Non-Exercise Activity Thermogenesis Can Help You Burn Calories

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

Portrait of three personal trainers standing in the office with their arms folded.

“For individuals looking to improve overall health and wellness, how can paying attention to non-exercise activities help burn more calories and improve metabolic rates?”

Table of Contents

Non-Exercise Activity Thermogenesis – NEAT

Non-exercise activity thermogenesis, or NEAT, describes the calories burned by daily movements and activities. These physical movements are not planned or structured exercises, workouts, or sports. It is also referred to as non-exercise physical activity or NEPA. Examples include activities like:

Cleaning
Cooking
Shopping
Playing a musical instrument
Small movements like fidgeting
When buying a few items, carry a basket instead of a shopping cart.
Take the stairs instead of the elevator or escalator.

While these movements might not seem like a lot, they can have a substantial impact on metabolic rates and calorie expenditures. A study followed over 12,000 women for 12 years and found that fidgeting can reduce the risk of death associated with excessive sedentariness. (Gareth Hagger-Johnson et al., 2016)

Calories Burned

The amount of calories burned varies from person to person. A study reported that the number of calories burned from non-exercise activity thermogenesis varies up to 2000 kilocalories a day between two individuals of similar size. (Christian von Loeffelholz et al., 2000). A number of factors can account for this difference, including environment and genetics. Individuals’ occupations and lifestyles can also influence non-exercise activity thermogenesis. For example, two individuals with similar body mass indexes or BMIs but different jobs, sedentariness versus activity, will burn different calorie amounts.

Improving Health

Non-exercise activity thermogenesis is thought to be one of the ways the body manages weight. When gaining weight, NEAT tends to increase, whereas when losing weight, NEAT decreases with individuals sitting more without moving as much. A research review noted that the benefits of non-exercise go well beyond the extra calories expended. (Pedro A. Villablanca et al., 2015). Increasing non-exercise activity thermogenesis reduces the risk of metabolic syndrome, cardiovascular issues, and other health problems. Plus, research shows that inactivity can negate the time and effort put into structured exercise. (John D. Akins et al., 2019). Combating sedentary behavior with non-activity thermogenesis helps increase the benefits of regular workouts.

Incorporating NEAT

There are small ways to incorporate non-exercise activity thermogenesis at work and at home. This could be using a standing desk or stability ball. According to the National Academy of Sports Medicine, a 145-pound person can approximately burn:

102 calories an hour while sitting at work.
174 calories if standing at work.
72 calories extra may not seem like a lot, but it can add up to more than 18,000 calories burned per year, leading to an approximate 5-pound weight loss.

If waiting in line or sitting in traffic, finding small ways to move, like tapping the hands or feet or moving the head to music, helps the body take advantage of non-exercise activity thermogenesis. Making more conscious efforts to move can go a long way in improving health.

Is Motion Key To Healing?

References

Hagger-Johnson, G., Gow, A. J., Burley, V., Greenwood, D., & Cade, J. E. (2016). Sitting Time, Fidgeting, and All-Cause Mortality in the UK Women’s Cohort Study. American journal of preventive medicine, 50(2), 154–160. https://doi.org/10.1016/j.amepre.2015.06.025

von Loeffelholz, C., & Birkenfeld, A. L. (2022). Non-Exercise Activity Thermogenesis in Human Energy Homeostasis. In K. R. Feingold (Eds.) et. al., Endotext. MDText.com, Inc.

Villablanca, P. A., Alegria, J. R., Mookadam, F., Holmes, D. R., Jr, Wright, R. S., & Levine, J. A. (2015). Nonexercise activity thermogenesis in obesity management. Mayo Clinic proceedings, 90(4), 509–519. https://doi.org/10.1016/j.mayocp.2015.02.001

Akins, J. D., Crawford, C. K., Burton, H. M., Wolfe, A. S., Vardarli, E., & Coyle, E. F. (2019). Inactivity induces resistance to the metabolic benefits following acute exercise. Journal of applied physiology (Bethesda, Md. : 1985), 126(4), 1088–1094. https://doi.org/10.1152/japplphysiol.00968.2018

Low Back Decompression for Herniation Pain Relief

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

Can individuals with herniated pain associated with low back pain find relief through spinal decompression to restore mobility?

Table of Contents

Introduction

Many people worldwide have experienced pain in the back region and often complain that it affects their mobility when doing their normal routine. The musculoskeletal system has various muscles, soft tissues, joints, ligaments, and bones that help surround the spine and protect the vital organs. The spine consists of bones, joints, and nerve roots that have an outstanding relationship with the central nervous system and musculoskeletal system as the spinal cord is protected by the spinal joints and discs that have the nerve roots spread out and help provide the sensory-motor function to the upper and lower extremities. When various pathogens or environmental factors start to cause the spine to compress the spinal discs constantly, it can lead to herniation and affect the body’s mobility over time. Individuals, both young and old, will notice that the pain is not going away from home remedies and may have to seek out treatment if the pain is too much. However, it can lead to dealing with unnecessary stress when looking for affordable treatment. Today’s article looks at how herniation can affect low back mobility and how treatments like decompression can help restore the spine. We speak with certified medical providers who incorporate our patients’ information to provide various solutions to restore low back mobility to the spine. We also inform patients how treatments like decompression can restore the spine’s mobility to the body. We encourage our patients to ask intricated and educational questions to our associated medical providers about the pain-like symptoms they are experiencing correlating with disc herniation affecting the spine. Dr. Alex Jimenez, D.C., utilizes this information as an academic service. Disclaimer.

Disc Herniation Affecting Low Back Mobility

Do you often experience stiffness or limited mobility in your lower back that causes you to walk a little slower than usual? Do you feel pain in your lower back muscles from stretching or bending down to pick up an object? Or do you feel numbness or tingling sensations down your legs that feel uncomfortable? When many individuals start to do repetitive motions, that can cause their spinal discs to compress over time and eventually become herniated. When many individuals overwork their bodies, their spinal discs can eventually crack, causing the inner portion to protrude and press on the surrounding nerve root. This causes the disc tissue to have a central ballon-type cyst that causes degenerative changes, leading to low back pain and herniation. (Ge et al., 2019)

At the same time, when many individuals start to deal with lower back pain from herniated discs, they will begin to lose mobility in their lower backs. This could be due to weak abdominal muscles combined with limited mobility. When many individuals do not have strong core muscles to provide support and mobility to their lower backs, it can start with simple muscle aches, leading to constant lower back pain without treatment and negatively impacting their quality of life. (Chu, 2022) However, dealing with low back pain does not have to be tedious as numerous therapies can reduce the effects of low back pain correlated with disc herniation while restoring low back spinal mobility.

The Science Of Motion-Video

The Science of Motion "Chiropractic Care" | El Paso, Tx (2024)

Have you ever experienced unquestionable muscle aches that radiate from your lower back and travel down your legs? Do you feel stiffness when bending down to pick up an object that causes muscle strain on your lower back? Or do you feel pain in your lower back from excessive sitting or standing? When many people are dealing with these pain-like issues in their lower backs, it can lead to a life of disability while affecting their quality of life. This is due to a disc herniation that affects a person’s lower back mobility and, when not treated right away, can lead to chronic issues. However, many individuals will seek treatment for their lower back pain and find the relief they need. Many therapeutic exercises combined with non-surgical treatments can help retrain the weakened trunk muscles to stabilize the lower back better and help reduce lower back pain. (Hlaing et al., 2021) When individuals start to think about their health and wellness, especially when they are dealing with low back pain affecting their mobility, they will find that most of the pain is from normal, repetitive factors that cause their spinal disc to be compressed and herniated. Hence, applying traction to the lumbar spine can help reduce lumbar disc protrusion that causes low back pain. (Mathews, 1968) Treatments like chiropractic care, traction therapy, and spinal decompression are all non-surgical treatments that are cost-effective and gentle on the spine. They help realign the body and help kick start the body’s natural healing factor to rehydrate the spinal discs. When many individuals start to do continuous treatment to reduce their lower back pain associated with herniated discs, they will begin to see improvements in their spinal mobility and their pain diminished. Check out the video above to look at how non-surgical treatments can help restore mobility to the body and reduce pain-like symptoms.

Decompression Restoring The Spine

When it comes to reducing pain-like symptoms caused by disc herniation that is causing limited mobility and low back pain, spinal decompression could be the answer that many individuals are looking for to incorporate into their health and wellness routine. Since lumbar herniated spinal discs are a common cause of low back pain and radiculopathy, spinal decompression can help gently pull the herniated disc back to its original position to promote healing. Since spinal decompression and lumbar traction are part of the physiotherapy treatment, they can help decrease the pain intensity from the spine and reduce the size of the herniated disc. (Choi et al., 2022) When many individuals feel relief from the gentle pull from spinal decompression, they will notice that their mobility is back. After consecutive treatment, their pain will be diminished as their spinal disc is completely healed. (Cyriax, 1950) With many individuals who are looking for numerous treatments to reduce their lower back pain and regain their sense of life, incorporating these treatments can provide beneficial results to their musculoskeletal system.

References

Choi, E., Gil, H. Y., Ju, J., Han, W. K., Nahm, F. S., & Lee, P. B. (2022). Effect of Nonsurgical Spinal Decompression on Intensity of Pain and Herniated Disc Volume in Subacute Lumbar Herniated Disc. International Journal of Clinical Practice, 2022, 6343837. https://doi.org/10.1155/2022/6343837

Chu, E. C. (2022). Large abdominal aortic aneurysm presented with concomitant acute lumbar disc herniation – a case report. J Med Life, 15(6), 871-875. https://doi.org/10.25122/jml-2021-0419

Cyriax, J. (1950). The treatment of lumbar disk lesions. Br Med J, 2(4694), 1434-1438. https://doi.org/10.1136/bmj.2.4694.1434

Ge, C. Y., Hao, D. J., Yan, L., Shan, L. Q., Zhao, Q. P., He, B. R., & Hui, H. (2019). Intradural Lumbar Disc Herniation: A Case Report and Literature Review. Clin Interv Aging, 14, 2295-2299. https://doi.org/10.2147/CIA.S228717

Hlaing, S. S., Puntumetakul, R., Khine, E. E., & Boucaut, R. (2021). Effects of core stabilization exercise and strengthening exercise on proprioception, balance, muscle thickness and pain related outcomes in patients with subacute nonspecific low back pain: a randomized controlled trial. BMC Musculoskelet Disord, 22(1), 998. https://doi.org/10.1186/s12891-021-04858-6

Mathews, J. A. (1968). Dynamic discography: a study of lumbar traction. Ann Phys Med, 9(7), 275-279. https://doi.org/10.1093/rheumatology/9.7.275

Disclaimer

Healthy Spine Rotation: Vertebrae Causes and Prevention

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

“For individuals trying to maintain a healthy spine, can understanding the causes and prevention of rotated vertebrae help protect the spine from harmful rotation of vertebrae?”

