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Managing Chronic Sciatica Symptoms: A Multidisciplinary Plan

By
Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP
-
Experienced doctor examines the back of a gray-haired patient, a modern ultrasound machine indoors

“For individuals dealing with chronic sciatica, when pain and other symptoms significantly impact daily activities and the ability to walk, can a musculoskeletal healthcare provider help relieve and manage symptoms through a multidisciplinary treatment plan?”

Managing Chronic Sciatica Symptoms: A Multidisciplinary Plan

Chronic Sciatica

Sciatica is a common condition that results from compression of the sciatic nerve in the lower back or leg. Chronic sciatica occurs when symptoms last for 12 months or longer.

Advanced Sciatica Symptoms

Advanced or chronic sciatica usually produces pain that radiates or travels down the back of the leg. Long-term sciatic nerve compression can result in:

  • Leg pain
  • Numbness
  • Tingling
  • Electrical or burning sensations
  • Weakness
  • Weakness
  • Instability of the legs, which can impact the ability to walk.
  1. Severe nerve compression can progress to leg paralysis if the nerve is significantly damaged from chronic compression. (Antonio L Aguilar-Shea, et al., 2022)
  2. Sciatica can progress to nerve damage of the smaller nerves and travel into the legs and feet. Nerve damage/neuropathy can result in pain, tingling, and loss of sensation. (Jacob Wycher Bosma, et al., 2014)

Disabling Sciatica Treatment Options

When sciatica becomes disabling, affecting an individual’s ability to walk, more involved treatment is needed to bring relief. Many cases of chronic and disabling sciatica are caused by problems with the lumbar spine. Compression of the nerve roots that form the sciatic nerve can occur from bulging or herniated discs or spinal stenosis. If symptoms of sciatica persist beyond 12 months with little or no relief from physical therapy, non-surgical mechanical decompression, stretches and exercises, or pain management techniques, surgical procedures may be needed. (Lucy Dove, et al., 2023)

Lumbar decompression surgery encompasses several procedures to create more space in the lumbar spine and relieve nerve compression. Lumbar decompression surgery can include: (Mayfield Clinic. 2021)

Discectomy

  • This procedure removes a portion of a damaged disc between vertebrae to alleviate root compression from a bulging or herniated disc.

Laminectomy

  • This procedure removes the lamina, a portion of the vertebrae causing nerve compression, especially if there is a bone spur due to arthritic and degenerative changes in the spine.

Foraminotomy

  • This procedure widens the foramina, the openings in the vertebrae where the nerve roots exit to relieve compression.

Spinal Fusion

  • This procedure takes two or more vertebrae fusing them together with metal rods and screws for stabilization.
  • The procedure can be performed if:
  • An entire disc is removed.
  • Multiple laminectomies were performed.
  • One vertebra has slipped forward over another.

Daily Relief Management for Advanced Sciatica

Achieving relief from advanced sciatica symptoms at home can include regularly practicing methods like taking a hot bath or shower massage, and applying a heating pad to the lower back or glutes to relax tight muscles to help release the tightness surrounding the sciatic nerve.

  • Corrective or therapeutic exercises like sciatic nerve glides can help reduce tension along the nerve while low-back exercises that move the spine into forward or backward bending can reduce compression. (Witold Golonka, et al., 2021)
  • Medications like nonsteroidal anti-inflammatory drugs/NSAIDs, muscle relaxants, or nerve-pain medications may be recommended. (Antonio L Aguilar-Shea, et al., 2022)
  • Advanced sciatica may not be as responsive to conservative treatment methods, as the injury has set in and the nerve and surrounding tissues have become significantly restricted.
  • Sciatica symptoms lasting longer than 12 months require more involved treatment like injections or surgery to address symptoms effectively. (Antonio L Aguilar-Shea, et al., 2022)

Healing Chronic Sciatica

If the underlying cause can be effectively treated then chronic sciatica can be healed. Chronic sciatica often results from spinal conditions like herniated discs or lumbar spinal stenosis. These conditions narrow the space around the nerve roots that exit from the spinal cord and merge to form the sciatica nerve. Surgery is performed to open the space in the spine. (Mayfield Clinic. 2021) Sometimes sciatica is brought on by less common causes like a tumor or a spinal infection. In these cases, symptoms will not resolve until the underlying cause is addressed. Tumors may need to be surgically removed while infections require aggressive antibiotics to prevent spreading to other regions of the body. (Hospital for Special Surgery. 2023)

Pain Specialist Treatment Plan Development

Ongoing pain, numbness, tingling, and weakness are all symptoms that should be addressed with a healthcare provider. A pain specialist can help create a treatment plan that involves: (Hospital for Special Surgery. 2023)

  • Physical therapy
  • Therapeutic massage
  • Chiropractic decompression and spinal adjustments
  • Targeted stretches and exercises
  • Referrals to specialized healthcare providers
  • Injections
  • Medications

Sciatica Causes and Treatments

References

Aguilar-Shea, A. L., Gallardo-Mayo, C., Sanz-González, R., & Paredes, I. (2022). Sciatica. Management for family physicians. Journal of family medicine and primary care, 11(8), 4174–4179. https://doi.org/10.4103/jfmpc.jfmpc_1061_21

Bosma, J. W., Wijntjes, J., Hilgevoord, T. A., & Veenstra, J. (2014). Severe isolated sciatic neuropathy due to a modified lotus position. World journal of clinical cases, 2(2), 39–41. https://doi.org/10.12998/wjcc.v2.i2.39

Dove, L., Jones, G., Kelsey, L. A., Cairns, M. C., & Schmid, A. B. (2023). How effective are physiotherapy interventions in treating people with sciatica? A systematic review and meta-analysis. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 32(2), 517–533. https://doi.org/10.1007/s00586-022-07356-y

Mayfield Clinic. ( 2021). Spinal decompression laminectomy & foraminotomy.

Golonka, W., Raschka, C., Harandi, V. M., Domokos, B., Alfredson, H., Alfen, F. M., & Spang, C. (2021). Isolated Lumbar Extension Resistance Exercise in Limited Range of Motion for Patients with Lumbar Radiculopathy and Disk Herniation-Clinical Outcome and Influencing Factors. Journal of clinical medicine, 10(11), 2430. https://doi.org/10.3390/jcm10112430

Hospital for Special Surgery. (2023). Sciatica.

Hospital for Special Surgery. (2023). Pain management.

Pain Management Specialists: The Multidisciplinary Approach

By
Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP
-
Caucasian woman in neck brace looking at x-ray image on digital device held by bearded therapist in lab coat. Medical specialist explaining test results to patient with walking cane in exam room.

“For individuals dealing with chronic pain conditions can having a better understanding of pain management specialists help in developing effective multidisciplinary treatment plans?”

Pain Management Specialists: The Multidisciplinary Approach

Pain Management Specialists

Pain management is a growing medical specialty that takes a multi-disciplinary approach to treating all types of pain. It is a branch of medicine that applies scientifically proven techniques and methods to relieve, reduce, and manage pain symptoms and sensations. Pain management specialists evaluate, rehabilitate, and treat a spectrum of conditions, including neuropathic pain, sciatica, postoperative pain, chronic pain conditions, and more. Many primary healthcare providers refer their patients to pain management specialists if pain symptoms are ongoing or significant in their manifestation.

Specialists

Healthcare providers specializing in pain management recognize the complex nature of pain and approach the problem from all directions. Treatment at a pain clinic is patient-centric but depends on the clinic’s available resources. Currently, there are no set standards for the types of disciplines needed, another reason treatment options vary from clinic to clinic. Experts say that a facility should offer patients:

  • A coordinating practitioner specializing in pain management and consulting specialists on the patient’s behalf.
  • A physical rehabilitation specialist.
  • A psychiatrist to help the individual deal with any accompanying depression or anxiety, especially when dealing with chronic pain. (American Society of Regional Anesthesia and Pain Medicine. 2023)

Other Medical Specialties

Other specialties represented in pain management are anesthesiology, neurosurgery, and internal medicine. A coordinating healthcare provider may refer an individual for services from:

A healthcare provider should have completed additional training and credentialing in pain medicine and be an MD with board certification in at least one of the following (American Board of Medical Specialties. 2023)

  • Anesthesiology
  • Physical rehabilitation
  • Psychiatry
  • Neurology

A pain management physician should also have their practice limited to the specialty they hold the certification.

Management Goals

The field of pain management treats all types of pain as a disease. Chronic, such as headaches; acute, from surgery, and more. This allows for applying science and the latest medical advances to pain relief. There are now many modalities, including:

  • Medication
  • Interventional pain management techniques – nerve blocks, spinal cord stimulators, and similar treatments.
  • Physical therapy
  • Alternative medicine
  1. The objective is to minimize and make symptoms manageable.
  2. Improve function.
  3. Increase the quality of life. (Srinivas Nalamachu. 2013)

A pain management clinic will go through the following:

  • Evaluation.
  • Diagnostic tests, if necessary.
  • Physical therapy – increases the range of motion, strengthens the body, and prepares individuals to return to work and daily activities.
  • Interventional treatment – injections or spinal cord stimulation.
  • Referral to a surgeon if indicated by the tests and evaluation.
  • Psychiatry to deal with depression, anxiety, and/or other issues that accompany chronic pain symptoms.
  • Alternative medicine to support and enhance the other treatments.

Individuals who do well with a pain management program

Individuals who have:

  • Back pain
  • Neck pain
  • Had multiple back surgeries
  • Failed surgeries
  • Neuropathy
  • Individuals determined that surgery does not benefit their condition.

A better understanding of pain syndromes by communities and insurance companies and increased pain studies will help increase insurance coverage for treatments and technology to improve interventional outcomes.

Chiropractic Care for Leg Instability

References

American Society of Regional Anesthesia and Pain Medicine. (2023). The specialty of chronic pain management.

American Academy of Pain Medicine (2023). About the American Academy of Pain Medicine.

American Board of Medical Specialties. (2023). The Most Trusted Medical Specialty Certification Organization.

Nalamachu S. (2013). An overview of pain management: the clinical efficacy and value of treatment. The American journal of managed care, 19(14 Suppl), s261–s266.

American Society of Interventional Pain Physicians. (2023). Pain Physician.

What You Need to Know about Nutrition in Turkey

By
Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP
-
Roasted turkey breast sliced on a board with Thanksgiving sides

“For individuals watching their food intake during the Thanksgiving holiday, can knowing the nutritional value of turkey help maintain diet health?”

What You Need to Know about Nutrition in Turkey

Nutrition and Benefits

Minimally processed turkey can be a beneficial source of protein, vitamins, and minerals. However, processed turkey can be high in sugar, unhealthy fats, and sodium.

Nutrition

Nutrition information for a roasted turkey leg with the skin – 3 ounces – 85g. (U.S. Department of Agriculture. 2018)

  • Calories – 177
  • Fat – 8.4
  • Sodium – 65.4mg
  • Carbohydrates – 0g
  • Fiber – 0g
  • Sugars – 0g
  • Protein – 23.7g

Carbohydrates

  • Turkey does not contain any carbohydrates.
  • Certain deli lunch meats contain carbs as the turkey is breaded, marinated, or coated in a sauce containing sugar or added during processing.
  • Choosing fresh can make a big difference in sugar content.

Fats

  • Most of the fat comes from the skin.
  • Turkey generally has equal parts of saturated, monounsaturated, and polyunsaturated fat.
  • Removing the skin and cooking without added fat significantly reduces total fat content.

