Tips for Maintaining Correct Posture Throughout the Day

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

hardworking handsome doctor with mask stretching his patient during appointment in hospital

For individuals who are feeling back pain, neck pain, or shoulder pain, can using postural techniques help decrease pain and develop strategies to maintain correct posture?

Maintaining Correct Posture

Exercise and postural correction are two of the most important strategies to manage pain. (Robin McKenzie, the great spine guru PT, (May S. and Donelson R. 2008) However, it is not easy to maintain correct posture as the day progresses. While working or driving, most of us forget to be mindful of our posture; we slip back into unhealthy habits of sitting slouched, to the side, forward, etc, which often leads to continued pain and movement limitations. Studies on postural correction and its effect on overall back or neck pain levels are limited. (Lederman E. 2011) However, some studies show that a forward-head posture increases stress and load on the neck. (Hansraj K. K. 2014) If an individual has pain that improves with sitting upright, perhaps checking posture as the day progresses could be beneficial. There are ways to start changing posture and maintain the change. First, visit a physical therapist, spine specialist, or chiropractor to learn how to sit or stand to manage posture problems. They can teach individuals how to attain healthy posture and manage their condition. These strategies can then be used to maintain correct posture.

Lumbar Support

A lumbar roll/support is one of the simplest ways to attain and maintain a healthy sitting posture. These specialized pillows can help maintain the forward curve in the lower back. Maintaining the lumbar lordosis curve is essential for keeping stress off the back muscles, joints, and discs. Lumbar support pillows can be found in various stores, office supply stores, or purchased online. A physical therapist PT can help train individuals to use a lumbar roll properly.

Utilize the Slouch Overcorrect Exercise

The slouch overcorrect exercise is a simple maneuver for training the body to find and maintain its neutral position. It involves slowly shifting from a slouched position to an overcorrected postural position. Once posture is overcorrected, a slight relaxation from a fully erect posture will return to sitting properly. Practicing this exercise daily can help train the body to feel the muscles, listen to the body, and maintain proper posture. The muscles have memory, and the more often the body is placed in optimal posture, the muscles memorize their healthy, pain-free positioning.

Kinesiology Tape

Kinesiology tape is a flexible cotton adhesive that facilitates muscle contractions and inhibits muscle spasms and pain. (Han J. T. et al., 2015) Using the tape is a simple way to help facilitate the postural support muscles. The tape can be applied to the middle trapezius and rhomboid muscles to help support the shoulder blades and spine. Kinesiology tape for postural control also gently pulls on the muscles when slouching to remind the individual to sit up or stand straight.

Scapular Stabilization Exercises

A physical therapist or chiropractor can help improve posture through targeted exercises. Strengthening the muscles attached to the shoulder blades can help individuals better control their posture. (Shiravi S. et al., 2019) Exercises like the prone T, I, or Y can help improve the muscles’ neuromuscular recruitment to maintain correct posture.

Use an Alarm

Setting an alarm while working can help train the body to maintain correct posture. Most of us sit at a computer, desk, or workstation with proper posture, but depending on what we’re working on, we eventually slouch, lean to the side, or have a forward head posture. Pretty much all computers and phones have an alarm setting or app. Use the alarm or timer to go off every 20 to 30 minutes. When the alarm rings, look at your posture to recognize what you’re doing, get up and move around to stretch the body, sit and readjust, reset the alarm, and continue working. As you get better at maintaining appropriate posture, you won’t need the alarm anymore, and readjusting will become automatic.

Chiropractic Team

Sitting and standing with unhealthy posture can significantly cause back, neck, and shoulder pain. By visiting a chiropractic and physical therapy team and learning to attain and maintain correct posture, you can quickly relieve pain, resolve musculoskeletal issues, and prevent future pain symptoms. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop a personalized care plan for each patient through an integrated approach to treating injuries and chronic pain syndromes, improving flexibility, mobility, and agility programs to relieve pain and help return to normal and optimal function. If other treatments are needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments.

Scapular Winging In-Depth

References

May, S., & Donelson, R. (2008). Evidence-informed management of chronic low back pain with the McKenzie method. The spine journal : official journal of the North American Spine Society, 8(1), 134–141. https://doi.org/10.1016/j.spinee.2007.10.017

Lederman E. (2011). The fall of the postural-structural-biomechanical model in manual and physical therapies: exemplified by lower back pain. Journal of bodywork and movement therapies, 15(2), 131–138. https://doi.org/10.1016/j.jbmt.2011.01.011

Hansraj K. K. (2014). Assessment of stresses in the cervical spine caused by posture and position of the head. Surgical technology international, 25, 277–279.

Han, J. T., Lee, J. H., & Yoon, C. H. (2015). The mechanical effect of kinesiology tape on rounded shoulder posture in seated male workers: a single-blinded randomized controlled pilot study. Physiotherapy theory and practice, 31(2), 120–125. https://doi.org/10.3109/09593985.2014.960054

Shiravi, S., Letafatkar, A., Bertozzi, L., Pillastrini, P., & Khaleghi Tazji, M. (2019). Efficacy of Abdominal Control Feedback and Scapula Stabilization Exercises in Participants With Forward Head, Round Shoulder Postures and Neck Movement Impairment. Sports health, 11(3), 272–279. https://doi.org/10.1177/1941738119835223

Exploring Voluntary Muscles: Their Importance and Function

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

Professional chiropractor or physiotherapist helps to heal a young woman's back. Doctor fixes the patient lying on a couch of a modern rehabilitation clinic Concept of physical rehabilitation.

Skeletal muscles attached to the arms, legs, neck, back, and trunk bones are voluntary and consciously controlled. Weakness or inability to control these muscles can signal a health issue like a neuromuscular disorder or electrolyte imbalance. Can recognizing the symptoms can help healthcare providers develop effective treatment programs?

Voluntary Muscles

Voluntary muscles are the skeletal muscles that attach to bones and control movement of the limbs, head, neck, and body under an individual’s conscious control. Skeletal muscles are controlled by neuromuscular signals from the brain that communicate with individual muscle fibers and cause them to contract.

Difference

Voluntary muscles are skeletal muscles that contract and relax under conscious control.
These muscles attach to bones and regulate movement of the body.
Involuntary muscles are not under conscious control.
Involuntary muscles involve automatic internal processes needed for survival, like controlling blood vessels and organs like the heart, lungs, and digestive system.
They contract and relax automatically and receive signals from the autonomic nervous system, which regulates internal bodily functions.

Voluntary

Voluntary muscles are skeletal muscles that comprise 40% of the body’s weight and 50% to 75% of the body’s proteins. These muscles can convert chemical and mechanical energy to cause voluntary muscle contraction and movement. (Trovato F.M. et al., 2016) Skeletal muscle comprises fascicles or bundled units of multiple muscle fibers or muscle cells. Each muscle fiber consists of a cross-banded structure further divided into myofibrils containing thick myosin and thin actin myofilaments, which give the muscle its stripe appearance, and the structure gives the characteristic striated structure. (Trovato F.M. et al., 2016) Muscle contraction occurs when these myofilaments move closer together, stimulated by the release of the neurotransmitter acetylcholine from nerve cells that communicate with the muscle fiber.

Involuntary

The autonomic nervous system controls involuntary muscles, regulating their contraction and relaxation. This system also controls the activity of organs and blood vessels for essential daily functions, including breathing, circulation, digestion, heartbeat regulation, and urination. Most involuntary muscles are composed of smooth muscles. Smooth muscles do not have the striated structure of skeletal muscles and consist of sheets or layers of smooth muscle cells. When the autonomic nervous system stimulates these muscle cells to contract by releasing hormones or other chemical signals, smooth muscle cells shorten through the movement of actin and myosin myofilaments. Involuntary smooth muscles include the blood vessel walls, diaphragm, intestines, and bladder. (Webb R. C. 2003) One exception of an involuntary muscle is the myocardium, or heart muscle. The myocardium comprises a specialized cardiac muscle cell found only in the heart. Cardiac muscle is striated like skeletal muscle but is controlled by the autonomic nervous system and pacemaker cells, causing it to contract automatically and rhythmically.

Weakened Voluntary Muscles

Skeletal muscle diseases, neuromuscular disorders, and other causes can weaken muscles. Neuromuscular or skeletal muscle disorders affect the nerves that send electrical signals to voluntary skeletal muscles to control movement. When the nerves are damaged, communication between the nerves and muscles becomes disrupted. This can result in significant muscle weakness, atrophy, and loss of function. Most neuromuscular disorders are genetic or caused by issues with the immune system. Nerves communicate with muscles through the release of neurotransmitters at the neuromuscular junction, which is the space between a nerve cell and muscle fiber. Neuromuscular disorders can damage the nerve or the neuromuscular junction. Neuromuscular disorder symptoms can include: (Cleveland Clinic, 2023)

Numbness and tingling
Muscle weakness
Muscle twitches, cramps, or spasms
Muscle pain
Muscle atrophy
Decreased coordination
Balance problems
Drooping eyelids and double vision from eye muscle weakness.
Difficulty swallowing due to weakness of the pharynx.
Difficulty breathing due to weakness of the diaphragm.

Common Neuromuscular Disorders

Amyotrophic Lateral Sclerosis – ALS

More commonly known as Lou Gehrig’s disease, it is a genetic disorder that results from hardening of the spinal cord.
It causes damage to the nerves that control muscles and voluntary movement.

Charcot-Marie-Tooth Disease

This is a class of peripheral nerve disorders that cause muscle weakness, atrophy, and loss of sensation, most commonly in the legs and feet.
It is a genetic disorder caused by a gene mutation that damages myelin, or the insulating sheath that surrounds all nerves and supports the conduction of electrical signals.

Multiple Sclerosis – MS

MS causes degeneration of the myelin sheath surrounding nerves, decreasing the impulses along the nerves to muscles.
It can result in muscle weakness, which is often more severe on the dominant side of the body.
There are different forms of MS, but the condition is often progressive and gets worse over time if left untreated.

Muscular Dystrophies

These are genetic diseases characterized by gradual loss of motor function, muscle weakness and atrophy, walking gait problems, progressive respiratory failure, and cardiomyopathy.
There are nine types of muscular dystrophy, all caused by genetic mutations.

Myasthenia Gravis

This is an autoimmune disease that causes inflammation throughout the body.
An autoimmune disease occurs when the immune system attacks healthy cells by mistake.
With myasthenia gravis, the body produces antibodies that attack the receptors for acetylcholine, reducing the body’s ability to contract muscles.
This leads to muscle weakness, atrophy, and fatigue.

Myopathies

These are diseases of muscles that cause muscle weakness and atrophy.
Depending on the type, they may progress and get worse over time.

Electrolyte Imbalances

Muscle weakness can result from altered sodium, potassium, calcium, or magnesium levels.