Table of Contents

Spinal Rotation

Healthy spine rotation is an important aspect of injury prevention, and rotated vertebrae or a twisted spine can result from spine, nerve, or muscle disease or certain movements.

Normal Spine Twisting Capability

The spine can move in several ways. Spine movements include:

Bending – Rounding forward
Extending – Arching backward
Tilting sideways is powered by muscles that aid in twisting.

Although the spine can move in many directions, there are limits to how far it can and should go. (Xinhai Shan et al., 2013). This is especially true with twisting. The spinal column is made of 26 interconnected bones called vertebrae. When moving, each vertebrae bone moves accordingly. Rotated or twisted vertebrae, especially when bending forward like lifting heavy objects, are associated with a risk of back injuries like strain and herniated discs.

How Rotation Works

Rotation is a basic movement in which individuals can turn their spinal column. When twisting, the spine also bends to the side. The muscles involved in spine rotation include:

The internal oblique abdominals and the external oblique abdominals don’t directly attach to the spine but are the primary muscles responsible for powering spinal rotation in the lower back.
Intrinsic muscles, including the multifidus and longissimus, contribute to twisting movement as well.
The multifidus helps the spine twist when one side is contracted/activated and extends the lumbar spine when both sides contract.
The multifidus helps control the movement, and the longissimus provides the movement with some extension.

Age and The Spine

As individuals age, the body accumulates tension and/or weakness in the oblique abdominal and other trunk muscles. Sedentary habits primarily bring on these changes. (Pooriput Waongenngarm et al., 2016)

Chronically tight back and abdominal muscles impair the range of motion of the trunk, as well as twisting ability.
Muscle weakness and tightness affect spinal movements.
Weakened muscles can decrease support for spinal movement and decrease overall trunk stability.

Spinal Rotation and Scoliosis

Scoliosis is a common condition that causes a lateral curve of the spine. Some of the vertebrae become displaced to the side. Often, abnormal vertebral rotation underlies this displacement. Treatment often focuses on controlling vertebral rotation with medical guidance and physical therapy. (John P. Horne et al., 2014)

Over-Rotating The Spine

Many individuals over-rotate their spines with manual work, which can increase the risk of back injuries. (National Institutes of Health. 2020). Over-rotation can happen with activities like digging or shoveling.

Exercise For A Healthy Spine

A recommended way to achieve optimal rotation of the spine is with daily back exercises. (National Spine Health Foundation. 2015). An effective back exercise program will consist of movements in every direction.

Yoga is recommended because it places emphasis on developing flexibility and strength in all directions.
Pilates does the same.
An injury prevention exercise program will work the hip and pelvic muscles as well.
Individuals with a spine condition should consult their healthcare provider or physical therapist about how to exercise the spine safely, as rotation exercises could worsen back problems like bulging or herniated discs.

Core Strength For A Pain-Free Back

References

Shan, X., Ning, X., Chen, Z., Ding, M., Shi, W., & Yang, S. (2013). Low back pain development response to sustained trunk axial twisting. 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, 22(9), 1972–1978. https://doi.org/10.1007/s00586-013-2784-7

Waongenngarm, P., Rajaratnam, B. S., & Janwantanakul, P. (2016). Internal Oblique and Transversus Abdominis Muscle Fatigue Induced by Slumped Sitting Posture after 1 Hour of Sitting in Office Workers. Safety and health at work, 7(1), 49–54. https://doi.org/10.1016/j.shaw.2015.08.001

Horne, J. P., Flannery, R., & Usman, S. (2014). Adolescent idiopathic scoliosis: diagnosis and management. American family physician, 89(3), 193–198.

National Institutes of Health. (2020). Low Back Pain Fact Sheet.

National Spine Health Foundation. (2015). Breaking Down The Exercises That Break Down Your Spine.

Understanding Cracked Ribs: Causes, Symptoms, & Complications

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

Traffic Accident Automotive Collision at Night. Heavy Damaged Modern Car on a Street. Transportation Safety Theme. Car Crash.

“Individuals may not realize they have a cracked rib until symptoms like pain when taking in a deep breath begin to present. Can knowing the symptoms and causes of cracked or broken ribs help in diagnosis and treatment?”

Table of Contents

Cracked Rib

A broken/fractured rib describes any break in the bone. A cracked rib is a type of rib fracture and is more a description than a medical diagnosis of a rib that has been partially fractured. Any blunt impact to the chest or back can cause a cracked rib, including:

Falling
Vehicle collision
Sports injury
Violent coughing

The main symptom is pain when inhaling.
The injury typically heals within six weeks.

Symptoms

Cracked ribs are usually caused by a fall, trauma to the chest, or intense violent coughing. Symptoms include:

Swelling or tenderness around the injured area.
Chest pain when breathing/inhaling, sneezing, laughing, or coughing.
Chest pain with movement or when lying down in certain positions.
Possible bruising.
Although rare, a cracked rib can cause complications like pneumonia.
See a healthcare provider immediately if experiencing difficulty breathing, severe chest pain, or a persistent cough with mucus, high fever, and/or chills.

Types

In most cases, a rib usually gets broken in one area, causing an incomplete fracture, which means a crack or break that does not go through the bone. Other types of rib fractures include:

Displaced and Nondisplaced Fractures

Completely broken ribs may or may not shift out of place.
If the rib does move, this is known as a displaced rib fracture and is more likely to puncture lungs or damage other tissues and organs. (Yale Medicine. 2024)
A rib that stays in place usually means the rib is not completely broken in half and is known as a nondisplaced rib fracture.

Flail Chest

A section of the ribcage can break away from the surrounding bone and muscle, although this is rare.
If this happens, the ribcage will lose stability, and the bone will move freely as the individual inhales or exhales.
This broken ribcage section is called a flail segment.
This is dangerous as it can puncture the lungs and cause other serious complications, like pneumonia.

Causes

Common causes of cracked ribs include:

Vehicle collisions
Pedestrian accidents
Falls
Impact injuries from sports
Overuse/Repetitive stress brought on by work or sports
Severe coughing
Older individuals can experience a fracture from a minor injury due to the progressive loss of bone minerals. (Christian Liebsch et al., 2019)

The Commonality of Rib Fractures

Rib fractures are the most common type of bone fracture.
They account for 10% to 20% of all blunt trauma injuries seen in emergency rooms.
In cases where an individual seeks care for a blunt injury to the chest, 60% to 80% involve a broken rib. (Christian Liebsch et al., 2019)

Diagnosis

A cracked rib is diagnosed with a physical exam and imaging tests. During the examination, a healthcare provider will listen to the lungs, press gently on the ribs, and watch as the rib cage moves. The imaging test options include: (Sarah Majercik, Fredric M. Pieracci 2017)

X-rays – These are for detecting recently cracked or broken ribs.
CT Scan – This imaging test comprises multiple X-rays and can detect smaller cracks.
MRI – This imaging test is for soft tissues and can often detect smaller breaks or cartilage damage.
Bone Scan – This imaging test uses a radioactive tracer to visualize the structure of bones and can show smaller stress fractures.

Treatment

In the past, treatment used to involve wrapping the chest with a band known as a rib belt. These are rarely used today as they can restrict breathing, increasing the risk of pneumonia or even a partial lung collapse. (L. May, C. Hillermann, S. Patil 2016). A cracked rib is a simple fracture that requires the following:

Rest
Over-the-counter or prescription medications can help manage pain symptoms.
Nonsteroidal anti-inflammatory drugs – NSAIDs like ibuprofen or naproxen are recommended.
If the break is extensive, individuals may be prescribed stronger pain medication depending on the severity and underlying conditions.
Physical therapy can expedite the healing process and help maintain the range of motion of the chest wall.
For patients who are frail and elderly individuals, physical therapy can help the patient walk and normalize certain functions.
A physical therapist can train the individual to transfer between bed and chairs safely while maintaining awareness of any movements or positioning that make the pain worse.
A physical therapist will prescribe exercises to keep the body as strong and limber as possible.
For example, lateral twists can help improve the range of motion in the thoracic spine.

During the early stages of recovery, it is recommended to sleep in an upright position.
Lying down can add pressure, causing pain and possibly worsen the injury.
Use pillows and bolsters to help support sitting up in bed.
An alternative is to sleep in a reclining chair.
Healing takes at least six weeks. (L. May, C. Hillermann, S. Patil 2016)

Other Conditions

What may feel like a cracked rib may be a similar condition, which is why it’s important to get checked out. Other possible symptom causes can include:

Bruised ribs – This occurs when the ribs are not cracked, but the smaller blood vessels around the region burst and leak into surrounding tissues. (Sarah Majercik, Fredric M. Pieracci 2017)
Popped ribs – This is when the rib cartilage tears and breaks, causing it to slip out of position. (Sarah Majercik, Fredric M. Pieracci 2017)
Pulled muscle – A muscle strain, or pulled muscle, occurs when the muscle gets overstretched, which can lead to a tear. The ribs are not affected, but it can feel like they are. (Sarah Majercik, Fredric M. Pieracci 2017)

Emergency

The most common complication is being unable to take a deep breath because of the pain. When the lungs cannot breathe deeply enough, mucous and moisture can build up and lead to an infection like pneumonia. (L. May, C. Hillermann, S. Patil 2016). Displaced rib fractures can also damage other tissues or organs, increasing the risk of a collapsed lung/pneumothorax or internal bleeding. It is recommended to seek immediate medical attention if symptoms develop like:

Shortness of breath
Difficulty breathing
A bluish color of the skin caused by lack of oxygen
A persistent cough with mucus
Chest pain when breathing in and out
Fever, sweating, and chills
Rapid heart rate

The Power of Chiropractic Care In Injury Rehabilitation

References

Yale Medicine. (2024). Rib fracture (broken rib).

Liebsch, C., Seiffert, T., Vlcek, M., Beer, M., Huber-Lang, M., & Wilke, H. J. (2019). Patterns of serial rib fractures after blunt chest trauma: An analysis of 380 cases. PloS one, 14(12), e0224105. https://doi.org/10.1371/journal.pone.0224105

May L, Hillermann C, Patil S. (2016). Rib fracture management. BJA Education. Volume 16, Issue 1. Pages 26-32, ISSN 2058-5349. doi:10.1093/bjaceaccp/mkv011

Majercik, S., & Pieracci, F. M. (2017). Chest Wall Trauma. Thoracic surgery clinics, 27(2), 113–121. https://doi.org/10.1016/j.thorsurg.2017.01.004

Learn How Ice Tape Can Reduce Musculoskeletal Injury Swelling

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

Physio Tape in Rehabilitation — Portrait of male rehabilitation therapist explaining physio tape technique to young woman, copy space

“For individuals into sports, fitness enthusiasts, and those that engage in physical activities, musculoskeletal injuries are common. Can ice tape help decrease inflammation and swelling during the initial or acute phase of injury to expedite recovery and return to activities sooner?”

