How to Choose the Best Protein Bar for Your Diet

By

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

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“For individuals trying to make healthy lifestyle adjustments, can adding protein bars into their diet help achieve health goals?”

Table of Contents

Protein Bar

Protein bars provide a quick energy boost between meals that can help curb appetite and avoid filling up on high-fat, sodium-packed snacks for individuals trying to lose weight. They can also increase calorie intake for individuals like athletes trying to increase muscle mass. Protein bars can vary in terms of factors like additives, calories, fat, sugars, and other ingredients. Labels need to be read carefully; otherwise, the bar can be more of a candy bar than a healthy, nutritious mini-meal or snack. It’s important to have a sense of how much protein is really needed each day, and the amount varies depending on individual factors.

How Much Protein Is Needed

Protein is vital to many body functions, but the body can’t produce this macronutrient, and it has to come from food. Dietary protein is broken down during digestion, and compounds known as amino acids are formed:

These are the building blocks the body uses to build and maintain muscles and organs.
It is vital to the production of blood, connective tissue, antibodies, enzymes, and hair. (Marta Lonnie, et al., 2018)
As protein is necessary for building muscle, athletes or individuals with physically demanding jobs are recommended to eat more.
The same is true of women who are pregnant or breastfeeding. (Trina V. Stephens, et al., 2015)
Bodybuilders eat even more protein than the average person to support muscle growth.

Protein Calculator

A calculator from the U.S. Department of Agriculture can help figure out daily protein requirements and recommended amounts of other nutrients based on sex, age, activity level, and other factors.
The ideal protein intake considers how much is eaten at individual sittings. The average individual is recommended to consume between 25 and 35 grams of protein at every meal. (Emily Arentson-Lantz, et al., 2015)

Sources

The richest sources of dietary protein include:

Meats
Poultry
Fish and shellfish
Eggs
Milk and other dairy products

Plant sources include:

Beans
Legumes
Nuts
Seeds
Whole grains

These are foods that are easy to include in a balanced diet, so eating a variety in ample quantities daily will equal the recommended amount of protein. Recommendations are to stick with those low in saturated fat and processed carbs and rich in nutrients. However, eating too much protein can cause kidney problems. Therefore, individuals who are predisposed to kidney disease are recommended to be careful over-protein intake. (Kamyar Kalantar-Zadeh, Holly M. Kramer, Denis Fouque. 2020)

What To Look For

Incorporating protein bars into a diet, either as a between-meal snack, as a grab-and-go option when there is no time for a full meal, or as a part of a weight-loss or weight-gain strategy, individuals need to read and understand the ingredients on the different types of bars to choosing the healthiest options. Some general guidelines to consider:

Protein Content

For a between-meal or pre-post-workout snack, look for a bar with at least 20 grams of protein.
Meal replacement bars should have at least 30 grams of protein.
A less is more approach to these guidelines is recommended, as the body can digest only between 20 and 40 grams of protein in one sitting. (Brad Jon Schoenfeld, Alan Albert Aragon. 2018)

Protein Type

The protein usually comes from dairy or plant sources.
The most common include eggs, milk, rice, whey, soy, peas, and hemp.
Individuals with allergies or sensitivities need to choose a bar that is comprised of a type of protein that is safe to eat.

Calories

For a bar to eat between meals, recommendations are those with around 220 to 250 calories.
A protein bar that substitutes for a full meal can have 300 to 400 calories.

Fat

Ten to 15 grams of total fat and no more than two grams of saturated fat is ideal.
Steer clear of unhealthy trans fats found in partially hydrogenated oils.

Fiber

Fiber is filling, so the more fiber, the more likely it is to keep hunger satisfied until the next snack or meal.
It is recommended to choose those that contain more than three to five grams of fiber.

Sugar

Some protein bars have just as much sugar content as candy bars.
Some have as much as 30 grams of added sugar.
The ideal amount is around five grams or less.
Artificial sweeteners like erythritol, sorbitol, and maltitol are not better options as they can cause bloating and gas.

It is recommended to work with a nutritionist to figure out the most effective type so that they can be incorporated into an individual’s diet to achieve and maintain health goals.

Nutrition Fundamentals

References

Lonnie, M., Hooker, E., Brunstrom, J. M., Corfe, B. M., Green, M. A., Watson, A. W., Williams, E. A., Stevenson, E. J., Penson, S., & Johnstone, A. M. (2018). Protein for Life: Review of Optimal Protein Intake, Sustainable Dietary Sources and the Effect on Appetite in Ageing Adults. Nutrients, 10(3), 360. https://doi.org/10.3390/nu10030360

Stephens, T. V., Payne, M., Ball, R. O., Pencharz, P. B., & Elango, R. (2015). Protein requirements of healthy pregnant women during early and late gestation are higher than current recommendations. The Journal of nutrition, 145(1), 73–78. https://doi.org/10.3945/jn.114.198622

Arentson-Lantz, E., Clairmont, S., Paddon-Jones, D., Tremblay, A., & Elango, R. (2015). Protein: A nutrient in focus. Applied physiology, nutrition, and metabolism = Physiologie appliquee, nutrition et metabolisme, 40(8), 755–761. https://doi.org/10.1139/apnm-2014-0530

Kalantar-Zadeh, K., Kramer, H. M., & Fouque, D. (2020). High-protein diet is bad for kidney health: unleashing the taboo. Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association – European Renal Association, 35(1), 1–4. https://doi.org/10.1093/ndt/gfz216

Schoenfeld, B. J., & Aragon, A. A. (2018). How much protein can the body use in a single meal for muscle-building? Implications for daily protein distribution. Journal of the International Society of Sports Nutrition, 15, 10. https://doi.org/10.1186/s12970-018-0215-1

Essential Guide To Rehabilitation Exercise Program

By

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

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Senior woman with trainer doing rehab using pilates ball in the rehabilitation center

“Individuals who have gone through recent low back surgery, like a lumbar laminectomy and discectomy, could they benefit from physical therapy for full recovery? (Johns Hopkins Medicine. 2008)”

Table of Contents

Rehabilitation Exercise Program

A lumbar laminectomy and discectomy is a surgical procedure performed by an orthopedic or neurologic surgeon to help decrease pain, relieve associated symptoms and sensations, and improve flexibility and mobility. The procedure involves cutting away disc and bone material that presses against, irritates, and damages the spinal nerves. (Johns Hopkins Medicine. 2023)

Post-Surgery

The therapist will work with the individual to develop a rehabilitation exercise program. The objective of a rehabilitation exercise program is to help the individual:

Relax their muscles to prevent muscle tensing and becoming over-cautious
Regain full range of motion
Strengthen their spine
Prevent injuries

A guide on what to expect in physical therapy.

Postural Retraining

After back surgery, individuals have to work to maintain proper posture when sitting and standing. (Johns Hopkins Medicine. 2008)
Postural control is important to learn as it maintains the lower back in the optimal position to protect and expedite the healing of lumbar discs and muscles.
A physical therapist will teach the individual how to sit with proper posture and use lumbar support.
Attaining and maintaining proper posture is one of the most important things to help protect the back and prevent future back problems.

Walking Exercise

Walking is one of the best exercises after lumbar surgery. (Johns Hopkins Medicine. 2008)

Walking helps to improve cardiovascular health and blood circulation throughout the body.
This helps to provide added oxygen and nutrients to the spinal muscles and tissues as they heal.
It is an upright exercise that puts the spine in a natural position, which helps to protect the discs.
The therapist will help set up a program tailored to the individual’s condition.

Prone Press Up

One of the exercises to protect the back and lumbar discs is prone press-ups. (Johns Hopkins Medicine. 2008) This exercise helps keep the spinal discs situated in the proper position. It also helps to improve the ability to bend back into lumbar extension.

To perform the exercise:

Lie facing down on a yoga/exercise mat and place both hands flat on the floor under the shoulders.
Keep the back and hips relaxed.
Use the arms to press the upper part of the body up while allowing the lower back to remain against the floor.
There should be a slight pressure in the lower back while pressing up.
Hold the press-up position for 2 seconds.
Slowly lower back down to the starting position.
Repeat for 10 to 15 repetitions.

Sciatic Nerve Gliding

Individuals who had leg pain coming from the back prior to surgery may have been diagnosed with sciatica or an irritation of the sciatic nerve. Post-surgery, individuals may notice their leg feels tight whenever straightening it out all the way. This could be a sign of an adhered/trapped sciatic nerve root, a common problem with sciatica.

After lumbar laminectomy and discectomy surgery, a physical therapist will prescribe targeted exercises called sciatic nerve glides to stretch and improve how the nerve moves. (Richard F. Ellis, Wayne A. Hing, Peter J. McNair. 2012)
Nerve glides can help free the stuck nerve root and allow for normal motion.

To perform the exercise:

Lie on the back and bend one knee up.
Grab underneath the knee with the hands.
Straighten the knee while supporting it with the hands.
Once the knee is fully straightened, flex and extend the ankle about 5 times.
Return to the starting position.
Repeat the sciatic nerve glide 10 times.
The exercise can be performed several times to help improve how the nerve moves and glides in the lower back and leg.

Supine Lumbar Flexion

After surgery, gentle back flexion exercises can help safely stretch the low-back muscles and gently stretch the scar tissue from the surgical incision. Supine lumbar flexion is one of the simplest exercises to improve lumbar flexion range of motion.