Protein

  • Turkey is an excellent source of complete protein, with around 24 grams in a 3-ounce serving.
  • Leaner cuts, like skinless turkey breast, have more protein.

Vitamins and Minerals

  • Provides vitamin B12, calcium, folate, iron, magnesium, phosphorus, potassium, and selenium.
  • Dark meat is higher in iron than the white meat.

Health Benefits

Supports Muscle Retention

  • Sarcopenia, or muscle wasting, commonly leads to frailty in elderly individuals.
  • Getting enough protein at every meal is essential for older adults to maintain muscle mass and physical mobility.
  • Turkey can help meet guidelines suggesting lean meat consumption 4-5 times a week to maintain muscle health with aging. (Anna Maria Martone, et al., 2017)

Reduces Diverticulitis Flare-Ups

Diverticulitis is inflammation of the colon. Dietary factors that influence the risk of diverticulitis include:

  • Fiber intake – lowers risk.
  • Processed red meat intake – raises risk.
  • Intake of red meat with higher total fat – raises risk.
  1. Researchers studied 253 men with diverticulitis and determined that replacing one serving of red meat with a serving of poultry or fish reduces the risk of diverticulitis by 20%. (Yin Cao et al., 2018)
  2. The study’s limitations are that the meat intake was recorded in men only, the intake was self-reported, and the amount consumed at each eating episode was not recorded.
  3. It may be a helpful substitution for anyone at risk for diverticulitis.

Prevents Anemia

  • Turkey offers nutrients required by blood cells.
  • It provides heme iron, easily absorbed during digestion, to prevent iron deficiency anemia. (National Institutes of Health. 2023)
  • Turkey also contains folate and vitamin B12, which are needed in the formation and proper function of red blood cells.
  • Regular turkey consumption can help maintain healthy blood cells.

Supports Heart Health

  • Turkey is a lean alternative to other low-sodium meats, especially if the skin is removed and cooked fresh.
  • Turkey is also high in the amino acid arginine.
  • Arginine can help keep arteries open and relaxed as a precursor to nitric oxide. (Patrick J. Skerrett, 2012)

Allergies

Meat allergies can happen at any age. A turkey allergy is possible and may be associated with allergies to other types of poultry and red meat.  Symptoms can include: (American College of Allergy, Asthma & Immunology. 2019)

  • Vomiting
  • Diarrhea
  • Wheezing
  • Shortness of breath
  • Repetitive cough
  • Swelling
  • Anaphylaxis

Storage and Safety

Preparation

  • The USDA recommends 1 pound for each person.
  • That means a family of five needs a 5-pound turkey, a group of 12 a 12-pound. (U.S. Department of Agriculture. 2015)
  • Keep fresh meat in the refrigerator until ready to cook.
  • Frozen pre-stuffed turkeys labeled with the USDA or state mark of inspection have been prepared under safe, controlled conditions.
  • Cook frozen pre-stuffed turkeys directly from the frozen state rather than thawing first. (U.S. Department of Agriculture. 2015)
  1. Safe ways to thaw a frozen turkey: in the refrigerator, in cold water, or microwave oven.
  2. They should be thawed for a specified amount of time using guidelines based on weight.
  3. It needs to be cooked to an internal temperature of 165 degrees Fahrenheit.
  4. Cooked turkey needs to be refrigerated within 1–2 hours after cooking and used within 3–4 days.
  5. Turkey leftovers stored in the freezer should be eaten within 2–6 months.

Eating Right to Feel Better

References

U.S. Department of Agriculture. FoodData central. (2018). Turkey, all classes, leg, meat and skin, cooked, roasted.

Martone, A. M., Marzetti, E., Calvani, R., Picca, A., Tosato, M., Santoro, L., Di Giorgio, A., Nesci, A., Sisto, A., Santoliquido, A., & Landi, F. (2017). Exercise and Protein Intake: A Synergistic Approach against Sarcopenia. BioMed research international, 2017, 2672435. https://doi.org/10.1155/2017/2672435

Cao, Y., Strate, L. L., Keeley, B. R., Tam, I., Wu, K., Giovannucci, E. L., & Chan, A. T. (2018). Meat intake and risk of diverticulitis among men. Gut, 67(3), 466–472. https://doi.org/10.1136/gutjnl-2016-313082

National Institutes of Health, Office of Dietary Supplements. (2023). Iron: Fact Sheet for Health Professionals.

Skerrett PJ. Harvard Health Publishing, Harvard Medical School. (2012). Turkey: A Healthy Base of Holiday Meals.

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

U.S. Department of Agriculture. (2015). Let’s Talk Turkey — A Consumer Guide to Safely Roasting a Turkey.

Non-Surgical Solutions for Back Pain: The Ultimate Guide

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

For individuals with back pain, how can health practitioners incorporate non-surgical solutions to reduce spinal pain?

Introduction

The spine is one of the most important structures in the human body, providing host mobility and stability when vertical pressure is pressing on the spinal structure. The spine is surrounded by various muscles, ligaments, and tissues that help support the upper and lower body portions and extremities. When normal factors like heaving lifting, improper stances, obesity, or pre-existing conditions start to affect the body, it can cause the spinal structure to potentially cause unwanted issues that lead to back, neck, and shoulder pain. When experiencing these three common body pains often correlate with other associated symptoms that can affect the other extremities. When this happens, many individuals begin to miss out on work or daily activities that can cause them to be miserable, and they even try to look for various solutions to reduce the pain they are experiencing. Today’s article looks at one of the common body pains like back pain and how it can cause numerous issues that affect a person’s ability to function, and how non-surgical solutions can not only reduce the pain-like effects but also provide the necessary relief that many people deserve in their health and wellness journey. We speak with certified medical providers who incorporate our patients’ information to provide numerous treatment plans to ease the pain-like symptoms associated with spinal issues causing back pain. We also inform our patients that there are non-surgical options to reduce these pain-like issues and restore spinal mobility to the body. We encourage our patients to ask intricated and educational questions to our associated medical providers about the pain-like symptoms they are experiencing correlating with the lower back. Dr. Alex Jimenez, D.C., utilizes this information as an academic service. Disclaimer.

 

Back Pain Affecting The Spine

Do you often experience radiating pain in your lower back that causes symptoms of numbness or tingling sensations down to your legs and feet? Do you feel muscle stiffness in the morning while getting up, only to slowly disappear throughout the day? Or do you feel symptoms of muscle aches and pain when carrying a heavy object from one location to another? Many individuals, more often than not, have dealt with back pain associated with various factors. With back pain being in the top three common problems in the workforce, many individuals have dealt with the common problem in multiple ways. From improper heavy lifting to excessive sitting at a desk, back pain can cause musculoskeletal issues that many are trying to find relief. Low back pain can either be acute or chronic, depending on the severity. It can lead to mobility impairment within the thoracic, lumbar, and sacroiliac spinal regions, causing referred pain to the lower extremities. It can lead to a life of impairment without any symptoms or signs of serious medical or psychological conditions associated with environmental factors. (Delitto et al., 2012) Back pain is also associated with spinal conditions like inflammation, asymmetric loading, and muscle strain, which can cause the spinal structures to be compressed, thus causing disc herniations. (Zemková & Zapletalová, 2021) 

 

 

Additionally, back pain is a multifactorial musculoskeletal condition that causes many individuals to be in a socio-economic situation that can decrease their quality of life. Many examples of back pain are correlated with altered motor control within the spinal erector muscles that causes impaired proprioception in the spine. (Fagundes Loss et al., 2020) When this happens to many individuals, they often experience a hindrance of lumbar stability, body balance, posture, and postural control. At the same time, when many working individuals are having severe back pain associated with everyday factors, the amount of pain they are in can change the threshold of the mechanoreceptors that are transmitting the pain signals through the spinal cord. To this point, back pain can affect the neuromuscular response and affect normal musculoskeletal functionality. Fortunately, numerous treatments can help reduce back pain and provide relief to spinal pain that is affecting many individuals.

 

The Role Of Chiropractic Care- Video

YouTube player

 How many times a day do you experience back pain associated with stiffness, general aches, or pains that are affecting your ability to work? Do you notice you hunching more when moving from one location to another? Or do you feel aches and pain in your back after stretching in the morning? Many individuals dealing with these common environmental factors are closely associated with back pain. Back pain is in the top three most common problems many individuals have experienced at some point in their lives. More often than not, many people have dealt with back pain by using home remedies to reduce the pain-like effects. However, research studies reveal that when many individuals start to ignore the pain, it can lead them to a life of disability and cause numerous amounts of distress if not treated right away. (Parker et al., 2015) Hence, non-surgical treatments can not only reduce the pain associated with back pain but also help restore spinal mobility. Non-surgical treatments like chiropractic care incorporate spinal manipulation, which can positively affect the spine. (Koes et al., 1996) What chiropractic care does is that it includes mechanical and manual manipulation techniques to stretch out tight muscles and reduce trigger points from reforming. The video above shows how chiropractic care can positively affect the individual while being part of a health and wellness journey to reducing back pain.

Non-Surgical Spinal Decompression For Back Pain

Just like chiropractic care, spinal decompression is another non-surgical treatment that uses traction to gently pull and stretch the spine to alleviate compressed spinal discs associated with back pain and help stretch out tight muscles. When many people start to incorporate spinal decompression as part of their routine, they will notice that spinal decompression can reduce intradiscal pressure within the negative range. (Ramos, 2004) What this does is that when the spinal discs are being pulled by gentle traction, all the fluids and nutrients that were not hydrating the disc flow back and help kickstart the body’s natural healing process. When many people begin to utilize spinal decompression for their back pain, they will notice a huge reduction in their pain after a few consecutive sessions. (Crisp et al., 1955) When many people start to combine other various non-surgical therapies with spinal decompression, they will be able to regain their spinal mobility while being more mindful of what environmental factors are affecting their spine and not repeat the issue to allow back pain to return.

References

Crisp, E. J., Cyriax, J. H., & Christie, B. G. (1955). Discussion on the treatment of backache by traction. Proc R Soc Med, 48(10), 805-814. https://www.ncbi.nlm.nih.gov/pubmed/13266831

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1919242/pdf/procrsmed00390-0081.pdf

Delitto, A., George, S. Z., Van Dillen, L., Whitman, J. M., Sowa, G., Shekelle, P., Denninger, T. R., & Godges, J. J. (2012). Low Back Pain. Journal of Orthopaedic & Sports Physical Therapy, 42(4), A1-A57. https://doi.org/10.2519/jospt.2012.42.4.a1

Fagundes Loss, J., de Souza da Silva, L., Ferreira Miranda, I., Groisman, S., Santiago Wagner Neto, E., Souza, C., & Tarrago Candotti, C. (2020). Immediate effects of a lumbar spine manipulation on pain sensitivity and postural control in individuals with nonspecific low back pain: a randomized controlled trial. Chiropr Man Therap, 28(1), 25. https://doi.org/10.1186/s12998-020-00316-7

Koes, B. W., Assendelft, W. J., van der Heijden, G. J., & Bouter, L. M. (1996). Spinal manipulation for low back pain. An updated systematic review of randomized clinical trials. Spine (Phila Pa 1976), 21(24), 2860-2871; discussion 2872-2863. https://doi.org/10.1097/00007632-199612150-00013

Parker, S. L., Mendenhall, S. K., Godil, S. S., Sivasubramanian, P., Cahill, K., Ziewacz, J., & McGirt, M. J. (2015). Incidence of Low Back Pain After Lumbar Discectomy for Herniated Disc and Its Effect on Patient-reported Outcomes. Clin Orthop Relat Res, 473(6), 1988-1999. https://doi.org/10.1007/s11999-015-4193-1

Ramos, G. (2004). Efficacy of vertebral axial decompression on chronic low back pain: study of dosage regimen. Neurol Res, 26(3), 320-324. https://doi.org/10.1179/016164104225014030

Zemková, E., & Zapletalová, L. (2021). Back Problems: Pros and Cons of Core Strengthening Exercises as a Part of Athlete Training. International Journal of Environmental Research and Public Health, 18(10), 5400. https://doi.org/10.3390/ijerph18105400

Disclaimer

Rib Cage and Pelvis: Connecting the Core for Healthy Posture

By
Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP
-
Exercises for posture, smooth straight back, spine. Slim woman training with yoga coach. Private lessons with personal trainer, fitness instructor. Workout, exercises in fitness gym.