Table of Contents

Ice Tape

After a musculoskeletal injury, individuals are recommended to follow the R.I.C.E. method to help reduce swelling and inflammation. R.I.C.E. is the acronym for Rest, Ice, Compression, and Elevation. (Michigan Medicine. University of Michigan. 2023) The cold helps to decrease pain, lower tissue temperature, and decrease swelling around the site of the injury. By controlling the inflammation with ice and compression early after injury, individuals can maintain the appropriate range of motion and mobility around the injured body part. (Jon E. Block. 2010) There are different ways to apply ice to an injury.

Store-bought ice bags and cold packs.
Soaking the injured body part in a cold whirlpool or tub.
Making reusable ice packs.
A compression bandage can be used together with the ice.

Ice Tape is a compression bandage that provides cold therapy all at once. After an injury, applying it can help decrease the pain and swelling during the acute inflammatory phase of healing. (Matthew J. Kraeutler et al., 2015)

How The Tape Works

The tape is a flexible bandage that is infused with therapeutic cooling gel. When applied to an injured body part and exposed to air, the gel activates, generating a cold sensation around the area. The therapeutic medicinal effect can last five to six hours. Combined with a flexible bandage, it provides ice therapy and compression. The ice tape can be used straight out of the package but can also be stored in the refrigerator to increase the cold effect. Depending on the maker’s instructions, the tape should not be stored in the freezer as this can make it too hard to wrap around the injured area.

Advantages

The benefits include the following:

Easy to Use

The product is easy to use.
Take out the tape, and start wrapping it around the injured body part.

Fasteners Not Required

The wrap sticks to itself, so the tape stays in place without using clips or fasteners.

Easy to Cut

The standard roll is 48 inches long by 2 inches wide.
Most injuries require enough to wrap around the injured area.
Scissors cut the exact amount needed, and store the rest in the resealable bag.

Reusable

After 15 to 20 minutes of application, the product can be easily removed, rolled up, stored in the bag, and used again.
The tape can be used multiple times.
The tape begins to lose its cooling quality after several uses.

Portable

The tape does not need to be placed in a cooler when traveling.
It is easily portable and perfect for a quick ice and compression application immediately after an injury.
It can decrease pain and inflammation and kept at the workplace.

Disadvantages

A few disadvantages include the following:

Chemical Odor

The gel on the flexible wrap can have a medicine odor.
It is not quite as powerful smelling as pain creams, but the chemical odor could bother some individuals.

Might Not Be Cold Enough

The tape works for immediate pain relief and inflammation, but it may not get cold enough for the user when applied right from the package at room temperature.
However, it can be placed in a refrigerator to increase the coldness and may provide a more therapeutic cooling effect, especially for those dealing with tendinitis or bursitis.

Stickiness Could Be Distracting

The tape could be a bit sticky for some.
This sticky factor can be a minor annoyance.
However, it just feels sticky when being applied.
A couple of flecks of the gel may get left behind when removed.
The ice tape can also stick to clothing.

For individuals looking for a quick, on-the-go cooling therapy for injured or aching body parts, ice tape may be an option. It could be good to have on hand to provide cooling compression if a minor injury occurs while participating in athletics or physical activities and relief for overuse or repetitive strain injuries.

Treating Ankle Sprains

References

Michigan Medicine. University of Michigan. Rest, Ice, Compression, and Elevation (RICE).

Block J. E. (2010). Cold and compression in the management of musculoskeletal injuries and orthopedic operative procedures: a narrative review. Open access journal of sports medicine, 1, 105–113. https://doi.org/10.2147/oajsm.s11102

Kraeutler, M. J., Reynolds, K. A., Long, C., & McCarty, E. C. (2015). Compressive cryotherapy versus ice-a prospective, randomized study on postoperative pain in patients undergoing arthroscopic rotator cuff repair or subacromial decompression. Journal of shoulder and elbow surgery, 24(6), 854–859. https://doi.org/10.1016/j.jse.2015.02.004

Sit and Reach Test Guide For Lower Back and Hamstring Flexibility

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

Woman doing sit and reach flexibility test

“For individuals experiencing tightness in the lower back and hamstrings, can utilizing the sit and reach test help determine an individual’s risk for future pain and injury?”

Table of Contents

Sit and Reach Test

Lower back and hamstring tightness and pain symptoms are usually brought on by muscle stiffness. The sit-and-reach test is one of the most common ways to measure lower back and hamstring flexibility. Exercise physiologists, physical therapists, chiropractors, and fitness trainers use the sit-and-reach test to measure lower back and hamstring flexibility to assess baseline flexibility. The test has been around since 1952 (Katharine F. Wells & Evelyn K. Dillon 2013) and has an extensive database of results across all age groups and genders.

Individuals can use the sit-and-reach test to compare flexibility to the average result for individuals of the same gender and age.
For healthcare providers, the test may be repeated after several weeks to determine flexibility progress.

Measurement

The test can be a valuable measurement of functional flexibility to sit with the legs straight in front and reach the toes. Jobs, sports, and everyday tasks regularly require bending over, reaching, and lifting objects. These are real-life examples of how having a healthy back and hamstring flexibility is vital in preventing pain symptoms and injuries. New flexibility assessments are currently being developed, and many trainers and therapists use their own versions with patients and clients. But even with more advanced specialized flexibility tests, the sit and reach test can be a functional testing tool for tracking general flexibility changes over time. (Daniel Mayorga-Vega et al., 2014)

Performing The Test

A special sit-and-reach testing box is used; however, individuals can make their own testing box by finding a heavy-duty box around 30cm or 11.811 inches tall. Set a measurement ruler/stick on top of the box so that 26 cm or 10.2362 inches of the ruler extends over the front edge toward the individual being tested. The 26cm mark should be at the edge of the box.

Get into position – Remove shoes and sit on the floor with legs stretched out in front with the knees straight and feet flat against the front end of the test box.
Start the movement – In a slow, steady motion, lean forward, keeping the knees straight, and slide the hands up the ruler as far as possible.
Stretch and repeat – Extend as far as possible, record the results, rest, and repeat three times.
Calculate the results – Average the results.

Results

Results compare flexibility over time to norms, or averages, for gender and age. Adequate flexibility is reaching the toes – the 26-cm mark on the ruler while keeping the legs straight.

Adult Women

37cm or 14.5669 inches or above: Excellent
33 to 36cm or 12.9921 inches: Above average
29 to 32cm or 11.4173 inches: Average
23 to 28cm or 9.05512 inches: Below average
Below 23cm or 8.66142 inches: Poor

Adult Men

34cm or 13.3858 inches or above: Excellent
28 to 33cm or 11.0236 inches: Above average
23 to 27cm or 9.05512 inches: Average
16 to 22cm or 6.29921 inches: Below average
Below 16cm or 5.90551 inches: Poor

Alternatives

Individuals can test their own hamstring and lower back flexibility with some easy at-home tests. Use these methods while working on flexibility, and keep a record to see improvements. (Brittany L. Hansberger et al., 2019) One alternative is the V-sit reach test.

To perform this, make a line on the floor with tape, then place a measuring tape perpendicular to the tape, making a cross.
Sit with the feet in a V shape, touching the tape, feet about a foot apart, with the measuring tape between the legs; the 0 end starts where the legs part.
Overlap hands with arms outstretched in front.
Repeat three times, leaning forward and reaching with hands out.
Then, repeat and take note of how far the hands could reach.

Another alternative is the fingertip-to-floor-distance test.

Individuals will need someone to measure the distance between their fingertips and the floor.
Warm up with a few practice stretches of standing and bending toward the floor.
Then, measure how far from the floor the fingertips are.
The ability to touch the floor is a good sign.

Improving Flexibility

Individuals with less than adequate flexibility are recommended to work on stretching the major muscle groups in both the upper and lower body on a regular basis to improve and maintain body flexibility.

Individuals can incorporate dynamic stretching, which consists of active movements utilizing a full range of motion as part of warming up for workouts, sports, or other activities.
Static stretching is recommended when cooling down after the muscles are warmed up and joints are lubricated.
The American College of Sports Medicine recommends 2 to 3 sessions a week of flexibility training and learning to stretch daily.
Stretches should be held for 15 to 30 seconds, then released and repeated 2 to 4 times. (Phil Page 2012)

This will take time and dedication, but with the help of trained specialists, regaining flexibility and full range of motion can be accomplished.

Benefits of Stretching

References

Katharine F. Wells & Evelyn K. Dillon (1952) The Sit and Reach—A Test of Back and Leg Flexibility, Research Quarterly. American Association for Health, Physical Education and Recreation, 23:1, 115-118, DOI: 10.1080/10671188.1952.10761965

Mayorga-Vega, D., Merino-Marban, R., & Viciana, J. (2014). Criterion-Related Validity of Sit-and-Reach Tests for Estimating Hamstring and Lumbar Extensibility: a Meta-Analysis. Journal of sports science & medicine, 13(1), 1–14.

Hansberger, B. L., Loutsch, R., Hancock, C., Bonser, R., Zeigel, A., & Baker, R. T. (2019). EVALUATING THE RELATIONSHIP BETWEEN CLINICAL ASSESSMENTS OF APPARENT HAMSTRING TIGHTNESS: A CORRELATIONAL ANALYSIS. International journal of sports physical therapy, 14(2), 253–263.

Page P. (2012). Current concepts in muscle stretching for exercise and rehabilitation. International journal of sports physical therapy, 7(1), 109–119.

Healthy Benefits of Oat Milk: An Overview

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

Vegan oat milk with oat flakes close up — Vegan oat milk with bowl of oat flakes close up

“For individuals switching to non-dairy and plant-based diets, can oat milk be a beneficial substitute for non-dairy milk drinkers?”

Table of Contents

Oat Milk

Oat milk is a dairy-free, lactose-free alternative nearly free of saturated fats, has more protein than most nut-based kinds of milk, adds fiber, and offers a healthy dose of B vitamins and minerals. It contains steel-cut or whole oats soaked in water that are then blended and strained with a cheesecloth or special milk bag that is cheaper to make than almond milk and is environmentally friendly.

Nutrition

Individuals can acquire 27% of daily calcium, 50% of daily vitamin B12, and 46% of daily B2. The nutritional information is for one serving of 1 cup of oat milk. (USDA FoodData Central. 2019)

Calories – 120
Fat – 5 grams
Sodium – 101 milligrams
Carbohydrates – 16 grams
Fiber – 1.9 grams
Sugars – 7 grams
Protein – 3 grams
Calcium – 350.4 milligrams
Vitamin B12 – 1.2 micrograms
Vitamin B2 – 0.6 milligrams

Carbohydrates

According to the United States Department of Agriculture, the number of carbohydrates in a cup of oat milk is 16, higher than other milk products.
However, the carbohydrates come from fiber and not fat.
Because oat milk is made from steel-cut or whole oats, there is more fiber per serving than cow’s milk, which offers no fiber, and almond and soy, which only contain one gram of fiber per serving.