Always seek immediate medical attention for any sudden, unexplained muscle weakness. Individuals who experience skeletal muscle weakness should discuss the type and duration of symptoms with their doctor, specialist, physical therapist, or chiropractor, as this might be a sign of a medical condition such as a neuromuscular disorder. Working with a chiropractic team can help expedite healing. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop a personalized treatment program through an integrated approach to treat injuries and chronic pain syndromes, improving flexibility, mobility, and agility, relieving pain, and helping individuals return to normal activities. If other treatments are needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments.

Chiropractic Massage Therapy

References

Trovato FM, I. M., Conway N, Castrogiovanni P. (2016). Morphological and functional aspects of human skeletal muscle. J Funct Morphol Kinesiol., 1(3), 289-302. https://doi.org/https://doi.org/10.3390/jfmk1030289

Webb R. C. (2003). Smooth muscle contraction and relaxation. Advances in physiology education, 27(1-4), 201–206. https://doi.org/10.1152/advan.00025.2003

Cleveland Clinic. (2023). Mitochondrial diseases. https://my.clevelandclinic.org/health/diseases/15612-mitochondrial-diseases

Homemade Electrolyte Drink: Replenish Your Body Naturally

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

Sports women group, grass and bottle in circle for toast, celebration and diversity with team build.

Replenishing electrolytes and maintaining hydration is essential for individuals who work out, fitness enthusiasts, and those who play recreational or serious sports and want to improve overall health. Can making a homemade sugar-free electrolyte drink help individuals achieve health goals faster?

Homemade Electrolyte Drink

Sports drinks can help replenish the body’s lost electrolytes. Individuals who follow a low-carb diet and exercise or who are on a low-carb diet and get sick need double the added electrolytes. There is evidence that electrolytes are very effective in regulating the body’s fluid balance, especially during and after exercise or illness, and for those on a strict low-carb diet. (Maughan R. J. 1991)

Why More Electrolytes Are Needed

On a low-carb diet, insulin levels drop, so the kidneys retain less sodium. As the body excretes water, important minerals, such as the electrolytes calcium, sodium, magnesium, chloride, and potassium, are also excreted from the body’s system. Therefore, it is important to replenish them to avoid negative symptoms like lightheadedness and dehydration—especially when exercising or ill. (Bostock E. C. S. et al., 2020)

Two tablespoons of lemon juice contain almost the same amount of potassium in an 8-ounce sports drink.
A pinch of salt supplies 110 milligrams of sodium, the same amount in 8 ounces of a sports drink.

Individuals can make a low-carb homemade electrolyte sports drink. Many sports drinks contain a lot of sugar and other additives. The science behind why many of these drinks contain sugar is that a quick hit of sugar provides glucose for replenishing energy stores. Most individuals benefit from having small amounts of carbohydrates during heavy exercise. However, those who want to avoid sugar might want a sugar-free option to replace fluids and electrolytes.

Basic Recipe

Homemade Electrolyte Drink Mix:

1 cup or 8 ounces of non-carbonated water
Two tablespoons of lemon juice
A small pinch of salt—a teaspoon contains 2,300 milligrams of sodium, but the body needs 1/20th of a teaspoon.
Flavoring and sweetener for taste are optional. Try unsweetened Kool-Aid, Crystal Light Drink Mix, or sugar-free flavored syrups.
If avoiding artificial sweeteners, Stevia could be an option.

Sports Drink Ingredients

What goes into most sports drinks and adapting to a low-carb diet?

Water

Water is a primary ingredient, as the goal is to hydrate the body.

Sugar

Sports drinks can contain a lot of sugar, but only about half the sugar of most commercial beverages. For example,

A 20-ounce bottle of Gatorade has about 34 grams of sugar.
A 20-ounce soda has about 69 grams of sugar.

Sports drinks have less sugar to prevent gastrointestinal cramping during exercise and strenuous physical activity. Although Gatorade contains less sugar than soda, depending on individual health goals, it may not be the best option. Studies of nutritional needs during exercise for those restricting carbohydrates are not extensive. However, it is known that when individuals cut carbs, their bodies switch from primarily using carbohydrates to using fat for energy. This change, known as keto-adaptation, can take two to three weeks. Native populations, like the Inuit, traditionally ate a very low-carbohydrate diet and could maintain vigorous endurance for a long time without ill effects. (Phinney S. D. 2004) This suggests that bodies adapt to using fat for energy during physical activity and exercise over time. However, cutting carbohydrates too much and too soon can lead to symptoms like the keto flu. (Harvard Medical School, 2018). Individuals may need to replace carbohydrates during training for longer, more vigorous workouts, such as running longer than an hour. In addition, what is eaten before and after exercise can also affect physical performance. Working with a registered dietitian, nutritionist, or health coach could be helpful to achieve specific fitness goals.

Electrolytes

Electrolytes are molecules of certain minerals that contain an electrical charge. The nervous system runs on those charges generated by manipulating molecules called ions. (Faber D. S. and Pereda A. E. 2018) Every body function that depends on the nervous system, which includes muscle movement, breathing, digestion, thinking, etc., requires electrolyte activity. Those who exercise strenuously for long periods, individuals who follow a low-carb diet, or those with illness may need extra salt and potassium. Sports drinks contain small amounts of sodium and potassium. A balanced diet will supply plenty of minerals for electrolyte needs for individuals engaged in moderate exercise.

Using an integrated approach to treat and prevent injuries and chronic pain syndromes, improve flexibility, mobility, and agility, and help individuals return to normal activities, Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop a personalized treatment, nutrition, and fitness programs. Each case is different and requires reviewing individual medical history and physical examination to determine the proper and most effective plan. Dr. Jimenez has teamed up with top trainers, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments and training.

Is Intermittent Fasting the Ultimate Weight Loss Hack?

References

Maughan R. J. (1991). Fluid and electrolyte loss and replacement in exercise. Journal of sports sciences, 9 Spec No, 117–142. https://doi.org/10.1080/02640419108729870

Bostock, E. C. S., Kirkby, K. C., Taylor, B. V., & Hawrelak, J. A. (2020). Consumer Reports of “Keto Flu” Associated With the Ketogenic Diet. Frontiers in nutrition, 7, 20. https://doi.org/10.3389/fnut.2020.00020

Phinney S. D. (2004). Ketogenic diets and physical performance. Nutrition & metabolism, 1(1), 2. https://doi.org/10.1186/1743-7075-1-2

Harvard Medical School, Harvard Health Publishing, Marcelo Campos, M., Contributor. (2018). What is keto flu? Harvard Health Blog. https://www.health.harvard.edu/blog/what-is-keto-flu-2018101815052

Faber, D. S., & Pereda, A. E. (2018). Two Forms of Electrical Transmission Between Neurons. Frontiers in molecular neuroscience, 11, 427. https://doi.org/10.3389/fnmol.2018.00427

Choosing the Right Pickleball Footwear: A Guide for Players

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

Couple playing pickleball outdoor at daylight. Outdoor sport leisure activity. Bright blue sky

Proper shoes are highly recommended when playing sports, whether professional or recreational. Can wearing pickleball footwear help increase optimal performance and prevent injuries?

Pickleball Footwear

Pickleball has become quite popular because individuals of all ages and abilities can play it. Although it is a relatively new sport, it emerged in 1965. (USA Pickleball, 2021) It’s now one of the fastest-growing sports, with over 8 million players nationwide. (Brandon, 2023) The game can be played with most shoes designed for sports, like running or cross-fit shoes. There are shoes specifically for pickleball that improve traction, enhance stability and cushioning, and increase impact absorption. For those getting into the game long-term, investing in high-quality pickleball footwear is a worthwhile investment that can contribute to long-term enjoyment and injury prevention.

The Demands of Pickleball

Like tennis or table tennis, pickleball involves dynamic and fast-paced movements, including lateral strides, pivoting, and quickly changing direction. The body has to move forward, backward, and side to side across the court and pivot. When chasing the ball, to control the shots, produce power, decrease the risk of injury, and change direction while maintaining balance, the feet, body, and shoes must work together to make all this possible. One consideration depends on where the game will be played, whether flat ground or a harder surface. Wearing sneakers or tennis shoes is recommended for flat-ground play, as they provide supportive cushioning and shock absorption. For harder surfaces like concrete or hardwood courts, specialized shoes like those designed for pickleball are recommended.

Benefits

Some of the benefits of investing in pickleball footwear include.

Optimal Traction

Traction is incredibly important in pickleball. Optimal traction can help players execute quick movements, maintain stability, and prevent slips and falls. When looking for the right shoes, consider traction-specific materials like rubber, nylon, and leather. Individuals are most likely to find rubber pickleball shoes because they’re cheaper and commonly used in other outdoor sport-specific shoes, such as soccer. Nylon is more expensive but offers better traction than rubber and is often used in high-tech sneakers because it provides significant shock absorption and long-term durability. Leather is the most expensive material but offers the best grip. Because of its natural look and feel, it is also becoming more popular in sneakers.

Stability and Support

Moving from side to side in a lateral fashion requires players to be on top of their balance and maintain steadiness when making shots. Pickleball shoes are designed to support stability and can help reduce injuries like sprains.

Impact Absorption Cushioning

Pickleball footwear is designed similarly to running shoes, with cushioned comfort and a midsole that offers shock absorption and reduces the impact felt in the joints, including the knees, lower back, and feet. Individuals can find pickleball footwear that utilizes various sports technologies, like gel inserts or responsive foam, which can help cushion and reduce the impact on the joints. When cushioned, the body can maintain more balance, promote positive movement habits, prevent muscular fatigue and joint pain, help reduce overall stress, and allow individuals to play harder without experiencing pain. Long-term benefits result in a stronger, more flexible body.

Proper Fit and Considerations

Make sure that the pickleball shoes fit well and provide adequate support. Measure your feet using a ruler or measuring tape, and have the measurements handy while shopping. Suggestions include:

Look for shoes that fit snugly but don’t allow the feet to move around too much during play.
Pay attention to arch support.
Individuals with high arches should look for shoes with adjustable straps or more supportive materials built into the sole.

Using an integrated approach to treat and prevent injuries and chronic pain syndromes, improve flexibility, mobility, and agility, and help individuals return to normal activities, Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop a personalized fitness program. Each case is different and requires reviewing individual medical history and physical examination to determine the proper training plan. Dr. Jimenez has teamed up with top trainers, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments if other training is needed.

Custom Foot Orthotics

References

USA Pickleball. (2021). History of the game. https://usapickleball.org/what-is-pickleball/history-of-the-game/

Mackie, B. Pickleheads. (2024). Pickleball statistics. https://www.pickleheads.com/blog/pickleball-statistics#h-key-pickleball-statistics

Headache Self-Care Techniques to Alleviate Pain

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

woman with headache depression stress health problem migraine. High quality photo

For individuals dealing with headaches, can utilizing self-care techniques help ease symptoms?

