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Bioidentical Hormone Replacement Therapy Part 1: Everything You Need to Know

By
Dr. Alex Jimenez
-

Can bioidentical hormone replacement therapy can help many individuals dealing with pain and fatigue while regulating hormone function?

Introduction

Many individuals have dealt with pain and discomfort in their bodies due to environmental factors that can impact the various muscles, tissues, organs, and bones. However, environmental factors can also affect the body’s hormones. They can cause overlapping risk profiles that can cause disastrous issues like pain, fatigue, unexplained weight changes, and even visceral-somatic issues. However, many individuals can seek various treatments to replenish their hormones and start getting back to their normal selves. In this 2-part article series, we will look at what hormones are exactly, what hormone replacement therapy is, and what types of hormones are in our bodies. In part 2, we will go in-depth with hormone therapy and its beneficial properties. We talk with certified associated medical providers who inform our patients about hormone therapy and how it can help provide helpful results to reduce pain in the body. While asking their associated medical provider intricate questions, we advise patients to incorporate non-surgical treatments combined with hormone therapy to reduce pain and discomfort from returning to the body. Dr. Alex Jimenez, D.C., includes this information as an academic service. Disclaimer.

 

What Are Hormones?

Do you experience an elevated blood sugar level more than usual? Do you experience changes in your heartbeat even though you are walking at a normal pace? Or have you noticed that you are more thirstier than usual? Many people who are experiencing these issues could be dealing with a hormone imbalance. Hormones are chemicals produced and released by specialized cells, many of which are found in endocrine glands. They are released into the bloodstream and affect the target cells’ biochemistry. The presence of hormone receptors, intracellularly in the target cells or on the cell surface, controls hormone activity. Hormones activating the cellular machinery result in higher metabolism, protein synthesis, improved cellular repair, and increased cell formation.

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Hormones affect every facet of aging and often decrease with age, resulting in many individuals having a higher hormone dosage to induce a change in cell function. For this very reason, people require ideal hormone levels. Additionally, even if their levels are normal, their bodies still require more hormones to function and feel better. These hormonal shifts impede tissue healing and repair of the body. Hormone shortages and endocrine dysfunction have been linked to the signs and symptoms of aging, as research has now demonstrated that hormone therapy is an effective way to enhance and extend quality of life.

 

Since aging cannot be stopped, hormones can halt the progression and support by keeping our health in check. Many individuals are trying to find the genetic location that can help regulate aging, and using genetic engineering to modify these genes is necessary for effective age reversal. Regretfully, no technology is currently available to reverse this age through genetic engineering. We must make the most of these changes by incorporating small changes like non-surgical treatments, avoiding risk factors for disease, eating a healthy diet, getting enough exercise, limiting our calorie intake, using antioxidant treatment, and replacing hormones at ideal levels. Slowing the aging process to have less disease and less degradation can provide a higher quality of life while improving feelings and functioning.

 

What Are Biologically Identical Hormones?

There is no structural difference between the hormone found naturally in the body and the natural hormone. Natural or bioidentical chemicals are not patentable to pharmaceutical corporations since they can patent very profitable chemically distinct compounds. A pharmaceutical company’s exclusive right to produce and profit from its product is ensured by a patent. While it makes sense that pharmaceutical corporations would want their investment protected with a unique, patented product after the enormous financial commitment that goes into researching and creating a pharmaceutical product. Natural hormones need to be better researched and marketed.

 

Teaching doctors how and when to administer a medication is a significant component of drug marketing. Physicians learn a great deal about medications from pharmaceutical corporations that are actively pushing their products. Since pharmaceutical firms do not produce natural hormones, most doctors only know them once they conduct independent studies on when they originate naturally. Either plants are used to extract the pure physiologically similar (human identical) hormone, or it is synthesized. The most crucial factor is that the final output should be a molecule like a hormone molecule the body naturally produces, which includes DHEA, progesterone, estrogen, thyroid, and progesterone.

 

Where can natural hormone prescriptions be filled? Many compounding pharmacies are a particular kind of pharmacy that are legitimate, licensed pharmacies can supply individuals with any medication from pharmaceutical manufacturers and are more capable. The traditional image of a pharmacy is that of using a motor and pestle, compared to a compounding pharmacist. They obtain pure pharmaceutical-grade hormones and mix them according to the doctor’s orders. The prescription for dosage and form varies for individuals in tablets, capsules, liquids, and lotions.

