Electrical stimulation in physiotherapy in the physiotherapy center.

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

Paraspinal Muscle Spasms and Their Effects

Paraspinal Muscle Spasm Chain Reaction

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

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

Leading to symptoms similar to sciatica:

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

Possible Mechanisms

Triggering Muscle Spasms in the Lower Back

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

Can Affect Lower Back Muscles and Cause Hamstring Spasms

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

Entrapment of the Sciatic Nerve

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

How acupuncture helps relieve sciatica

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

Releases endorphins

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

Reduces inflammation

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

Improves circulation

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

Relaxes tight muscles

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

Regulates the nervous system

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

Promotes regeneration

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

Needling Types

Distal needling

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

Local needling

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

Holistic approach

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

Injury Medical Chiropractic and Functional Medicine Clinic

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

Chiropractic and Integrative Healthcare

References

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

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

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

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

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

Pseudoarthrosis: When Fusion Surgery Does Not Heal

By
Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP
-
Doctor examining patient at hospital reception

What is pseudoarthrosis of the cervical and lumbar spine?

Pseudoarthrosis: When Fusion Surgery Does Not Heal

Pseudoarthrosis of the cervical and lumbar spine

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

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

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

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

In many cases, revision surgery is needed.

Surgery-Related

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

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

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

Number of Vertebrae Being Fused

Hardware

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

Bone Graft

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

Risk Factors

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

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

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

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

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

Symptoms

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

Diagnosis

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

Treatment

Treatment for pseudoarthrosis will likely start with:

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

Injury Medical Chiropractic and Functional Medicine Clinic

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

Enhancing Health Together

References

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

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

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

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

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

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

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

Length of Time to Improve Flexibility Effectively

By
Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP
-
physio checking the lower back of her female patient

For individuals dealing with or experiencing muscle pain and stiffness, how long does it take to loosen tight muscles?

Length of Time to Improve Flexibility Effectively

Length Of Time to Loosen Tight Muscles

Tight muscles are often caused by overuse or strain, combined with muscle soreness, a common symptom of tight muscles. The soreness peaks around the third day and begins to subside, typically resolving within a few days. But if tightness persists or is accompanied by other symptoms like numbness, inability to move, or swelling, it’s important to consult a medical provider. (Spine Medicine and Surgery of Long Island, 2024) However, it can take much longer for individuals who have never stretched and have had tight muscles for years, depending on the severity, injury history, and underlying causes.

Factors Influencing Timeline

Consistent stretching can take anywhere from a few weeks to a few months to noticeably loosen tight muscles and improve flexibility. The specific time frame depends on factors like the severity of the tightness, underlying causes, and individual consistency with stretching. (Peterson Physical Therapy, 2024)

Severity of Tightness

  • Muscle knots and significant limitations in range of motion may take longer to resolve than minor stiffness.

Underlying Causes

  • If tightness is due to a specific injury or condition, addressing that cause is important for lasting and maintaining improvements. (Healthline, 2023)

Individual Factors

  • Genetics, age, and overall health can influence how quickly muscles adapt to stretching.

Consistency

  • Regular stretching, ideally daily or several times a week, is essential for feeling progress. (Mayo Clinic, 2023)

Stretching Routine

The length of time can vary based on the starting flexibility level and the specific stretching routine. (Mayo Clinic, 2023) It typically takes several weeks of consistent stretching, at least 3-4 times a week, to notice flexibility improvements. Longer-term changes, beyond the initial feeling of being looser, usually take 8 to 12 weeks.

Consistency

Hold Time

  • Hold static stretches for at least 30 seconds.
  • Longer holds (1-2 minutes) can provide deeper benefits.

Long-term Gains

  • For substantial and sustained improvements, stretching consistently for several months is recommended. (Mayo Clinic, 2023)

Initial Changes

  • Individuals may notice small improvements in the first few weeks, especially starting from a more inflexible position.

Influencing Factors and Results

  • Individual genetics, current flexibility level, and the specific exercises can affect how quickly improvements are seen and felt. (Peterson Physical Therapy, 2024)

What To Expect

Improvements

  • Within a few weeks, individuals might notice a decrease in the sensation of tightness or increased ease in reaching a stretch. (Peterson Physical Therapy, 2024)

Longer-Term Changes

  • Significant muscle length and flexibility improvements may take several weeks to months of consistent effort.

Maintenance

Treatment Options

  • Stretching, physical therapy, massage, and other therapies can help alleviate tight muscles and promote recovery. (Spine Medicine and Surgery of Long Island, 2024)
  • Consider professional guidance for specific concerns or limitations. Consult a physical therapist or healthcare provider for personalized recommendations.

The length of time to see results means consistency and patience are important.

Injury Medical Chiropractic and Functional Medicine Clinic

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

Understanding Long-Lasting Injuries

References

Spine Medicine and Surgery of Long Island. (2024). How Long Do Muscle Knots Last? Spine Medicine and Surgery of Long Island. https://www.spinemedli.com/how-long-do-muscle-knots-last/#:~:text=The%20duration%20of%20a%20muscle,chronic%20pain%20if%20left%20untreated.