Headaches Self Care

There are different self-pain-relieving approaches to ease headache-related pain that use non-medication options. While headache self-care pain-relieving techniques can help temporarily, they are recommended to help ease headache symptoms until professional treatment is available. Individuals are encouraged to try multiple strategies to find the right treatment regimen that works for them, which is usually a process of trial and error. Self-care headache relief maneuvers can include temple massages, breathing exercises, exercise, or applying a cold pack to the head.

Self-Care Relief

Commonly used for tension headaches or migraine, a few examples of self-care techniques include (Espí-López G. V. et al., 2016)

Massaging the temples, neck, or scalp with the hand, fingers, or a massage tool.
Applying a cold pack to the affected area.
Heat can be used on the affected area, like a headband or a hot shower.
Compression such as a handkerchief or belt wrapped tightly around the head or pressing firmly on the painful area.

Compression is more commonly utilized in migraineurs versus scalp massage in people with tension headaches. This is often due to the throbbing sensation caused by a migraine versus a tension headache, which feels like a tight grip or band around the head.

Individuals with cluster headaches are more likely to utilize unique approaches, such as covering one ear, rotating the head, shallow breathing, moving around, or closing the nostril on the same side as the head pain.

Other Complementary Options

Other complementary therapies for headache and migraine care include: (Millstine D. et al., 2017)

Trigger point release massage
Progressive muscle relaxation
Aerobic exercise
Yoga
Deep breathing exercises
Meditation
Cognitive-Behavioral Therapy

Various scientific studies support the potential benefit of these complementary therapies. However, individuals should talk with a healthcare provider to choose the best strategy for their headache type and their unique needs/goals. Working with a chiropractic team can help expedite healing. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop a customized treatment plan through an integrated approach to treating injuries and chronic pain syndromes, improving flexibility, mobility, and agility, relieving pain, and helping individuals return to normal activities. If other treatments are needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments.

Tension Headaches and Chiropractic Care

References

Espí-López, G. V., Zurriaga-Llorens, R., Monzani, L., & Falla, D. (2016). The effect of manipulation plus massage therapy versus massage therapy alone in people with tension-type headache. A randomized controlled clinical trial. European journal of physical and rehabilitation medicine, 52(5), 606–617.

Millstine, D., Chen, C. Y., & Bauer, B. (2017). Complementary and integrative medicine in the management of headache. BMJ (Clinical research ed.), 357, j1805. https://doi.org/10.1136/bmj.j1805

Intuitive Eating: Listening to Your Body for Better Health

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

Can understanding the philosophy of intuitive eating help individuals achieve and maintain health goals by breaking free from diets and getting healthy by improving their relationship with food and exercise?

Intuitive Eating

Intuitive eating is a non-diet approach to eating that focuses on listening to the body with internal body cues. Strict food rules are the main reason diets don’t work and negatively impact overall health and well-being. (Linardon, J., & Mitchell, S. 2017) Intuitive eating is characterized by eating in response to physiological hunger and satiety cues rather than emotional cues. The body was born to eat when hungry and stop when full. However, this natural way of eating can get lost in emotions, food rules, and restrictions. Fortunately, getting back to intuitive eating is possible for everyone.

How Does It Work?

Intuitive eating is a non-diet approach that steps away from a diet mentality and applies healthy behaviors around food. It focuses on unlearning external rules, like diet rules and expectations of what and how much to eat, and emphasizes internal cues like hunger, fullness, and how foods make you feel. It is based on principles that help build a healthier relationship with food. Individuals become aware of what to eat, how much to eat, and when to eat naturally, without worry or guilt.

Mindful Eating

Mindful eating is not the same thing as intuitive eating. Individuals can think of mindful eating as a skill or practice, while intuitive eating is a philosophy.

Principles

Understanding the ten core principles and how they work together is important.

Remove The Diet Mentality

Let go of the quick fixes and gimmick diets. These offer false hope that weight loss is easy, quick, and permanent and can make individuals feel like failures for losing and regaining weight.

Honor Hunger

Hunger is a normal, biological process. The body requires adequate amounts of energy and carbohydrates to function properly. Ignoring these cues and hunger can lead to cravings, overeating, and binges. Learning to honor hunger cues sets the stage for rebuilding trust with food. A food scale can help determine proper portions.

Make Friends With Food

Allow yourself unconditional permission to eat what you want. This means including all foods without labeling them as good or bad. Once an individual tells themself they can’t have a certain food, they can feel deprived, and intense cravings can build that often lead to overeating, binges, and extreme food guilt.

Get the Food Police Out Of Your Head

Learn to say no to self-induced thoughts of good or bad based on what is being eaten or how many calories are involved. Diets often say eating too many calories or enjoying a cookie is bad. These rules and restrictions can lower self-esteem and cause feelings of guilt. Removing negative food thoughts, guilt, and other rules is critical to intuitive eating.

Respect The Body’s Fullness

Listen for body cues that say you are full. This means your body is no longer hungry and should stop eating. Enjoy the flavors, stay aware of satiety signals throughout meals, and always be aware of your fullness level.

Satisfaction Factor

Learn to find joy and satisfaction in the eating experience. Eating what they want in an inviting environment promotes happiness and satisfaction, and a positive eating experience has been shown to promote satisfaction with even less food.

Honor Feelings Without Using Food

Don’t fix problems with food. Learn healthy ways to cope with emotions like stress, anxiety, anger, or boredom without turning to food. Feeding emotional hunger only makes feelings worse and adds guilt to the mix.

Respect Your Body

Body size and shape are unique for each person. Acceptance is an important part of self-respect and love. Instead of being critical, embrace individual genetic blueprints.
Being unrealistic and critical about one’s body makes it difficult to reject the diet mentality.

Exercise

Exercise doesn’t have to be intense or extreme to be effective. Individuals should focus on how good it feels to be active and moving their bodies rather than how many calories are burned during the workout sessions. Feeling great and motivated about exercise is easy when there is increased energy, better sleep, and improved quality of life.

Honor Health

Individuals don’t have to be perfect eaters. Infrequently eating a certain snack or meal won’t make you gain weight or cause health problems.
It’s what is eaten consistently over time that matters. Making food choices that taste good and nourish the body is what counts.

Weight Loss Benefits

Intuitive eating is not designed for weight loss. It aims to improve an individual’s relationship with food, including building healthier food behaviors and not focusing on the weight scale. However, learning to be an intuitive eater can help individuals lose weight by allowing the body to break the diet cycle and settle into its natural set point weight range.

Overall Health Benefits

Intuitive eating has been shown to have both physical and emotional health benefits that include:

Higher levels of contentment and satisfaction
Reduced stress
Increased self-esteem
Better body image outlook
Improved cholesterol levels
Improved metabolism
Lower rates of emotional and disordered eating

In a 24-study review that examined the psychosocial effect intuitive eating had on adult women was associated with the following positive results (Bruce, L. J., and Ricciardelli, L. A. 2016)

Decreased eating disorders
Improved positive outlook on body image
Higher emotional functioning

Another study compared restrictive diets and intuitive eating among men and women. The study found that intuitive eating uniquely and consistently presented lower levels of disordered eating and body image concerns. (Linardon, J., & Mitchell, S. 2017) Participants using intuitive eating expressed high levels of body appreciation, and researchers suggested promoting the practice within public health approaches to eating disorder prevention. The study also supported intuitive eating by promoting body acceptance and removing unhealthy thinking about food and eating.

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop a personalized treatment plan through an integrated approach to create personalized care plans for each patient and restore health and function to the body through nutrition and wellness, functional medicine, acupuncture, Electroacupuncture, and sports medicine protocols. If the individual needs other treatment, they will be referred to a clinic or physician best suited for them. Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, nutritionists, and health coaches to provide the most effective clinical treatments.

Eating Smart To Feel Better

References

Linardon, J., & Mitchell, S. (2017). Rigid dietary control, flexible dietary control, and intuitive eating: Evidence for their differential relationship to disordered eating and body image concerns. Eating behaviors, 26, 16–22. https://doi.org/10.1016/j.eatbeh.2017.01.008

Bruce, L. J., & Ricciardelli, L. A. (2016). A systematic review of the psychosocial correlates of intuitive eating among adult women. Appetite, 96, 454–472. https://doi.org/10.1016/j.appet.2015.10.012

Swimmer’s Shoulder: How to Recover and Prevent Future Injuries

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

Female warming up on pool edge — Female warming up for swimming. Stamding on pool edge and warming up hands and shoulders

Competitive swimmers, recreational, and swimming enthusiasts who experience pinching and sharp shoulder pain while swimming may suffer from shoulder impingement. Can understanding symptoms can help healthcare providers develop an effective treatment program?

Swimmer’s Shoulder

Swimmer’s shoulder, medically known as rotator cuff impingement syndrome, is a common injury among swimmers. It can limit swimming ability and normal arm use for functional tasks. It is caused by persistent and abnormal rubbing and pinching of the structures in the shoulder, causing pain and irritation of the shoulder’s rotator cuff tendons and the bursa. The injury affects 40% to 90% of swimmers at some point. (Wanivenhaus F. et al., 2012) Self-care treatment involves rest, anti-inflammatory medication, and exercise to restore normal shoulder mobility. Most cases resolve within a few months, but physical therapy may be needed along with continued exercises and stretches to maintain pain relief.

Anatomy

The shoulder is a complex joint with extreme mobility. It is comprised of three bones:

The scapula or shoulder blade.
The clavicle or collar bone.
The humerus or upper arm bone.

These three bones combine at various places to make up the joint. Several muscles attach to and move the joint. (Kadi R. et al., 2017) The rotator cuff is one group of four muscles deep in the shoulder surrounding the joint. When lifting the arm, these muscles contract to hold the ball in the joint’s socket, allowing the arm to be raised in a fluid and smooth motion. Several ligaments hold the shoulder joint together and connect the various bones of the shoulder, giving the joint stability when moving. (Kadi R. et al., 2017)

Symptoms

Common symptoms include: (Wanivenhaus F. et al., 2012)

Swelling in the front or top of the shoulder
Difficulty reaching up overhead
Shoulder pain
Shoulder pain when bearing weight through the arm.
Symptoms tend to be worse during or immediately after swimming.

This is due to the position of the arms and upper extremities while swimming. (Wanivenhaus F. et al., 2012) Reaching overhead and turning the hand inward can cause the rotator cuff tendons or shoulder bursa to become pinched underneath the acromion process of the shoulder blade, similar to the motion that occurs during the crawl or freestyle stroke. When pinching/impingement occurs, the tendons or bursa can become inflamed, leading to pain and difficulty with normal arm use. (Struyf F. et al., 2017) The condition may also occur due to the laxity of the shoulder ligaments. (Wanivenhaus F. et al., 2012) It is theorized that the ligaments in swimmers become stretched and lax, leading to shoulder joint instability. This can cause the shoulder joint to become loose and compress the shoulder structures.