“For older individuals experiencing posture problems, slumping, slouching, and upper back pain, could adding rib cage exercises help bring relief and prevent the condition from worsening?”

Rib Cage and Pelvis: Connecting the Core for Healthy Posture

Improved Posture

It’s common to associate a collapsed upper back posture with age, but other factors can also contribute to the problems. (Justyna Drzał-Grabiec, et al., 2013) The rib cage and the pelvis are important to body structure and comprise much of the core. If these bone structures become misaligned due to unhealthy posture, the muscles that attach to them become tight, weak, or both, and the surrounding muscles have to compensate, causing a worsening of the condition and further injury.

  • Unhealthy postures can be caused by a rib cage that compresses down onto the pelvic bone.
  • As the upper back slumps or compresses, height can begin to decrease.
  • Posture awareness exercises can help lift the rib cage off the pelvic bone.

Rib Cage Exercises

This exercise can be done sitting or standing. A daily routine can help improve posture and relieve back problems and pain.

  • The sitting version helps keep the focus on doing the exercise right.
  • The standing version challenges body awareness, allowing the individual to feel how the rib cage and upper back movements affect pelvic and lower back posture.
  • To begin, it is recommended to start in a sitting position.
  • Once the basics are learned, then certainly progress to standing.

Exercise

  1. Position the pelvis so it is in a slight forward tilt.
  2. This forward tilt will exaggerate the low back curve slightly while tightening the lower back muscles in a good way.
  3. Establishing and maintaining this curve in the sitting position should feel natural.
  4. Inhale and exaggerate the upward lift of the rib cage.
  5. Inhaling causes the spine and ribs to extend slightly.
  6. Exhale and allow the rib cage and upper back to return to their natural position.
  7. Repeat up to 10 times once or twice a day.
  • For this exercise, use breathing to develop the rib cage’s lift and carriage incrementally.
  • Don’t max out on the spinal extension.
  • Instead, focus on how breathing/inhaling supports the movement of the ribs and upper back and develops the muscles from there.
  • Try to lift the rib cage equally on both sides as the body allows.

With practice, individuals will realize the healthy posture changes and increased distance between the ribs and pelvis.

Guidance and Variation

  • Perform the exercise with the back against a wall for upper back guidance.
  • Another variation of the pelvis and rib cage posture training exercise is to raise the arms.
  • This will create a different posture awareness training perspective.
  • Focus on rib cage movement when the arms are raised.
  • Does lifting the arms make the exercise easier, harder, or different?
  • To enhance posture improvement, stretch the pectoral muscles.

Yoga

Individuals looking for more ways to strengthen healthy posture should consider yoga.

A study published in the International Journal of Yoga suggests that a great way to activate the core may be to include a variety of yoga postures into the routine. (Mrithunjay Rathore et al., 2017) The ab muscles attach to various places on the rib cage and play a role in posture, alignment, and balance. The researchers identified two muscles, the external obliques, and the transverse abdominal, as key to a healthily aligned posture.

Core Strength

References

Drzał-Grabiec, J., Snela, S., Rykała, J., Podgórska, J., & Banaś, A. (2013). Changes in the body posture of women occurring with age. BMC geriatrics, 13, 108. https://doi.org/10.1186/1471-2318-13-108

Rathore, M., Trivedi, S., Abraham, J., & Sinha, M. B. (2017). Anatomical Correlation of Core Muscle Activation in Different Yogic Postures. International journal of yoga, 10(2), 59–66. https://doi.org/10.4103/0973-6131.205515

Papegaaij, S., Taube, W., Baudry, S., Otten, E., & Hortobágyi, T. (2014). Aging causes a reorganization of cortical and spinal control of posture. Frontiers in aging neuroscience, 6, 28. https://doi.org/10.3389/fnagi.2014.00028

What Causes Facet Hypertrophy? Causes & Symptoms

By
Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP
-
young female athlete feeling pain in the body after sport exercise, sport injury

“Facet hypertrophy is an incurable, chronic disease that affects the facet joints in the spine. Can recognizing symptoms, help in diagnosis, and treatment?”

What Causes Facet Hypertrophy? Causes & Symptoms

Facet Hypertrophy

Facet hypertrophy causes the facet joints in the spine to enlarge. They are found where the vertebrae come into contact on the back of the vertebrae that form the backbone. These joints stabilize the spine when twisting and bending. Hypertrophy results when damage wears down the cartilage that cushions the bones that meet in the joint. This can include:

  • Aging
  • Wear and tear
  • Arthritis
  • Other joint diseases can damage facet joints.

Swelling, new bone growth, and bone spurs can occur as the joint tries to repair the damaged cartilage. The swelling and new bone growth can narrow the spinal canal and compress surrounding nerves, causing pain and other sensation symptoms. This ailment does not have a cure and worsens over time. The objective of treatment is to manage the pain symptoms and slow down the disease’s progress.

Types

Facet hypertrophy can be described as unilateral or bilateral.

  • Unilateral – the pain is felt on one side.
  • Bilateral – the pain is felt on both sides

On the following areas: (Romain Perolat et al., 2018)

  • Buttocks
  • Sides of the groin
  • Thighs

Symptoms

Symptoms can have a wide range of intensity, from a dull ache to chronic, disabling pain. The location of symptoms depends on the affected joint and the nerves involved, Pain manifests when the enlarged joints and new bone growth compresses the nearby nerves. The result leads to nerve damage and the following symptoms: (Weill Cornell Medicine Brain & Spine Center. 2023) (Cedars Sinai. 2022)

  • Stiffness, especially when standing up or getting out of a chair.
  • Inability to stand straight when walking.
  • Inability to look up to the left or right without turning the whole body.
  • Reduced range of motion and mobility.
  • Numbness or a tingling sensation of pins and needles.
  • Muscle spasms
  • Muscle weakness
  • Burning pain

The following symptoms are specific to the location of the affected joint (Weill Cornell Medicine Brain & Spine Center. 2023) (Cedars Sinai. 2022)

  • Radiating pain from the affected joint into the buttocks, hips, and upper thigh when the affected joint/s are in the lower back.
  • Radiating pain from the affected joint into the shoulder, neck, and back of the head when the affected joint/s are in the upper back.
  • Headaches when the affected joint is in the neck.

Causes

A common cause is the age-related degeneration of the joints, called spondylosis. Research indicates that more than 80% of individuals who are 40 or older have radiologic evidence of spondylosis, even though they may not have symptoms. (The University of Toledo Medical Center. N.D.) The following conditions can also increase the risk of facet hypertrophy (Weill Cornell Medicine Brain & Spine Center. 2023)

  • Unhealthy posture
  • Being overweight or obese
  • Sedentary lifestyle
  • Injury or trauma to the spine
  • Inflammatory conditions like rheumatoid arthritis or ankylosing spondylitis
  • Osteoarthritis
  • Genetic predisposition to the condition

Diagnosis

Diagnosis can be challenging when neck or back pain is the main complaint, as symptoms can mimic conditions such as sciatica from a herniated disc or hip arthritis. (Weill Cornell Medicine Brain & Spine Center. 2023)

  1. CT scans with or without myelogram – the use of contrast dye in the space around the spinal cord.
  2. MRI
  3. X-rays with or without a myelogram

A diagnosis is confirmed by injecting a diagnostic block that involves administering an anesthetic injection, sometimes with an anti-inflammatory like cortisone, into the joint or nerves near the affected joint. Two injections are given at different times to confirm the effect. (Romain Perolat et al., 2018)

  • If immediate relief improves after each injection, the facet joint is confirmed as the source of the pain symptoms.
  • If the block does not decrease the pain, the facet joint is probably not the source of the pain symptoms. (Brigham and Women’s Hospital. 2023)

Treatment

There is no cure for facet hypertrophy.
The goal of treatment is to make the pain more manageable.
Conservative treatment is usually successful in making a difference.

Conservative Treatment

First-line treatment involves utilizing conservative therapies (Romain Perolat et al., 2018)

  • Massage therapy
  • Physical therapy to strengthen the core muscles and spine.
  • Targeted exercises to help maintain flexibility.
  • Chiropractic adjustments to realign the spine.
  • Healthy posture retraining.
  • Non-surgical mechanical decompression.
  • Bracing to stabilize the spine
  • Acupuncture
  • Nonsteroidal anti-inflammatory – aspirin, ibuprofen, and naproxen.
  • Muscle relaxers – cyclobenzaprine or metaxalone.
  • Steroid injection into the facet joints.
  • Injection of platelet-rich plasma/PRP into the joints.

Medial Branch or Facet Block

  • A medial branch block injects local anesthetic near the medial nerves that connect to an inflamed joint.
  • Medial nerves are small nerves outside the joint space near the nerve that transmit signals and other impulses to the brain.
  • A facet block injects the medication outside the joint space near the nerve that supplies the joint called the medial branch.

Neurolysis

Neurolysis, also known as rhizotomy or neurotomy, is a procedure that destroys affected nerve fibers to relieve pain, reduce disability, and reduce the need for analgesics. This treatment can relieve pain for six to 12 months until the nerve regenerates, where further treatments may be necessary. (Matthew Smuck et al., 2012) Neurolysis can be performed using one of the following techniques (Romain Perolat et al., 2018)

  • Radiofrequency ablation RFA – the application of heat through radiofrequency.
  • Cryoneurolysis – the application of cold temperatures to the targeted nerve.
  • Chemical neurolysis – applying chemical agents, like a combination of phenol and alcohol.
  • Severing the nerves with surgical instrumentation.

Surgery

When one or more facet joints are severely damaged, they can become nonfunctional and painful. Surgery may be recommended when symptoms are not relieved by other therapies. (Ali Fahir Ozer, et al., 2015)

Prognosis

Facet hypertrophy is a chronic condition that progresses with age and does not affect life expectancy. (Weill Cornell Medicine Brain & Spine Center. 2023) The disorder is incurable, but symptoms can be managed with conservative therapies

  • A healthcare provider can help develop a treatment plan based on the extent and location of the joint affected.
  • Early diagnosis and treatment can help individuals achieve the best results.

Maintaining an active lifestyle and healthy weight can help prevent further joint stress. Individuals may be recommended to do regular stretching and strengthening exercises to lower inflammation, reduce stress, and improve overall health.

Facet Syndrome Treatment

References

Perolat, R., Kastler, A., Nicot, B., Pellat, J. M., Tahon, F., Attye, A., Heck, O., Boubagra, K., Grand, S., & Krainik, A. (2018). Facet joint syndrome: from diagnosis to interventional management. Insights into imaging, 9(5), 773–789. https://doi.org/10.1007/s13244-018-0638-x

Weill Cornell Medicine Brain & Spine Center. (2023). Symptoms of facet syndrome.