To perform the exercise:

Lie on the back with the knees bent.
Slowly lift the bent knees towards the chest and grasp the knees with both hands.
Gently pull the knees toward the chest.
Hold the position for 1 or 2 seconds.
Slowly lower the knees back to the starting position.
Perform for 10 repetitions.
Stop the exercise if experiencing an increase in pain in the lower back, buttocks, or legs.

Hip and Core Strengthening

Once cleared, individuals can progress to an abdominal and core strengthening program. This involves performing specific motions for the hips and legs while maintaining a pelvic neutral position. Advanced hip strengthening exercises help generate strength and stability in the muscles that surround the pelvic area and lower back. A physical therapist can help decide which exercises are recommended for the specific condition.

Return-to-Work and Physical Activities

Once individuals have gained an improved lumbar range of motion, hip, and core strength, their doctor and therapist may recommend working on specific activities to help them return to their previous level of work and recreation. Depending on job occupation, individuals may need to:

Work on proper lifting techniques.
Require an ergonomic evaluation if they spend time sitting at a desk or workstation.
Some surgeons may have restrictions on how much an individual can bend, lift, and twist from two to six weeks after surgery.

Low-back surgery can be difficult to rehab properly. Working with a healthcare provider and physical therapist, individuals can be sure to improve their range of motion, strength, and functional mobility to return to their previous level of function quickly and safely.

Sciatica, Causes, Symptoms and Tips

References

Johns Hopkins Medicine. (2008). The road to recovery after lumbar spine surgery.

Johns Hopkins Medicine. (2023). Minimally Invasive Lumbar Discectomy.

Ellis, R. F., Hing, W. A., & McNair, P. J. (2012). Comparison of longitudinal sciatic nerve movement with different mobilization exercises: an in vivo study utilizing ultrasound imaging. The Journal of orthopaedic and sports physical therapy, 42(8), 667–675. https://doi.org/10.2519/jospt.2012.3854

Headache on Top of the Head: Common Causes & Solutions

By

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

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Headache and migraine in woman alone at home, Hispanic woman sick has severe headache sitting alone tired on couch in living room.

“Individuals experiencing headaches on top of the head could be caused by different factors. Can recognizing what triggers pain or pressure help prevent this type of headache, and healthcare providers develop effective treatment plans?”

Table of Contents

Headache On Top of The Head

Various factors could cause a headache on top of the head; common causes include:

Stress
Sleep problems
Eye strain
Caffeine withdrawal
Dental problems
Hormonal changes
Alcohol consumption

Causes

Many causes have to do with underlying issues happening in other parts of the body.

Stress

Stress is a common cause of headaches, including one on top of the head.
Researchers don’t know exactly how stress causes headaches, but they think it causes tightening of the muscles in the back of the head or neck, which
pulls the tissues down, resulting in pain or pressure in the scalp and/or forehead area.
These are also called tension headaches.
Headaches caused by stress generally feel like dull pressure rather than throbbing pain.

Sleep Problems

Not getting enough sleep can induce a headache on top of the head.
When the mind and body do not get proper sleep, it can interfere with body functions like temperature, hunger, and sleep-wake cycles, which can lead to headaches.
It is common to feel more stressed when sleep-deprived, which can cause or compound a headache and other symptoms.

Eye Strain

You may develop a headache on the top of your head after you’ve been reading, watching, or otherwise focusing on something for a while.
Over time, your eye muscles tire and have to work harder, causing them to contract.
These spasms can lead to headaches. Squinting can make the muscle contractions even worse.

Caffeine Withdrawl

Individuals may feel pain on the top of their heads if they skip their regular coffee.
Regular caffeine consumption can lead to dependency and withdrawal symptoms, which include headaches when intake is reduced or stopped.
This type of headache can be moderate to severe and can feel worse with activity.
Most individuals start to feel better from caffeine withdrawal after a week. (World Health Organization. 2016)

Dental Problems

Teeth issues like cracks, cavities, or impaction can irritate the trigeminal nerve, setting off head pain.
Teeth grinding can also lead to headaches.

Hormonal Changes

Individuals who have a low level of thyroid hormone may experience headaches.
This could be from having too little thyroid or a symptom of the condition.
Like stress-induced headaches, this type is generally dull and not throbbing.
Some women may feel pain on the top of their heads before menstruation triggered by estrogen levels dropping.

Alcohol

Some individuals develop a headache on the top of their head or elsewhere within a few hours after drinking alcohol.
This is known as a cocktail headache.
Alcohol-induced headaches usually resolve within 72 hours.
The mechanism behind this headache is not fully researched, but it’s been thought that the widening of blood vessels in the brain/vasodilation when consuming alcohol may trigger head pain.
This type of headache is different than a hangover headache that comes from overconsumption and is based on dehydration and the toxic effects of alcohol. (J G Wiese, M. G. Shlipak, W. S. Browner. 2000)

Rare Causes

Top-of-the-head pain can also result from more serious and rare causes:

Brain Tumor

Headaches are one of the most common symptoms of brain tumors.
A headache on the top of the head depends on the location and size of the tumor. (MedlinePlus. 2021)

Brain Aneurysm

This is a weak or thin area in a brain artery that bulges and fills with blood, which can cause a life-threatening rupture.
Headaches are the most common symptom. (Brigham and Women’s Hospital. 2023)

Brain Bleed

Also known as a brain hemorrhage, this condition can cause intensely painful and quick headaches.
Brain bleeds can be caused by head trauma, high blood pressure, an aneurysm, a bleeding disorder, or liver disease. (New York-Presbyterian. 2023)

Treatment

Treatment for reducing a headache on top of the head includes:

Putting an ice bag over the area to reduce inflammation.
Getting an eye examination.
Making healthy lifestyle adjustments like drinking more water throughout the day.
Less caffeine intake.
Changing sleep patterns for a healthier, rested mind and body.
Taking a therapeutic bath to relax the body.
Gentle exercises like walking, pilates, or yoga.
Practicing deep breathing.
Mindfulness exercises like meditation.
Taking non-steroidal anti-inflammatory medication or NSAIDs like aspirin, Advil/ibuprofen), or Aleve/naproxen.

Depending on the cause and symptoms, a doctor may suggest specialist treatment options like:

Physical therapy
Cognitive behavioral therapy
Chiropractic therapy
Acupuncture
Prescription medication

A medical professional will be able to help identify the type of headache being experienced, offer treatment options, and advise on how to manage triggers.

Neck Injuries, El Paso, Texas

References

World Health Organization. (2016) Headache disorders.

Wiese, J. G., Shlipak, M. G., & Browner, W. S. (2000). The alcohol hangover. Annals of internal medicine, 132(11), 897–902. https://doi.org/10.7326/0003-4819-132-11-200006060-00008

MedlinePlus. (2021) Brain tumor.

Brigham and Women’s Hospital. (2023) Brain aneurysm.

New York-Presbyterian. (2023) Brain hemorrhage.

Exploring Pomegranates: A Guide to Their Benefits

By

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

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Fruit salad with grapefruit and orange, pomegranate seeds, honey and lemon, decorated with mint

“For individuals looking to increase their antioxidant, fiber, and vitamin intake, can adding pomegranates to their diet help?”

Table of Contents

Pomegranates

Pomegranates can amplify various dishes, from breakfasts to sides to dinners, with their balanced blend of mild sweetness, tartness, and crunch from their seeds.

Health Benefits

The fruit has been found to be a healthy source of vitamins, fiber, and antioxidants. A medium-sized fruit contains:

High amounts of vitamin C, vitamin K, copper, and other micronutrients (FoodData Central. U.S. Department of Agriculture. 2019)
About 18% of the recommended daily value of vitamin C.
28% of the recommended value of vitamin K based on a 2,000-calorie-per-day diet. (FoodData Central. U.S. Department of Agriculture. 2019)
6 grams of fiber (FoodData Central. U.S. Department of Agriculture. 2019)
High in antioxidants (Aida Zarfeshany et al., 2014)

Ways to use a pomegranate include:

Guacamole

Stir in some pomegranate arils before serving. They will provide an unexpected crunch that contrasts deliciously with guacamole’s smoothness.

Mash 2 ripe avocados
Mix in 1/4 cup diced red onion
1/4 tsp. salt
1 Tbsp. lemon juice
2 cloves garlic – minced
1/2 cup chopped fresh cilantro
Stir in 1/4 cup pomegranate arils
Serves 6

Nutrition per serving:

144 calories
13.2 grams fat
2.8 grams of saturated fat
103 milligrams sodium
7.3 grams carbs
4.8 grams fiber
1.5 grams protein

Smoothie

Smoothies provide extra nutrition and a healthy snack.

In a blender, mix 1/2 cup pomegranate arils
1 frozen banana
1/4 cup low-fat Greek yogurt
2 tsp. honey
Splash of orange juice
Pour into a glass and enjoy!

Nutrition per serving:

287 calories
2.1 grams fat
0.6 grams of saturated fat
37 milligrams sodium
67.5 grams carbs
6.1 grams fiber
4.9 grams protein

Oatmeal

Enhance oatmeal as pomegranates bounce off other fruits, sweeteners, and butter nicely.

Prepare 1/2 cup oats
Stir in 1/2 of a medium banana, sliced
1 Tbsp. brown sugar
2 Tbsp. pomegranate arils
1/2 tsp. ground cinnamon

Nutrition per serving:

254 calories
3 grams fat
0.5 grams of saturated fat
6 milligrams sodium
52.9 grams carbohydrates
6.7 grams fiber
6.2 grams protein

Brown Rice

Another way to use pomegranates is on rice.