Diagnosis

A clinical examination can diagnose cases of swimmer’s shoulder. (Wanivenhaus F. et al., 2012) The exam can include:

Palpation
Strength test
Specialized tests

One shoulder test that is often used is called Neer’s test. A physician elevates the arm overhead to the maximum degree during this examination. If this results in pain, the rotator cuff tendons may be compressed, and the test is positive. Individuals may begin treatment after the examination, but a doctor may also refer them for diagnostic testing. An X-ray may be taken to examine the bone structures, and an MRI may be used to examine the soft tissue structures, such as the rotator cuff tendons and the bursa.

Treatment

Appropriate treatment of swimmer’s shoulder involves managing pain and inflammation in your shoulder and improving the way your shoulder moves so you avoid pinching structures inside the joint. (Wanivenhaus F. et al., 2012) There are various treatments available and can include:

Rest
Physical therapy
Acupuncture
Non-surgical decompression
Targeted exercises and stretches
Medications
Injections
Surgery for serious cases

Physical Therapy

A physical therapist can treat shoulder impingement. They can assess the condition and prescribe treatments and exercises to improve mobility and strength. (Cleveland Clinic, 2023) They may use various treatment modalities to decrease pain and improve circulation to facilitate and expedite healing. Physical therapy treatments can include:

Ice
Heat
Trigger point release
Joint mobilizations
Stabilization
Stretching
Exercise
Electrical stimulation
Ultrasound
Taping

Medication

Medication may include over-the-counter anti-inflammatory medicine to help decrease pain and inflammation. A physician may prescribe stronger medication to manage inflammation if the condition is severe. While taking medication, the shoulder will need rest, so avoiding swimming or other shoulder movements for a week or two may be necessary.

Injections

Cortisone is a powerful anti-inflammatory medicine. Individuals may benefit from cortisone injections into their shoulders. (Wanivenhaus F. et al., 2012) When injected, cortisone decreases pain, reduces swelling in the rotator cuff and bursa, and improves shoulder mobility.

Surgery

If symptoms are persistent and fail to be alleviated with conservative treatments, surgery may be recommended. An arthroscopic procedure called subacromial decompression may be performed. (Cleveland Clinic, 2023) This type of surgery is done with small incisions, inserting a camera, and tiny tools. During this procedure, inflamed tissue and bone spurs are removed from the underside of the acromion process of the shoulder blade, allowing more space to the shoulder joint. Post-surgery, individuals can gradually return to swimming and all other activities in about eight weeks.

Recovery

Most episodes last about eight to ten weeks, and severe cases last up to three months. (Struyf F. et al., 2017) Often, the symptoms slowly resolve with rest and gentle stretching. As symptoms improve, individuals can slowly return to normal activity and swimming. However, performing prescribed exercises two to three times a week may be necessary to maintain shoulder strength and mobility and help prevent future episodes of shoulder impingement. Individuals experiencing any of these symptoms should visit their physician for an accurate diagnosis of their condition to begin proper treatment. Discuss goals with a healthcare professional and physical therapist.

Sports Injuries Rehabilitation

References

Wanivenhaus, F., Fox, A. J., Chaudhury, S., & Rodeo, S. A. (2012). Epidemiology of injuries and prevention strategies in competitive swimmers. Sports health, 4(3), 246–251. https://doi.org/10.1177/1941738112442132

Kadi, R., Milants, A., & Shahabpour, M. (2017). Shoulder Anatomy and Normal Variants. Journal of the Belgian Society of Radiology, 101(Suppl 2), 3. https://doi.org/10.5334/jbr-btr.1467

Struyf, F., Tate, A., Kuppens, K., Feijen, S., & Michener, L. A. (2017). Musculoskeletal dysfunctions associated with swimmers’ shoulder. British journal of sports medicine, 51(10), 775–780. https://doi.org/10.1136/bjsports-2016-096847

Cleveland Clinic. (2023). Swimmer’s shoulder. https://my.clevelandclinic.org/health/diseases/17535-swimmers-shoulder

Knee Strengthening Exercises for Joint Health and Pain Relief

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

Woman doctor examining male patient leg in clinic — African American man sitting on massage table in doctor office while female physiotherapist checking male leg injury

Can incorporating stretches and exercises help relieve pain and provide more support for individuals with knee pain?

Knee Strengthening

The knee is the largest joint connecting the shin and thigh bones. Its cartilage, muscles, ligaments, and nerves all play a role in maintaining the joint’s health and movement. Individuals of all ages can experience knee pain, but it is more common in those with labor-intensive jobs, arthritis, and athletes. A healthcare provider will prescribe targeted stretches and exercises for individuals with pain, inflammation, or a health disorder that affects the strength of their knees to relieve knee pain while strengthening the muscles around the joint. Knee stretches and exercises are great for those with sore knees and knee pain or stiffness, but they can also be used as preventative medicine.

Exercise Benefits

Doing knee-strengthening exercises can significantly improve joint health. The benefits associated with exercises include (Zeng C. Y. et al., 2021)

Reduced pain, stiffness, and joint dysfunction.
Reduced inflammation.
Improved mobility.
Improved strength.
Cartilage degeneration prevention.
Bone loss prevention.

Leg Lifts

Leg lifts are done by lying on the back with one leg bent and the other fully extended. To perform the exercise: (American Academy of Orthopaedic Surgeons, 2009)

Raise the extended leg, keeping it straight.
Hold for three to five seconds once the leg is elevated roughly one foot off the floor.
Lay it back down to rest.
Repeat the exercise 20 times for each leg.

What To Avoid

When performing the single-leg lift, there are certain things to avoid as they can lead to other issues or injuries. This includes: (American Academy of Orthopaedic Surgeons, 2009)

Arching the back
Flexing the neck
Moving too quickly through the motion.
Using momentum instead of the muscles.

To know the exercise is being performed correctly, individuals should feel it in the front of their thighs.

Hamstring Stretch on a Bench

If a weight bench is available, doing hamstring stretches can help strengthen the knee. To perform this stretch:

Sit straight on the bench, with one leg straight out and the other planted on the floor.
With the knee straight, hinge over from the hips, keeping a straight, neutral spine.
Slowly push the chest towards the leg straight out on the bench. Hold for 15 to 30 seconds.

This exercise helps with overall strength, stamina, and balance. (Kothawale S. Rao K. 2018) (Wang H. et al., 2016)

What To Avoid

Avoid curving the spine to get closer to the thigh during the stretch. The key is not how far you can bend down but getting a deep stretch. Individuals not yet flexible enough to go all the way down should bend until comfortable but can still feel the stretch in their hamstrings. With practice and time, flexibility will improve. This stretch should be felt in the hamstrings.

Step Exercises

Step exercises, or step-ups, involve using a platform at least 6 inches high. To perform the exercise:

Put one foot onto the platform and use that leg to lift the other foot off the floor.
Hold the position with the foot hanging loosely for 3 to 5 seconds, then place the foot back on the floor.
Repeat each motion 20 times on each leg. (American Academy of Orthopaedic Surgeons, 2009)

What To Avoid

Avoid locking the knees when stepping up on the platform. Locking the knees switches off the muscles that need strengthening (American Academy of Orthopaedic Surgeons, 2009). Step exercises work out various areas of the leg. Individuals should feel this exercise in the thigh, hip, and buttocks.

Post-Exercise Stretching

Post-exercise stretching is vital in physical rehabilitation and strengthening. Stretching after exercise, individuals can (Afonso J. Clemente. et al., 2021)

Relieve and reduce soreness.
Expedite recovery times.
Increase range of motion.
Strengthen the knees more quickly and effectively.

Post-exercise stretches for knee pain and weakness can include:

Quadricep Stretch

This stretch targets the quad muscles located in the thighs. To perform this stretch:

Stand with the feet planted flat on the floor, spaced the same width as the shoulders.
Bending the left knee, grab the foot with the left hand and pull the heel toward the buttocks.
Hold for 5 to 10 seconds.
Repeat on both sides.

What to Avoid

There is no need to pull the heel too far into the buttocks. The goal is to feel a deep stretch. Pushing it too far can lead to injury. (Lee J. H. et al., 2021)

Toe Touches

Toe touches will help stretch calve muscles and hamstrings. To perform this stretch:

Sit on the floor with the legs straight out in front.
Bend the body over the legs at the hips, reaching for the toes in front while maintaining a straight back.
Relax the shoulders and keep them away from the ears.
Once touching the toes, hold the stretch for 15 seconds.

What To Avoid

Individuals who cannot yet touch their toes should perform the same steps and reach only as far as is comfortably possible. Over time, flexibility will improve. (Lee J. H. et al., 2021)

Injury Medical Chiropractic Clinic

These are examples of exercises and stretches that a physical therapy and chiropractic team may prescribe. Each case is different and requires reviewing individual medical history and physical examination to determine the proper treatment program. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop a personalized treatment program through an integrated approach to treating injuries and chronic pain syndromes, improving flexibility, mobility, and agility to relieve pain and help individuals return to normal activities. If other treatments are needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments.

Knee Pain Rehabilitation

References

Zeng, C. Y., Zhang, Z. R., Tang, Z. M., & Hua, F. Z. (2021). Benefits and Mechanisms of Exercise Training for Knee Osteoarthritis. Frontiers in physiology, 12, 794062. https://doi.org/10.3389/fphys.2021.794062

American Academy of Orthopaedic Surgeons. OrthoInfo. (2009). Knee exercises. https://orthoinfo.aaos.org/en/staying-healthy/knee-exercises/

Kothawale S. and Rao K. (2018). Effectiveness of positional release technique versus active release technique on hamstrings tightness. Int J Physiother Res., 6(1), 2619-2622. https://doi.org/https://dx.doi.org/10.16965/ijpr.2017.265

Wang, H., Ji, Z., Jiang, G., Liu, W., & Jiao, X. (2016). Correlation among proprioception, muscle strength, and balance. Journal of physical therapy science, 28(12), 3468–3472. https://doi.org/10.1589/jpts.28.3468

Afonso, J., Clemente, F. M., Nakamura, F. Y., Morouço, P., Sarmento, H., Inman, R. A., & Ramirez-Campillo, R. (2021). The Effectiveness of Post-exercise Stretching in Short-Term and Delayed Recovery of Strength, Range of Motion and Delayed Onset Muscle Soreness: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Frontiers in physiology, 12, 677581. https://doi.org/10.3389/fphys.2021.677581

Lee, J. H., Jang, K. M., Kim, E., Rhim, H. C., & Kim, H. D. (2021). Effects of Static and Dynamic Stretching With Strengthening Exercises in Patients With Patellofemoral Pain Who Have Inflexible Hamstrings: A Randomized Controlled Trial. Sports health, 13(1), 49–56. https://doi.org/10.1177/1941738120932911

Understanding Hip Tendonitis: Causes, Symptoms, and Treatment

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

Full length shot of a female physician working with a senior male patient.