Cedars Sinai. (2022). Facet joint syndrome.

The University of Toledo Medical Center. (N.D.). Spondylosis.

Weill Cornell Medicine Brain & Spine Center. (2023). Facet syndrome.

Weill Cornell Medicine Brain & Spine Center. (2023). Diagnosing and treating facet syndrome.

Brigham and Women’s Hospital. (2023). Facet and medial branch blocks.

Smuck, M., Crisostomo, R. A., Trivedi, K., & Agrawal, D. (2012). Success of initial and repeated medial branch neurotomy for zygapophysial joint pain: a systematic review. PM & R : the journal of injury, function, and rehabilitation, 4(9), 686–692. https://doi.org/10.1016/j.pmrj.2012.06.007

Ozer, A. F., Suzer, T., Sasani, M., Oktenoglu, T., Cezayirli, P., Marandi, H. J., & Erbulut, D. U. (2015). Simple facet joint repair with dynamic pedicular system: Technical note and case series. Journal of craniovertebral junction & spine, 6(2), 65–68. https://doi.org/10.4103/0974-8237.156049

What to Know About Groin Strain Injury Treatment

By
Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP
-
Osteopath performing a sacroiliac myofascial massage on a young woman manipulating the muscles of her sacrum, pelvis ans spine with his hands in a healthcare concept

“When a groin strain injury happens, can knowing the symptoms help in the diagnosis, treatment, and recovery times?”

What to Know About Groin Strain Injury Treatment

Groin Strain Injury

A groin strain is an injury to an inner thigh muscle. A groin pull is a type of muscle strain affecting the adductor muscle group (the muscles help pull the legs apart). (Parisa Sedaghati, et al., 2013) The injury is caused when the muscle is stretched beyond its normal range of motion, creating superficial tears. Severe strains can tear the muscle in two. (Parisa Sedaghati, et al., 2013)

  • A groin muscle pull causes pain and tenderness that worsens when squeezing the legs together.
  • There may also be swelling or bruising in the groin or inner thigh.
  • An uncomplicated groin pull takes four to six weeks to heal with proper treatment. (Andreas Serner, et al., 2020)

Symptoms

A groin pull can be painful, interfering with walking, navigating stairs, and/or driving a car. In addition to pain, other symptoms around the injured area include: (Parisa Sedaghati et al., 2013)

  • A popping sound or snapping sensation when the injury occurs.
  • Increased pain when pulling the legs together.
  • Redness
  • Swelling
  • Bruising of the groin or inner thigh.

Groin pulls are graded by severity and how much they impact mobility:

Grade 1

  • Mild discomfort but not enough to limit activities.

Grade 2

  • Moderate discomfort with swelling or bruising that limits running and/or jumping.

Grade 3

  • Severe injury with significant swelling and bruising can cause pain while walking and muscle spasms.

Signs of a severe groin strain

  • Difficulty walking
  • Groin pain while sitting or resting
  • Groin pain at night
  • A healthcare provider should see severe groin pulls because the muscle may have ruptured or be on the verge of rupturing.
  • In severe cases, surgery is necessary to reattach the torn ends.

Groin pulls are sometimes accompanied by a stress fracture of the pubis/forward-facing pelvic bones, which can significantly extend healing and recovery time. (Parisa Sedaghati et al., 2013)

Causes

Groin pulls are often experienced by athletes and individuals who play sports where they must stop and change directions quickly, placing excessive strain on the adductor muscles. (Parisa Sedaghati et al., 2013) The risk is increased in individuals who: (T. Sean Lynch et al., 2017)

  • Have weak hip abductor muscles.
  • Are not in adequate physical condition.
  • Have a previous groin or hip injury.
  • Pulls can also occur from falls or extreme activities without the proper conditioning.

Diagnosis

A healthcare provider will perform a thorough investigation to confirm the diagnosis and characterize the severity. This involves: (Juan C. Suarez et al., 2013)

Medical History Review

  • This includes any previous injuries and specifics about where and when the symptoms started.

Physical Examination

  • This involves palpating – lightly touching and pressing the groin region and manipulating the leg to understand better where and how extensive the injury is.

Imaging Studies

  • Ultrasound or X-rays.
  • If a muscle rupture or fracture is suspected, an MRI scan may be ordered to visualize soft tissue injuries and stress fractures better.

Differential Diagnosis

Certain conditions can mimic a groin pull and require different treatments. These include: (Juan C. Suarez, et al., 2013)

Sports Hernia

  • This type of inguinal hernia occurs with sports and work injuries.
  • It causes a portion of the intestine to pop through a weakened muscle in the groin.

Hip Labral Tear

  • This is a tear in the cartilage ring of the labrum outside the rim of the hip joint socket.

Hip Osteoarthritis

  • This is the wear-and-tear form of arthritis that can present with groin pain symptoms.

Osteitis Pubis

  • This is inflammation of the pubic joint and surrounding structures, usually caused by the overuse of the hip and leg muscles.

Referred Groin Pain

  • This nerve pain originates in the lower back, often due to a pinched nerve, but is felt in the groin.

Treatment

Beginning treatment is conservative and includes rest, ice application, physical therapy, and prescribed gentle stretching and exercises.

  • Individuals may need crutches or a walking device to reduce pain and prevent further injury if the pain is significant. (Andreas Serner, et al., 2020)
  • Physical therapy will be a part of the treatment plan.
  • Over-the-counter pain medications like Tylenol/acetaminophen or Advil/ibuprofen can help with pain relief short term.
  • If there is severe pain from a grade 3 injury, prescription medications may be used for a short period to help minimize pain. (Andreas Serner, et al., 2020)
  • Surgery is not usually necessary. (Andreas Serner, et al., 2020)

Recovery

Recovery times can vary based on the injury’s severity and physical condition before the injury.

  • Most injuries will heal within four to six weeks with rest and proper treatment.
  • Severe groin strains can take up to 12 weeks or longer if surgery is involved. (Andreas Serner, et al., 2020)

Injury Rehabilitation

References

Sedaghati, P., Alizadeh, M. H., Shirzad, E., & Ardjmand, A. (2013). Review of sport-induced groin injuries. Trauma monthly, 18(3), 107–112. https://doi.org/10.5812/traumamon.12666

Serner, A., Weir, A., Tol, J. L., Thorborg, K., Lanzinger, S., Otten, R., & Hölmich, P. (2020). Return to Sport After Criteria-Based Rehabilitation of Acute Adductor Injuries in Male Athletes: A Prospective Cohort Study. Orthopaedic journal of sports medicine, 8(1), 2325967119897247. https://doi.org/10.1177/2325967119897247

Lynch, T. S., Bedi, A., & Larson, C. M. (2017). Athletic Hip Injuries. The Journal of the American Academy of Orthopaedic Surgeons, 25(4), 269–279. https://doi.org/10.5435/JAAOS-D-16-00171

Suarez, J. C., Ely, E. E., Mutnal, A. B., Figueroa, N. M., Klika, A. K., Patel, P. D., & Barsoum, W. K. (2013). Comprehensive approach to the evaluation of groin pain. The Journal of the American Academy of Orthopaedic Surgeons, 21(9), 558–570. https://doi.org/10.5435/JAAOS-21-09-558

Recognizing the Symptoms of Osteitis Pubis Injury

By
Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP
-
Male physiotherapist doing leg and knee treatment on a young female patient in a supine position. Athletic woman visiting her rehabilitation specialist

“Athletes and physically active individuals who participate in activities, exercises, and sports that involve kicking, pivoting, and/or shifting directions can develop pelvis overuse injury of the pubic symphysis/joint at the front of the pelvis known as osteitis pubis. Can recognizing the symptoms and causes help in treatment and prevention?”

Recognizing the Symptoms of Osteitis Pubis Injury

Osteitis Pubis Injury

Osteitis pubis is the inflammation of the joint that connects the pelvic bones, called the pelvic symphysis, and the structures around it. The pubic symphysis is a joint in front of and below the bladder. It holds the two sides of the pelvis together in the front. The pubis symphysis has very little motion, but when abnormal or continued stress is placed on the joint, groin and pelvic pain can present. An osteitis pubis injury is a common overuse injury in physically active individuals and athletes but can also occur as the result of physical trauma, pregnancy, and/or childbirth.

Symptoms

The most common symptom is pain over the front of the pelvis. The pain is most often felt in the center, but one side may be more painful than the other. The pain typically radiates/spreads outward. Other signs and symptoms include: (Patrick Gomella, Patrick Mufarrij. 2017)

  • Lower abdominal pain in the center of the pelvis
  • Limping
  • Hip and/or leg weakness
  • Difficulty climbing stairs
  • Pain when walking, running, and/or shifting directions
  • Clicking or popping sounds with movement or when shifting directions
  • Pain when lying down on the side
  • Pain when sneezing or coughing

Osteitis pubis can be confused with other injuries, including a groin strain/groin pull, a direct inguinal hernia, ilioinguinal neuralgia, or a pelvic stress fracture.

Causes

An osteitis pubis injury usually occurs when the symphysis joint is exposed to excessive, continued, directional stress and overuse of the hip and leg muscles. Causes include: (Patrick Gomella, Patrick Mufarrij. 2017)

  • Sports activities
  • Exercising
  • Pregnancy and childbirth
  • Pelvic injury like a severe fall

Diagnosis

The injury is diagnosed based on a physical examination and imaging tests. Other tests may be used to rule out other possible causes.

  • The physical exam will involve manipulation of the hip to place tension on the rectus abdominis trunk muscle and adductor thigh muscle groups.
  • Pain during the manipulation is a common sign of the condition.
  • Individuals may be asked to walk to look for irregularities in gait patterns or to see if symptoms occur with certain movements.
  1. X-rays will typically reveal joint irregularities as well as sclerosis/thickening of the pubic symphysis.
  2. Magnetic resonance imaging – MRI may reveal joint and surrounding bone inflammation.
  3. Some cases will show no signs of injury on an X-ray or MRI.

Treatment

Effective treatment can take several months or longer. Because inflammation is the underlying cause of symptoms, the treatment will often involve: (Tricia Beatty. 2012)

Rest

  • Allows the acute inflammation to subside.
  • During recovery, sleeping flat on the back may be recommended to reduce pain.

Ice and Heat Applications

  • Ice packs help reduce inflammation.
  • The heat helps ease pain after the initial swelling has gone down.

Physical Therapy

Anti-inflammatory Medication

  • Over-the-counter nonsteroidal anti-inflammatory medications – NSAIDs like ibuprofen and naproxen can reduce pain and inflammation.

Assistive Walking Devices

  • If the symptoms are severe, crutches or a cane may be recommended to reduce stress on the pelvis.

Cortisone

  • There have been attempts to treat the condition with cortisone injections, but the evidence supporting its use is limited and needs further research. (Alessio Giai Via, et al., 2019)

Prognosis

Once diagnosed, the prognosis for full recovery is optimal but can take time. It can take some individuals six months or more to return to pre-injury level of function, but most return by around three months. If conservative treatment fails to provide relief after six months, surgery could be recommended. (Michael Dirkx, Christopher Vitale. 2023)

Sports Injuries Rehabilitation

References

Gomella, P., & Mufarrij, P. (2017). Osteitis pubis: A rare cause of suprapubic pain. Reviews in urology, 19(3), 156–163. https://doi.org/10.3909/riu0767

Beatty T. (2012). Osteitis pubis in athletes. Current sports medicine reports, 11(2), 96–98. https://doi.org/10.1249/JSR.0b013e318249c32b

Via, A. G., Frizziero, A., Finotti, P., Oliva, F., Randelli, F., & Maffulli, N. (2018). Management of osteitis pubis in athletes: rehabilitation and return to training – a review of the most recent literature. Open access journal of sports medicine, 10, 1–10. https://doi.org/10.2147/OAJSM.S155077

Dirkx M, Vitale C. Osteitis Pubis. [Updated 2022 Dec 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK556168/

Acupuncture as an Alternative Treatment for Allergies

By
Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP
-
Male reflexologist conducts an acupuncture session for an expectant mother, the specialist works in protective gloves

“For individuals suffering from allergies, could using acupuncture help relieve and manage symptoms?”