 

Many products in health food stores offer a range of natural solutions, typically derived from plants or herbs. People are turning more and more to herbalists, naturopaths, and folk medicine as alternatives to synthetic, conventional medications. Nevertheless, many compounding pharmacies offer unique products in a few different ways. Initially, a prescription is needed for a pharmacy’s medication, and products from health food stores typically have dosages so low that no prescription is required. According to lab tests, the dosage is normally so low that it is insufficient to cause a discernible change in the body. Second, the compounding pharmacy uses micronized, pure medicinal-grade components in its goods. When a product is micronized, it is a fine grain that absorbs readily. Third, long-acting or time-release prescriptions are available for the natural hormones from the compounding pharmacy. This helps the body avoid the highs and lows associated with rapidly acting, rapidly absorbed, or poorly absorbed goods and instead allows the body to have more balanced hormone levels. A compounding pharmacy offers various possibilities for customized hormone treatment. It even creates a single prescription from personalized dosages, lactose-free fillers, and administration methods such as sublingual triturates, pills, capsules, liquids, and creams. The hormone levels are evaluated and then regulated to maintain ideal amounts of each hormone to ensure appropriate replenishment. If HRT is monitored and adjusted, it may be useful.

 

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Hormone Replacement Therapy & Aging

Age causes a decrease in hormones in all people, from young and old. Many doctors believe that this is how things should naturally be. So when a younger person and an older person have hormone deficiencies, the younger individual would be promptly treated if detected with them, and the older individual is not. The term “normal” is relative; even though this low level is barely 20% of a 30-year-old’s level, labs describe it as “normal” even though many individuals do not want the hormone levels of an 80-year-old. Global research teams have now demonstrated that the age-related hormonal deficit should be replaced with a younger person’s hormone levels. Patients enthusiastically welcomed the improvement as soon as they could see and feel it. The damage that the absence of these hormones is causing to the body is realized once one tries this new therapy and feels the dramatically boosted vitality. Its health benefits are an additional bonus.

 

While progesterone, estrogen, and thyroid have long been administered, effective hormone replacement is a relatively recent development. Instead of maintaining lower or mid-normal levels, it has become a reasonable therapy to replace and balance all hormones simultaneously to an ideal physiological level. This is because when many individuals start to try out hormone replacement therapy, it can provide anti-inflammatory effects and regulate pathogenesis issues that are affecting the body. (Weare-Regales et al., 2022) This distinguishes the best possible hormone replacement from conventional medical treatment. Thankfully, many medical professionals and patients can understand the idea of perfect hormone replacement. With many doctors utilizing HRT training programs, the science underlying this new preventative medicine is reaching a wider audience of physicians.

 

Numerous aging-related changes, such as osteoporosis, muscle atrophy, sleep disturbances, and decreased sociability, have been demonstrated to be partially brought on by a drop in hormones. Some of the symptoms include reduced protein synthesis in the body, decreased lean body and bone mass, and increased body fat, which are all linked to human aging. The gradual decrease in hormone secretion is commensurate with the changes in body composition. It has been demonstrated that these age-related alterations can be lessened by replenishing these hormones to physiological levels, which are ideal but within reasonable bounds and not excessive. Our hormones’ inability to maintain the equilibrium they once did is a major contributing factor to many aging problems. The disorders like diabetes, heart disease, and hypertension that have come to be associated with normal aging are mostly caused by an imbalance in the proper balance of hormone levels. Immunity is restored by reestablishing the right hormone balance, which can fend against many age-related illnesses.

 

In conclusion, studies have demonstrated that a decrease in hormone levels can cause aging-related disorders, and the only treatment available at this time to address these symptoms is hormone replacement therapy. Numerous recently published publications about hormone replacement therapy are replete with patient endorsements of the treatment’s advantages. Many patients are middle-aged, healthy, normal persons who have gradually developed symptoms like low energy, low feelings of well-being, lethargy, and loss of interest in routine daily activities. Patients often have weak skin and hair, lose muscular tone, and develop fat around their midsections. Apart from the observable degenerative issues, they will also have elevated cholesterol levels, indications of heart disease, and arthritic changes. Patients have reported transformed bodies, fat disappearing, enhanced muscular tone, and youthful vigor within six to twelve months of starting hormone replacement therapy. Patients report feeling better about themselves and having a more positive attitude. There are amazing feel-good effects as well as fantastic health benefits.

 

Regretfully, around 90% of patients who come to us from other doctors taking “natural hormones” are not following a proper regimen. How are we aware? The blood levels are almost nil when we measure them. For a younger person, the blood hormone levels must be maintained within the ideal upper limit of normal values for the hormones to have therapeutic effects. The majority of doctors need to be educated to aim for optimal outcomes.