Cook 1 cup brown rice.
Toss with 1/4 cup pomegranate arils
1 Tbsp. olive oil
1/4 cup chopped, toasted hazelnuts
1 Tbsp. fresh thyme leaves
Salt and pepper to taste
Makes 4 servings

Nutrition per serving:

253 calories
9.3 grams fat
1.1 grams of saturated fat
2 milligrams sodium
38.8 grams carbohydrates
2.8 grams fiber
4.8 grams protein

Cranberry Sauce

Make a tangy and crunchy cranberry sauce.

In a medium saucepan, combine 12 oz. fresh cranberries
2 cups pomegranate juice
1/2 cup granulated sugar
Cook over medium heat – adjust if the mixture gets too hot
Stir frequently for about 20 minutes or until most of the cranberries have popped and released their juice.
Stir in 1 cup pomegranate arils
Serves 8

Nutrition per serving:

97 calories
0.1 grams fat
0 grams of saturated fat
2 milligrams sodium
22.5 grams carbohydrates
1.9 grams fiber
0.3 grams protein

Infused Water

A fruit-infused water can help reach proper hydration.

Place 1 cup pomegranate arils
1/4 cup fresh mint leaves in the insert of a 1-quart infuser water bottle
Mix lightly
Fill with filtered water
Refrigerate for at least 4 hours to let flavors steep
Serves 4

Each serving will offer only trace amounts of nutrients, which depend on how much pomegranate juice infuses into the water.

For any questions about more specific nutrition goals or how to achieve them, consult the Injury Medical Chiropractic and Functional Medicine Clinic Health Coach and/or Nutritionist.

Healthy Diet and Chiropractic

References

FoodData Central. U.S. Department of Agriculture. (2019) Pomegranates, raw.

Zarfeshany, A., Asgary, S., & Javanmard, S. H. (2014). Potent health effects of pomegranate. Advanced biomedical research, 3, 100. https://doi.org/10.4103/2277-9175.129371

What You Need to Know About Dormant Butt Syndrome

By

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

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Young athletic woman doing exercises on legs and buttocks in gym. Sport, fitness, bodybuilding, training, healthy lifestyle concept.

“Individuals dealing with chronic knee discomfort, hip tightness, and lower back pain could be experiencing dormant gluteal-butt syndrome. Can recognizing the symptoms and signs and incorporating lower body and core fitness help prevent and treat the condition?”

Table of Contents

Dormant Gluteal Butt Syndrome

Knee, hip, and lower back problems could be traced back to weakened buttocks. Some scientists call the condition “dormant butt syndrome” (Ohio State University, .2023). However, researchers are learning about the important role the gluteal muscles provide in maintaining the lower body strong and healthy. (Hal David Martin, Manoj Reddy, Juan Gómez-Hoyos. 2015)

What Is It?

The syndrome is defined as weak buttock muscles and tight hip flexors. Experts from the Ohio State Wexner Medical Center have worked with individuals dealing with knee, hip, or back injuries and believe many of these issues are linked to weakened gluteal muscles. (Ohio State University.2023) The glutes are the muscles of the hips and buttocks. Weakened muscles fail to absorb the shock they’re supposed to during activities, which results in overloading the surrounding muscles and joints and increases the risk of injury. (Ohio State University, .2023)

Dormant gluteal-butt syndrome can result from a sedentary lifestyle and prolonged inactivity, like sitting for long periods.
The condition also occurs in runners and other physically active individuals who forget about these muscles with targeted exercises.

Exercises

Exercises to target the gluteals and prevent dormant gluteal-butt syndrome include activities/exercises that work the hips and core.

When walking properly, the gluteals should execute hip extension naturally.
Unhealthy postures, excessive sitting, and continued dysfunctional biomechanics mean walking without achieving optimal hip extension. (Hadi Daneshmandi. 2017)
When this happens, the gluteal muscles never get to fully function work, ending up with a series of aches and pains.
Pilates exercises can be adjusted to address order, repetition, and variation to strengthen the gluteals. (Laís Campos de Oliveira, 2015)

Hamstring Curls

Lie face down on an exercise mat.
Use your hands to create a cushion for the forehead.
Bend both knees so the feet point up towards the ceiling.
Let the knees be slightly apart, but keep the heels together.
Squeeze the heels together and tighten the gluteal muscles.
Hold for 3 seconds, then release the buttocks.
Repeat 10 times and then rest.
Hamstring curls can also be done using a weight machine.

Leg Pull Ups

Sit on a mat with your legs together in front.
Place the hands just behind the backside with the fingers pointing forward if possible.
Raise the body up.
Keep your head up and look straight ahead.
Raise one leg as high as possible.
Hold for as long as possible.
Lower and raise the other leg.
Repeat for a total of 3 reps.

Lining Up With A Wall Posture Helper

Standing posture is important to proper buttock function. Lining the body up with a wall can help train the body to maintain proper posture.

Find a wall and stand against it from the heels to the back of the head.
Work the backs of the legs and spine as firmly as possible into the wall.
Work to get the back of the skull into the wall as well.
Add some abdominal work by working the waistline inward and upward.
Hold for up to one minute.
The alignment is how you want to hold your body.
As you move off the wall, learn to maintain that posture throughout the day and night.
Repeat the wall exercise several times for reinforcement.

If aching of the hip, back, or knee is part of daily struggles, working out the gluteal muscles may be the solution. Contact the Injury Medical Chiropractic and Functional Medicine Clinic for a full consultation.

Easiest Weight Loss Hack

References

The Ohio State University Wexner Medical Center. (2023) Dormant butt syndrome may be to blame for knee, hip and back pain.

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

Daneshmandi, H., Choobineh, A., Ghaem, H., & Karimi, M. (2017). Adverse Effects of Prolonged Sitting Behavior on the General Health of Office Workers. Journal of lifestyle medicine, 7(2), 69–75. https://doi.org/10.15280/jlm.2017.7.2.69

Campos de Oliveira, L., Gonçalves de Oliveira, R., & Pires-Oliveira, D. A. (2015). Effects of Pilates on muscle strength, postural balance and quality of life of older adults: a randomized, controlled, clinical trial. Journal of physical therapy science, 27(3), 871–876. https://doi.org/10.1589/jpts.27.871

A Comprehensive Guide to Understanding the Sacrum

By

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

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Female doctor with anatomical spine model in clinic

“Various problems with the sacrum make up or contribute to a significant portion of lower back problems. Can understanding the anatomy and function help prevent and treat back injuries?”

Table of Contents

The Sacrum

The sacrum is a bone shaped like an upside-down triangle located at the base of the spine that helps support the upper body when sitting or standing and provides pelvic girdle flexibility during childbirth. It comprises five vertebrae that fuse during adulthood and connect to the pelvis. This bone takes and endures all of the body’s pressure and stress from everyday activities and movements.

Formation

Humans are born with four to six sacral vertebrae. However, fusion does not take place in all sacral vertebrae simultaneously:

Fusion starts with the S1 and S2.
As the individual gets older, the overall shape of the sacrum begins to solidify, and the vertebrae fuse into a single structure.
The process usually starts in the mid-teens and finishes in the early to mid-twenties.
It is believed to start earlier in females than males.

The timing of the fusion can be used for estimating the age and sex of skeletal remains. (Laura Tobias Gruss, Daniel Schmitt. et al., 2015)

The sacrum in a female is wider and shorter and has a more curved top or the pelvic inlet.
The male sacrum is longer, narrower, and flatter.

Structure

The sacrum is an irregular bone that makes up the back/posterior third of the pelvic girdle. There is a ridge across the front/anterior portion of the S1 vertebra known as the sacral promontory. Small holes/foramen on both sides of the sacrum are left over after the vertebrae fuse together. Depending on the number of vertebrae, there can be three to five foramen on each side, though there are usually four. (E. Nastoulis, et al., 2019)

Each anterior foramen is typically wider than the posterior or dorsal/backside foramen.
Each sacral foramina/plural of foramen provides a channel for the sacral nerves and blood vessels.

Small ridges develop between each of the fused vertebrae, known as transverse ridges or lines.
The top of the sacrum is called the base and is connected to the largest and lowest of the lumbar vertebrae – L5.
The bottom is connected to the tailbone/coccyx, known as the apex.
The sacral canal is hollow, runs from the base to the apex, and serves as a channel at the end of the spinal cord.
The sides of the sacrum connect to the right and left hip/iliac bones. The attachment point is the auricular surface.
Right behind the auricular surface is the sacral tuberosity, which serves as an attachment area for the ligaments that hold the pelvic girdle together.

Location

The sacrum is at the level of the lower back, just above the intergluteal cleft or where the buttocks split. The cleft starts at around the level of the tailbone or coccyx. The sacrum is curved forward and ends at the coccyx, with the curvature being more pronounced in females than males. It connects to the L5 lumbar vertebra by way of the lumbosacral joint. The disc between these two vertebrae is a common source of low back pain.

On either side of the lumbosacral joint are wing-like structures known as the sacral ala, which connect to the iliac bones and form the top of the sacroiliac joint.
These wings provide stability and strength for walking and standing.

Anatomical Variations

The most common anatomical variation applies to the number of vertebrae. The most common is five, but anomalies have been documented, including individuals with four or six sacral vertebrae. (E. Nastoulis, et al., 2019)

Other variations involve the sacrum’s surface and curvature, where the curvature differs widely between individuals.
In some cases, the first and second vertebrae do not fuse and remain separately articulated.
Failure of the canal to completely close during formation is a condition known as spina bifida.