Acupuncture as an Alternative Treatment for Allergies

Acupuncture Can Help With Allergies

Acupuncture is becoming a more respected alternative treatment for various medical issues, from anxiety to fibromyalgia to weight loss. There is evidence that acupuncture can help with allergies by alleviating symptoms and improving the quality of life. (Shaoyan Feng, et al., 2015) The American Academy of Otolaryngology-Head and Neck Surgery Foundation recommends doctors offer acupuncture to patients looking for nonpharmacological treatments for their allergies or refer them to an acupuncturist. (Michael D. Seidman, et al., 2015)

Acupuncture

Acupuncture is a traditional Chinese medicine/TCM practice in which extremely thin needles are inserted into the body at specific points, creating a network of energy pathways known as meridians.

  • These pathways circulate vital life energy/chi or qi.
  • Each meridian is associated with a different body system.
  • Needles are placed to target the organs associated with the condition being treated.
  1. Acupuncture can help with allergies by targeting several meridians, including the lungs, colon, stomach, and spleen. These meridians are believed to circulate defensive life energy or a type of immunity energy.
  2. A backup of defensive energy or a deficiency can cause allergy symptoms like swelling, watery eyes, runny nose, sneezing, allergic eczema, and conjunctivitis. (Bettina Hauswald, Yury M. Yarin. 2014)
  3. The objective is to stimulate the points to restore balance in the energies and relieve symptoms.

Scientific Theories

  • One theory is the needles work directly on nerve fibers, influencing messages to the brain or the autonomic nervous system and transmission of signals within the body, including the immune system. (Tony Y. Chon, Mark C. Lee. 2013)
  • Another is the needles influence certain activities of cells, particularly the transport, breakdown, and clearance of bioactive mediators.
  • The combination of these actions is thought to decrease inflammatory conditions like allergic rhinitis – hay fever, in which the inside of the nose becomes inflamed and swollen after breathing in an allergen. (Bettina Hauswald, Yury M. Yarin. 2014)

A 2015 review concluded there have been high-quality randomized controlled trials demonstrating acupuncture’s efficacy in treating seasonal and perennial allergic rhinitis. Smaller studies have shown some preliminary benefits of acupuncture when compared with antihistamines, but more research is needed. (Malcolm B. Taw, et al., 2015)

Treating Allergies

  • Some individuals who choose acupuncture are seeking alternatives to standard treatment like medications, nasal sprays, and immunotherapy.
  • Others are looking for ways to enhance the effectiveness of medications already being taken, such as antihistamines or nasal sprays, or shorten how long or how frequently they are needed.
  • Initial treatment usually involves weekly or twice-weekly appointments over several weeks or months, depending on symptom severity.
  • This may be followed by annual treatments or on an as-needed basis. (American Academy of Medical Acupuncture. 2020)
  1. Most states require a license, certification, or registration to practice acupuncture, but these vary from state to state.
  2. Recommendations are for a practitioner who is certified by the National Certification Commission for Acupuncture and Oriental Medicine.
  3. A medical doctor who offers acupuncture.
  4. The American Academy of Medical Acupuncture has a list of acupuncturists who are also medical doctors.

Improperly administered acupuncture needles can cause serious side effects that range from infections, punctured organs, collapsed lungs, and injury to the central nervous system. (National Center for Complementary and Integrative Health. 2022) Before trying acupuncture, consult your primary healthcare provider, allergist, or integrative medicine specialist to make sure it’s a safe and viable option and the best way to integrate it into overall allergy care.

Fighting Inflammation Naturally

References

Feng, S., Han, M., Fan, Y., Yang, G., Liao, Z., Liao, W., & Li, H. (2015). Acupuncture for the treatment of allergic rhinitis: a systematic review and meta-analysis. American journal of rhinology & allergy, 29(1), 57–62. https://doi.org/10.2500/ajra.2015.29.4116

Seidman, M. D., Gurgel, R. K., Lin, S. Y., Schwartz, S. R., Baroody, F. M., Bonner, J. R., Dawson, D. E., Dykewicz, M. S., Hackell, J. M., Han, J. K., Ishman, S. L., Krouse, H. J., Malekzadeh, S., Mims, J. W., Omole, F. S., Reddy, W. D., Wallace, D. V., Walsh, S. A., Warren, B. E., Wilson, M. N., … Guideline Otolaryngology Development Group. AAO-HNSF (2015). Clinical practice guideline: Allergic rhinitis. Otolaryngology–head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 152(1 Suppl), S1–S43. https://doi.org/10.1177/0194599814561600

Hauswald, B., & Yarin, Y. M. (2014). Acupuncture in allergic rhinitis: A Mini-Review. Allergo journal international, 23(4), 115–119. https://doi.org/10.1007/s40629-014-0015-3

Chon, T. Y., & Lee, M. C. (2013). Acupuncture. Mayo Clinic proceedings, 88(10), 1141–1146. https://doi.org/10.1016/j.mayocp.2013.06.009

Taw, M. B., Reddy, W. D., Omole, F. S., & Seidman, M. D. (2015). Acupuncture and allergic rhinitis. Current opinion in otolaryngology & head and neck surgery, 23(3), 216–220. https://doi.org/10.1097/MOO.0000000000000161

American Academy of Medical Acupuncture. (2020). Acupuncture and Seasonal Allergies.

National Center for Complementary and Integrative Health. (2022). Acupuncture: What You Need To Know.

Getting to Know Functional Gastrointestinal Disorders

By
Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP
-
woman in gray t shirt health problems abdominal pain diarrhea. High quality photo

“Individuals with digestive problems that cannot be diagnosed could be experiencing functional gastrointestinal disorders. Could understanding the types help in developing effective treatment plans?”

Getting to Know Functional Gastrointestinal Disorders

Functional Gastrointestinal Disorders

Functional gastrointestinal disorders, or FGDs, are disorders of the digestive system in which the presence of structural or tissue abnormality cannot explain symptoms. Functional gastrointestinal disorders lack identifiable biomarkers and are diagnosed based on symptoms. (Christopher J. Black, et al., 2020)

Rome Criteria

FGDs used diagnoses of exclusion, meaning that they could only be diagnosed after organic/identifiable disease was ruled out. However, in 1988, a group of researchers and healthcare providers met to devise strict criteria for the diagnosis of the various types of FGDs. The criteria is known as the Rome Criteria. (Max J. Schmulson, Douglas A. Drossman. 2017)

FGDs

A comprehensive list as described by the Rome III criteria (Ami D. Sperber et al., 2021)

Functional Esophageal Disorders

  • Functional heartburn
  • Functional chest pain believed to be of esophageal origin
  • Functional dysphagia
  • Globus

Functional Gastroduodenal Disorders

  • Unspecified excessive belching
  • Functional dyspepsia – includes postprandial distress syndrome and epigastric pain syndrome.
  • Chronic idiopathic nausea
  • Aerophagia
  • Functional vomiting
  • Cyclic vomiting syndrome
  • Rumination syndrome in adults

Functional Bowel Disorders

  • Irritable bowel syndrome – IBS
  • Functional constipation
  • Functional diarrhea
  • Unspecified functional bowel disorder

Functional Abdominal Pain Syndrome

  • Functional abdominal pain – FAP

Functional Gallbladder and Sphincter of Oddi Disorders

  • Functional gallbladder disorder
  • Functional biliary Sphincter of Oddi disorder
  • Functional pancreatic Sphincter of Oddi disorder

Functional Anorectal Disorders

  • Functional fecal incontinence
  • Functional Anorectal Pain – includes chronic proctalgia, Levator ani syndrome, unspecified functional anorectal pain, and proctalgia fugax.
  • Functional Defecation Disorders – include dyssynergic defecation and inadequate defecatory propulsion.

Childhood Functional GI Disorders

Infant/Toddler (Jeffrey S. Hyams et al., 2016)

  • Infant colic
  • Functional constipation
  • Functional diarrhea
  • Cyclic vomiting syndrome
  • Infant regurgitation
  • Infant rumination syndrome
  • Infant dyschezia

Childhood Functional GI Disorders:

Child/Adolescent

  • Vomiting and Aerophagia – cyclic vomiting syndrome, adolescent rumination syndrome, and aerophagia
  • Abdominal Pain-Related Functional GI Disorders include:
  1. functional dyspepsia
  2. IBS
  3. Abdominal migraine
  4. Childhood functional abdominal pain
  5. Childhood functional abdominal pain syndrome
  • Constipation – functional constipation
  • Incontinence – nonretentive fecal incontinence

Diagnosis

Although the Rome criteria allow the diagnosis of FGDs to be symptom-based, a healthcare provider may still run standard diagnostic tests to rule out other diseases or look for structural problems resulting in symptoms.

Treatment

Although no visible signs of disease or structural problems may be identified as causing the symptoms, it does not mean that they are not treatable and manageable. For individuals who suspect they may have or have been diagnosed with a functional gastrointestinal disorder, it will be essential to work with a healthcare provider on a working treatment plan. Treatment options can include: (Asma Fikree, Peter Byrne. 2021)

  • Physical therapy
  • Nutritional and dietary adjustments
  • Stress management
  • Psychotherapy
  • Medication
  • Biofeedback

Eating Right To Feel Better

References

Black, C. J., Drossman, D. A., Talley, N. J., Ruddy, J., & Ford, A. C. (2020). Functional gastrointestinal disorders: advances in understanding and management. Lancet (London, England), 396(10263), 1664–1674. https://doi.org/10.1016/S0140-6736(20)32115-2

Schmulson, M. J., & Drossman, D. A. (2017). What Is New in Rome IV. Journal of neurogastroenterology and motility, 23(2), 151–163. https://doi.org/10.5056/jnm16214

Sperber, A. D., Bangdiwala, S. I., Drossman, D. A., Ghoshal, U. C., Simren, M., Tack, J., Whitehead, W. E., Dumitrascu, D. L., Fang, X., Fukudo, S., Kellow, J., Okeke, E., Quigley, E. M. M., Schmulson, M., Whorwell, P., Archampong, T., Adibi, P., Andresen, V., Benninga, M. A., Bonaz, B., … Palsson, O. S. (2021). Worldwide Prevalence and Burden of Functional Gastrointestinal Disorders, Results of Rome Foundation Global Study. Gastroenterology, 160(1), 99–114.e3. https://doi.org/10.1053/j.gastro.2020.04.014

Hyams, J. S., Di Lorenzo, C., Saps, M., Shulman, R. J., Staiano, A., & van Tilburg, M. (2016). Functional Disorders: Children and Adolescents. Gastroenterology, S0016-5085(16)00181-5. Advance online publication. https://doi.org/10.1053/j.gastro.2016.02.015

Fikree, A., & Byrne, P. (2021). Management of functional gastrointestinal disorders. Clinical medicine (London, England), 21(1), 44–52. https://doi.org/10.7861/clinmed.2020-0980

Pelvic Floor Physical Therapy: A Treatment & Prevention Guide

By
Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP
-
High-qualified man orthopedist adjusting kneecap to female patient who complained for pain during walking, trauma and quick recovery, rehabilitation centre

“For individuals experiencing pelvis pain symptoms and associated problems, can integrating pelvic floor physical therapy exercises help with treatment and prevention?”