 

Many doctors need to learn how to prescribe the right amounts. They are unaware of the ideal levels based on blood tests—not saliva tests. They may not know that there are numerous ways to synthesize a natural hormone so that the patient can receive a form that is absorbed and processed in their own way.

 

To ensure that the therapy yields the greatest possible benefit, the patient must first and foremost urge the doctor to explain, monitor, and optimize the hormone levels. Menopausal women experience significant changes in their skin’s thickness, texture, and tightness from dehydration. The same unsettling changes are noticed by women who discontinue hormone medication.  This is because many women who have started on hormone therapy can begin to see relief in their vasomotor symptoms, improve cardioprotection, and prevent other chronic diseases from developing over time. (Shufelt & Manson, 2021) Research published in journals dedicated to dermatology shows that the loss of thyroid, estrogen, and testosterone hormones causes this harmful effect on the skin. Hormone replacement therapy is the only effective treatment for and defense against changes in skin elastin and collagen and wrinkle prevention. The internal alterations, however, are more significant. Not only does the skin on the outside show obvious indications of aging, but there is also noticeable internal degradation. This could cause widespread complaints made by men and women in their midlife about not feeling as good as they would want. If taken care of early on, much of this can be helped. Rather than being afraid of how much you’ve aged, you’d rather hear, “Wow, you look great!” at that high school reunion.

 

Thyroid Hormones

The thyroid gland secretes thyroid hormone, a metabolic hormone that helps regulate temperature, metabolism, and brain function in the body. Thyroid hormones are crucial for normal development in the body and are necessary for normal physiological functioning. (Babic Leko et al., 2021)  The thyroid also lowers cholesterol and promotes weight loss by increasing fat breakdown, protecting against cardiovascular illnesses, avoiding cognitive deterioration, and enhancing cerebral metabolism. When environmental factors affect the thyroid, it can lead to overlapping risk profiles in the body.

 

Low thyroid function is associated with low levels of energy and exhaustion, slowness of thought and movement, depression, forgetfulness, mental disorientation, discomfort similar to that of arthritis, and an increased risk of infections and colds. Many of these features are thought to be typical of aging; however, many individuals will begin to notice that thyroid deficiency is the secondary cause. As we get older, our thyroid produces fewer hormones. So, regulating the hormone function in the body starts with the thyroid hormone. This is now understood to be thyroid insufficiency rather than actual hypothyroidism, which in the past was believed to necessitate hormone replacement therapy.  Hypothyroidism occurs when the thyroid gland has inadequate hormone production, which causes nonspecific signs and symptoms and develops overlapping risk profiles that affect the body’s metabolism and function of many cells and vital organs. (Wilson et al., 2021)  According to numerous research studies, raising thyroid levels can help the body system work more effectively and efficiently while relieving many symptoms associated with thyroid insufficiency.

 

Estrogen

Doctors have been giving estrogen for menopausal symptoms, including sleeplessness and hot flashes, to women for almost 40 years. Many ladies used estrogen for as long as they could because they felt so healthy and energized when taking it. Numerous studies witness estrogen’s remarkable impact on women’s health and well-being. A woman’s quality of life is greatly enhanced by estrogen, which makes them feel more youthful and invigorated. After menopause, women have more pleasurable, fulfilling sex lives, stronger, glossier hair, and greater muscle tone. Users of estrogen do not have the usual osteoporosis-related bone loss and instead stand taller and straighter. This is because even though estrogen’s main goal is to ascribe reproduction, it can help target non-reproductive tissues like skeletal muscle. (Critchlow et al., 2023) Those who utilize estrogen have a 50% lower risk of heart disease and stroke than those who do not. Alzheimer’s dementia and senility are incredibly rare among estrogen users. Users of estrogen are not susceptible to the potentially crippling conditions of urogenital atrophy, vaginal dryness, and concurrent infections. One of the few hormones that women ask their doctors for is estrogen. Estrogen was the most commonly prescribed medication in the U.S., with over 10 million women taking it. We have discovered the benefits of proper hormone supplementation and the synergy that results from restoring all hormone levels through estrogen supplementation.

 

In the past, doctors frequently performed hysterectomy, which involved removing a woman’s ovaries. This stopped the manufacturing of important hormones. Doctors now attempt to save ovaries wherever possible after realizing the pain and negative consequences of hormone loss. We would remove ovaries surgically at a young age if hormones were that bad. Rather, we aim to maintain ovarian function and the production of healthy hormones for as long as possible. Instead of using a whole separate hormone with a different molecular structure, we need to employ the same hormone to restore the lost hormones to pre-menopausal levels when menopause occurs and hormone levels drop. The human body is aware of a difference, even though the pharmaceutical business denies it.