Function

Studies on the sacrum are ongoing, but some proven functions include:

It serves as an anchor point for the spinal column to attach to the pelvis.
It provides stability for the body’s core.
It acts as a platform for the spinal column to rest on when sitting.
It facilitates childbirth, providing pelvic girdle flexibility.
It supports upper body weight when sitting or standing.
It provides extra stability for walking, balance, and mobility.

Conditions

The sacrum can be a main source or focal point for lower back pain. It is estimated that 28% of men and 31.6% of women aged 18 years or older have experienced low back pain in the past three months. (Centers for Disease Control and Prevention. 2020) Conditions that can cause sacrum pain symptoms include.

Sacroiliitis

This is a common condition of sacroiliac/SI joint inflammation.
A doctor only makes the diagnosis when all other possible causes of pain have been ruled out, known as a diagnosis of exclusion.
Sacroiliac joint dysfunction is thought to account for between 15% and 30% of low back pain cases. (Guilherme Barros, Lynn McGrath, Mikhail Gelfenbeyn. 2019)

Chordoma

This is a type of primary bone cancer.
About half of all chordomas form in the sacrum, but the tumors can also develop elsewhere in the vertebral column or at the base of the skull. (National Library of Medicine. 2015)

Spina Bifida

Individuals can be born with conditions that affect the sacrum.
Spina bifida is a congenital condition that can arise from the malformation of the sacral canal.

Unlocking the Secrets of Inflammation

References

Gruss, L. T., & Schmitt, D. (2015). The evolution of the human pelvis: changing adaptations to bipedalism, obstetrics and thermoregulation. Philosophical transactions of the Royal Society of London. Series B, Biological sciences, 370(1663), 20140063. https://doi.org/10.1098/rstb.2014.0063

Nastoulis, E., Karakasi, M. V., Pavlidis, P., Thomaidis, V., & Fiska, A. (2019). Anatomy and clinical significance of sacral variations: a systematic review. Folia morphologica, 78(4), 651–667. https://doi.org/10.5603/FM.a2019.0040

Centers for Disease Control and Prevention. QuickStats: Percentage of adults aged 18 years or older who had lower back pain in the past 3 months, by sex and age group.

Barros, G., McGrath, L., & Gelfenbeyn, M. (2019). Sacroiliac Joint Dysfunction in Patients With Low Back Pain. Federal practitioner : for the health care professionals of the VA, DoD, and PHS, 36(8), 370–375.

National Library of Medicine, Chordoma.

Treating Finger Sprains and Dislocations: An Analysis

By

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

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Closeup of x-ray filmof a fractured finger

“Finger sprains and dislocations are common hand injuries that can happen during work, physical/sports activities, or in automobile collisions and accidents. Can recognizing the symptoms help in developing an effective treatment strategy?”

Table of Contents

Finger Sprains and Dislocations

Finger sprains and dislocations are common injuries of the hand that cause pain and swelling.

A sprain happens when the finger tissue that supports a joint gets stretched beyond its limits in a way that stresses the ligaments and tendons.
The ligament tissue can be partially or completely torn. If the damage is bad enough, the joint comes apart.
This is a dislocation – A dislocation happens when the joint in the finger gets shifted out of its normal position.
Both injuries can cause pain and stiffness in the finger and hand.

Sprains

Finger sprains can happen any time the finger bends in an awkward or unusual way. This can happen from falling on the hand or getting hurt when engaged in physical activities like sports or household chores. Sprains can occur in any of the knuckle joints in the finger. However, most commonly, the joint in the middle of the finger gets sprained. It’s known as the proximal interphalangeal or PIP joint. (John Elfar, Tobias Mann. 2013) Symptoms of a finger sprain can include:

Pain when you move your finger
Swelling around the knuckle
Tenderness in the finger and around the joint
For a sprain, individuals may need to have imaging done to see if any of the bones in the hand are broken or fractured. (OrthoInfo. American Academy of Orthopaedic Surgeons. 2022)

Treatment

Individuals are encouraged not to move the injured finger while in recovery and healing. It can be hard to do, but wearing a splint can help.

Splints are supports that are usually made from foam and pliable metal.
A sprained finger can also be taped to one of the fingers next to it while in recovery, known as buddy-taping.
Splinting a sprained finger while engaged in activities can protect the hand from worsening or further injury.
However, splinting the finger when it is not needed can cause the joint to become stiff. (OrthoInfo. American Academy of Orthopaedic Surgeons. 2022)

An injury known as “gamekeeper’s thumb” is a more serious type of sprain.
Injury to the ligaments at the thumb joint can cause difficulty in pinching and gripping.
This injury must often be taped up or splinted for a significant amount of time for full recovery and could require surgery. (Chen-Yu Hung, Matthew Varacallo, Ke-Vin Chang. 2023)

Other treatments to help a sprained finger include:

Elevate the hand if swelling and inflamed.
Gentle finger exercises/movements to prevent stiffness.
Icing the injured finger.
Take an anti-inflammatory medication.

Individuals who have not broken bones or dislocated the joint will probably be able to move their finger in about a week. A doctor will set a timeline for when to start using the finger normally.

Individuals who sprain their finger that feels swollen and stiff for longer than a few weeks are recommended to consult a doctor or specialist.
They will need to check the hand to make ensure there aren’t any breaks or fractures. (OrthoInfo. American Academy of Orthopaedic Surgeons. 2022)
Thumb sprains and finger sprains in children may need to be splinted or taped for longer periods, as the ligament is not fully developed or as strong, which could lead to a tear.

Dislocations

A finger dislocation is a more severe injury involving the ligament, joint capsule, cartilage, and other tissues that causes misalignment of the finger. The ligaments and the joint capsule get torn when a joint is dislocated. The joint needs to be reset, which can be a simple process, or in severe cases, patients may need to be placed under anesthesia or undergo surgery to reset the joint properly.

In these cases, tendons or other tissues might be preventing the joint from getting into position.
Putting the finger back into the right position is known as”reduction.” Once reduced, the finger needs to be splinted.
Individuals also need an X-ray to ensure the joint is lined up correctly and that any bones were not broken or fractured when they sustained the injury. (James R. Borchers, Thomas M. Best. 2012)
Once reset, caring for a dislocated finger is basically the same as a sprained finger. Using ice on the finger, keeping the hand elevated to reduce swelling.
Individuals need to check with their doctor to find out when to start moving the finger. (James R. Borchers, Thomas M. Best. 2012)

The Chiropractic Approach To Improving Health

References

Elfar, J., & Mann, T. (2013). Fracture-dislocations of the proximal interphalangeal joint. The Journal of the American Academy of Orthopaedic Surgeons, 21(2), 88–98. https://doi.org/10.5435/JAAOS-21-02-88

OrthoInfo from the American Academy of Orthopaedic Surgeons. (2022) Hand fractures.

Hung, C. Y., Varacallo, M., & Chang, K. V. (2023). Gamekeeper’s Thumb. In StatPearls. StatPearls Publishing.

OrthoInfo from the American Academy of Orthopaedic Surgeons. (2022) Finger fractures.

Borchers, J. R., & Best, T. M. (2012). Common finger fractures and dislocations. American family physician, 85(8), 805–810.

Tips to Relieve Burning Feet and Heal the Underlying Condition

By

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

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Close up on women feet and hand massage on injury spot. — Close up on women feet and hand massage on injury spot

“Individuals’ feet will heat up when walking or running; however, burning feet could be a symptom of medical conditions like athlete’s foot or a nerve injury or damage. Can awareness of these symptoms help identify solutions to relieve and heal the underlying condition?”

Burning Feet

Walkers and runners often experience heat in their feet. This is natural from the increased circulation, heart rate, warm or hot sidewalks, and pavement. But the feet could experience an abnormal hot or burning sensation. Usually, the overheating is caused by socks and shoes and fatigue after a long workout. The first self-care steps include trying new or specialized footwear and workout adjustments. If burning feet persist or there are signs of infection, tingling, numbness, or pain, individuals should see their healthcare provider. (Mayo Clinic. 2018)

Footwear

The shoes and how they are worn may be the cause.

First, look at the material of the shoes. They could be shoes and/or insoles that don’t circulate air. They can get hot and sweaty without proper air circulation around the feet.
When choosing running shoes, consider a mesh material that allows airflow to keep the feet cool.
Consider getting fitted for shoes that are the right size, as the feet swell when running or walking.
If the shoes are too small, air can’t circulate, creating more friction between the foot and the shoe.
Shoes that are too large can also contribute to friction as the feet move around too much.
Insoles could also contribute.
Some insoles can make the feet hot, even if the shoes are breathable.
Swap the insoles from another pair of shoes to see if they are contributing, and if so, look into new insoles.

Tips to help prevent hot feet:

Topical Ointments

Use an anti-blister/chafing topical cream to lubricate and protect the feet.
This will reduce friction and prevent blisters.

Lace Properly

Individuals may be lacing the shoes too tight, constricting circulation, or irritating the nerves at the top of the foot.
Individuals should be able to slide one finger under the knot.
Remember that the feet will swell as walking or running commences
Individuals may need to loosen their laces after warming up.
Individuals are recommended to learn lacing techniques that will ensure they are not too tight over the sensitive areas.

Cushioning

Fatigue from long workouts or long days standing/moving can result in burning feet.
Individuals may need added cushioning in the shoes.
Look for work and athletic shoes that have added cushioning.

Shoe Allergies

Individuals may have an allergic reaction or a sensitivity to the fabric, adhesives, dyes, or other chemicals. (Cleveland Clinic. 2023) The chemicals used in production vary for leather compared to fabric and are different by brand and manufacturer.