Pelvic Floor Physical Therapy: A Treatment & Prevention Guide

Pelvic Floor Physical Therapy

When the muscles fail to function correctly, individuals can experience symptoms like:

  1. Painful intercourse
  2. Prolapse – when an organ or tissue drops or shifts out of place.
  3. Urinary incontinence
  4. Constipation problems
  5. These conditions are common in pregnant individuals or older women.

These symptoms can be treated with pelvic floor physical therapy to alleviate discomfort. Pelvic floor physical therapy can help women and individuals with vaginas:

  • Alleviate issues like painful sex, urinary leakage, and prolapse.
  • In physical therapy, individuals work on breathing, relaxation, and lengthening and strengthening techniques to train their muscles to function optimally.

Causes of Pelvic Floor Issues

Pelvic floor dysfunction tends to happen with age, during pregnancy, or in combination with events like the postpartum period and menopause, which can lower hormone levels.

  • Individuals who are pregnant are especially prone to pelvic floor issues but might not know they have a problem.
  • The pregnancy weight of a uterus can pressure and strain the muscles.
  • Vaginal childbirth can also stretch or weaken the muscles. (Ilaria Soave, et al., 2019)

Symptoms

Symptoms can include: (Columbia Surgery. 2022)

  • Pain in the pelvis region
  • Back pain
  • Painful urination
  • Constipation
  • Urinary leakage or incontinence
  • Stool leakage or incontinence
  • Painful intercourse
  • If left untreated, these symptoms can worsen over time.

Pelvic Floor Physical Therapy

An individual will meet with a specialist to discuss symptoms and undergo a physical examination that includes:

  1. Pelvic floor exam.
  2. Evaluation of posture, mobility, and core strength.
  3. Once the initial exams and evaluation are complete, the practitioner will go over pelvic floor exercises and provide a treatment plan.
  4. Recommended exercises vary based on symptoms but focus on relaxing, stretching, and/or strengthening muscles.

Muscle Relaxation

  • To relax the muscles, a therapist may recommend breathing exercises.
  • For pregnant individuals, this means timing breaths with contractions.
  • For individuals experiencing constipation, breathing exercises can help the body relax and reduce strain.

Stretching Muscles

  • Stretching can help relieve muscle tightness and stiffness.
  • A therapist may help stretch the pelvic floor through various therapy modalities.
  • This type of physical therapy can help loosen tight muscles or help gently reset dislocated organs back into place.

Strengthening Muscles

  • After the pelvic floor is loose and relaxed, the focus typically switches to strengthening the muscles.
  • Strength work may target abdominal muscles or the pelvic floor muscles themselves.

With time, commitment, and targeted treatment, individuals can use pelvic floor physical therapy to loosen tissues, strengthen muscles, and restore function.

Spinal Decompression In Depth

References

U.S. Food and Drug Administration. (2019). Pelvic organ prolapse (pop).

Sartori, D. V. B., Kawano, P. R., Yamamoto, H. A., Guerra, R., Pajolli, P. R., & Amaro, J. L. (2021). Pelvic floor muscle strength is correlated with sexual function. Investigative and clinical urology, 62(1), 79–84. https://doi.org/10.4111/icu.20190248

Raizada, V., & Mittal, R. K. (2008). Pelvic floor anatomy and applied physiology. Gastroenterology clinics of North America, 37(3), 493–vii. https://doi.org/10.1016/j.gtc.2008.06.003

Soave, I., Scarani, S., Mallozzi, M., Nobili, F., Marci, R., & Caserta, D. (2019). Pelvic floor muscle training for prevention and treatment of urinary incontinence during pregnancy and after childbirth and its effect on urinary system and supportive structures assessed by objective measurement techniques. Archives of gynecology and obstetrics, 299(3), 609–623. https://doi.org/10.1007/s00404-018-5036-6

Columbia Surgery. (2022). Pelvic floor disorders: frequently asked questions.

FITT for Beginners: Frequency, Intensity & Exercise Type

By
Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP
-
Strength training makes your joints stronger.

“For individuals trying to get into a regular fitness regimen, could using the FITT Principle help structure exercise, track progress, and achieve fitness goals?”

FITT for Beginners: Frequency, Intensity & Exercise Type

FITT Principle

The FITT principle is a set of guidelines for adjusting, revising, and improving exercise workouts. FITT is an acronym for:

  • Frequency
  • Intensity
  • Time
  • Type of exercise
  • Individuals take these elements to create and adjust workouts that fit their goals and fitness levels.

For example, this could be a workout of 3 to 5 days combined with low, medium, and high-intensity exercises for 30 to 60 minutes each session that incorporates cardio and strength training. Focusing on these details and progressing over time helps create an effective program.

Frequency

Workout frequency and how often the individual is going to exercise is the first thing to look at.

  • Frequency depends on various factors, including the type of workout being done, how hard the workout is, fitness levels, and exercise goals.
  • General exercise guidelines developed by the American College of Sports Medicine offer recommendations. (Carol Ewing Garber, et al., 2011)

Cardiovascular Workouts

  • Cardio workouts are usually scheduled more often.
  • Depending on goals, guidelines recommend moderate cardio exercise five or more days a week or intense cardio three days a week to improve health.
  • Individuals can adjust the exercise intensity level easily on a treadmill to provide excellent and convenient cardiovascular workouts.
  • Individuals who want to lose weight may want to work up to more workouts gradually.
  • However, more is not always better, and recovery time is essential. (Pete McCall. 2018)

Strength Training

  • The recommended frequency for strength training is two to three non-consecutive days a week. (National Strength and Conditioning Association. 2017)
  • Individuals should have at least one to two days of rest and recovery between sessions.
  • Workout frequency will often depend on the type of training sessions being performed as well as health goals.
  • For example, individuals want to work on each muscle group at least two times a week if their goal is to build muscle. (Brad J. Schoenfeld, Dan Ogborn, James W. Krieger. 2016)
  • For individuals following a split routine, like upper body one day and lower body the next, workouts can be more frequent than total body workouts.

Intensity

Workout intensity involves how hard the individual is pushing themselves during exercise. How it is increased or decreased depends on the type of workout. (Carol Ewing Garber, et al., 2011)

Cardiovascular Workouts

For cardio, individuals will monitor workout intensity by:

  • Heart rate
  • Perceived exertion
  • Talk test
  • Heart rate monitor
  • A combination of these measures.
  1. The general recommendation is to work at a moderate intensity for steady workouts.
  2. Interval training is done at a higher intensity for a shorter period.
  3. It’s recommended to mix up low, medium, and high-intensity cardio exercises to stimulate different energy systems and prevent overtraining. (Nathan Cardoos. 2015)

Strength Training

  • Individual intensity comprises the amount of weight being lifted and the number of reps and sets done.
  • The intensity can change based on health goals.
  1. Beginners looking to build stability, endurance, and muscle are recommended to use a lighter weight and do fewer sets with high repetitions – for example, two or three sets of 12 to 20 reps.
  2. Individuals wanting to grow muscle are recommended to do more sets with a moderate amount of reps – for example, four sets of 10 to 12 reps each.
  3. Individuals who want to build strength are recommended to use heavy weights and do more sets with fewer reps – for example, five sets of three reps each.
  4. Building muscle can be done with a wide range of repetitions and weights. (Brad J. Schoenfeld, Dan Ogborn, James W. Krieger. 2016)

Time

The next element of the plan is how long the exercise will be during each session. Exercise length depends on individual fitness level and the type of workout being done.

Cardiovascular Workouts

The exercise guidelines suggest 30 to 60 minutes of cardio, but workout duration will depend on fitness level and type of exercise. ((Carol Ewing Garber, et al., 2011)

  • Beginners are recommended to start with a 15- to 20-minute workout.
  • Individuals with some workout experience and are doing steady-state cardio, like jogging or using a cardio machine, might exercise for 30 to 60 minutes.
  • For individuals doing interval training and working at very high intensity, the workout will be shorter, around 10 to 15 minutes of high-intensity interval training.
  • Having a variety of workouts of different intensities and durations will provide a solid, balanced cardiovascular program.

Strength Training

  • How long an individual strength trains will depend on the type of workout and schedule.
  • A total body workout can take over an hour.
  • A split routine can take less time by working fewer muscle groups in one session.

Type

The type of exercise you do is the last part of the FIIT principle.
It is easy to manipulate to avoid overuse injuries or weight loss plateaus.

Cardiovascular Workouts

  • Cardio is easy to adjust and change because any activity that increases heart rate counts.
  1. Walking, dancing, running, cycling, swimming, and using an elliptical trainer are a few activities that can be incorporated.
  2. Having multiple cardio activities is recommended to reduce burnout and keep workouts fresh.

Strength Training

  • Strength training workouts can also be varied.
  • They include any exercise where some type of resistance  –  bands, dumbbells, machines, etc. are used to work the muscles.
  • Bodyweight exercises can also be considered a form of strength training.
  • Strength workouts can be changed from total body training to adding, for example, supersets or pyramid training.
  • Incorporating new exercises for each body area is another way to vary the type of workouts.
  • Spending a few weeks working on functional strength movements, then switching to hypertrophy or strength-based training.
  • Each modality includes various alternative types of strength-based exercises.

Using FITT

The FITT principle outlines how to adjust workout programs to achieve better results. It also helps figure out how to change workouts to avoid burnout, overuse injuries, and plateaus.

For example, walking three times a week for 30 minutes at a moderate pace is recommended for a beginner to start out with. After a few weeks, the body adapts to the workout. This results in burning fewer calories, burnout, or weight management efforts, and goals are put on hold. This is where the FITT principles come in. For example, a change-up could include:

  • Changing frequency by adding another day of walking or jogging.
  • Changing intensity by walking faster, adding more challenging terrain like a hill, or jogging at certain intervals.
  • Walking for a longer time each workout day.
  • Changing the type of workout by swapping one or more of the walk sessions for cycling or aerobics.
  1. Even just changing one element can make a big difference in the workout and how the body responds to exercise.
  2. It’s important to change things up regularly to keep the body healthy and mind engaged.

Injury Prevention

One of the best things about using FITT is that it allows individuals to monitor the length and intensity of their workouts. When individuals work out too frequently or don’t get enough rest, they run the risk of overuse injuries, burnout, and muscle strains. The FITT principle encourages adding variety to workouts. When following this practice, it allows the body to rest and recover properly. Because individuals are not working the same muscle groups over and over again, better results are achieved.

Fighting Inflammation Naturally

References

Garber, C. E., Blissmer, B., Deschenes, M. R., Franklin, B. A., Lamonte, M. J., Lee, I. M., Nieman, D. C., Swain, D. P., & American College of Sports Medicine (2011). American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Medicine and science in sports and exercise, 43(7), 1334–1359. https://doi.org/10.1249/MSS.0b013e318213fefb

McCall Pete. 8 reasons to take a rest day. (2018) American Council on Exercise.

National Strength and Conditioning Association. (2017) Determination of resistance training frequency.