Fats

Oat milk contains no fatty acids, no total saturated fat, and no total trans fats.
The milk does have 5 grams of total lipid fats.

Protein

Compared to cow’s and soy milk, oat milk has less protein, with only 3 grams per serving.
But compared to other substitutes, like almond milk and rice milk, oat milk provides more protein per serving.
This is beneficial for individuals following a vegan or dairy-free diet.

Vitamins and Minerals

Oat milk contains thiamin and folate, both B vitamins necessary for energy production.
The milk also has minerals, including copper, zinc, manganese, magnesium, and trace amounts of vitamins and minerals such as vitamin D, A IU, riboflavin, and potassium.
Most commercial oat milk is fortified with vitamins A, D, B12, and B2.

Calories

One serving of oat milk, about 1 cup, provides approximately 120 calories.

Benefits

Dairy Milk Alternative

Dairy allergies are common.
Around 2 to 3% of children younger than three years old are allergic to milk. (American College of Allergy, Asthma & Immunology. 2019)
80% outgrow the allergy, but the remaining 20% still deal with the allergy into adulthood, making dairy alternatives necessary.
An alternative to dairy milk for:
Allergies to dairy
Lactose intolerance
Following a vegan/dairy-free diet
Oat milk offers some of the same health benefits as cow’s milk, that include:
Protein to build and repair tissues.
Maintain hair and nail health.
Calcium for strong bones.
Macronutrients like folate help make red and white blood cells.

Lowers Cholesterol

A review determined that consuming oats and oat products has a profound effect in lowering total and LDL cholesterol levels. (Susan A Joyce et al., 2019)
The researchers found significant support between oat beta-glucans and blood cholesterol levels, showing that adding oats to one’s diet can help lower the risk of cardiovascular disease.

Cancer Fighting Properties

According to a review of plant-based milk alternatives, oat milk may contain anti-cancer properties and high nutritional value. (Swati Sethi et al., 2016)

Bowel Movement Regulation

Because a great deal of carbohydrates in oat milk come from fiber, it is also higher in fiber than regular milk.
Fiber can help because the nutrient absorbs water to regulate bowel movements and decrease constipation.
Only 5% of the population acquires daily fiber recommendations, making oat milk a healthy option. (Diane Quagliani, Patricia Felt-Gunderson. 2017)

Eco Friendly

Today the world is more mindful of the environmental impacts of farming. (American Society for Nutrition. 2019)
Spending on alternative milk has risen, and the consumption of dairy milk has dropped, not only for the benefits and taste but because of environmental concerns.
Dairy milk uses nine times more land to make one liter compared to rice milk, soy milk, almond milk, or oat milk.

Allergies

Oat milk is a beneficial alternative for individuals who are lactose intolerant or suffer from any other type of dairy allergy or those who have a nut allergy and can’t drink almond milk.
However, individuals should be careful of intake if they have celiac disease or any type of wheat allergy/sensitivity.
Individuals can still drink oat milk, but the labels need to be read to make sure the product contains gluten-free wheat.
Oats are gluten-free, but manufacturers often process them using the same equipment as other wheat products, which could cause a reaction.

Adverse Effects

Oat milk can contain acidity-regulating phosphates, which are common additives in processed foods and are linked to kidney disease.
Individuals will want to watch oat milk intake if they are prone to kidney stones. (Girish N. Nadkarni, Jaime Uribarri. 2014)
Individuals who eat a lot of processed foods might want to rotate with another non-dairy alternative milk to limit phosphate consumption.

Varieties

Many companies have their own oat milk, which is available at grocery and health food stores.
Additionally, the milk may come in multiple flavors, including vanilla and chocolate.
Several companies have also used their milk to create dairy-free ice creams.
Oat milk is available year-round.
Once opened, place store-bought oat milk in the refrigerator that will last 7 to 10 days.

Preparation

Individuals can make their own oat milk.
Use rolled or steel-cut oats with water, blend together, and strain.
Place the oats in a large bowl, cover them with water, and soak for at least four hours.
The next day, drain, rinse, blend in cold water, strain, and whisk.

Functional Medicine’s Influence Beyond Joints

References

USDA FoodData Central. (2019). The Original Oat-Milk.

American College of Allergy, Asthma & Immunology. (2019). Milk & Dairy.

Joyce, S. A., Kamil, A., Fleige, L., & Gahan, C. G. M. (2019). The Cholesterol-Lowering Effect of Oats and Oat Beta Glucan: Modes of Action and Potential Role of Bile Acids and the Microbiome. Frontiers in nutrition, 6, 171. https://doi.org/10.3389/fnut.2019.00171

Sethi, S., Tyagi, S. K., & Anurag, R. K. (2016). Plant-based milk alternatives an emerging segment of functional beverages: a review. Journal of food science and technology, 53(9), 3408–3423. https://doi.org/10.1007/s13197-016-2328-3

Quagliani, D., & Felt-Gunderson, P. (2016). Closing America’s Fiber Intake Gap: Communication Strategies From a Food and Fiber Summit. American journal of lifestyle medicine, 11(1), 80–85. https://doi.org/10.1177/1559827615588079

American Society for Nutrition. (2019). Going nuts about milk? Here’s what you need to know about plant-based milk alternatives.

Nadkarni, G. N., & Uribarri, J. (2014). Phosphorus and the kidney: What is known and what is needed. Advances in nutrition (Bethesda, Md.), 5(1), 98–103. https://doi.org/10.3945/an.113.004655

Understanding Thoracodorsal Nerve Injury & Treatment

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

Young brunette woman in brown jumper suffering from pain while massaging lymphatic nodes on armpit and sitting on couch at home, self-care ritual and holistic wellness practices concept

“Individuals experiencing pain symptoms like shooting, stabbing, or electrical sensations to the latissimus dorsi of the upper back could be caused by a nerve injury to the thoracodorsal nerve. Can knowing the anatomy and symptoms help healthcare providers develop an effective treatment plan?”

Table of Contents

Thoracodorsal Nerve

Also known as the middle subscapular nerve or the long subscapular nerve, it branches out from a part of the brachial plexus and provides motor innervation/function to the latissimus dorsi muscle.

Anatomy

The brachial plexus is a network of nerves that stem from the spinal cord in the neck. The nerves supply most of the sensation and movement of the arms and hands, with one on each side. Its five roots come from the spaces between the fifth through eighth cervical vertebrae and the first thoracic vertebra. From there, they form a larger structure, then divide, re-combine, and divide again to form smaller nerves and nerve structures as they travel down the armpit. Through the neck and chest, the nerves eventually join and form three cords that include:

Lateral cord
Medial cord
Posterior cord

The posterior cord produces major and minor branches that include:

Axillary nerve
Radial nerve

The minor branches include:

Superior subscapular nerve
Inferior subscapular nerve
Thoracodorsal nerve

Structure and Position

The thoracodorsal nerve branches off the posterior cord in the armpit and travels down, following the subscapular artery, to the latissimus dorsi muscle.
It connects to the upper arm, stretches across the back of the armpit, forming the axillary arch, and then expands into a large triangle that wraps around the ribs and the back.
The thoracodorsal nerve lies deep in the latissimus dorsi, and the lower edge typically reaches close to the waist.

Variations

There is a standard location and course of the thoracodorsal nerve, but individual nerves are not the same in everyone.
The nerve typically branches off the posterior cord of the brachial plexus from three different points.
However, different subtypes have been identified.
The thoracodorsal nerve supplies the teres major muscle in about 13% of individuals. (Brianna Chu, Bruno Bordoni. 2023)
The lats can have a rare anatomical variation known as a Langer’s arch, which is an extra part that connects to muscles or connective tissue of the upper arm beneath the common connecting point.
In individuals with this abnormality, the thoracodorsal nerve supplies function/innervation) to the arch. (Ahmed M. Al Maksoud et al., 2015)

Function

The latissimus dorsi muscle cannot function without the thoracodorsal nerve. The muscle and nerve help:

Stabilize the back.
Pull the body weight up when climbing, swimming, or doing pull-ups.
Assist with breathing by expanding the rib cage during inhalation and contracting when exhaling. (Encyclopaedia Britannica. 2023)
Rotate the arm inward.
Pull the arm toward the center of the body.
Extend the shoulders by working with the teres major, teres minor, and posterior deltoid muscles.
Bring down the shoulder girdle by arching the spine.
To bend to the side by arching the spine.
Tilt the pelvis forward.

Conditions

The thoracodorsal nerve can be injured anywhere along its path by trauma or disease. Symptoms of nerve damage can include: (U.S. National Library of Medicine: MedlinePlus. 2022)

Pain that can be shooting, stabbing, or electrical sensations.
Numbness, tingling.
Weakness and loss of function in the associated muscles and body parts, including wrist and finger drop.
Because of the nerve’s path through the armpit, doctors have to be cautious of the anatomical variants so they don’t inadvertently damage a nerve during breast cancer procedures, including axillary dissection.
The procedure is performed to examine or remove lymph nodes and is used in staging breast cancer and in treatment.
According to a study, 11% of individuals with axillary lymph node dissection suffered damage to the nerve. (Roser Belmonte et al., 2015)

Breast Reconstruction

In breast reconstruction surgery, the lats can be used as a flap over the implant.
Depending on the circumstances, the thoracodorsal nerve can be left intact or severed.
The medical community has not agreed on which method has the best outcomes. (Sung-Tack Kwon et al., 2011)
There is some evidence that leaving the nerve intact can cause the muscle to contract and dislocate the implant.
An intact thoracodorsal nerve may also cause atrophy of the muscle, which can lead to shoulder and arm weakness.

Graft Uses

A portion of the thoracodorsal nerve is commonly used in nerve graft reconstruction to restore function after injury, which includes the following:

Musculocutaneous nerve
Accessory nerve
Axillary nerve
The nerve can also be used to restore nerve function to the triceps muscle in the arm.

Rehabilitation

If the thoracodorsal nerve is injured or damaged, treatments can include:

Braces or splints.
Physical therapy to improve range of motion, flexibility, and muscle strength.
If there is compression, surgery may be required to alleviate the pressure.

Exploring Integrative Medicine

References

Chu B, Bordoni B. Anatomy, Thorax, Thoracodorsal Nerves. [Updated 2023 Jul 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539761/

Al Maksoud, A. M., Barsoum, A. K., & Moneer, M. M. (2015). Langer’s arch: a rare anomaly affects axillary lymphadenectomy. Journal of surgical case reports, 2015(12), rjv159. https://doi.org/10.1093/jscr/rjv159

Britannica, The Editors of Encyclopaedia. “latissimus dorsi“. Encyclopedia Britannica, 30 Nov. 2023, https://www.britannica.com/science/latissimus-dorsi. Accessed 2 January 2024.

U.S. National Library of Medicine: MedlinePlus. Peripheral neuropathy.