A shoe material allergy may also result in burning, itching, and swelling.
It’s recommended to note whether symptoms only happen when wearing a specific pair of shoes.
Recommendations are to try different kinds and brands of shoes.

Socks

The sock fabric could be contributing to hot or burning feet. Steps to take can include:

Avoid cotton

Cotton is a natural fiber but is not recommended for walking and running as it holds sweat that can keep the feet wet.
It is recommended to use socks made of Cool-Max and other artificial fibers that wick sweat away and cool them down.

Wool

Wool socks can also cause itching and burning sensations.
Consider athletic socks made from itch-free wool.

Mindfulness

Individuals could be sensitive to other fabrics or dyes in socks.
Take note of which socks cause hot or burning feet symptoms.
Individuals could also be sensitive to laundry products and are recommended to try a different brand or type.

Medical Conditions

In addition to shoes and socks, medical conditions could cause and contribute to symptoms.

Athlete’s Foot

Athlete’s foot is a fungal infection.
Individuals may feel a burning sensation in the affected area.
Typically, it is itchy, red, scaling, or cracking.

Rotate shoes.
The fungus grows in damp places, therefore, it is recommended to rotate shoes to allow them to dry out between workouts.
Wash and dry the feet after walking or running.
Try home and over-the-counter solutions, powders, and remedies to treat athlete’s foot.

Peripheral Neuropathy

Individuals frequently experiencing burning feet apart from when they have been exercising could be due to nerve damage known as peripheral neuropathy. (National Institute of Neurological Disorders and Stroke. 2023) Peripheral neuropathy symptoms include pins and needles, numbness, tickling, tingling, and/or burning sensations.

Examination

Diabetes is one of the most common causes of peripheral neuropathy.
Diabetes can come on at any age.
Individuals need to learn how to protect their feet, as exercise is recommended for diabetes.

Other conditions that can produce peripheral neuropathy include:

Vitamin B-12 deficiency
Alcohol abuse
Circulatory disorders
AIDS
Heavy metal poisoning

Massage and Movement

Massaging the feet also increases circulation.
Exercise such as walking is recommended for peripheral neuropathy as it improves circulation to the feet.

Other Causes

Symptoms could also be caused by other conditions including: (Cleveland Clinic. 2023)

Nerve Entrapment

Degenerative changes in the spine or back trauma can cause injury/damage to the nerves that can cause pain, tingling, and numbness in the feet.

Tarsal Tunnel Syndrome

Compression of the posterior tibial nerve in your lower leg can cause tingling and burning in your feet.

Morton’s Neuroma

Morton’s neuroma, which is caused by thickened nerve tissue, can cause pain and burning at the base of the toes.

Autoimmune Diseases

Diseases such as multiple sclerosis or Lupus can also cause burning feet.

Self-Care

Adjustments or additions to routines and habits can help.

Don’t walk or run in worn-out shoes.
Protect the feet by using the right socks, foot powder, and ointments, and cover any areas where rubbing and friction occur.
Immediately change out of shoes and socks after exercise, allowing thorough air drying.
This will help reduce the risk of the athlete’s foot fungus growth.
Soak the feet in cool water. Do not use ice, as it could damage the skin.
Soak the feet in Epsom salts to relieve pain and inflammation and dry up blisters.
Elevate the feet after exercising.
Rotate the shoes and socks between workout sessions and during the day.
Try different shoes, socks, and insoles.
Overtraining can worsen symptoms.
Try gradually building on distance while monitoring symptoms.

See a doctor or specialist healthcare provider if symptoms continue and are not associated with walking or running exercise.

Exploring Integrative Medicine

References

Mayo Clinic. (2018). Burning Feet.

National Institute of Neurological Disorders and Stroke. (2023). Peripheral Neuropathy.

Cleveland Clinic. (2023) Burning Feet Syndrome.

Iliopsoas Syndrome: Causes Behind Leg & Hip Pain

By

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

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Dissatisfied fit black lady holding aching hip, has kidney inflammation, touching location of paim, wearing sport clothes, having sporty shaped body

“Individuals suffering from hip, thigh, and/or groin pain could be experiencing iliopsoas syndrome. Could knowing the symptoms and causes help in diagnosis and treatment?”

Table of Contents

Iliopsoas Syndrome

Iliopsoas syndrome encompasses several conditions that affect the inner hip muscle and can cause hip and thigh pain. The muscle helps to bend the leg toward the body.

The condition is usually caused by overuse injuries and commonly affects individuals who perform repeated hip flexion movements, like cyclists, gymnasts, dancers, runners, and soccer players. (Liran Lifshitz, et al., 2020)
The term is often used interchangeably with psoas syndrome, iliopsoas tendonitis, snapping hip syndrome, and iliopsoas bursitis. However, there are clinical differences.

Symptoms

Symptoms include: (American Association of Hip and Knee Surgeons. 2020)

Tenderness in the hip and groin area.
Hip or groin clicking or snapping that can be heard and/or felt during movement.
Pain and/or stiffness in the hip and thigh area.
Pain that worsens when bending the hip – walking, climbing stairs, squatting, sitting.
Movements that involve bringing the knee toward the chest can worsen the pain.

Causes

The iliopsoas muscles are hip muscles on the front of the hip. They are made up of the psoas major, the psoas minor, and the iliacus. Small, fluid-filled sacs/bursae are within the hip joint between bones and soft tissues. The bursae reduce friction and provide cushioning to help the tendons, muscles, and other structures move smoothly over the bony prominences.

The greater trochanteric bursa and the iliopsoas bursa can become inflamed, which can lead to the syndrome. (American Association of Hip and Knee Surgeons. 2020)

Iliopsoas bursitis happens when the bursa, which is located between the iliopsoas tendon and the inside of the hip joint, becomes inflamed and irritated.
Iliopsoas tendonitis/hip tendonitis happens when the tendon that attaches the thigh bone to the iliopsoas muscle becomes inflamed and irritated.
Iliopsoas bursitis and tendonitis are commonly caused by overuse injuries and intense activities like cycling, running, rowing, or strength training.

Diagnosis

Healthcare providers can diagnose iliopsoas syndrome based on symptom history and a hip examination.
Imaging tests – MRI and X-rays may be used to rule out other injuries or conditions like muscle tears. (Paul Walker, et al., 2021)

Treatment

Most mild cases of hip bursitis and hip tendonitis can be managed using the RICE method (American Association of Orthopedic Surgeons. 2020)

Rest

Avoid putting weight on the hip for a few days after the injury.

Ice

Apply ice immediately after the injury to bring the swelling down.
Use a cold pack for 20 minutes at a time, several times a day.
Do not apply ice directly on the skin.

Compression

Wrap the area in a soft bandage or use compression shorts to prevent further swelling.

Elevation

Rest as often as possible with the leg raised higher than the heart.

Medical Treatment

Non-steroidal anti-inflammatory drugs like ibuprofen and naproxen sodium can alleviate pain and reduce inflammation. (Paul Walker, et al., 2021)
Steroid injections can be used if symptoms continue or come back with additional injections administered as necessary. (Paul Walker, et al., 2021)
After pain and swelling subside, physical therapy may be recommended, as well as mild exercises to gradually improve hip strength and flexibility. (Paul Walker, et al., 2021)
A healthcare provider may recommend surgery in severe cases where pain persists, and conservative treatments don’t provide enough relief.
However, this is rare due to muscle weakness and nerve damage risks. (Paul Walker, et al., 2021)

Hip Labral Tear – Chiropractic Treatment

References

Lifshitz, L., Bar Sela, S., Gal, N., Martin, R., & Fleitman Klar, M. (2020). Iliopsoas the Hidden Muscle: Anatomy, Diagnosis, and Treatment. Current sports medicine reports, 19(6), 235–243. https://doi.org/10.1249/JSR.0000000000000723

American Association of Hip and Knee Surgeons. Iliopsoas tendonitis/bursitis.

Walker, P., Ellis, E., Scofield, J., Kongchum, T., Sherman, W. F., & Kaye, A. D. (2021). Snapping Hip Syndrome: A Comprehensive Update. Orthopedic reviews, 13(2), 25088. https://doi.org/10.52965/001c.25088

American Association of Orthopedic Surgeons. OrthoInfo. Hip strains.

Reducing Osteoarthritis Pain with Massage Therapy

By

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

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Caucasian senior woman 60s doing physiotherapist with support from nurse. Senior elderly female sitting on sofa in living room workout exercise for patient with caregiver in nursing care..

“For individuals managing osteoarthritis, could massage therapy provide added treatment benefits?”

Table of Contents

Osteoarthritis Massage Therapy

Osteoarthritis happens when the cartilage between the joints wears away, causing stiffness and pain. Massage therapy is a treatment used to relieve various types of pain symptoms.

There are many types of massage therapy, that healthcare providers utilize to manipulate the muscles and other soft tissues to relieve symptoms, relax muscles, increase circulation, reduce inflammation, release trigger points, and restore mobility, flexibility, and function. (Ergonomic Trends. 2023)
Professional therapists can help relieve osteoarthritis joint pain by relaxing the surrounding muscles and other soft tissues to release stiffness. (Adam Perlman, et al., 2019)

Massage Objectives and Types

Massage therapists use their hands and fingers, forearms, elbows, and/or instruments to manipulate the body’s soft tissues. Soft tissues support and surround body structures and include muscle, fat, tendons, and ligaments.