Schoenfeld, B. J., Ogborn, D., & Krieger, J. W. (2016). Effects of Resistance Training Frequency on Measures of Muscle Hypertrophy: A Systematic Review and Meta-Analysis. Sports medicine (Auckland, N.Z.), 46(11), 1689–1697. https://doi.org/10.1007/s40279-016-0543-8

Cardoos, Nathan MD. Overtraining Syndrome. (May/June 2015). Current Sports Medicine Reports 14(3):p 157-158. DOI: 10.1249/JSR.0000000000000145

The Benefits of Posture Awareness Training

By
Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP
-
Beautiful young girl doing exercises at home using chair. Urdhva hastasana asana.

“For individuals trying to achieve a healthy posture, could using posture awareness training be effective in treatment and prevention?”

The Benefits of Posture Awareness Training

Posture Awareness

Spinal curves help support the body’s weight, movement, and balance. Five areas include the neck, upper back, lower back, sacrum, and coccyx. The bottom of the spine or sacrum rests between the two hip bones that comprise the pelvis. Because of this location, the movements made with the pelvis significantly affect the spine. (Ibrahim Alkatout, et al., 2021) When the pelvis moves, the spine moves.

  • Posture-related back pain and associated symptoms are often caused by a weakened strength and flexibility ratio between the opposing muscle groups that hold the body upright.
  • Achieving healthy posture requires technique and consistent practice for maintaining a healthy pelvis and low back curve. (DeokJu Kim, et al., 2015)
  • Finding the low back curve and exploring how it responds when moving the pelvis is important to effective posture awareness training.

Lower Back Curve Awareness Exercise

One important thing to do to increase postural awareness is to become aware of the low back curve. (Arkadiusz Łukaz Żurawski, et al., 2020)

Sit On a Firm Chair or Stool

  • So that the weight is planted into the seat in a balanced way.

Hold Onto the Arms of the Chair

  • If the chair doesn’t have arms, hold onto the edge of a desk/workstation or the sides of the chair seat.
  • This will support the back when moving the pelvis.
  • Maintaining core abdominal strength is key to preventing back injury. (Erika Zemková, Ludmila Zapletalová. 2021)

Movement

  • Tilt the pelvis forward.
  • In this position, notice the slightly exaggerated arch in the lower back and the increase in lower back muscle tension.
  • A moderate amount of this increase and exaggeration is normal.

Relax Back to the Start Position

Sitting upright with the hip bones/top of the pelvis directly above the bottom.

  • Next, tilt the pelvis back.
  • The abs may have to work hard to support this position
  • Use your hands against the chair for support.
  • Check the lumbar curve area, noticing if it has flattened out.
  • Notice the tension in the back muscles.
  • Is it a little looser? This is normal.

Relax Back to the Start Position

  • Sitting upright.
  • Repeat the sequence again.
  • This time, when in the forward position, pause briefly and slide a hand between the lower back and the back of the chair or the wall.
  • When in the backward position, there will be little to no space between the lower back and the seatback or wall.

Problems

  • If there are problems moving the pelvis back and forth, imagine a basket or bowl of fruit.
  • The pelvis has a round shape and is open at the top, like a bowl or basket.
  • Imagine the fruit is placed toward the front of the bowl, and the weight brings the bowl/pelvis forward.
  • To go back, imagine the fruits are placed toward the back.
  • The weight causes the bowl to roll backward.
  • This may help to get the rhythm of the movement.

This posture awareness exercise can be used as a posture muscle builder by doing it with the back against the wall.

  • A more challenging position for this exercise is standing against a wall.
  • Keep the heels against the baseboard to really work the abs.
  • Start with sitting and gradually to standing.

Foot Motion and Posture

References

Kim, D., Cho, M., Park, Y., & Yang, Y. (2015). Effect of an exercise program for posture correction on musculoskeletal pain. Journal of physical therapy science, 27(6), 1791–1794. https://doi.org/10.1589/jpts.27.1791

Alkatout, I., Wedel, T., Pape, J., Possover, M., & Dhanawat, J. (2021). Review: Pelvic nerves - from anatomy and physiology to clinical applications. Translational neuroscience, 12(1), 362–378. https://doi.org/10.1515/tnsci-2020-0184

Żurawski, A. Ł., Kiebzak, W. P., Kowalski, I. M., Śliwiński, G., & Śliwiński, Z. (2020). Evaluation of the association between postural control and sagittal curvature of the spine. PloS one, 15(10), e0241228. https://doi.org/10.1371/journal.pone.0241228

Zemková, E., & Zapletalová, L. (2021). Back Problems: Pros and Cons of Core Strengthening Exercises as a Part of Athlete Training. International journal of environmental research and public health, 18(10), 5400. https://doi.org/10.3390/ijerph18105400

Comprehensive Guide to Women’s Lower Back and Pelvic Pain

By
Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP
-
Gynecologist doctor shows bones of female pelvis and giving consultation to woman in modern medical clinic

“For women experiencing lower back and pelvic pain, could understanding symptoms help in the diagnostic process, treatment options, and prevention?”

Comprehensive Guide to Women's Lower Back and Pelvic Pain

Low Back and Pelvic Pain In Women

In women, lower back and hip pain that radiates to the front pelvis area can have a variety of causes. The pain can feel dull, sharp, or burning. The main causes of lower back and pelvic pain in women fall into two categories. (William S. Richardson, et al., 2009)

Musculoskeletal and nervous system

  • Related causes of pain affect how your muscles, nerves, ligaments, joints, and bones move.
  • Examples include sciatica, arthritis, and injury.

Other organ system-based

Causes may stem from the following:

  • Acute/chronic conditions or infections
  • Kidneys – stones, infection, and other ailments or conditions.
  • Reproductive system – such as the ovaries.
  • Gastrointestinal system – inguinal hernias or appendix.

Musculoskeletal and Nervous System Causes

Musculoskeletal and nervous system-related causes can be from injuries like a fall or practicing unhealthy posture.

Overuse Injuries and Trauma

Frequent use and repetitive movements can lead to overuse injuries to the muscles, ligaments, and joints.  :

  • Exercises, sports, and physical activities that require repetitive twisting and bending.
  • Lifting, carrying, and placing objects that require movements that are repeated regularly.
  • Trauma from vehicle collisions, accidents, falls, or sports accidents can inflict acute and chronic bodily injuries, like strained muscles or broken bones.
  • Depending on the type of trauma, healing and recovery time and treatment vary.
  • Both types of injuries can lead to numbness, tingling, pain, stiffness, popping sensations, and/or weakness in the legs.

Mobility Problems

Over time, a decreased range of motion and mobility in muscles and joints can cause discomfort and pain. Causes include:

  • Long periods of time spent in the same position.
  • Sitting for extended periods.
  • The pain often feels dull, achy, and stiff.
  • It can also lead to muscle spasms characterized by quick episodes of sharp and intense pain.

Posture

  • Posture while sitting, standing, and walking affects the body’s range of motion.
  • It can affect the nerves and blood circulation to the back and pelvic region.
  • Prolonged unhealthy postures can contribute to lower back pain and muscle strain.
  • Posture-related symptoms can feel achy and stiff and lead to quick episodes of severe or intense pain, depending on the position.

Sciatica and Nerve Compression

  • A bulging or herniating vertebral disc most commonly causes sciatica and pinched or compressed nerves.
  • The sensations can be sharp, burning, electrical, and/or radiating pain along the nerve pathway.

Arthritis

  • Arthritis inflammation causes swelling, stiffness, pain, and the breakdown of cartilage that cushions the joints.
  • Hip arthritis causes groin pain that can radiate to the back and becomes more intense when standing or walking.
  • Thoracic and lumbar spine arthritis, or degenerative disc disease, are other common causes of back pain.

Sacroiliac Joint Dysfunction

Renal and Urinary Causes

Kidney Stones

  • Kidney stones are the build-up of minerals and salts, which form into hard stones in the kidneys.
  • When the kidney stone begins to move to the bladder, pain symptoms will present.
  • It can trigger severe back and side pain that radiates to the pelvic region.
  • Other symptoms include – a change in urine color, pain when urinating, nausea, and vomiting.

Kidney Infection and Urinary Tract Infections

  • Urinary tract and kidney infections are also causes of lower back and pelvic pain in women.
  • They cause fever, continued urge to urinate, and painful urination.

Gynecological Causes

Pelvic Inflammatory Disease

Infections, known as pelvic inflammatory disease, occur when sexually transmitted bacteria spread through the vagina, womb, fallopian tubes, or ovaries. Symptoms include:

  • Pain during intercourse.
  • Bleeding between periods.
  • Vaginal discharge.
  • Pain in the lower abdomen or groin.
  • Fever.

Ovarian Cysts

  • The cyst can be a solid or fluid-filled sac on the surface or within an ovary.
  • Small ovarian cysts are unlikely to cause pain.
  • Large cysts or those that rupture can cause mild to severe pain.
  • The pain can occur during menstruation or intercourse and present acutely in the back, pelvis, or lower abdomen.

During Pregnancy

  • Back pain and discomfort in the pelvis area are common.
  • As the body adjusts, the bones and round ligaments in the pelvis move and stretch, which can cause discomfort.
  • Symptoms are usually normal but should be discussed with a healthcare provider during check-ups.
  • Pain in the lower back and groin can be a sign of miscarriage or labor – including preterm labor.

Sexually Transmitted Infection

  • Sexually transmitted infections, like chlamydia or gonorrhea, can cause lower back and groin pain.
  • Other symptoms can include – painful urination, vaginal discharge, intercourse pain, and bleeding between periods.

Yeast Infection

  • A yeast infection – overgrowth of the fungus candidiasis.
  • A common vaginal infection with symptoms including – itching, swelling, irritation, and pelvic pain.

Other Causes

Appendicitis

  • When the appendix becomes blocked, infected, and inflamed.
  • In most cases, a major symptom is pain that starts near or around the belly button.
  • In other cases, it can start in the lower back and radiate to the right side of the pelvic area. (Johns Hopkins Medicine. 2023)
  • Associated pain can worsen over time or when coughing, moving, or taking deep breaths.

Other symptoms include:

  1. Upset stomach
  2. Nausea
  3. Vomiting
  4. Loss of appetite
  5. Fever
  6. Chills
  7. Abnormal bowel movements – constipation and/or diarrhea. (Johns Hopkins Medicine. 2023)

Inguinal Hernia

  • A groin hernia is referred to an inguinal hernia.
  • It involves soft tissue and part of the intestine, pushing through weak groin muscles.
  • Pain presents in the abdomen, lower back, or pelvis, especially when bending or lifting objects.

Pancreatitis

  • Inflammation in the pancreas.
  • Infection, bile stones, or alcohol can cause it.
  • One symptom is abdominal pain that radiates to the back.
  • The pain becomes worse during and after eating.
  • Other symptoms include nausea, vomiting, and fever.

Enlarged Lymph Nodes

  • Lymph nodes lie in the internal and external regions of the iliac artery in the pelvis.
  • These can become enlarged by infection, injury, and, in rare cases, cancer.
  • Symptoms include pain, swelling, redness, skin irritation, and fever.

Enlarged Spleen

  • The spleen is located behind the left side of the rib cage.
  • It filters the blood and supports new blood cell creation.
  • Infections and diseases can cause the spleen to become enlarged.
  1. An enlarged spleen – a condition known as splenomegaly – causes pain in the upper left part of the belly and sometimes the left shoulder and upper back.
  2. However, some individuals with an enlarged spleen experience abdominal symptoms – not being able to eat without discomfort. (Mount Sinai. 2023)

Diagnosis

  • Depending on the cause of your pain, a healthcare provider may be able to diagnose it with a physical exam and by asking questions about your condition.
  • Other tests may be needed to find the cause, particularly blood work and imaging (X-ray or magnetic resonance imaging).