Belmonte, R., Monleon, S., Bofill, N., Alvarado, M. L., Espadaler, J., & Royo, I. (2015). Long thoracic nerve injury in breast cancer patients treated with axillary lymph node dissection. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 23(1), 169–175. https://doi.org/10.1007/s00520-014-2338-5

Kwon, S. T., Chang, H., & Oh, M. (2011). Anatomic basis of interfascicular nerve splitting of innervated partial latissimus dorsi muscle flap. Journal of plastic, reconstructive & aesthetic surgery : JPRAS, 64(5), e109–e114. https://doi.org/10.1016/j.bjps.2010.12.008

Dislocated Elbow Injury: A Guide To Treatment and Recovery

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

Man with adjustable articulated elbow orthosis typing on laptop keyboard — Man with elbow injury, special modern adjustable articulated elbow orthosis typing on laptop keyboard. Side view shot man wearing arm splint sitting at desk in front window working distantly at home

“A dislocated elbow is a common injury in adults and children and often happens in tandem with bone fractures and nerve and tissue damage. Can physical therapy help to support recovery and ensure range of motion?”

Table of Contents

Dislocated Elbow Injury

Elbow dislocations are generally caused by trauma when the elbow bones no longer connect. Individuals falling onto an outstretched hand is the most common cause of the injury. (James Layson, Ben J. Best 2023) Healthcare providers will try to relocate the elbow using a closed reduction. Individuals may require surgery if they cannot relocate the elbow using closed reduction.

Resetting The Elbow

The elbow is made up of a hinge and ball-and-socket joint, enabling unique motions: (American Society for Surgery of the Hand. 2021)

Hinge joint

The hinge function allows the bending and straightening of the arm.

Ball-and-socket joint

The ball-and-socket function allows you to rotate the palm of your hand to face up or face down.

A dislocated elbow injury can damage bones, muscles, ligaments, and tissues. (American Academy of Orthopaedic Surgeons. 2021) The longer the elbow remains out of the joint, the more damage can occur. Elbow dislocations rarely reset into their joints on their own and are recommended to be evaluated by a qualified healthcare provider to prevent permanent damage to nerves or function.

It is not recommended to try to reset the elbow on your own.
A healthcare provider will work to restore the joint and ensure proper alignment.
Before the reset, they will perform a physical examination to assess blood circulation and any nerve damage.
Providers will order an imaging scan to examine the dislocation and identify broken bones. (American Academy of Orthopaedic Surgeons. 2021)

Type of Dislocation

The two types of elbow dislocations are: (James Layson, Ben J. Best 2023)

Posterior Dislocation

Occurs when there is a significant force on the palm that spreads toward the elbow.
Falling with the hands stretched out to catch yourself, and the elbow joint pushes backward/posterior.

Anterior Dislocation

This is less common and results from applied force on a flexed elbow.
Falling to the ground when the hand is up near the shoulder.
In this case, the elbow joint pushes forward/anterior.
X-rays are used to determine the type of dislocation and to identify any broken bones. (American Society for Surgery of the Hand. 2021)
Depending on the injury, the provider may order a CT scan or MRI to ensure no damage has occurred to nerves or ligaments. (Radiopaedia. 2023)

Signs and Symptoms

A dislocated elbow injury is often caused by trauma. (American Academy of Orthopaedic Surgeons. 2021) General signs and symptoms include: (American Society for Surgery of the Hand. 2021)

Inability to move the elbow.
Bruising and swelling around the area.
Intense pain in the elbow and surrounding area.
Deformity around the elbow joint.
Numbness, tingling, or weakness in the arm or hand can indicate nerve damage.

Treatment Without Surgery

Healthcare providers initially try to treat a dislocated elbow using a closed reduction technique. (American Society for Surgery of the Hand. 2021)
A closed reduction means that the elbow can be relocated without surgery.
Before the closed reduction, a healthcare provider will administer medications to help relax the individual and address the pain. (Medline Plus. 2022)
Once relocated into the correct position, a healthcare provider applies a splint (usually at a 90-degree angle of flexion) to keep the elbow in place. (James Layson, Ben J. Best 2023)
The objective is to prevent elbow extension, which can cause re-dislocation.
The splint remains in place for one to three weeks. (American Academy of Orthopaedic Surgeons. 2021)
A physical therapist will assess motion and prescribe exercises to prevent elbow range of motion loss.

Treatment With Surgery

Depending on the severity of the dislocation and the success of the closed reduction, surgery may still be necessary. (James Layson, Ben J. Best 2023)
If any of the following are being experienced by the individual, a healthcare provider may recommend surgery: (American Academy of Orthopaedic Surgeons. 2021)

The elbow remains unstable with a slight extension.
The bones are not correctly aligning.
The ligaments need further repair after a closed reduction.

Complex elbow dislocations can make it difficult to maintain joint alignment.
An assistive device, like an external hinge, may be recommended to help prevent re-dislocating the elbow.
The surgeon will recommend physical therapy after surgery to assist with range-of-motion exercises to optimize and expedite recovery.

Recovery

Recovery times can vary as every injury is different. (American Society for Surgery of the Hand. 2021)
The recovery time depends on the elbow’s stability after closed reduction or surgery.
Healthcare providers will initiate active motion exercises. (American Society for Surgery of the Hand. 2021)
Limiting how long the joint is immobilized will prevent stiffness, scarring, and inhibited movement.
Healthcare providers don’t recommend immobilization for more than a few weeks.

Resuming Normal Activities

Resuming regular activity often depends on the type of treatment for the elbow dislocation: (Ortho Bullets. 2023)

Closed Reduction

The elbow is splinted for five to ten days.
Individuals may engage in physical therapy early motion activity to help prevent loss of range of motion.
Individuals are recommended to do light exercises within two weeks after the injury.

Surgical Reduction

The elbow may be placed in a brace that allows for a gradual increase in motion.
It is essential to maintain controlled movement to prevent motion loss.
The elbow can extend fully within six to eight weeks, although it could take up to five months for complete restoration.
The healthcare provider will determine when it’s safe to resume normal activity.

The Path to Healing Personal Injury

References

Layson J, Best BJ. Elbow Dislocation. [Updated 2023 Jul 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK549817/

American Society for Surgery of the Hand. (2021). Elbow dislocation.

American Academy of Orthopaedic Surgeons. (2023). Elbow dislocation.

Jones J, Carroll D, El-Feky M, et al. (2023). Elbow dislocation. Reference article, Radiopaedia.org https://doi.org/10.53347/rID-10501

Medline Plus. (2022). Closed reduction of a fractured bone.

Ortho Bullets. (2023). Elbow dislocation.

Ankle Replacement Surgery: What to Expect from Physical Therapy

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

A physiotherapist has a patient perform exercises for ankle proprioception in studio

“Progress can be challenging for individuals in post-total ankle replacement surgery. How can physical therapy help in recovery and restoring leg function?”

Table of Contents

Total Ankle Replacement Post Surgery Physical Therapy

Total ankle replacement surgery is a major procedure that takes time to recover. A total ankle replacement surgery or arthroplasty can benefit individuals with chronic ankle pain or disability. This procedure can significantly improve an individual’s overall pain and function with time. Physical therapy is essential to regaining movement in the ankle and restoring full mobility. A physical therapist will work with the individual to control pain and swelling, restore the ankle’s range of motion, train on walking gait and balance, and rebuild strength in the leg. This will help maximize the chances of a successful outcome after surgery.

Total Ankle Replacement

The ankle joint is the section of the lower leg where the shinbone/tibia meets the talus bone on the top of the foot. What can happen is the slippery surface/articular cartilage that coats the ends of these bones begins to thin or deteriorate. As the deterioration progresses, it can lead to significant pain, disability, and difficulty walking. (Cleveland Clinic. 2021) This is where a specialist may recommend total ankle replacement for the best results. Various conditions can be helped by this procedure, including:

Joint damage caused by gout
Post-traumatic arthritis
Rheumatoid arthritis
Advanced osteoarthritis
Osteonecrosis
Septic arthritis (Cort D. Lawton et al., 2017)

During an ankle replacement procedure, an orthopedic surgeon removes the damaged ends of the tibia and talus bones and replaces them with an artificial covering. A polyethylene component is also secured between the two structures to support the smooth movement of the new joint endings. (Massachusetts General Hospital. N.D.) Following the procedure, individuals are typically placed in a protective boot or splint. The healthcare provider will recommend staying off the leg for 4 to 8 weeks to allow healing.

Physical Therapy

Outpatient physical therapy is usually initiated several weeks after the ankle operation. (UW Health Orthopedics and Rehabilitation. 2018) Physical therapy can last for five months or more, depending on the severity of the condition and injury. The physical therapist will focus on different areas to get the best results. (Cort D. Lawton et al., 2017)

Pain and Swelling Control

Post-operative pain and swelling are normal after a total ankle replacement. It is not unusual for an ankle to be swollen for even six to 12 months after the operation. (UW Health Orthopedics and Rehabilitation. 2018) The surgeon will normally prescribe medication to help manage discomfort early on, and physical therapy also plays an important role in addressing the symptoms. Treatments used can include:

Electrical stimulation – mild electrical pulses applied to the muscles.
Ice
Vasopneumatic compression, where an inflatable sleeve is used to create pressure around the area, is commonly utilized at the beginning of physical therapy to reduce pain or swelling.
Other modalities, such as stretching and targeted exercises, are combined with other treatments.

Range of Motion

Early after the procedure, the ankle will be very stiff and tight. This is due to several factors, including the inflammation and swelling after surgery and the time spent immobilized in a boot.
The physical therapist will employ various techniques to improve the ankle joint’s range of motion to rotate and flex.
The physical therapist may employ passive stretching induced by an outside force such as the therapist or a resistance band) to help improve mobility.
Manual techniques like soft tissue massage and joint mobilizations are also utilized. (Massachusetts General Hospital. N.D.)
The therapist will develop a home rehabilitation program comprising self-stretching techniques and gentle movements.

Gait and Balance Training

After weeks of staying off the affected ankle, the surgeon will clear the patient to begin walking training.
The physical therapist will work to improve the overall gait pattern and reduce limping.
They will also help transition from using crutches or a walker to walking independently. (UW Health Orthopedics and Rehabilitation. 2018)
After multiple weeks of reduced movement and lack of bearing any weight on the ankle, the muscles that surround the ankle have often atrophied/weakened, which can impact balance.
When the individual can begin placing weight on the leg, the therapist will apply proprioceptive/sense of body position training to improve overall stability. (UW Health Orthopedics and Rehabilitation. 2018)
Balance exercises will be added to the home program and will progress from week to week.

Strength

The muscles in the leg, ankle, and foot become weak from the surgery and the time spent in a splint or boot. These structures have a significant role in balance, the ability to stand, walk, and go up or down the stairs.

Regaining the strength and power of these muscles is a critical goal of rehabilitation.
In the first weeks, the physical therapist will focus on gentle strengthening exercises.
Isometrics lightly activate the muscles but avoid irritating the surgical site.
As time passes and weight-bearing is allowed, these gentle moves are replaced with more challenging ones, like resistance bands and standing exercises, to accelerate strength gains.