The goal of osteoarthritis massage therapy is to relax muscles and soft tissues, increase blood and oxygen circulation, warm the affected area/s, relieve pain, and restore mobility and function.
Depending on the location of the muscles being massaged, individuals may be seated or lie down on a specialized table.
The amount of pressure and direction of movement depend on the body area.
Therapeutic oils and/or massage creams may be used to increase the therapy.

Types include:

Swedish

The therapist uses long strokes, kneading, and friction on the muscles.
Joints are moved to increase flexibility.

Deep Tissue

The therapist uses deep finger or instrument pressure, focusing on muscles that are tight or knotted.

Trigger Point

Trigger points represent a source of radiating pain symptoms.
The therapist focuses pressure on these myofascial tissue points using various strokes to release them.

Shiatsu

The therapist applies rhythmic pressure with their thumbs, fingers, and palms to redirect and increase energy or chi/qi.

A massage session lasts around 30–60 minutes depending on the severity of the condition and the number of sessions the patient has undergone. Chronic pain patients usually go through a series of specialized sessions that focus on specific areas and gradually build.

Risk Factors

Certain precautions must be taken before getting osteoarthritis massage therapy. Although there are a few serious risks, certain individuals are not suitable candidates and should not receive massage therapy. The conditions include: (Medical Massage Therapy Resource & Reference. 2023)

Damaged nerves.
Damaged blood vessels.
Infection and inflammation in the area to be massaged.
Open wounds.
Fever.
Taking a blood thinner.
Deep vein thrombosis – blood clots.
Bleeding disorders.
Osteoporosis – weak and brittle bones.
Recent fractures – broken bones.
Tumors.
Cancer.
Individuals who have recently undergone surgery.
Individuals with a skin condition that is contagious, like warts or herpes, or noncontagious, like psoriasis, could be aggravated by touch or pressure.
Individuals who have cancer, fragile skin, heart problems, or dermatomyositis are recommended to discuss osteoarthritis massage therapy with their healthcare provider.

Research on the effects of massage therapy on various health conditions is ongoing. Massage therapy promotes relaxation while reducing stress, which can help with chronic joint issues like osteoarthritis.

Arthritis Explained

References

Ergonomic Trends. 20 most common types of massages and their benefits explained.

Perlman, A., Fogerite, S. G., Glass, O., Bechard, E., Ali, A., Njike, V. Y., Pieper, C., Dmitrieva, N. O., Luciano, A., Rosenberger, L., Keever, T., Milak, C., Finkelstein, E. A., Mahon, G., Campanile, G., Cotter, A., & Katz, D. L. (2019). Efficacy and Safety of Massage for Osteoarthritis of the Knee: a Randomized Clinical Trial. Journal of general internal medicine, 34(3), 379–386. https://doi.org/10.1007/s11606-018-4763-5

Medical Massage Therapy Resource & Reference. When not to get a massage: 26 reasons you cannot get a massage.

The Health Benefits of Resistant Starch Explained

By

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

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Buddha bowl with baked potatoes, lentils and spicy chickpeas, av — Food bowl with baked potatoes, lentils and spicy chickpeas, avocado, arugula, vegan, vegetarian healthy dinner

“For individuals with digestive and other health issues, could resistant starch provide health benefits?”

Table of Contents

Resistant Starch

Typical starchy foods are simple starches that are rapidly digested. This sends their sugars into the bloodstream, contributing to weight gain and increasing the risk of diabetes and heart disease. (Erik E. J. G. Aller, et al., 2011) Resistant starch is a food component that is a type resistant to digestion. This means that it passes into the large intestine and interacts with the gut flora. Foods that contain resistant starch pass through the stomach and small intestine without being absorbed. In the large intestine, they are fermented by the gut bacteria which releases substances that are beneficial to health.

Health Benefits

Studies on the health benefits are ongoing. Scientists are researching how it can help with weight management and colon health:

Weight Management

Research is beginning to show indications that foods with resistant starch can help with weight loss and the ability to help offset the diseases associated with weight gain that include: (Janine A. Higgins. 2014)

High cholesterol
Diabetes
Metabolic syndrome
Cardiovascular disease

Colon Health

In addition, researchers are finding preliminary evidence indicating that it might possibly help with: (Diane F. Birt, et al., 2013)

A prebiotic that encourages a healthy balance of gut flora.
Inflammatory bowel disease symptom improvement.
Prevention of colon cancer.
Protection against diverticulitis.

However, more research is needed.

Consumption Amount

Estimates on how much should be consumed range from a minimum of 6 grams to a maximum of 30 grams. It is estimated that most individuals consume less than 5 grams per day, (Mary M. Murphy, et al., 2008). As individuals increase their intake, it is recommended to do so slowly, to minimize unwanted gas and bloating.

Bananas

Bananas are a healthy source of resistant starch.
They have the maximum amount when they are unripe.
The resistant starch content reduces as the banana ripens.
If green/unripe bananas are not appealing, making a smoothie can help with the taste.

Potatoes

Potatoes have their highest level of resistant starch when raw.
However, individuals can maximize their intake by allowing the potatoes to cool before eating.

Rice

Levels of resistant starch depend on whether the rice is white or brown.
Similar to potatoes, intake can be maximized from rice by allowing the rice to cool.

Oats

Cooking oats in water, as most are accustomed to making oatmeal, diminishes the resistant starch content.
Rolled or steel-cut oats are recommended as dependable sources of resistant starch.

Chickpeas

Chickpeas, also known as garbanzo beans, are nutritional powerhouses.
They are a healthy source of dietary fiber, along with many vitamins and minerals, and resistant starch.
Cooked and/or canned chickpeas contain high levels of resistant starch.
They go with salads or as a side dish or snack.
For individuals with IBS, well-rinsed canned chickpeas are considered to be low in FODMAPs or carbohydrates that can contribute to symptoms. (Anamaria Cozma-Petruţ, et al., 2017)
It is recommended to keep the serving size to a 1/4 cup.

Lentils

Lentils serve as a healthy source of plant-based protein.
Cooked they can provide resistant starch.
They can be prepared in soups or side dishes.
From a can, they can be IBS-friendly by being well-rinsed and limited to a 1/2 cup serving.

Bread

Various breads offer varying levels of resistant starch.
Pumpernickel bread contains high levels.
Breadsticks and pizza crusts have high levels.
Individuals with IBS may be reactive to the FODMAP fructan or the gluten protein.
Other recommended high-resistant starch options are corn tortillas or artisanal sourdough bread that is traditionally prepared.

Green Peas

Green peas, even when cooked, are a healthy source of resistant starch.
They can be prepared in soups or as a side dish.
However, green peas have been found to be high in the FODMAP GOS and could be problematic for individuals with IBS. (Anamaria Cozma-Petruţ, et al., 2017)

Beans

Most types of cooked and/or canned beans are recommended sources of resistant starch.
The highest levels are found in white and kidney beans.
They can be served in soups, as a side dish, or mixed with rice.
Beans are a high-FODMAP food and could contribute to digestive symptoms in individuals with IBS.

Body In Balance: Chiropractic Fitness and Nutrition

References

Aller, E. E., Abete, I., Astrup, A., Martinez, J. A., & van Baak, M. A. (2011). Starches, sugars and obesity. Nutrients, 3(3), 341–369. https://doi.org/10.3390/nu3030341

Higgins J. A. (2014). Resistant starch and energy balance: impact on weight loss and maintenance. Critical reviews in food science and nutrition, 54(9), 1158–1166. https://doi.org/10.1080/10408398.2011.629352

Birt, D. F., Boylston, T., Hendrich, S., Jane, J. L., Hollis, J., Li, L., McClelland, J., Moore, S., Phillips, G. J., Rowling, M., Schalinske, K., Scott, M. P., & Whitley, E. M. (2013). Resistant starch: promise for improving human health. Advances in nutrition (Bethesda, Md.), 4(6), 587–601. https://doi.org/10.3945/an.113.004325

Murphy, M. M., Douglass, J. S., & Birkett, A. (2008). Resistant starch intakes in the United States. Journal of the American Dietetic Association, 108(1), 67–78. https://doi.org/10.1016/j.jada.2007.10.012

Cozma-Petruţ, A., Loghin, F., Miere, D., & Dumitraşcu, D. L. (2017). Diet in irritable bowel syndrome: What to recommend, not what to forbid to patients!. World journal of gastroenterology, 23(21), 3771–3783. https://doi.org/10.3748/wjg.v23.i21.3771

What Triggers Plantar Fasciitis Flare-Ups and How to Treat Them

By

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

-

Orthopedist examining injured foot of a young woman. — Young woman getting examination of her injured leg by orthopedist at clinic.

“Individuals with plantar fasciitis may experience consistent flare-ups. Can knowing the causes help to find pain relief?”

Table of Contents

Plantar Fasciitis Flare-Up

Plantar fasciitis is a common cause of heel and foot pain. The plantar fascia is a band of tissue that runs along the bottom of the foot and becomes inflamed. Certain factors can cause plantar fasciitis flare-ups, including:

Increased levels of physical activity.
Not stretching regularly.
Wearing shoes without proper support.
Weight gain.

Causes

A plantar fasciitis flare-up is often triggered by physical activity. (MedlinePlus. U.S. National Library of Medicine. 2022) It can also be brought on by underlying conditions, like increased body weight, arthritis, or the shape of the foot. (Johns Hopkins Medicine. 2023) Despite the root cause, there are activities and experiences that can contribute to and/or worsen the condition.