Peterson Physical Therapy. (2024). How Long Does It Take to Improve Flexibility? https://petersenpt.com/how-long-does-it-take-to-improve-flexibility#:~:text=Over%20the%20years%2C%20I’ve,takes%20to%20become%20more%20flexible.

Healthline. (2023). Everything You Need to Know About Muscle Stiffness. https://www.healthline.com/health/muscle-stiffness

Mayo Clinic. (2023). Stretching: Focus On Flexibility. https://www.mayoclinic.org/healthy-lifestyle/fitness/in-depth/stretching/art-20047931#:~:text=Stretch%20in%20a%20smooth%20movement,hold%20for%20around%2060%20seconds.

Harvard Health Publishing. (2022). Everyday Stretching. https://www.health.harvard.edu/everyday-stretching#:~:text=A%20daily%20regimen%20will%20deliver,or%20three%20times%20a%20week.

Pilates Nutrition Guidelines for Balanced Energy

By
Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP
-
Man exercising on pilates reformer bed, Gymnastics pilates

Many ask, what and when should you eat before, during, and after engaging in Pilates exercises?

Pilates Nutrition Guidelines for Balanced Energy

Pilates Nutrition Plan

Pilates involves a lot of core work on the mat. However, it does not require a special diet. To fully utilize Pilates nutrition, individuals should consider what foods keep their bodies feeling the most balanced. A balanced nutrition plan can enhance Pilates practice by:

  • Providing sustained energy
  • Supporting muscle recovery
  • Promoting overall well-being

Pre-Pilates

Timing

  • Eat a light meal or snack 2-3 hours before a class or a smaller snack 30 minutes before.

Food Options

  • Eat complex carbohydrates like whole grains, fruits, and vegetables for sustained energy.

Avoid

  • Heavy, greasy, or spicy foods may cause discomfort during exercise.
  • Foods that will make you gassy or cause queasiness.

During the Workout

Complex carbohydrates and lean proteins, with a little healthy fat, are good pre-Pilates meals, as they sustain energy better than simple carbs or sugary snacks. (American Heart Association, 2024) Suggestions for a pre-Pilates meal.

  • Individuals can adjust the portion size.
  • A protein shake that uses fruit can be convenient.
  • Peanut butter on whole-grain bread offers a quick source of complex carbohydrates and protein.
  • Yogurt with fruit.
  • Small portion of oatmeal.

Because Pilates emphasizes using the abdominal muscles, individuals will want to ensure that any food they’ve eaten before their session is fully digested. Try to eat light before, like snacking on a banana or sipping on a smoothie for some carbohydrates for energy. Regardless of what is eaten, nutrition experts recommend waiting two to three hours after eating before exercising.

Maintain Hydration

  • Drink water and/or eat hydrating fruits throughout the day, especially before and during the workout or class.

After Working Out

Individuals want to ensure their bodies have enough nutrients to strengthen their muscles and replenish their energy. Try a protein green smoothie afterward or a light snack with lean protein like fish or chicken and carbohydrates like whole grains. The diet between workouts will depend on weight loss goals.

Timing

  • Consume a protein-rich snack or meal within 30-60 minutes after your class to aid muscle recovery.

Food Choices

  • Focus on protein for muscle repair and carbohydrates to replenish energy stores.

Hydration

  • Continue to hydrate to replenish fluids lost through perspiration.

While Pilates can complement cardiovascular exercise as part of a fat-burning workout program, health experts advise that losing weight will not come from exercise alone. Individuals will need to work on reducing their calorie intake overall. (Centers for Disease Control and Prevention, 2023)

Injury Medical Chiropractic and Functional Medicine Clinic

As a Family Practice Nurse Practitioner, Dr. Jimenez combines advanced medical expertise with chiropractic care to address various conditions.

  • Wellness & Nutrition: Personalized plans to optimize health and prevent disease.

  • Sports Injuries & Orthopedic Care: Treatment for sprains, strains, and complex injuries.

  • Chronic Pain Management: Non-invasive solutions for fibromyalgia, sciatica, and low back pain.

  • Personal Injury & Auto Accident Care: Tailored rehabilitation for whiplash, soft tissue injuries, and more.

  • Functional Medicine: Root-cause analysis for chronic disorders, incorporating nutrition, lifestyle, and environmental factors.

  • Neuromusculoskeletal Health: Care for neck pain, migraines, herniated discs, and scoliosis.

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

Home Exercises for Pain Relief

References

American Heart Association. (2024). Food as fuel before, during, and after workouts. https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/nutrition-basics/food-as-fuel-before-during-and-after-workouts

Centers for Disease Control and Prevention. (2023). Tips for Maintaining Healthy Weight. Retrieved from https://www.cdc.gov/healthy-weight-growth/about/tips-for-balancing-food-activity.html?CDC_AAref_Val=https://www.cdc.gov/healthyweight/calories/index.html

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