Treating Ankle Sprains with Chiropractic Care

References

Cleveland Clinic. (2021). Total ankle replacement.

Lawton, C. D., Butler, B. A., Dekker, R. G., 2nd, Prescott, A., & Kadakia, A. R. (2017). Total ankle arthroplasty versus ankle arthrodesis-a comparison of outcomes over the last decade. Journal of orthopaedic surgery and research, 12(1), 76. https://doi.org/10.1186/s13018-017-0576-1

Massachusetts General Hospital. (N.D.). Physical therapy guidelines for total ankle arthroplasty.

UW Health Orthopedics and Rehabilitation. (2018). Rehabilitation guidelines following total ankle arthroplasty.

Living With Postural Orthostatic Tachycardia Syndrome

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

Session of manual therapy for pregnant woman in modern wellness center — Session of manual therapy for a pregnant woman in a modern wellness center, the room has a lot of sunlight

“Postural orthostatic tachycardia syndrome is a medical condition that causes lightheadedness and palpitations after standing. Can lifestyle adjustments and multidisciplinary strategies help reduce and manage symptoms?”

Table of Contents

Postural Orthostatic Tachycardia Syndrome – POTS

Postural orthostatic tachycardia syndrome, or POTS, is a condition that varies in severity from relatively mild to incapacitating. With POTS:

The heart rate increases dramatically with body position.
This condition often affects young individuals.
Most individuals with postural orthostatic tachycardia syndrome are women between the ages of 13 and 50.
Some individuals have a family history of POTS; some individuals report POTS began after an illness or stressor, and others report it began gradually.
It usually resolves over time.
Treatment can be beneficial.
Diagnosis is based on assessing blood pressure and pulse/heart rate.

Symptoms

Postural orthostatic tachycardia syndrome can affect young individuals who are otherwise healthy and can begin suddenly. It usually happens between the ages of 15 and 50, and women are more likely to develop it than men. Individuals can experience various symptoms within a few minutes of standing up from a lying or seated position. The symptoms can occur regularly and daily. The most common symptoms include: (National Institutes of Health. National Center for Advancing Translational Sciences. Genetic and Rare Diseases Information Center. 2023)

Anxiety
Lightheadedness
A feeling like you’re about to pass out.
Palpitations – sensing rapid or irregular heart rate.
Dizziness
Headaches
Blurred vision
Legs turn to reddish-purple.
Weakness
Tremors
Fatigue
Sleep problems
Trouble concentrating/brain fog.
Individuals may also experience recurrent episodes of fainting, usually without any trigger/s other than standing up.
Individuals can experience any combination of these symptoms.
Sometimes, individuals cannot handle sports or exercise and may feel light-headed and dizzy in response to mild or moderate physical activity, which can be described as exercise intolerance.

Associated Effects

Postural orthostatic tachycardia syndrome can be associated with other dysautonomia or nervous system syndromes, like neurocardiogenic syncope.
Individuals are often co-diagnosed with other conditions like:
Chronic fatigue syndrome
Ehlers-Danlos syndrome
Fibromyalgia
Migraines
Other autoimmune conditions.
Bowel conditions.

Causes

Usually, standing up causes blood to rush from the torso to the legs. The sudden change means less blood is available for the heart to pump. To compensate, the autonomic nervous system sends signals to the blood vessels to constrict to push more blood to the heart and maintain blood pressure and a normal heart rate. Most individuals do not experience significant changes in blood pressure or pulse when standing up. Sometimes, the body is unable to perform this function correctly.

If blood pressure drops from standing and causes symptoms like lightheadness, it is known as orthostatic hypotension.
If the blood pressure remains normal, but the heart rate gets faster, it is POTS.
The exact factors that cause postural orthostatic tachycardia syndrome are different in individuals but are related to changes in:
The autonomic nervous system, adrenal hormone levels, total blood volume, and poor exercise tolerance. (Robert S. Sheldon et al., 2015)

Autonomic Nervous System

The autonomic nervous system controls blood pressure and heart rate, which are the areas of the nervous system that manage internal bodily functions like digestion, respiration, and heart rate. It is normal for blood pressure to drop slightly and the heart rate to speed up a little when standing. With POTS, these changes are more pronounced.

POTS is considered a type of dysautonomia, which is diminished regulation of the autonomic nervous system.
Several other syndromes are also thought to be related to dysautonomia, like fibromyalgia, irritable bowel syndrome, and chronic fatigue syndrome.
It isn’t clear why the syndrome or any of the other types of dysautonomia develop, but there seems to be a familial predisposition.

Sometimes the first episode of POTS manifests after a health event like:

Pregnancy
Acute infectious illness, for example, a severe case of influenza.
An episode of trauma or concussion.
Major surgery

Diagnosis

A diagnostic evaluation will include a medical history, a physical examination, and diagnostic tests.
The healthcare provider will take blood pressure and pulse at least twice. Once while lying down and once while standing.
Blood pressure measurements and pulse rate lying down, sitting, and standing are orthostatic vitals.
Typically, standing up increases the heart rate by 10 beats per minute or less.
With POTS, heart rate increases by 30 beats per minute while blood pressure remains unchanged. (Dysautonomia International. 2019)
The heart rate stays elevated for over a few seconds upon standing/usually 10 minutes or more.
Symptoms happen frequently.
Lasts more than a few days.

Positional pulse changes are not the only diagnostic consideration for postural orthostatic tachycardia syndrome, as individuals can experience this change with other conditions.

Tests

Some experts use a tilt-table test for the initial diagnosis and monitor therapy. (National Institutes of Health. National Center for Advancing Translational Sciences. Genetic and Rare Diseases Information Center. 2023)
During this test, blood pressure and pulse are measured several times when lying on a table and when the table is moved to an upright position.

Differential Diagnosis

There are various causes of dysautonomia, syncope, and orthostatic hypotension.
Throughout the evaluation, the healthcare provider may look at other conditions, like dehydration, deconditioning from prolonged bed rest, and diabetic neuropathy.
Medications like diuretics or blood pressure medication can cause similar effects.

Treatment

Several approaches are used in managing POTS, and individuals may require a multidisciplinary approach. The healthcare provider will advise regularly checking blood pressure and pulse at home to discuss the results when going in for medical checkups.

Fluids and Diet

Drinking non-caffeinated fluids can keep the body hydrated.
A healthcare provider can calculate the right amount of fluids that are needed each day.
Overnight dehydration is common, so it is especially important to drink fluids first thing in the morning, preferably before getting out of bed and standing.
It is also important to maintain adequate sodium levels. (National Institutes of Health. National Center for Advancing Translational Sciences. Genetic and Rare Diseases Information Center. 2023)

Exercise Therapy

Exercise and physical therapy can help the body learn to adjust to an upright position.
Because it can be challenging to exercise when dealing with POTS, a targeted exercise program under supervision may be required.
An exercise program may begin with swimming or using rowing machines, which do not require upright posture. (Dysautonomia International. 2019)
After a month or two, walking, running, or cycling may be added.
Studies have shown that individuals with POTS, on average, have smaller cardiac chambers than individuals who don’t have the condition.
Regular aerobic exercise has been shown to increase cardiac chamber size, slow heart rate, and improve symptoms. (Qi Fu, Benjamin D. Levine. 2018)
Individuals must continue an exercise program for the long term to keep symptoms from returning.

Medication

Prescription medications to manage POTS include midodrine, beta-blockers, pyridostigmine – Mestinon, and fludrocortisone. (Dysautonomia International. 2019)
Ivabradine, used for the heart condition of sinus tachycardia, has also been used effectively in some individuals.

Conservative Interventions

Other ways to help prevent symptoms include:

Sleeping in the head-up position by elevating the head of the bed off the ground 4 to 6 inches utilizing an adjustable bed, blocks of wood, or risers.
This increases the blood volume in circulation.
Performing countermeasure maneuvers like squatting, squeezing a ball, or crossing the legs. (Qi Fu, Benjamin D. Levine. 2018)
Wearing compression stockings to prevent too much blood from flowing into the legs when standing can help avoid orthostatic hypotension. (Dysautonomia International. 2019)

Conquering Congestive Heart Failure

References

National Institutes of Health. National Center for Advancing Translational Sciences. Genetic and Rare Diseases Information Center (GARD). (2023). Postural orthostatic tachycardia syndrome.

Sheldon, R. S., Grubb, B. P., 2nd, Olshansky, B., Shen, W. K., Calkins, H., Brignole, M., Raj, S. R., Krahn, A. D., Morillo, C. A., Stewart, J. M., Sutton, R., Sandroni, P., Friday, K. J., Hachul, D. T., Cohen, M. I., Lau, D. H., Mayuga, K. A., Moak, J. P., Sandhu, R. K., & Kanjwal, K. (2015). 2015 heart rhythm society expert consensus statement on the diagnosis and treatment of postural tachycardia syndrome, inappropriate sinus tachycardia, and vasovagal syncope. Heart rhythm, 12(6), e41–e63. https://doi.org/10.1016/j.hrthm.2015.03.029

Dysautonomia International. (2019). Postural Orthostatic Tachycardia Syndrome

Fu, Q., & Levine, B. D. (2018). Exercise and non-pharmacological treatment of POTS. Autonomic neuroscience : basic & clinical, 215, 20–27. https://doi.org/10.1016/j.autneu.2018.07.001

Maintaining a Healthy Fitness Level: Taking A Workout Break

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

Young fitness woman taking a break after jogging and listening to music on smartphone

“For athletes, fitness enthusiasts, and individuals getting into regular exercise, can a workout break be beneficial if structured properly?”

Table of Contents

Workout Break

Giving oneself permission to take a break from exercising is necessary, especially to maintain a current fitness level. To stay fit at every level and injury-free, the body needs rest and recovery, especially to progress in performance levels. Regular exercise is important for:

Building endurance
Improving strength
Losing and maintaining weight
Relieving stress

What Is It?

A voluntary pause/workout break is a dedicated amount of time when the individual chooses not to work out. It is typically a response to individual body cues when the person knows their mind and body need to take a break from exercising. A workout break is different than a rest day as it may last one or two weeks from the regular training routine. Individuals may need to take a break because the workouts are becoming boring and/or the possibility of burning out or overtraining.