Can understanding the causes and symptoms of potential hip tendonitis help healthcare providers diagnose and treat the condition for individuals experiencing pain in the front of the hip with restricted hip flexibility that worsens during movement?

Hip Tendonitis

Hip tendonitis is inflammation of the iliopsoas tendon. It is most commonly caused by overuse of the hip flexors without adequate rest for recovery. The condition can occur when the hip muscles overpower the tendons attached to the hip bone, causing inflammation and irritation. This can lead to pain, tenderness, and mild swelling near the hip joint. Hip tendonitis can be diagnosed with a physical examination, and treatment can include:

Rest
Ice
NSAIDs
Stretching
Physical therapy
Chronic cases may require a cortisone injection into the iliopsoas tendon to decrease inflammation.
Surgical release of the iliopsoas tendon may be recommended to decrease tightness and pain.

There is a high prognosis for a full recovery.

Tendonitis

Inflammation in a muscle’s tendon leads to pain and tenderness that worsens the more the muscle is used. An overuse injury means the tendon becomes repeatedly stressed through repetitive muscle contractions, causing muscle and tendon fibers to micro-tear. If not enough rest is allowed for the micro-tears to heal, a chronic cycle of pain and inflammation develops within the affected tendon. Other tendons that are prone to developing the condition include:

The tendon of the wrist extensors/tennis elbow.
The tendon of the wrist flexors/golfer’s elbow.
The Achilles’ tendon/Achilles tendonitis.
The patellar tendon/jumper’s knee.
The tendons of the thumb/De Quervain’s tenosynovitis.

Bursitis

Bursae are small fluid-filled sacs that help cushion and decrease friction around joints.
Because the iliopsoas tendon overlays bursae, inflammation of the tendon can also cause bursitis or inflammation of the bursae surrounding the tendon.
Tendonitis and bursitis can and often occur together due to overlapping symptoms.

Causes

The iliopsoas originates in the pelvis and vertebrae of the lower spine and attaches to the top of the femur or thigh bone. It allows the hip joint movement that brings the leg closer to the front of the body, like lifting the leg to step up or jump. It also helps keep the torso stable when standing with one or both feet on the ground and rising from a lying position. Hip tendonitis most often results from physical activities that require repeated leg lifting when stepping, running, kicking, or jumping. This can include:

Running
Dancing
Gymnastics
Martial arts
Cycling
Playing soccer

Iliopsoas tendonitis can also occur after hip arthroscopy, a minimally invasive surgical procedure to repair structures inside the hip joint because of altered joint movement and muscle activation patterns after surgery. (Adib F. et al., 2018)

Symptoms

The primary symptoms of hip tendonitis include a soreness or deep ache in the front of the hip that worsens after physical activity and limits the range of motion because of the pain. Other symptoms include:

Tenderness to touch in the front of the hip.
The pain can feel like a dull ache.
Stiffness may also be present.
Hip flexor tightness.
Altered posture, with the pelvis rotated forward and an exaggerated curve in the lower back.
Lower back pain.
Discomfort after prolonged sitting.
Altered walking pattern characterized by shortened steps.

Diagnosis

Hip tendonitis is diagnosed through a physical examination and medical history reviews of individual symptoms.
Individuals may also have an X-ray of their hip performed to examine the joint alignment and determine if a fracture or arthritis is present.

Treatment

Initial treatment involves rest from physical activities, applying ice, and gentle stretching.
Nonsteroidal anti-inflammatory drugs/NSAIDs can ease pain and swelling, decrease inflammation, and reduce muscle spasms.
If chronic pain persists, individuals may receive a cortisone injection into their iliopsoas tendon. (Zhu Z. et al., 2020)
A personalized physical therapy program focusing on hip flexor stretching and strengthening, as well as strengthening the glutes and core, will help expedite an optimal recovery.

Surgery

For cases that do not improve after three months of treatment, surgery to lengthen the iliopsoas tendon, a procedure known as a tenotomy, may be performed. It involves making a small cut into a portion of the tendon, allowing the tendon to increase in length while decreasing tension as it heals back together. A tenotomy temporarily reduces the strength of the iliopsoas; however, this weakness usually resolves within three to six months after surgery. (Anderson C. N. 2016)

Chiropractic Care

Chiropractic care can be an effective treatment because it can help restore proper alignment and motion in the hip, reduce inflammation, and improve muscle and joint function. Treatments may include:

Spinal adjustments to realign the spine and other joints, reducing pressure on nerves and inflammation.
Non-surgical decompression
Manual therapy – massage, trigger point therapy, or spinal manipulation.
Acupuncture
Graston technique
Rehabilitative exercises like stretching, strengthening, and range of motion exercises.

Tendonitis generally has an excellent prognosis for full recovery as long as thorough rest from activities is taken to allow the inflamed tendon to heal. The postsurgical prognosis is positive for chronic and severe cases of iliopsoas tendonitis that require surgery.

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop a customized treatment program through an integrated approach to treating injuries and chronic pain syndromes, improving flexibility, mobility, and agility to relieve pain and help individuals return to normal activities. If other treatments are needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments.

Inflammation and Integrative Medicine

References

Adib, F., Johnson, A. J., Hennrikus, W. L., Nasreddine, A., Kocher, M., & Yen, Y. M. (2018). Iliopsoas tendonitis after hip arthroscopy: prevalence, risk factors and treatment algorithm. Journal of hip preservation surgery, 5(4), 362–369. https://doi.org/10.1093/jhps/hny049

Zhu, Z., Zhang, J., Sheng, J., Zhang, C., & Xie, Z. (2020). Low Back Pain Caused by Iliopsoas Tendinopathy Treated with Ultrasound-Guided Local Injection of Anesthetic and Steroid: A Retrospective Study. Journal of pain research, 13, 3023–3029. https://doi.org/10.2147/JPR.S281880

Anderson C. N. (2016). Iliopsoas: Pathology, Diagnosis, and Treatment. Clinics in sports medicine, 35(3), 419–433. https://doi.org/10.1016/j.csm.2016.02.009

Understanding the Gluteus Maximus: Functions and Importance

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

Man professional doctor osteopath fixing and stretching mans back with hands during exersicing at rehabilitation theapy in manual therapy clinic, top view. Chiropractor during work.

Individuals dealing with pain in the buttocks can make life difficult to sit, walk, or perform simple, everyday tasks. Can understanding the anatomy, location, and function of the gluteus maximus muscle help in muscle rehabilitation and avoid potential injuries?

Gluteus Maximus

The gluteus maximus is the largest human body muscle responsible for hip extension, external rotation, adduction, and abduction, as well as the ability to stand upright. The primary muscle extends laterally and keeps the body upright by supporting the bony pelvis and trunk. (Neto W. K. et al., 2020) When the gluteus maximus is strained, injured, or weak, it can lead to pain and inflammation.

Common symptoms can include:

Stiffness in the buttock
Discomfort while sitting
Difficulty standing up from sitting
Difficulty bending over
Pain when walking, especially upstairs or on a hill
Pain in the lower back and/or tailbone

Anatomy and Structure

The muscles that comprise the glutes are the gluteus maximus, gluteus medius, and gluteus minimus. The gluteus medius runs underneath the gluteus maximus, and the gluteus minimus is underneath the gluteus medius.

The gluteus maximus is one of the strongest muscles. Fibers from the muscle connect to different body parts, including the femur/thighbone and the iliotibial band, which comprises connective tissue that runs up the thigh. The superior gluteal artery transports blood from the heart to the glutes.

Nerve Supply

The inferior gluteal nerve, part of the sacral plexus branch, innervates the maximus muscle. The sacral plexus nerves support motor and sensory function in the thighs, lower legs, feet, and pelvis. The sciatic nerve runs under the gluteus maximus, from the lower back down to the leg, and is often the cause of nerve pain in and around the area. (Carro L. P. et al., 2016) The main nerve of the perineum is the pudendal nerve, which runs under the gluteus maximus muscle.

Location

The gluteus maximus muscle defines the buttocks. It can be called a superficial muscle, sometimes referred to muscles that help provide shape. The origin of the gluteus maximus connects to the sacrum, the ilium, or the large upper part of the hip bone, the thoracolumbar fascia tissue, and the sacrotuberous ligaments attached to the posterior superior iliac spine. The gluteus maximus has a 45-degree angle from the pelvis to the buttocks and then inserts at the gluteal tuberosity of the femur and the iliotibial tract.

Variations

Sometimes, a duplicate muscle may originate from the gluteus maximus muscle in rare cases. However, it is more common that the gluteus maximus muscle fibers may be inserted into different body parts than where they are typically inserted. (Taylor, V. G., Geoffrey & Reeves, Rustin. 2015) This can cause a condition called greater trochanteric pain syndrome or GTPS. Inflammation of the gluteus medius, minimum tendons, and bursa inflammation can also cause GTPS. Individuals with GTPS will have tenderness or a pulsing feeling on the outer side of the hip and thigh when lying on the side, along with other symptoms.

Function

The gluteus maximus extends and externally rotates the hip joint, stabilizing the body. It is highly engaged during running and hiking activities. Regular walking does not typically target gluteus maximus strength training. However, the gluteus maximus promotes balance when walking and other activities by helping keep the pelvis and posture upright.

Conditions

The most common condition associated with the gluteus maximus is muscle strain, and deep gluteus maximus syndrome is another condition that can cause pain and involves the muscles.

Muscle Strain

A muscle strain can result from stretching and working the muscle too much that it becomes overstretched or tears. (Falótico G. G. et al., 2015) This can happen from not warming up or cooling down properly, repetitive use injury, and over-exercising. Alternatively, not exercising and not utilizing your gluteus maximus can weaken it, leading to lower back pain, hip pain, and stability and posture issues. (Jeong U. C. et al., 2015)

Deep Gluteus Maximus Syndrome

This syndrome causes pain in the buttocks when the sciatic nerve becomes entrapped. (Martin, H. D. et al., 2015) The location of the pain can help healthcare providers determine where the nerve is trapped. Those with deep gluteus maximus syndrome may experience various types of discomfort, including (Martin, H. D. et al., 2015)

Numbness and tingling in the leg
Pain when sitting
Pain when walking
Pain that radiates down the back and hips and into the thigh

To diagnose the condition, a healthcare provider may perform a physical examination and various tests to rule out other conditions that can cause similar symptoms.

Treatment and Rehabilitation

If there is pain in the buttocks and/or lower extremities, it’s important to consult a primary doctor, chiropractor, or physical therapist. They will evaluate the strength of the gluteus muscles to diagnose any strain or weakness. From there, they will develop a personalized treatment plan to help heal the injury, strengthen the muscles, and restore function. Treatment will include stretches once the strain is rested and improves.