New Exercise Routine

Being highly physically active can exacerbate plantar fasciitis symptoms.
A plantar fasciitis flare-up can happen after a sudden increase in activity, like starting a new exercise program or adding new exercises to a routine. (MedlinePlus. U.S. National Library of Medicine. 2022)
Walking or running on uneven surfaces or downhill can be a trigger. (Johns Hopkins Medicine. 2023)
Minimizing physical activity and time standing can help.
If this is not possible, wearing cushioned shoes with arch support can help minimize pain. (Johns Hopkins Medicine. 2023)

Weight Gain

Individuals who have an increased or increasing body weight add more pressure to their feet, placing them at higher risk for plantar fasciitis. (MedlinePlus. U.S. National Library of Medicine. 2022)
If experiencing consistent flare-ups, a healthcare provider may suggest an appropriate weight loss program combined with a treatment plan.

Pregnancy

Rapid weight gain can cause a plantar fasciitis flare-up, including during pregnancy. (Boston Children’s Hospital. 2023)

Shoes Without Support

Wearing shoes without arch support can cause general foot pain and plantar flare-ups.
Individuals should wear shoes with plenty of cushioning and arch support, like sneakers. (Ortho Info. Academy of Orthopaedic Surgeons. 2022)
Shoes that are not recommended include:
Flip-flops
Shoes that are flat.
High heels, boots, or shoes that raise the heel above the toes.
Worn-out shoes like exercise workout shoes.

Not Stretching Properly or At All

Tight calves can increase pressure on the plantar fascia.
Stretching the calves, Achilles tendon/heel, and the bottom of the feet is highly recommended to help treat and prevent the condition. (Johns Hopkins Medicine. 2023)
Not stretching thoroughly or skipping stretches can worsen symptoms.
Individuals with plantar fasciitis are recommended to stretch before and after physical activities, exercise, before going to bed, and after waking up.

Working Through the Pain

Individuals may try to continue physical activities during a flare-up.
This is not recommended as doing so can cause more pain and worsen the condition.
When pain presents, it’s recommended to:
Stop all activities that strain the feet
Stay off the feet for at least a week.

Tearing the Plantar Fascia

The plantar fascia rarely tear completely from repeated stress known as a plantar fascia rupture.
If this happens, sudden severe pain will present and individuals are advised to call their healthcare provider. (Stephanie C. Pascoe, Timothy J. Mazzola. 2016)
However, individuals can recover relatively fast, and pain alleviates quickly.
Individuals with tears will be recommended to wear a foot orthotic as the foot may have flattened more.

Risk Factors

Plantar fasciitis can happen to anyone, but individuals who have the following characteristics are at an increased risk: (Ortho Info. Academy of Orthopaedic Surgeons. 2022)

A high-foot arch.
Jobs or hobbies that place added strain on the feet.
Tight calf muscles.
A sudden increase in physical activity.
A new exercise regimen.
Increased body weight.
Sudden weight gain like during pregnancy.

How Long Does a Flare Last?

Plantar fasciitis can become chronic if untreated.
With treatment, 90% of cases will improve within 10 months. (Ortho Info. Academy of Orthopaedic Surgeons. 2022)
During a flare-up, stay off the feet as much as possible.

Treatment

In addition to rest treatments for plantar fasciitis can include: (Ortho Info. Academy of Orthopaedic Surgeons. 2022)

Ice

Icing the bottom of the foot for 15 minutes a few times a day decreases inflammation.

Nonsteroidal anti-inflammatory drugs – NSAIDs

Over-the-counter NSAIDs like ibuprofen and naproxen, can reduce pain and inflammation.
It is recommended to consult a healthcare provider for short-term use and dosage.

Proper Shoes

Shoes with arch supports are highly recommended.
A healthcare provider can order custom orthotics for more support.

Stretching

Stretches are essential for treatment.
Stretching the calf and bottom of the foot daily will keep the tissue relaxed.

Massages

Massaging the area with a therapeutic massage ball soothes the tissues.
Using a percussive massager can increase circulation.

What is Plantar Fasciitis?

References

MedlinePlus. National Library of Medicine. (2022) U.S. Plantar fasciitis.

Johns Hopkins Medicine. (2023) Plantar fasciitis.

Boston Children’s Hospital. (2023) Plantar fasciitis.

Ortho Info. Academy of Orthopaedic Surgeons. (2022) Plantar fasciitis and bone spurs.

Pascoe, S. C., & Mazzola, T. J. (2016). Acute Medial Plantar Fascia Tear. The Journal of orthopaedic and sports physical therapy, 46(6), 495. https://doi.org/10.2519/jospt.2016.0409

Mental Toughness: Strategies for Maximum Performance

By

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

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Female athlete taking rest after fitness training looking away

“It can be difficult for individuals and athletes to stay motivated, manage stress, and prevent becoming overwhelmed. Can mental toughness and a positive attitude help increase potential and performance levels?”

Table of Contents

Mental Toughness

Athletes and fitness enthusiasts work on conditioning, skills training, and perfecting techniques. Physical training can take individuals far but another necessary part of maximizing athletic potential is building mental toughness and having the right attitude. Like anything, mental training takes time, effort, and regular adjustments to find ways to shift a losing or bad attitude into a positive one that can bring out the best.

Attitude Is Important

If negativity begins to set in like dealing with an injury, getting rid of self-limiting beliefs can be difficult, as well as generate optimism to rise up and succeed. For athletes or individuals who enjoy competitive sports, developing a positive mental attitude will help with:

Emotions that can affect cognitive functioning strategies.
Energy levels.
Other aspects of physical performance.

Mental Strategies

Mood Improvement

Individuals frustrated by a pessimistic perspective tend to dwell on problems or issues. To shift into a positive mood do something to lift your spirits, even if you don’t think it will help.

Listen to your favorite or uplifting music.
Watch an inspirational movie.
Read a sports psychology book.
Get together or call a teammate or friend that are cheerful and upbeat.
Play different games just for fun.
Take a break, go to the park, walk around, and meditate.
Get into hobbies.
Relax with a therapeutic massage.

Positive Self Talk

Continuing sports psychology research shows that practicing positive self-talk can improve athletic performance. (Nadja Walter, et al., 2019) Sports psychologists describe this through the idea that thoughts create beliefs, that drive actions.

Positive self-talk can take different forms.
For some reciting a specific phrase, sentence, or a single word can effectively manage thoughts, push out the negativity, and focus on taking care of business. Anything that inspires can include:

Focus
Remember the fundamentals!
You know what to do!
You can do it!
You got this!

Research shows that positive self-talk reduces anxiety and increases self-confidence, optimization, efficacy, and performance. (Nadja Walter, et al., 2019) However, self-talk needs to be practiced and part of a regular routine to be effective.

Visualization

Another strategy is using visualization exercises.

This means imagining various scenarios in which competition is happening and things are working out. (Mathias Reiser, Dirk Büsch, Jörn Munzert. 2011)
This could be using all the senses to imagine the venue where the tournament is taking place, the sound of the crowd, the smells, how the ground or court feels, and/or how the ball or specific sports object feels.
The wisdom is if you can think it, you can do it, once that is determined apply strategies to get there.

Sports Injury Rehabilitation

References

Walter, N., Nikoleizig, L., & Alfermann, D. (2019). Effects of Self-Talk Training on Competitive Anxiety, Self-Efficacy, Volitional Skills, and Performance: An Intervention Study with Junior Sub-Elite Athletes. Sports (Basel, Switzerland), 7(6), 148. https://doi.org/10.3390/sports7060148

Reiser, M., Büsch, D., & Munzert, J. (2011). Strength gains by motor imagery with different ratios of physical to mental practice. Frontiers in psychology, 2, 194. https://doi.org/10.3389/fpsyg.2011.00194

What Are The Therapeutic Options For Upper Crossed Syndrome?

By

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

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Can various therapeutic options provide relief for individuals with upper crossed syndrome to restore muscle strength?

Table of Contents

Introduction

Many individuals often suffer neck and shoulder pain from poor posture, improper heavy lifting, musculoskeletal conditions, auto accidents, whiplash, etc. The surrounding muscles that connect the neck and shoulders help protect the cervical and thoracic region of the spine and can succumb to injuries that can cause pain-like symptoms causing discomfort to the individual. Neck, shoulder, and back pain are the three most common issues many individuals have experienced. These musculoskeletal disorders can also correlate with pre-existing conditions; many people will feel pain and discomfort while trying to find the relief they seek. One of the most common issues people often experience is upper crossed syndrome, which can be associated with neck and shoulder pain. Today’s article explains what upper cross syndrome is and how it affects the neck and shoulders while also diving into how different therapeutic options like spinal decompression and chiropractic care can reduce the effects of upper cross syndrome. We speak with certified medical providers who incorporate our patients’ information to provide numerous treatment plans to mitigate upper-crossed syndrome in the neck and shoulders. We also inform our patients that there are many therapeutic options, like chiropractic care and spinal decompression, to minimize muscle pain in the neck and shoulders. 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 upper-crossed syndrome. Dr. Alex Jimenez, D.C., utilizes this information as an academic service. Disclaimer

What Is Upper Crossed Syndrome?

Have you been dealing with muscle pain in your shoulders or neck after being on the computer for a while? Do you feel stiffness in your shoulders that rotating them causes temporary relief? Or does it hurt when you turn your head from side to side? Many of these pain-like scenarios are often associated with upper-cross syndrome. Many people don’t often realize that upper crossed syndrome is a musculoskeletal condition that affects the neck, shoulder, and chest muscles and causes them to be weak and tight due to poor posture. The upper crossed syndrome can cause referred pain to the upper extremities, leading to cervicogenic headaches, limited range of motion, trigger points in the muscles, and muscle imbalance. (Moore, 2004) When many people are dealing with upper crossed syndrome due to poor posture, it can lead to many issues in the neck and shoulders.