Fitness Impact

Studies on recreational soccer players showed that three to six weeks of inactivity did not change aerobic capacity and muscle strength. (Chang Hwa Joo. 2018)
Extremely fit individuals will experience a rapid drop in fitness during the first three weeks of inactivity before leveling off. (Chang Hwa Joo. 2018)
It takes about two months of inactivity to lose the gains made completely. (Jonny St-Amand et al., 2012)

Medical experts provide terms for individuals who may be doing too much:

Overreaching is when the training becomes excessive, and performance begins to fall. It can be short- or long-term.
Overtraining occurs when overreaching is not addressed.
Overtraining syndrome/OTS lasts longer and results in more serious performance setbacks along with symptoms like hormone changes, depression, fatigue, and systemic inflammation. (Jeffrey B. Kreher. 2016)
Overreaching or overtraining feels like fitness progress is moving backward instead of forward. The more training, the slower and more fatigued the body becomes.
Endurance athletes have an increased risk of overreaching and overtraining. (Jeffrey B. Kreher. 2016)
The endurance mindset encourages pushing more hours of training to get stronger and faster. However, at a certain point, performance suffers.
Some research suggests using the term paradoxical deconditioning syndrome that can lead to overtraining. (Flavio A. Cadegiani, Claudio Elias Kater. 2019)

Break Benefits

Taking a break allows the restoration of balance to focus on work or school, manage various life events, and enjoy friends and family time. Studies have suggested that achieving a better work/life balance can improve:

Job performance and satisfaction.
Organization
Life and family satisfaction.
Fitness, life balance, and health vary for everybody. (Andrea Gragnano et al., 2020)
Overtraining usually results from training too much and insufficient recovery.
Fitness and training experts recommend rest and light training as therapy for overtraining. (Jeffrey B. Kreher. 2016)

Signs The Body Needs A Break

A few signs and common symptoms may indicate a workout break may be needed.

Constantly unmotivated or bored
Not looking forward to working out
Poor performance
Physical exhaustion
Fatigue
Soreness that does not resolve
Lack of progress in workouts

Alternate Activities

During the workout break, engage in other active things that work the body differently, like playing table tennis, for example, or activities that are fun but keep the body moving without doing hard workouts. Remember, the body doesn’t have to be completely inactive. Individuals can try out:

Leisurely bike riding
Dancing
Climbing
Easy yardwork
Yoga or Pilates
Stretching

Returning To Working Out

It could feel like starting over, but it won’t take long for the body to remember how to exercise. It just needs to get used to working out again. It can be tempting to jump into an all-out workout routine, but that is not recommended because of the risk of injury. Here are a few basic principles to keep the body strong and healthy while easing back into a regular workout routine.

Start Simple

Start with a lighter version of the regular routine using lighter weights and less intensity.

Give The Body Time

Use the first two weeks for the body to get used to the workouts.
It can take up to three weeks to get back, depending on workouts before and how much relaxation time has passed.

Take Extra Rest Days

Returning to exercise means the body is going to be extra sore.
Plan extra recovery days so the body can heal and gain strength.
Each week, gradually increase the intensity until it is back to regular performance.

Revolutionizing Healthcare

References

Joo C. H. (2018). The effects of short term detraining and retraining on physical fitness in elite soccer players. PloS one, 13(5), e0196212. https://doi.org/10.1371/journal.pone.0196212

St-Amand, J., Yoshioka, M., Nishida, Y., Tobina, T., Shono, N., & Tanaka, H. (2012). Effects of mild-exercise training cessation in human skeletal muscle. European journal of applied physiology, 112(3), 853–869. https://doi.org/10.1007/s00421-011-2036-7

Kreher J. B. (2016). Diagnosis and prevention of overtraining syndrome: an opinion on education strategies. Open access journal of sports medicine, 7, 115–122. https://doi.org/10.2147/OAJSM.S91657

Cadegiani, F. A., & Kater, C. E. (2019). Novel insights of overtraining syndrome discovered from the EROS study. BMJ open sport & exercise medicine, 5(1), e000542. https://doi.org/10.1136/bmjsem-2019-000542

Gragnano, A., Simbula, S., & Miglioretti, M. (2020). Work-Life Balance: Weighing the Importance of Work-Family and Work-Health Balance. International journal of environmental research and public health, 17(3), 907. https://doi.org/10.3390/ijerph17030907

A Healthy Snack Option – Sunflower Seeds Explained

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

Composition with sunflower, oil and seeds on wooden background

“For individuals looking for a quick healthy snack, can adding sunflower seeds to one’s diet provide health benefits?”

Table of Contents

Sunflower Seeds

Sunflower seeds are the fruit of the sunflower plant. They have been found to contain antioxidants, vitamins, and minerals, which can help maintain immune system health, heart health, and more. Regularly grabbing a handful as a snack or adding to salads, oatmeal, baked goods, tuna salad, pasta, and vegetable toppings can help increase energy levels, reduce inflammation, and support general body health.

Benefits

Sunflower seeds are beneficial for various bodily functions and protect against certain chronic health conditions. They can help with the following: (Bartholomew Saanu Adeleke, Olubukola Oluranti Babalola. 2020) (Ancuţa Petraru, Florin Ursachi, Sonia Amariei. 2021)

Inflammation

The seed’s high vitamin E value, combined with flavonoids and various plant compounds, can help reduce inflammation.
Research suggests that eating seeds at least five times a week may reduce inflammation and lower the risk of developing certain diseases. (Rui Jiang et al., 2006)

Heart Health

They are high in healthy fats, like polyunsaturated and monounsaturated fats.
Plant sterols, or the natural compounds in sunflower seeds, are recommended for their cholesterol-lowering properties. (University of Wisconsin Health. 2023)
Data show sunflower and other seeds consumption may lower rates of heart disease, high blood pressure, and high cholesterol.

Energy

The seeds contain vitamin B, selenium, and protein, which can help energize the body throughout the day.
These nutrients support blood circulation, oxygen delivery, and food conversion into energy.

Immune System Support

Sunflower seeds contain minerals and nutrients like zinc and selenium that help the body’s natural ability to defend against viruses and bacteria.
These minerals translate into benefits like immune cell maintenance, inflammation reduction, infection protection, and an overall increase in immunity.

Nutrition

Individuals don’t need to consume a lot of sunflower seeds to gain the nutritional benefits. Inside is a well-rounded mix of healthy fats, antioxidants, and other nutrients. Inside a 1-ounce portion of roasted sunflower seeds/without salt: (U.S. Department of Agriculture. 2018)

Calories – 165
Carbohydrates – 7 grams
Fiber – 3 grams
Sugar – 1 grams
Protein – 5.5 grams
Total fat – 14 grams
Sodium – 1 milligrams
Iron – 1 milligram
Vitamin E – 7.5 milligrams
Zinc – 1.5 milligrams
Folate – 67 micrograms

Female Health

When it comes to female reproductive health, there are aspects that the seeds may be able to help support.
The seed’s rich amounts of vitamin E, folate, phosphorus, and healthy fats are crucial for fetal development and maternal health.
In addition, the seeds’ phytochemicals can support digestion and the immune system, which can be beneficial during pregnancy. (National Institutes of Health Office of Dietary Supplements. 2021)

Male Health

Sunflower seeds can help males acquire protein for muscle-building.
As an alternative to meat, these seeds contain a healthy amount of plant-based protein without the additional saturated fat or cholesterol of meat.
A handful provides this nutrient for those who don’t get the daily potassium requirement. (Ancuţa Petraru, Florin Ursachi, Sonia Amariei. 2021)

Shelled Seeds and Salt Intake

Sunflower seeds naturally do not contain high amounts of sodium, but they are often packaged with added salt that can potentially sabotage their nutritional benefits.
The shells are usually coated in salt for flavor, as much as 70 milligrams for every 1 ounce of seeds.
High in calories, individuals should consider moderating portions to one-quarter cup and eating the unsalted varieties. (U.S. Department of Agriculture. 2018)

Other Ways To Incorporate Seeds Into Meals

Other ways to add sunflower seeds to meals include:

Sprinkling them on chicken or a tuna salad.
Salad topping.
Topping for cereal and oatmeal.
Mixing them into batter for baked goods, like cookies.
Adding them to homemade or grocery store trail mix.
Grinding the seeds for a flour coating for meat or fish.
Sprinkling them into vegetable dishes, casseroles, stir-fries, and pasta.
Sunflower butter can be an alternative to peanut or other nut butters.

Sports Injury Rehabilitation

References

Adeleke, B. S., & Babalola, O. O. (2020). Oilseed crop sunflower (Helianthus annuus) as a source of food: Nutritional and health benefits. Food science & nutrition, 8(9), 4666–4684. https://doi.org/10.1002/fsn3.1783

Petraru, A., Ursachi, F., & Amariei, S. (2021). Nutritional Characteristics Assessment of Sunflower Seeds, Oil and Cake. Perspective of Using Sunflower Oilcakes as a Functional Ingredient. Plants (Basel, Switzerland), 10(11), 2487. https://doi.org/10.3390/plants10112487

Jiang, R., Jacobs, D. R., Jr, Mayer-Davis, E., Szklo, M., Herrington, D., Jenny, N. S., Kronmal, R., & Barr, R. G. (2006). Nut and seed consumption and inflammatory markers in the multi-ethnic study of atherosclerosis. American journal of epidemiology, 163(3), 222–231. https://doi.org/10.1093/aje/kwj033

University of Wisconsin Health. (2023). Health facts for you: Plant stanols and sterols.

U.S. Department of Agriculture. (2018). Seeds, sunflower seed kernels, dry roasted, without salt.

National Institutes of Health Office of Dietary Supplements. (2021). Vitamin E: Fact Sheet for Health Professionals.

U.S. Department of Agriculture. (2018). Seeds, sunflower seed kernels, toasted, with salt added.

How to Reduce Chronic Tension Headaches

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

Chiropractor readjusting the cervical of a patient lying on a stretcher in a clinic

“For individuals affected by headaches that occur 15 or more days a month for more than three months, can knowing the signs and symptoms help healthcare providers help treat and prevent chronic tension headaches?”

Table of Contents

Chronic Tension Headaches

Most individuals have experienced a tension-type headache. The pain is usually described as a dull tightening or pressure on both sides of the head, like having a tightening band around the head. Some individuals experience these headaches frequently, a condition known as chronic tension headaches. Chronic tension headaches are uncommon but can be debilitating, as they can interfere with a healthy quality of life and daily living.

Tension headaches are typically caused by stress, anxiety, dehydration, fasting, or lack of sleep and usually resolve with over-the-counter medications. (Cleveland Clinic. 2023)
This is a primary headache disorder that affects around 3% of the population.
Chronic tension headaches can occur daily and negatively impact the quality of life and daily functioning. (Cleveland Clinic. 2023)

Symptoms

Tension headaches can be referred to as stress headaches or muscle contraction headaches.
They can present with dull, aching pain and include tightness or pressure across the forehead, sides, or back of the head. (Cleveland Clinic. 2023)
Additionally, some individuals experience tenderness on the scalp, neck, and shoulders.
Chronic tension headaches materialize 15 or more days a month on average for more than three months.
The headache can last for several hours or be continuous for several days.