Recommendations can include taking a few days off to rest the muscle or, at the very least, stop performing the work or activity that caused the strain.
Ice and over-the-counter medication like ibuprofen can help reduce inflammation.
For weak gluteus maximus, a physical therapist will strengthen and retrain the muscle with a tailored program of exercises. (Jeong U. C. et al., 2015)
Treatment for deep gluteus maximus syndrome may include conservative treatment, such as chiropractic decompression and realignment, physical therapy, medications for pain and inflammation, and injections.
If conservative treatments do not relieve the pain, a primary healthcare provider may recommend surgery. (Martin, H. D. et al., 2015)

Working with a chiropractic physical therapy team can help individuals return to normal function and expedite healing. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop a customized treatment program through an integrated approach to treating injuries and chronic pain syndromes, improving flexibility, mobility, and agility to relieve pain and help individuals return to normal activities. If other treatments are needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments.

The Science of Motion and Chiropractic Care

References

Neto, W. K., Soares, E. G., Vieira, T. L., Aguiar, R., Chola, T. A., Sampaio, V. L., & Gama, E. F. (2020). Gluteus Maximus Activation during Common Strength and Hypertrophy Exercises: A Systematic Review. Journal of sports science & medicine, 19(1), 195–203.

Carro, L. P., Hernando, M. F., Cerezal, L., Navarro, I. S., Fernandez, A. A., & Castillo, A. O. (2016). Deep gluteal space problems: piriformis syndrome, ischiofemoral impingement and sciatic nerve release. Muscles, ligaments and tendons journal, 6(3), 384–396. https://doi.org/10.11138/mltj/2016.6.3.384

Taylor, Victor & Guttmann, Geoffrey & Reeves, Rustin. (2015). A variant accessory muscle of the gluteus maximus. International Journal of Anatomical Variations. 8. 10-11.

Falótico, G. G., Torquato, D. F., Roim, T. C., Takata, E. T., de Castro Pochini, A., & Ejnisman, B. (2015). Gluteal pain in athletes: how should it be investigated and treated?. Revista brasileira de ortopedia, 50(4), 462–468. https://doi.org/10.1016/j.rboe.2015.07.002

Jeong, U. C., Sim, J. H., Kim, C. Y., Hwang-Bo, G., & Nam, C. W. (2015). The effects of gluteus muscle strengthening exercise and lumbar stabilization exercise on lumbar muscle strength and balance in chronic low back pain patients. Journal of physical therapy science, 27(12), 3813–3816. https://doi.org/10.1589/jpts.27.3813

Martin, H. D., Reddy, M., & Gómez-Hoyos, J. (2015). Deep gluteal syndrome. Journal of hip preservation surgery, 2(2), 99–107. https://doi.org/10.1093/jhps/hnv029

Discover How to Reduce Stiff Person Syndrome

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

Can individuals with stiff person syndrome incorporate non-surgical treatments to reduce muscle stiffness and restore muscle mobility?

Introduction

The musculoskeletal system allows the body’s extremities to be mobile, provides stability to the host, and has an outstanding relationship with the other body systems. The musculoskeletal system’s muscles, tissues, and ligaments help protect the body’s vital organs from environmental factors. However, many individuals often deal with repetitive motions in the upper and lower body extremities that can cause pain and discomfort. Additionally, environmental factors, illnesses, and injuries can affect the musculoskeletal system and play a part in co-morbidities in overlapping risk profiles. These issues can cause the musculoskeletal system to develop a condition known as stiff person syndrome. Today’s articles focus on what stiff person syndrome is, the symptoms it is associated with, and how non-surgical treatments can help alleviate the symptoms of stiff person syndrome. We discuss with certified associated medical providers who consolidate our patients’ information to assess stiff person syndrome and its associated symptoms affecting the musculoskeletal system. We also inform and guide patients while asking their associated medical provider intricate questions to integrate non-surgical treatments to reduce the overlapping symptoms correlating with stiff person syndrome. Dr. Jimenez, D.C., includes this information as an academic service. Disclaimer.

What Is Stiff Person Syndrome

Have you been dealing with muscle stiffness in your lower extremities affecting your mobility? Have you noticed that your posture is rigid due to ongoing muscle spasms in your lower back? Or have you felt tightness in your back muscles? Many pain-like symptoms are associated with back pain, a common musculoskeletal condition; however, they can also correlate with a rare condition known as stiff person syndrome. Stiff person syndrome is a rare autoimmune disorder that is progressive and is characterized by rigidity and stimulus-triggered painful muscle spasms that affect the lower body and extremities. (Muranova & Shanina, 2024) There are three classifications that a person is experiencing with stiff person syndrome, and they are:

Classic Stiff Person Syndrome
Partial Stiff Person Syndrome
Stiff Person Syndrome Plus

Since stiff person syndrome is a rare condition, many individuals may not exhibit any objective findings early on, which then causes a delayed diagnosis that can impact a person’s quality of life (Newsome & Johnson, 2022). At the same time, since stiff person syndrome is a rare autoimmune disease, it can affect the musculoskeletal system with associated pain-like symptoms.

The Symptoms

Some symptoms associated with stiff person syndrome that can develop over time are muscle stiffness and painful muscle spasms. This is because the neuron receptors from the central nervous system can become haywire and cause non-specific somatic symptoms that make the individuals deal with comorbid chronic pain and myofascial tenderness in the muscles. (Chia et al., 2023) This is because stiff person syndrome can spread into different areas of the musculoskeletal system and can gradually develop over time. For muscle stiffness associated with stiff person syndrome, the muscles can become stiff over time, causing pain and discomfort, thus leading to many individuals developing abnormal posture, making it difficult to be mobile. Muscle spasms can affect the entire body itself or in a specific location and cause intense pain that lasts for hours. However, many individuals can incorporate non-surgical treatments to reduce the pain-like symptoms in the musculoskeletal system.

Movement Medicine: Chiropractic Care- Video

Movement Medicine: Chiropractic Care | El Paso, Tx (2024)

Non-Surgical Treatments For Stiff Person Syndrome

When it comes to reducing the musculoskeletal pain symptoms of stiff person syndrome, many individuals can begin to go to their primary doctor for early diagnosis and develop a customized treatment plan to manage the pain-like symptoms and provide a positive impact in creating awareness of this rare condition. (Elsalti et al., 2023) By assessing the pain-like symptoms of stiff person syndrome, many people can incorporate non-surgical treatments to manage the musculoskeletal pain symptoms and improve a person’s quality of life. Non-surgical treatments are cost-effective and can be combined with other therapies to restore mobility. One of the primary goals for managing stiff person syndrome is through pain management, symptom relief, and improved quality of life. (Cirnigliaro et al., 2021)

Chiropractic Care For Stiff Person Syndrome

One of the non-surgical treatments that can help reduce symptoms of muscle spasms and muscle stiffness is chiropractic care. Chiropractic care incorporates mechanical and manual manipulation to stretch and mobilize the joint-muscle function while reducing pain and discomfort. (Coulter et al., 2018) For individuals suffering from stiff person syndrome, chiropractic care can help reduce muscle stiffness and muscle spasms in the upper and lower extremities and relieve the pain. Additionally, incorporating non-surgical treatments like chiropractic care and combined therapies can help manage the musculoskeletal pain associated with stiff person syndrome and improve a person’s quality of life.

References

Chia, N. H., McKeon, A., Dalakas, M. C., Flanagan, E. P., Bower, J. H., Klassen, B. T., Dubey, D., Zalewski, N. L., Duffy, D., Pittock, S. J., & Zekeridou, A. (2023). Stiff person spectrum disorder diagnosis, misdiagnosis, and suggested diagnostic criteria. Ann Clin Transl Neurol, 10(7), 1083-1094. https://doi.org/10.1002/acn3.51791

Cirnigliaro, F. A., Gauthier, N., & Rush, M. (2021). Management of refractory pain in Stiff-Person syndrome. BMJ Case Rep, 14(1). https://doi.org/10.1136/bcr-2020-237814

Coulter, I. D., Crawford, C., Hurwitz, E. L., Vernon, H., Khorsan, R., Suttorp Booth, M., & Herman, P. M. (2018). Manipulation and mobilization for treating chronic low back pain: a systematic review and meta-analysis. Spine J, 18(5), 866-879. https://doi.org/10.1016/j.spinee.2018.01.013

Elsalti, A., Darkhabani, M., Alrifaai, M. A., & Mahroum, N. (2023). Celebrities and Medical Awareness-The Case of Celine Dion and Stiff-Person Syndrome. Int J Environ Res Public Health, 20(3). https://doi.org/10.3390/ijerph20031936

Muranova, A., & Shanina, E. (2024). Stiff Person Syndrome. In StatPearls. https://www.ncbi.nlm.nih.gov/pubmed/34424651

Newsome, S. D., & Johnson, T. (2022). Stiff person syndrome spectrum disorders; more than meets the eye. J Neuroimmunol, 369, 577915. https://doi.org/10.1016/j.jneuroim.2022.577915

Disclaimer

Fish Nutrition Facts: Caloric Content, Fat Composition, and More

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

Happy doctor nutritionist sitting at workplace at desk in office among fresh vegetables, diet plan concept

For individuals trying to lose weight or improve their diet, can incorporating more fish help improve overall health?

Fish Nutrition

The American Heart Association recommends eating at least two servings of fish each week (American Heart Association, 2021). The type of fish chosen makes a difference, as fish nutrition and calories vary. Some can have a higher calorie count but contain healthy fat.

Nutrition

Comparing fish calories and nutrition data can be tricky. How it is prepared can significantly change its nutritional makeup, and the exact nutrition also varies depending on the variety. As an example, a half portion of a Wild Alaskan Salmon Fillet contains: (U.S. Department of Agriculture. FoodData Central. 2019)

Serving Size 1/2 fillet – 154 grams
Calories – 280
Calories from Fat – 113
Total Fat – 12.5 grams
Saturated Fat – 1.9 grams
Polyunsaturated Fat – 5 grams
Monounsaturated Fat – 4.2 grams
Cholesterol – 109 milligrams
Sodium – 86 milligrams
Potassium – 967.12 milligrams
Carbohydrates – 0 grams
Dietary Fiber – 0 grams
Sugars – 0 grams
Protein – 39.2 grams

The following guide includes other types of fish based on USDA nutrition data (U.S. Department of Agriculture. FoodData Central). Fish calories and nutrition are listed for a 100-gram or 3.5-ounce serving.