How Does It Affect The Neck & Shoulders?

Now, why does upper crossed syndrome affect the neck and shoulders? Many people unintentionally hunched over when looking at their phones, being on the computer, or relaxing at home. This causes specific muscles in the neck and shoulder region, like the serratus and lower trapezius muscles, to become weak while the pectoral and neck muscles are tight. (Chu & Butler, 2021) This, in turn, causes the shoulders to be more rounded and hunched, causing the neck and head to crane forward. When people are dealing with upper crossed syndrome, many would often complain about pain-like symptoms like:

Headaches
Neck Strain
Muscle tightness
Upper back pain
Restricted range of motion
Numbness/Tingling sensations in the arms

The upper crossed syndrome can also occur gradually over time and cause nerve compression to the upper extremities. When the upper neck and shoulder muscles start to affect the surrounding nerve roots, which then leads to nerve dysfunction in the sensory and motor skills when a person picks up an object. (Lee & Lim, 2019) However, many individuals dealing with upper-crossed syndrome can seek treatment to relieve muscle pain in their neck and shoulders.

An Overview Of Upper Crossed Syndrome- Video

What is Upper Cross Syndrome? | El Paso, Tx (2023)

Since upper cross syndrome is a musculoskeletal condition that affects the neck and shoulders, it can result in muscle imbalance and pain in the individual. Many people, especially in the working field, develop this syndrome by being hunched over for an extended period. (Mujawar & Sagar, 2019) This causes the head to be more forward, the neck posture to be curved and hunched, and the shoulders to be rounded. The video above explains upper-crossing syndrome, its causes, and how it is treated.

Spinal Decompression Reducing Upper Crossed Syndrome

Numerous treatments can help restore muscle strength and reduce muscle pain in the neck and shoulders. Treatments like spinal decompression can help reduce upper crossed syndrome by slowly using gentle traction to the cervical spine region and gently stretching the neck muscles to provide relief. Spinal decompression is one of the non-surgical treatments that many individuals with headaches associated with upper crossed syndrome can find the comfort they seek through pain reduction and improve their quality of life. (Eskilsson et al., 2021) At the same time, spinal decompression can be part of a personalized treatment plan that many individuals can add to their daily routine to prevent the pain from returning. (Saunders, 1983)

Chiropractic Care Restoring Muscle Strength

Just like spinal decompression, chiropractic care is a non-surgical treatment that can be combined with various stretching techniques to restore the neck’s range of motion and reduce pain associated with upper-crossed syndrome. (Mahmood et al., 2021) Chiropractic care incorporates manual and mechanical techniques like MET (muscle energy techniques) and spinal manipulation to realign the spine out of subluxation. When chiropractors integrate MET to manage upper crossed syndrome, many individuals find that their pain has decreased, their cervical range of motion is improved, and their neck disability is reduced. (Gillani et al., 2020) When many individuals start thinking about their health and wellness, they can make small changes to improve their posture and be more mindful of their bodies to reduce the chances of upper-cross syndrome returning.

References

Chu, E. C., & Butler, K. R. (2021). Resolution of Gastroesophageal Reflux Disease Following Correction for Upper Cross Syndrome-A Case Study and Brief Review. Clin Pract, 11(2), 322-326. https://doi.org/10.3390/clinpract11020045

Eskilsson, A., Ageberg, E., Ericson, H., Marklund, N., & Anderberg, L. (2021). Decompression of the greater occipital nerve improves outcome in patients with chronic headache and neck pain – a retrospective cohort study. Acta Neurochir (Wien), 163(9), 2425-2433. https://doi.org/10.1007/s00701-021-04913-0

Gillani, S. N., Ain, Q., Rehman, S. U., & Masood, T. (2020). Effects of eccentric muscle energy technique versus static stretching exercises in the management of cervical dysfunction in upper cross syndrome: a randomized control trial. J Pak Med Assoc, 70(3), 394-398. https://doi.org/10.5455/JPMA.300417

Lee, E. Y., & Lim, A. Y. T. (2019). Nerve Compression in the Upper Limb. Clin Plast Surg, 46(3), 285-293. https://doi.org/10.1016/j.cps.2019.03.001

Mahmood, T., Afzal, W., Ahmad, U., Arif, M. A., & Ahmad, A. (2021). Comparative effectiveness of routine physical therapy with and without instrument assisted soft tissue mobilization in patients with neck pain due to upper crossed syndrome. J Pak Med Assoc, 71(10), 2304-2308. https://doi.org/10.47391/JPMA.03-415

Moore, M. K. (2004). Upper crossed syndrome and its relationship to cervicogenic headache. J Manipulative Physiol Ther, 27(6), 414-420. https://doi.org/10.1016/j.jmpt.2004.05.007

Mujawar, J. C., & Sagar, J. H. (2019). Prevalence of Upper Cross Syndrome in Laundry Workers. Indian J Occup Environ Med, 23(1), 54-56. https://doi.org/10.4103/ijoem.IJOEM_169_18

Saunders, H. D. (1983). Use of spinal traction in the treatment of neck and back conditions. Clin Orthop Relat Res(179), 31-38. https://www.ncbi.nlm.nih.gov/pubmed/6617030

Disclaimer

Understanding Forward Head Posture: Guide to Posture Correction

By

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

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Shot of a young female doctor writing down a patients information in an office.

“Individuals that sit at a desk/workstation for hours for work or school, or drive for a living, could be fostering a long-term condition known as forward head posture. Can understanding the signs and symptoms help to prevent the condition?”

Table of Contents

Forward Head Posture

Neck pain often causes or is caused by misalignment in the area between the shoulders and head. Forward head posture is a common problem that can strain the neck muscles, leading to pain and worsening neck, shoulder, and back posture. (Jung-Ho Kang, et al., 2012) For individuals who are at risk of developing or are already showing signs/symptoms, it’s important to get medical attention to prevent complications, such as chronic neck pain or compressing a nerve. Individuals can continue to do the work that they need to do but may need some postural adjustments and re-training so as not to continue straining the neck while working.

Postural Deviation

The head is in a healthy alignment with the neck when the ears line up with the gravity line.
The gravity line is an imaginary straight line that represents gravity’s downward pull.
It is used in posture assessments as a reference for noting the positions of the body and determining the presence of any postural misalignment or deviation.
A forward head posture occurs when the head begins to position forward of the gravity line when looking at the body from the side.
Forward head posture is a postural deviation because the head varies from the reference line. (Jung-Ho Kang, et al., 2012)

Muscle Imbalances

Forward head posture often results in a strength imbalance between muscles that support and move your neck, shoulders, and head. (Dae-Hyun Kim, et al., 2018)
The muscles in the back of the neck become shortened and overactive as they flex forward, while the muscles in the front become lengthened, weaker, and strained when they relax.

Kyphosis

Kyphosis also known as hunchback is when the shoulders round forward, and the head is also brought forward. (Jung-Ho Kang, et al., 2012) After many hours sitting at a desk, computer, or driving, kyphosis can also cause and/or worsen forward head posture.

This occurs because the upper back area supports the neck and head.
When the upper back moves or changes position, the head and neck follow.
The majority of the head’s weight is in the front, and this contributes to the forward movement.
An individual with kyphosis has to lift their head to see.

Treatment

A chiropractic injury specialist team can develop a personalized treatment plan to relieve pain symptoms, provide postural retraining, realign the spine, and restore mobility and function.

Standing and sitting using a healthy posture, along with exercises to strengthen the neck muscles, can help get the spine in alignment. (Elżbieta Szczygieł, et al., 2019)
Targeted stretching can help if the neck muscles are tight.
At-home stretches may also relieve pain.

Risk Factors

Pretty much everyone is at risk of developing a forward head posture. Common risk factors include:

Constantly looking down at a phone and staying in this position for a long time aka text neck.
Desk jobs and computer use can significantly round the shoulders and upper back, leading to a forward head posture. (Jung-Ho Kang, et al., 2012)
Driving for a living causes prolonged back, neck, and shoulder positioning.
Sleeping or reading with a large pillow under the head can contribute to forward head posture.
Doing work that requires dexterity and close-up positions, like a seamstress or technician can cause over-positioning of the neck.
Individuals who regularly carry a significant amount of weight in front of their body may begin to develop kyphosis.
An example is carrying a child or another load in front of the body.
Large breasts can also increase the risk of kyphosis and forward head posture.

Neck Injuries

References

Kang, J. H., Park, R. Y., Lee, S. J., Kim, J. Y., Yoon, S. R., & Jung, K. I. (2012). The effect of the forward head posture on postural balance in long time computer based worker. Annals of rehabilitation medicine, 36(1), 98–104. https://doi.org/10.5535/arm.2012.36.1.98

Kim, D. H., Kim, C. J., & Son, S. M. (2018). Neck Pain in Adults with Forward Head Posture: Effects of Craniovertebral Angle and Cervical Range of Motion. Osong public health and research perspectives, 9(6), 309–313. https://doi.org/10.24171/j.phrp.2018.9.6.04

Szczygieł, E., Sieradzki, B., Masłoń, A., Golec, J., Czechowska, D., Węglarz, K., Szczygieł, R., & Golec, E. (2019). Assessing the impact of certain exercises on the spatial head posture. International journal of occupational medicine and environmental health, 32(1), 43–51. https://doi.org/10.13075/ijomeh.1896.01293

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