Causes

Tension headaches are typically caused by tight muscles in the shoulders, neck, jaw, and scalp.
Teeth grinding/bruxism and jaw clenching can also contribute to the condition.
Headaches can be brought on by stress, depression, or anxiety and are more common in individuals who:
Work long hours in stressful jobs.
Don’t get enough sleep.
Skip meals.
Frequently consume alcohol. (Cleveland Clinic. 2023)

Diagnosis

Individuals experiencing headaches that interfere with daily life or need to take medication more than twice a week are recommended to consult a healthcare provider. Before the appointment, it can be helpful to keep a headache diary:

Record the days
Times
Description of the pain, intensity, and other symptoms.

Some questions the healthcare provider may ask include:

Is the pain pulsating, sharp, or stabbing, or is it constant and dull?
Where is the pain most intense?
Is it all over the head, on one side, on the forehead, or behind the eyes?
Do the headaches interfere with sleep?
Is working or doing tasks difficult or impossible?

A healthcare provider will likely be able to diagnose the condition based on symptoms alone. However, if the headache pattern is unique or different, the provider may order imaging tests, like MRI or CT scans, to rule out other diagnoses. Chronic tension headaches can be confused with other chronic daily headache disorders like chronic migraine, hemicrania continua, temporomandibular joint dysfunction/TMJ, or cluster headaches. (Fayyaz Ahmed. 2012)

Treatment

Pharmacological therapy for chronic tension headaches usually involves preventive medication.

Amitriptyline is one medication that has been found to be beneficial in chronic tension headache prevention.
A tricyclic antidepressant is a sedating medication and is usually taken before sleeping. (Jeffrey L. Jackson et al., 2017)
According to a meta-analysis of 22 published studies in the Journal of General Internal Medicine, these medications are superior to placebo in reducing headache frequency, with an average of 4.8 fewer headache days per month.

Additional preventive medications may include other antidepressants like:

Remeron – mirtazapine.
Anti-seizure medications – like Neurontin – gabapentin, or Topamax – topiramate.

A healthcare provider may also prescribe medication to treat headache episodes, which include:

Prescription non-steroidal anti-inflammatory drugs or NSAIDs, including acetaminophen, naproxen, indomethacin, or ketorolac.
Opiates
Muscle relaxants
Benzodiazepines – Valium

Non-Medication Treatment

Behavioral therapies are sometimes used on their own or in combination with medication to prevent and manage chronic tension headaches. Examples include:

Acupuncture

An alternative therapy that involves using needles to stimulate specific points on the body believed to connect with certain pathways/meridians that carry vital energy/chi throughout the body.

Biofeedback

In Electromyography – EMG biofeedback, electrodes are placed on the scalp, neck, and upper body to detect muscle contraction.
The patient is trained to control muscle tension to prevent headaches. (William J. Mullally et al., 2009)
The process can be costly and time-consuming, and there is little evidence to support its effectiveness.

Physical Therapy

A physical therapist can work out stiff and tight muscles.
Train individuals on stretches and targeted exercises for loosening tight head and neck muscles.

Cognitive Behavioral Therapy/CBT

Involves learning how to identify headache triggers and cope in a less stressful and more adaptive way.
Headache specialists often recommend CBT in addition to medication when developing a treatment plan. (Katrin Probyn et al., 2017)
Teeth-grinding and jaw-clenching training/treatment can help when they are contributors.
Regular exercise, as well as practicing healthy sleep hygiene, can be beneficial in prevention.

Supplements

Some individuals with chronic tension headaches may find relief using supplements. The American Academy of Neurology and the American Headache Society report the following supplements can be effective: (National Center for Complementary and Integrative Health. 2021)

Butterbur
Feverfew
Magnesium
Riboflavin

If the headaches come on suddenly, cause waking up from sleep, or last for days, it’s important to consult a healthcare provider to rule out any underlying causes and develop a personalized treatment plan.

Tension Headaches

References

Cleveland Clinic. (2023). Tension Headaches.

Ahmed F. (2012). Headache disorders: differentiating and managing the common subtypes. British journal of pain, 6(3), 124–132. https://doi.org/10.1177/2049463712459691

Jackson, J. L., Mancuso, J. M., Nickoloff, S., Bernstein, R., & Kay, C. (2017). Tricyclic and Tetracyclic Antidepressants for the Prevention of Frequent Episodic or Chronic Tension-Type Headache in Adults: A Systematic Review and Meta-Analysis. Journal of general internal medicine, 32(12), 1351–1358. https://doi.org/10.1007/s11606-017-4121-z

Mullally, W. J., Hall, K., & Goldstein, R. (2009). Efficacy of biofeedback in the treatment of migraine and tension type headaches. Pain physician, 12(6), 1005–1011.

Probyn, K., Bowers, H., Mistry, D., Caldwell, F., Underwood, M., Patel, S., Sandhu, H. K., Matharu, M., Pincus, T., & CHESS team. (2017). Non-pharmacological self-management for people living with migraine or tension-type headache: a systematic review including analysis of intervention components. BMJ open, 7(8), e016670. https://doi.org/10.1136/bmjopen-2017-016670

National Center for Complementary and Integrative Health. (2021). Headaches: What You Need To Know.

Diagnosis & Treatment of Spinal Synovial Cysts

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

Physiatrist examining patient for sciatica using straight leg raise test — Smiling adult man lying supine on examination bed while physiotherapist lifting his extended lower limb with resistance

“Individuals that have gone through a back injury may develop a synovial spinal cyst as a way to protect the spine that could cause pain symptoms and sensations. Can knowing the signs help healthcare providers develop a thorough treatment plan to relieve pain and prevent worsening of the condition and other spinal conditions?”

Table of Contents

Spinal Synovial Cysts

Spinal synovial cysts are benign fluid-filled sacs that develop in the spine’s joints. They form because of spinal degeneration or injury. The cysts can form anywhere in the spine, but most occur in the lumbar region/lower back. They typically develop in the facet joints or junctions that keep the vertebrae/spinal bones interlocked.

Symptoms

In most cases, synovial cysts don’t cause symptoms. However, the doctor or specialist will want to monitor for signs of degenerative disc disease, spinal stenosis, or cauda equina syndrome. When symptoms do present, they typically cause radiculopathy or nerve compression, which can cause back pain, weakness, numbness, and radiating pain caused by the irritation. The severity of symptoms depends on the size and location of the cyst. Synovial cysts can affect one side of the spine or both and can form at one spinal segment or at multiple levels.

Effects Can Include

Radiculopathy symptoms can develop if the cyst or inflammation caused by the cyst comes into contact with a spinal nerve root. This can cause sciatica, weakness, numbness, or difficulty controlling certain muscles.
Neurogenic claudication/impingement and inflammation of spinal nerves can cause cramping, pain, and/or tingling in the lower back, legs, hips, and buttocks. (Martin J. Wilby et al., 2009)
If the spinal cord is involved, it may cause myelopathy/severe spinal cord compression that can cause numbness, weakness, and balance problems. (Dong Shin Kim et al., 2014)
Symptoms related to cauda equina, including bowel and/or bladder problems, leg weakness, and saddle anesthesia/loss of sensation in the thighs, buttocks, and perineum, can present but are rare, as are synovial cysts in the middle back and neck. If thoracic and cervical synovial cysts develop, they can cause symptoms like numbness, tingling, pain, or weakness in the affected area.

Causes

Spinal synovial cysts are generally caused by degenerative changes like osteoarthritis that develop in a joint over time. With regular wear and tear, facet joint cartilage/the material in a joint that provides protection, a smooth surface, friction reduction, and shock absorption begins to waste away. As the process continues, the synovium can form a cyst.

Traumas, large and small, have inflammatory and degenerative effects on joints that can result in the formation of a cyst.
Around a third of individuals who have a spinal synovial cyst also have spondylolisthesis.
This condition is when a vertebrae slips out of place or out of alignment onto the vertebra underneath.
It is a sign of spinal instability.
Instability can occur in any spine area, but L4-5 are the most common levels.
This segment of the spine takes most of the upper body weight.
If instability occurs, a cyst can develop.
However, cysts can form without instability.

Diagnosis

Cysts are generally diagnosed through MRI. (Nancy E, Epstein, Jamie Baisden. 2012)
They can sometimes be seen with ultrasound, X-ray, or CT scans.

Treatment

Some cysts remain small and cause few to no symptoms. Cysts only need treatment if they are causing symptoms. (Nancy E, Epstein, Jamie Baisden. 2012)

Lifestyle Adjustments

A healthcare professional will recommend avoiding certain activities that worsen symptoms.
Individuals might be advised to begin stretching and targeted exercises.
Physical therapy or occupational therapy may also be recommended.
Intermittent use of over-the-counter nonsteroidal anti-inflammatories/NSAIDs like ibuprofen and naproxen can help relieve occasional pain.

Outpatient Procedures

For cysts that cause intense pain, numbness, weakness, and other issues, a procedure to drain fluid/aspiration from the cyst may be recommended.
One study found that the success rate ranges from 0 percent to 50 percent.
Individuals who go through aspiration usually need repeat procedures if fluid build-up returns. (Nancy E, Epstein, Jamie Baisden. 2012)
Epidural corticosteroid injections can reduce inflammation and could be an option to relieve pain.
Patients are recommended to receive no more than three injections per year.

Surgical Options

For severe or persistent cases, a doctor may recommend decompression surgery to remove the cyst and surrounding bone to relieve pressure on the nerve root. Surgical options range from minimally invasive endoscopic procedures to larger, open surgeries. The best surgical option varies based on the severity of the situation and whether associated disorders are present. Surgical options include:

Laminectomy – Removal of the bony structure that protects and covers the spinal canal/lamina.
Hemilaminectomy – A modified laminectomy where a smaller portion of the lamina is removed.
Facetectomy – The removal of part of the affected facet joint where the synovial cyst is located, usually following a laminectomy or hemilaminectomy.
Fusion of the facet joints and vertebra – Decreases vertebral mobility in the injured area.

Most individuals experience immediate pain relief following a laminectomy or hemilaminectomy.
Fusion can take six to nine months to heal completely.
If surgery is performed without fusion where the cyst originated, the pain could return, and another cyst could form within two years.
Surgery Complications include infection, bleeding, and injury to the spinal cord or nerve root.

How I Gained My Mobility Back With Chiropractic

References

Wilby, M. J., Fraser, R. D., Vernon-Roberts, B., & Moore, R. J. (2009). The prevalence and pathogenesis of synovial cysts within the ligamentum flavum in patients with lumbar spinal stenosis and radiculopathy. Spine, 34(23), 2518–2524. https://doi.org/10.1097/BRS.0b013e3181b22bd0

Kim, D. S., Yang, J. S., Cho, Y. J., & Kang, S. H. (2014). Acute myelopathy caused by a cervical synovial cyst. Journal of Korean Neurosurgical Society, 56(1), 55–57. https://doi.org/10.3340/jkns.2014.56.1.55

Epstein, N. E., & Baisden, J. (2012). The diagnosis and management of synovial cysts: Efficacy of surgery versus cyst aspiration. Surgical neurology international, 3(Suppl 3), S157–S166. https://doi.org/10.4103/2152-7806.98576