Halibut

Raw with skin
116 calories
3 grams fat
0 grams carbohydrate
20 grams protein

Tuna

Yellowfin, fresh, raw
109 calories
Less than one gram of fat
0 grams carbohydrate
24 grams protein

Cod

Atlantic, raw
82 calories,
0.7 grams fat
0 grams carbohydrate
18 grams protein

Mahimahi

Raw
85 calories
0.7 grams fat
0 grams carbohydrate
18.5 grams protein

Ocean Perch

Atlantic, raw
79 calories
1.4 grams fat
0 grams carbohydrate
15 grams protein

Research suggests that fatty fish is the best for weight loss and improved health. Certain types of fish contain an essential fatty acid called omega-3. This polyunsaturated fat provides the body with various health benefits, like reducing the risk of heart disease. Studies show that individuals who eat seafood at least once per week are less likely to die from heart disease. (National Institutes of Health. National Center for Complementary and Integrative Health, 2024) Researchers also believe that omega-3 fatty acids may help reduce symptoms of rheumatoid arthritis and could even improve brain and eye health. Essential omega-3 fatty acids can be taken as a supplement. However, research has not shown that supplements can provide the same benefits as eating omega-3 foods. (Rizos E. C. et al., 2012)

Benefits

The American Heart Association suggests eating a variety of low-calorie fish that include: (American Heart Association, 2021)

Salmon

3 ounces
175 calories
10 grams fat
1.7 grams of omega-3 fatty acids

Anchovies

3 ounces
111 calories
4 grams fat
1.7 grams of omega-3 fatty acids

Pacific and Jack Mackerel

3 ounces
134 calories
7 grams fat
1.6 grams of omega-3 fatty acids

Pacific Black Cod

3 ounces
70 calories
1 gram fat
1.5 grams of omega-3 fatty acids

Whitefish

3 ounces
115 calories
5 grams fat
1.5 grams of omega-3 fatty acids

Albacore Tuna

3 ounces, canned, packed in water
109 calories
3 grams fat
0.7 grams of omega-3 fatty acids

Atlantic Herring

3 ounces
134 calories
8 grams of fat
1.4 grams of omega-3 fatty acids

Tilapia

4 ounces
145 calories
3 grams of fat
0.1 grams of omega-3 fatty acids

The way that the fish is prepared can change the calorie count. Baked, grilled, and broiled fish are usually the lowest in calories.

Storage and Safety

Fish experts suggest that individuals buy the freshest available. What questions should you ask when visiting the local market?

When was it caught?

The fresher, the better. Fish may remain edible for five days after being caught but may not taste as fresh.

How was it stored?

How the fish is stored and delivered to the market will impact its taste. Fish should be chilled immediately after catching and kept cold throughout delivery and transport.

How does it look and smell?

If the fish has a bad odor, it is likely not fresh. Fresh fish should smell like seawater. If buying fillets, look for a moist texture with clean-cut edges. If the fish is whole, look for clear eyes and a firm texture.

Where is it from?

Buying local fish from sustainable fisheries is recommended but not always possible, depending on where individuals live. There is a Smart Seafood Buying Guide that advises on buying American fish and provides a list of fish with lower mercury levels for health and safety. (Natural Resources Defense Council, 2024)

What is the best way to prepare this fish?

Sometimes, the fishmonger is the best source for simple and healthy recipes and preparation methods. Use fresh fish within two days, or store in the freezer. When ready to use frozen fish, thaw in the refrigerator and never at room temperature. For individuals who don’t like fish taste, there are a few things to help improve the taste. First, try less fishy types. For example, many report that around 100 calories per serving of red snapper tastes less fishy than heavier fish like salmon. Second, try adding fresh herbs and citrus to manage the taste.

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop a personalized treatment plan through an integrated approach to treating injuries and chronic pain syndromes, improving flexibility, mobility, and agility programs to relieve pain and help individuals return to optimal function. Our providers use an integrated approach to create personalized care plans for each patient and restore health and function to the body through nutrition and wellness, functional medicine, acupuncture, Electroacupuncture, and sports medicine protocols. If the individual needs other treatment, they will be referred to a clinic or physician best suited for them. Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, nutritionists, and health coaches to provide the most effective clinical treatments.

Nutrition Fundamentals

References

American Heart Association. (2021). Fish and Omega-3 Fatty Acids. https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/fats/fish-and-omega-3-fatty-acids

U.S. Department of Agriculture. FoodData Central. (2019). Fish, salmon, king (chinook), raw (Alaska Native). Retrieved from https://fdc.nal.usda.gov/fdc-app.html#/food-details/168047/nutrients

National Institutes of Health. National Center for Complementary and Integrative Health. (2024). 7 things to know about omega-3 fatty acids. Retrieved from https://www.nccih.nih.gov/health/tips/things-to-know-about-omega-fatty-acids

Rizos, E. C., Ntzani, E. E., Bika, E., Kostapanos, M. S., & Elisaf, M. S. (2012). Association between omega-3 fatty acid supplementation and risk of major cardiovascular disease events: a systematic review and meta-analysis. JAMA, 308(10), 1024–1033. https://doi.org/10.1001/2012.jama.11374

Natural Resources Defense Council. (2024). The smart seafood buying guide: five ways to ensure the fish you eat is healthy for you and for the environment. https://www.nrdc.org/stories/smart-seafood-buying-guide

Managing Meralgia Paresthetica: Treatment Options and Tips

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

Individuals experiencing pain, numbness, tingling, or a burning sensation in the front and outer thigh could have meralgia paresthetica, a nerve entrapment. Can understanding the condition help healthcare providers develop an effective treatment plan?

Meralgia Paresthetica

Meralgia paresthetica, or MP, is also known as Bernhardt-Roth syndrome, lateral femoral cutaneous nerve syndrome, or lateral femoral cutaneous neuralgia. It occurs when the lateral femoral cutaneous nerve, a sensory nerve that passes over the brim of the pelvis and down the front of the thigh, becomes compressed. The nerve supplies information about sensations over the front and outside of the thigh. This can happen for several reasons, including:

Recent hip injuries, such as from a motor vehicle collision/accident.
Repetitive hip activities, like cycling.
Pregnancy
Weight gain
Wearing tight clothing.

The nerve entrapment condition causes tingling, numbness, and burning pain in the front and/or outer thigh.

Causes

There can be several different causes of this condition, but it is frequently seen in pregnancy, sudden weight gain, wearing tight clothing or belts, and other conditions. (Ivins G. K. 2000) Sometimes, meralgia paresthetica can be caused by medical procedures. For example, the condition can present after an individual has surgery and is in an unusual position for a long period of time, where there is direct external pressure on the nerve. Also, the nerve can become damaged during a surgical procedure. (Cheatham S. W. et al., 2013) This can occur when a bone graft is obtained from the pelvis or anterior hip replacement surgery.

Symptoms

Individuals may experience some or all of the following symptoms (Chung K. H. et al., 2010)

Numbness over the outside of the thigh.
Pain or burning on the outside of the thigh.
Sensitivity to lightly touching the outside of the thigh.
Worsening of symptoms with certain positions.
Increased symptoms when wearing belts, work belts, or tight-waist clothes.

The symptoms may come and go or be persistent. Some individuals are hardly noticeable and do not impact their lives or activities, while others can be very bothersome and cause significant pain. (Scholz C. et al., 2023)

Treatment

Treatment depends on how long the injury has been present and the frequency and severity of the condition.

Clothing Modifications

If the cause is due to tight clothing, belts, or work belts, then garment modification should alleviate symptoms.

Pregnancy

Pregnant women usually find complete relief of their symptoms after delivery. (Hosley, C. M., and McCullough, L. D. 2011)

Weight Loss Program

If recent weight gain is thought to contribute to the condition, then a weight loss program may be recommended.

Cortisone Injections

If simple steps do not relieve symptoms, a cortisone injection around the nerve area may be recommended. The goal is to reduce inflammation that contributes to nerve pressure (Houle S. 2012). Cortisone injections may be a definitive treatment or a temporary treatment.

Chiropractic

Chiropractic care can be an effective, natural, and safe treatment. Adjustments can help relieve pressure on the lateral femoral cutaneous nerve (LFCN) by realigning the spine and restoring nerve function. Chiropractors may also use soft tissue therapies, such as massage, to relieve muscle tension and support the body’s healing process. Other chiropractic techniques that may be used include:

Pelvic mobilizations
Myofascial therapy
Transverse friction massage
Stretching exercises
Stabilization exercises for the core and pelvis
Therapeutic kinesiology tape

A chiropractic treatment program may include 10–15 treatments over 6–8 weeks, but the number of treatments needed will vary from person to person. If there’s no noticeable progress after 3–4 weeks, it may be time to consult a specialist or surgeon.

Surgery

Surgery is rarely necessary. However, a surgical procedure may be considered when all conservative treatments fail to provide relief. (Schwaiger K. et al., 2018) A surgeon dissects and identifies the nerve, looks for compression locations, and tries to free the nerve from any areas where it may be pinched. Alternatively, some surgeons transect/cut the nerve so it no longer causes problems. If the transection procedure is performed, there will be a permanent area of numbness over the front of the thigh.

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop a customized treatment plan to relieve pain, treat injuries, improve flexibility, mobility, and agility, and help individuals return to optimal function. If other treatments are needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments.

Chiropractic Care for Leg Instability

References

Ivins G. K. (2000). Meralgia paresthetica, the elusive diagnosis: clinical experience with 14 adult patients. Annals of surgery, 232(2), 281–286. https://doi.org/10.1097/00000658-200008000-00019

Cheatham, S. W., Kolber, M. J., & Salamh, P. A. (2013). Meralgia paresthetica: a review of the literature. International journal of sports physical therapy, 8(6), 883–893.

Chung, K. H., Lee, J. Y., Ko, T. K., Park, C. H., Chun, D. H., Yang, H. J., Gill, H. J., & Kim, M. K. (2010). Meralgia paresthetica affecting parturient women who underwent cesarean section -A case report-. Korean journal of anesthesiology, 59 Suppl(Suppl), S86–S89. https://doi.org/10.4097/kjae.2010.59.S.S86

Scholz, C., Hohenhaus, M., Pedro, M. T., Uerschels, A. K., & Dengler, N. F. (2023). Meralgia Paresthetica: Relevance, Diagnosis, and Treatment. Deutsches Arzteblatt international, 120(39), 655–661. https://doi.org/10.3238/arztebl.m2023.0170

Hosley, C. M., & McCullough, L. D. (2011). Acute neurological issues in pregnancy and the peripartum. The Neurohospitalist, 1(2), 104–116. https://doi.org/10.1177/1941875211399126

Houle S. (2012). Chiropractic management of chronic idiopathic meralgia paresthetica: a case study. Journal of chiropractic medicine, 11(1), 36–41. https://doi.org/10.1016/j.jcm.2011.06.008

Schwaiger, K., Panzenbeck, P., Purschke, M., Russe, E., Kaplan, R., Heinrich, K., Mandal, P., & Wechselberger, G. (2018). Surgical decompression of the lateral femoral cutaneous nerve (LFCN) for Meralgia paresthetica treatment: Experimental or state of the art? A single-center outcome analysis. Medicine, 97(33), e11914. https://doi.org/10.1097/MD.0000000000011914

Unlocking the Potential of Magnesium Spray for Pain Relief

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

Close-up photo of curly-haired woman at home near the window with severe neck pain, mulatto business woman massaging her neck with closed eyes

When muscle pains and aches present from health conditions, work, exercise, housework, etc., many individuals turn to topical sprays, creams, ointments, and gels to bring relief. Can magnesium spray be beneficial in the fight against neuromusculoskeletal pain?