Treatment

  • Treatment of symptoms depends on the cause.
  • Once a diagnosis is made, an effective treatment plan will be developed and contain a combination of therapies:

Lifestyle Adjustments

  • For injuries caused by muscle strains, joint sprains, overuse, and smaller traumas, pain can be resolved with:
  • Rest
  • Ice therapy
  • Over-the-counter pain relievers – acetaminophen or ibuprofen.
  • Braces or compression wraps can help support the body and alleviate symptoms during healing and recovery.
  1. Exercises to improve posture
  2. Paying attention to form when lifting objects
  3. Stretching can help ease the pain.

Medication

Medications can be used in a variety of ways to help in the treatment of lower back and pelvic pain. If an infection is the cause, medications will be prescribed to remove the infection and resolve the symptoms, which can include:

  • Antibiotics
  • Antifungals
  • Antivirals

Medications may also be prescribed to help manage pain symptoms and may include:

  • Medication to relieve nerve pain
  • Muscle relaxants
  • Steroids

Physical Therapy

A physical therapist can help to correct problems with:

  • Posture
  • Decreased mobility
  • Walking gait
  • Strengthening
  1. A physical therapist will provide exercises to help increase and maintain strength, range of motion, and flexibility.

Pelvic Floor Therapy

  • This is physical therapy that focuses on the muscles, ligaments, and connective tissues in the pelvis.
  • It helps with pain, weakness, and dysfunction in the pelvic area.
  • A treatment plan will be developed to help with strength and range of motion in the pelvic muscles.

Chiropractic Care

Surgery

  • Some more severe conditions could require surgery.
  • Ovarian cysts, hernias, and other infections sometimes require surgery to remove infected or unhealthy tissue – ruptured ovarian cysts or appendicitis.

Recommended surgeries can include:

  1. A hernia repair.
  2. Hip replacement.
  3. Gallbladder removal to prevent recurring pancreatitis.

Prevention

Not all conditions and diseases cause lower back and pelvic pain. Symptoms can be prevented and reduced by adopting lifestyle changes. Prevention recommendations can include:

  • Staying hydrated.
  • Using proper bending and lifting techniques.
  • Eating healthy foods.
  • Regularly engaging in some form of physical activity – walking, swimming, yoga, cycling, or strength training.
  • Maintaining a healthy weight.

Pregnancy and Sciatica

References

Richardson, W. S., Jones, D. G., Winters, J. C., & McQueen, M. A. (2009). The treatment of inguinal pain. Ochsner journal, 9(1), 11–13.

Kurosawa, D., Murakami, E., & Aizawa, T. (2017). Groin pain associated with sacroiliac joint dysfunction and lumbar disorders. Clinical neurology and neurosurgery, 161, 104–109. https://doi.org/10.1016/j.clineuro.2017.08.018

Johns Hopkins Medicine. Appendicitis.

Mount Sinai. Splenomegaly.

Santilli, V., Beghi, E., & Finucci, S. (2006). Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized double-blind clinical trial of active and simulated spinal manipulations. The spine journal : official journal of the North American Spine Society, 6(2), 131–137. https://doi.org/10.1016/j.spinee.2005.08.001

Acupuncture Treatment for Stress and Inflammatory Conditions

By
Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP
-
Female lying on massage table, doctor holding acupuncture needle near her skin and performing procedure to relax back muscles

“For individuals dealing with pain, inflammatory conditions, and stress issues, could adding acupuncture to a treatment plan help bring relief and healing?”

Acupuncture Treatment for Stress and Inflammatory Conditions

Acupuncture Treatment

Acupuncture treatment is a traditional Chinese medicine based on circulating the body’s life energy, or qi, with the idea that a blockage or disturbance in the energy flow can cause health issues. Acupuncturists insert thin needles into specific points throughout the body to rebalance the body’s energy, stimulate healing, and promote relaxation. (Johns Hopkins Medicine. 2023) Researchers are not exactly sure how the treatment works; however, theories suggest that it can help release endorphins, as well as influence the autonomic nervous system.

How Does It Work?

Researchers have not been able to understand how acupuncture works fully, but some theories include:

  • The needles stimulate the release of endorphins – the body’s natural pain-relieving chemicals.
  • They can influence the autonomic nervous system, and specific needle placement impacts breathing, blood pressure, and heart rate. (Tony Y. Chon, Mark C. Lee. 2013)

Conditions

Acupuncture has been useful for a variety of conditions, including (Tony Y. Chon, Mark C. Lee. 2013)

  • Chronic pain
  • Migraines and associated symptoms
  • Sinus congestion or nasal stuffiness
  • Insomnia and sleep-related difficulties
  • Stress
  • Anxiety
  • Arthritis joint inflammation
  • Nausea
  • Infertility – difficulty getting pregnant
  • Depression
  • Skin appearance (Younghee Yun et al., 2013)

Benefits

The health benefits can vary depending on the individual. It may take several sessions before benefits are noticed. (Tony Y. Chon, Mark C. Lee. 2013) Research is still limited; however, there are some studies that found acupuncture to be helpful for certain conditions.

Low Back Pain

  • A study on non-pharmacological options for lower back pain showed that acupuncture treatment relieved intense pain and promoted better back functioning.
  • However, in terms of long-term benefits, it was not clear how helpful the treatment was. (Roger Chou, et al., 2017)

Migraines

Research done over a six-month period showed that:

  • Acupuncture was able to reduce the frequency of migraine symptoms by half in 41% of individuals compared to those not receiving acupuncture.
  • Treatment was noted as being helpful as preventative migraine medications. (Klaus Linde, et al., 2016)

Tension Headaches

  • According to research, having at least six acupuncture sessions may be helpful for individuals with frequent head pain or pressure/tension headaches.
  • This study also noted that acupuncture, combined with pain medication, significantly reduced headache frequency compared to those only given medication. (Klaus Linde, et al., 2016)

Knee Pain

  • Multiple studies found that acupuncture treatment may be able to improve knee function short and long-term in individuals who have knee osteoarthritis.
  • This condition causes the connective tissue in the knee to break down.
  • The study also found that treatment was able to help with osteoarthritis and decrease knee pain but was only helpful for the short term. (Xianfeng Lin, et al., 2016)
  • Another review looked at multiple studies that found that treatment delayed and reduced the use of pain medication in individuals who had knee replacement surgery. (Dario Tedesco, et al., 2017)

Facial Elasticity

  • Cosmetic or facial acupuncture is used to improve the appearance of the skin on the head, face, and neck.
  • In a study, individuals had five acupuncture sessions in three weeks, and a little over half of the participants showed skin elasticity improvement. (Younghee Yun et al., 2013)

The Process

Before getting acupuncture treatment, the acupuncturist will ask the individual about their medical history and may perform a physical examination.

  • Thin needles are placed in specific areas to address your concern or condition.
  • The acupuncturist may gently twist the needles to emphasize stimulation.
  • The needles are left in for 20 to 30 minutes, with the total session lasting anywhere from 30 minutes to an hour. (Tony Y. Chon, Mark C. Lee. 2013)

The acupuncturist may use additional techniques that can include: (Tony Y. Chon, Mark C. Lee. 2013)

Moxibustion

  • This is the burning of dried herbs near the acupuncture needles to warm and stimulate the points and enhance healing.

Electroacupuncture

  • An electrical device is connected to the needles, providing a gentle electrical current that stimulates the muscles.

Cupping

  • Glass or silicone cups are placed on the area, creating a vacuum/suction effect, which helps stimulate blood circulation and rebalance the energy. (Johns Hopkins Medicine. 2023)
  • After the treatment, some individuals may feel relaxed, while others may feel energized.

Is It Painful?

Individuals may feel a slight ache, sting, or pinch as the needle is inserted. Some acupuncturists adjust the needle after it has been inserted, which can cause additional pressure.

  • Once the needle is properly placed, individuals may feel a tingling or heavy feeling, referred to as de qi. (National Institutes of Health. (N.D.)
  • Let the acupuncturist know if there is discomfort or increased pain at any point during the session.
  • Intense pain may mean the needle has not been inserted or placed correctly. (Johns Hopkins Medicine. 2023)

Side Effects

As with any treatment, side effects can present in individuals that include:

  • Pain and bleeding from the needle insertion
  • Bruising around the area, the needles were placed
  • Nausea
  • Allergic reaction
  • Skin rash
  • Infections
  • Dizziness (Malcolm W. C. Chan et al., 2017)

In order to reduce the risks, the treatment should always be done by a licensed trained healthcare provider using clean, disposable needles. It is recommended to consult with a primary care physician before getting acupuncture, as the treatment may not be right for individuals with certain health conditions.

Heel Spurs

References

Johns Hopkins Medicine. (2023) Acupuncture.

Chon, T. Y., & Lee, M. C. (2013). Acupuncture. Mayo Clinic proceedings, 88(10), 1141–1146. https://doi.org/10.1016/j.mayocp.2013.06.009

Yun, Y., Kim, S., Kim, M., Kim, K., Park, J. S., & Choi, I. (2013). Effect of facial cosmetic acupuncture on facial elasticity: an open-label, single-arm pilot study. Evidence-based complementary and alternative medicine : eCAM, 2013, 424313. https://doi.org/10.1155/2013/424313

Chou, R., Deyo, R., Friedly, J., Skelly, A., Hashimoto, R., Weimer, M., Fu, R., Dana, T., Kraegel, P., Griffin, J., Grusing, S., & Brodt, E. D. (2017). Nonpharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice Guideline. Annals of internal medicine, 166(7), 493–505. https://doi.org/10.7326/M16-2459

Linde, K., Allais, G., Brinkhaus, B., Fei, Y., Mehring, M., Vertosick, E. A., Vickers, A., & White, A. R. (2016). Acupuncture for the prevention of episodic migraine. The Cochrane database of systematic reviews, 2016(6), CD001218. https://doi.org/10.1002/14651858.CD001218.pub3

Linde, K., Allais, G., Brinkhaus, B., Fei, Y., Mehring, M., Shin, B. C., Vickers, A., & White, A. R. (2016). Acupuncture for the prevention of tension-type headache. The Cochrane database of systematic reviews, 4(4), CD007587. https://doi.org/10.1002/14651858.CD007587.pub2

Lin, X., Huang, K., Zhu, G., Huang, Z., Qin, A., & Fan, S. (2016). The Effects of Acupuncture on Chronic Knee Pain Due to Osteoarthritis: A Meta-Analysis. The Journal of bone and joint surgery. American volume, 98(18), 1578–1585. https://doi.org/10.2106/JBJS.15.00620

Tedesco, D., Gori, D., Desai, K. R., Asch, S., Carroll, I. R., Curtin, C., McDonald, K. M., Fantini, M. P., & Hernandez-Boussard, T. (2017). Drug-Free Interventions to Reduce Pain or Opioid Consumption After Total Knee Arthroplasty: A Systematic Review and Meta-analysis. JAMA surgery, 152(10), e172872. https://doi.org/10.1001/jamasurg.2017.2872

National Institutes of Health. (N.D.) De qi sensation.

Chan, M. W. C., Wu, X. Y., Wu, J. C. Y., Wong, S. Y. S., & Chung, V. C. H. (2017). Safety of Acupuncture: Overview of Systematic Reviews. Scientific reports, 7(1), 3369. https://doi.org/10.1038/s41598-017-03272-0

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