Magnesium Spray

Magnesium spray is a liquid form of magnesium applied externally to the skin that has been marketed to promote muscle relaxation, improve sleep, and manage migraines. However, studies of its effectiveness have had mixed results. Some studies have shown that topical use can:

Improve chronic muscle and joint pain. Example: fibromyalgia.
Decrease the frequency and severity of nerve pain symptoms. Example: peripheral neuropathy.
Reduce the incidence and severity of an intubation-related sore throat after surgery.
Further studies of various groups are necessary to clarify the optimal dose for each condition and to determine how topical magnesium affects magnesium blood levels.

What is It?

Magnesium is a mineral that has an important role in many of the body’s processes and is essential for the following (Gröber U. et al., 2017)

Nerve transmission
Muscle contraction
Blood pressure regulation
Blood sugar regulation
Protein production
DNA and RNA production

Currently, there is no recommended dosage for topical magnesium use. However, some major health institutions have established a recommended daily amount taken by mouth. Listed are the recommended daily magnesium intake based on age and other factors. (National Institutes of Health Office of Dietary Supplements, 2022)

14 to 18 years old: 410 mg for males, 360 mg for females and when lactating, and 400 mg when pregnant.
19 to 30 years old: 400 mg for males, 310 mg for females and when lactating, and 350 mg when pregnant.
31 to 50 years old: 420 mg for males, 320 mg for females and when lactating, and 360 mg when pregnant.
51 years old and above: 420 mg for males and 320 mg for females.

Although self-care is appropriate for minor injuries or exercise, individuals are encouraged to see their healthcare provider for severe musculoskeletal pain symptoms.

Benefits

Though taking oral magnesium supplements is common, there is limited research on using magnesium on the skin to improve magnesium levels. Studies comparing the absorption of magnesium taken by mouth with the spray applied to the skin require further research. However, some studies look at the localized effect of magnesium spray on improving a sore throat after surgery and nerve, muscle, and joint pain.

Intubation-Related Sore Throat

Topical magnesium reduced the severity of sore throat after surgery in individuals undergoing tracheal intubation compared to a placebo. (Kuriyama, A. et al., 2019) However, further studies are necessary to clarify the optimal dose.

Nerve Pain

Peripheral neuropathy is nerve damage that causes a tingling and numbing sensation in the arms or legs. In a study of individuals with chronic kidney disease, the daily application of magnesium sprays to limbs affected by peripheral neuropathy for twelve weeks decreased the frequency and severity of nerve pain symptoms. However, one limitation was that it was performed mostly in females. (Athavale, A. et al., 2023)

Chronic Muscle and Joint Pain

A small study assessed whether applying magnesium to the skin could improve the quality of life of female participants with fibromyalgia – a chronic condition that causes muscle and joint pain, fatigue, and other symptoms. The study found that four sprays of magnesium chloride applied twice daily to the upper and lower limbs for four weeks could benefit those with fibromyalgia. However, further research with larger studies is needed to confirm the results. (Engen D. J. et al., 2015)

Does The Spray Increase Overall Magnesium Levels?

Magnesium is transported into cells through magnesium transporters. The outer layer of the skin does not contain these transporters, so absorption occurs in the small areas of the sweat glands and hair follicles. (Gröber U. et al., 2017) One study suggested that applying magnesium to the skin can help with magnesium deficiency within four to six weeks, compared to four to 12 months in the case of oral magnesium supplementation. However, there is minimal research on topical magnesium and its impact on magnesium levels. Another study suggested that 56 mg of magnesium cream applied daily on the skin for 14 days had no statistically significant effect on magnesium blood levels. Although the results were statistically insignificant, a clinically relevant increase in magnesium blood levels was observed. (Kass, L. et al., 2017) Because it remains unclear if magnesium absorption via the skin is more effective than by mouth, further studies are necessary to confirm the amount of magnesium absorbed into the skin.

Using The Spray

In one study, a magnesium chloride solution was poured into a spray bottle and applied as follows (Engen D. J. et al., 2015)

The solution was sprayed into the palm and applied evenly on the affected area.
There is a four-hour wait time between spray dose applications.
Individuals should wait at least one hour after application before showering or washing the product off.
Leave the product on the skin throughout the day and wash it off before bed.
Rinse the solution off with water if the skin becomes irritated.
Avoid applying to open wounds.

Precautions

Avoid magnesium chloride sprays if you are allergic to them or their components. If you have a severe allergic reaction, such as itching, hives, or shortness of breath, seek immediate medical attention. Topically applied magnesium solution has no known side effects other than skin irritation. (Engen D. J. et al., 2015)

Why Choose Chiropractic?

References

Gröber, U., Werner, T., Vormann, J., & Kisters, K. (2017). Myth or Reality-Transdermal Magnesium?. Nutrients, 9(8), 813. https://doi.org/10.3390/nu9080813

National Institutes of Health Office of Dietary Supplements. (2022). Magnesium. Retrieved from https://ods.od.nih.gov/factsheets/Magnesium-HealthProfessional/#h2

Kuriyama, A., Maeda, H., & Sun, R. (2019). Topical application of magnesium to prevent intubation-related sore throat in adult surgical patients: a systematic review and meta-analysis. Application topique de magnésium pour prévenir les maux de gorge liés à l’intubation chez les patients chirurgicaux adultes: revue systématique et méta-analyse. Canadian journal of anaesthesia = Journal canadien d’anesthesie, 66(9), 1082–1094. https://doi.org/10.1007/s12630-019-01396-7

Athavale, A., Miles, N., Pais, R., Snelling, P., & Chadban, S. J. (2023). Transdermal Magnesium for the Treatment of Peripheral Neuropathy in Chronic Kidney Disease: A Single-Arm, Open-Label Pilot Study. Journal of palliative medicine, 26(12), 1654–1661. https://doi.org/10.1089/jpm.2023.0229

Engen, D. J., McAllister, S. J., Whipple, M. O., Cha, S. S., Dion, L. J., Vincent, A., Bauer, B. A., & Wahner-Roedler, D. L. (2015). Effects of transdermal magnesium chloride on quality of life for patients with fibromyalgia: a feasibility study. Journal of integrative medicine, 13(5), 306–313. https://doi.org/10.1016/S2095-4964(15)60195-9

Kass, L., Rosanoff, A., Tanner, A., Sullivan, K., McAuley, W., & Plesset, M. (2017). Effect of transdermal magnesium cream on serum and urinary magnesium levels in humans: A pilot study. PloS one, 12(4), e0174817. https://doi.org/10.1371/journal.pone.0174817

Understanding Swayback Posture and Its Effects on the Body

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

Osteopath exterminating a patient in the clinic — Female osteopath performing a examination to a standing patient in the clinic

Can chiropractic treatment alleviate pain and correct swayback posture, a postural deformity that can cause lower back pain and mobility issues, for individuals experiencing it?

Swayback Posture

Swayback posture is a common dysfunction involving the pelvis and hip joints tilted forward in front. This causes the pelvis to shift forward, which exaggerates the curves in the lower and upper back, known as lordosis and kyphosis. The pelvis may tilt backward relative to the upper half, causing the buttocks to tuck under. The pelvis coordinates the movements of the head, shoulders, and trunk with those of the feet, legs, and thighs. A neutral pelvis, the ideal position, generally supports a mild curve/normal lordosis in the lower back. The small arch helps the body balance the skeletal parts as they work together to support and move the body’s weight. When a postural deformity occurs, one or more bones may shift from their ideal position to compensate for any pain or loss of balance caused by the original deviation. This deviation can lead to muscle strain, ligament sprain, and/or pain. (Czaprowski, D. et al., 2018)

Postural Deviations

Swayback posture causes the thoracic spine to move backward and round over into kyphosis. At the same time, the pelvis is tilted forward, resulting in an exaggeration of the normal lumbar lordosis. (Czaprowski, D. et al., 2018)

Healthcare providers, chiropractors, and physical therapists use exact measurements to define and treat postural deformities.
A neutral pelvis is a position of balance the entire body uses to help it stay upright, move, and be pain-free.
The ideal or neutral pelvic tilt is a 30-degree angle between the vertical and the plane that passes through the top of the sacrum and the axis of the hip joint socket in the front.
Swayback posture causes the pelvis to tilt forward another 10 degrees.
As a result, the spine compensates, exaggerating the curves in the lower back/lordotic curve and in the mid and upper back/kyphotic curve.
When viewed from the side, individuals can see a backward movement of the thoracic spine.
In front, the chest tends to sink in.

Muscle Group Imbalances

Healthcare providers look at different contributors or causes of postural deviations. Swayback can sometimes be associated with strength imbalances between muscle groups that move the hips, spine, and pelvis and hold the body upright. This includes:

Weakened hip flexors and overly strong or tense hip extensors/the hamstrings.
Tight upper abdominals, weak lower abdominals, and weak mid-back muscles may also contribute.
A corrective exercise program after seeing a physical therapist will help address some or all underlying muscle imbalances.

Risk Factors

Because weight in the abdominal region pulls the pelvis forward, pregnant women and obese individuals can have an increased risk of developing a swayback posture. (Vismara, L. et al., 2010)

Symptoms

The symptoms of swayback posture often include:

Severe lower back pain
Difficulty sitting or standing for long periods
Difficulty performing certain physical activities.
Tightness in the hamstrings and hip flexors
Tightness in the upper back muscles
Headaches or migraines

Chiropractic Treatment

Chiropractic adjustments are a common treatment used to correct swayback posture and can be corrected through various treatments. These include:

Spinal adjustments: The doctor applies pressure to specific spine areas to realign them and help restore proper spinal function.
Non-surgical decompression
Massage therapies
Muscle Energy Technique, or MET, improves muscle strength, flexibility, and function.
Acupuncture
Exercises to strengthen and stabilize the core muscles
Lifestyle adjustments to help reduce stress on the spine
Posture exercises
Biomechanics training

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop a personalized care plan for each patient through an integrated approach to treating injuries and chronic pain syndromes, improving flexibility, mobility, and agility programs to relieve pain and help individuals return to optimal function. If other treatments are needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments.

How I Gained My Mobility Back With Chiropractic Care

References

Czaprowski, D., Stoliński, Ł., Tyrakowski, M., Kozinoga, M., & Kotwicki, T. (2018). Non-structural misalignments of body posture in the sagittal plane. Scoliosis and spinal disorders, 13, 6. https://doi.org/10.1186/s13013-018-0151-5

Vismara, L., Menegoni, F., Zaina, F., Galli, M., Negrini, S., & Capodaglio, P. (2010). Effect of obesity and low back pain on spinal mobility: a cross sectional study in women. Journal of neuroengineering and rehabilitation, 7, 3. https://doi.org/10.1186/1743-0003-7-3

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