 

The adrenal glands and ovaries both create estrogen. Men do produce a very tiny amount of estrogen through the conversion of testosterone. The body of a woman contains three different forms of estrogen. They are estriol, estradiol, and estrone. The symptoms and negative health effects of menopause are caused by a sharp decline in the levels of all these hormones at the beginning of menopause. Menopause symptoms include anxiety, vaginal dryness, hot flashes, sleeplessness, bladder issues, and trouble focusing. Unfortunately, the lack of estrogen makes the disease processes—such as Alzheimer’s, osteoporosis, stroke, and cardiovascular disease—worse. Incorporating hormone replacement therapy to replenish estrogen levels for females can ultimately enhance their reproductive health and overall well-being. (Moustakli & Tsonis, 2023)

 

Progesterone

Pro-gestational, or progesterone, is vitally essential for the onset and maintenance of pregnancy. Progesterone, which guards against osteoporosis, heart disease, breast cancer, and uterine cancer, is lost by women going through menopause. Regretfully, most clinicians utilize medroxyprogesterone, or Provera, a synthetic, chemically distinct medication, rather than progesterone to replace the lost progesterone. Despite having the same name as progesterone (medroxyprogesterone), Provera differs from progesterone in molecular and biological ways. This section discusses why progesterone is so safe and helpful and why Provera is so damaging, even though most doctors believe they are interchangeable.

 

Despite being disregarded frequently, progesterone is another female hormone that is just as important for aging women as estrogen. The ovaries create the hormone progesterone, which the body uses to balance estrogen. Additionally, progesterone can prevent numerous chronic conditions like osteoporosis and cancer, alleviate menopausal symptoms, and enhance general health. Doctors have historically been used to prescribing the synthetic progestin, which is marketed under the name Provera. These synthetic progestins lack the advantages of natural progesterone and have the same serious side effects and issues as synthetic estrogens. This is because hormones like progesterone and estrogen play a different role in any pain-related conditions that can affect anyone. (Athnaiel et al., 2023) More significantly, new research continuously shows that progesterone prevents breast cancer.

 

Since the two hormones were designed to cooperate to preserve a healthy hormonal balance, natural progesterone can amplify the effects of estrogen. When a person is dealing with low progesterone, it can bring on similar illness processes as low estrogen. These include heart disease, osteoporosis, a decline in libido, and a markedly reduced quality of life. Natural progesterone and estrogen can stop this downward spiral by maintaining women’s vitality, strength, and health.

 

Additionally, natural progesterone raises HCL, or good cholesterol, and lowers cholesterol levels more. Synthetic progestin, on the other hand, has the opposite effect. Regrettably, many doctors who prescribe progestin are ignorant of the existence of a safer, more well-tolerated alternative. Furthermore, it has been demonstrated that natural progesterone can stop the advancement of osteoporosis by stimulating osteoblasts. These cells produce new bones, while only estrogen can prevent bone loss.

 

Conclusion

Overall, it is important to replenish lost hormones in the body by reducing numerous environmental factors that can enhance the overlapping risk profiles that cause pain and discomfort. When many start thinking about their health, they can make small changes in their habits like eating right, utilizing non-surgical treatments, exercising, and being mindful of their stress to live healthier lives. In part 2, we will explore hormone therapy and its beneficial properties more in-depth.

 

References

Athnaiel, O., Cantillo, S., Paredes, S., & Knezevic, N. N. (2023). The Role of Sex Hormones in Pain-Related Conditions. Int J Mol Sci, 24(3). doi.org/10.3390/ijms24031866

Babic Leko, M., Gunjaca, I., Pleic, N., & Zemunik, T. (2021). Environmental Factors Affecting Thyroid-Stimulating Hormone and Thyroid Hormone Levels. Int J Mol Sci, 22(12). doi.org/10.3390/ijms22126521

Critchlow, A. J., Hiam, D., Williams, R., Scott, D., & Lamon, S. (2023). The role of estrogen in female skeletal muscle aging: A systematic review. Maturitas, 178, 107844. doi.org/10.1016/j.maturitas.2023.107844

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

Shufelt, C. L., & Manson, J. E. (2021). Menopausal Hormone Therapy and Cardiovascular Disease: The Role of Formulation, Dose, and Route of Delivery. J Clin Endocrinol Metab, 106(5), 1245-1254. doi.org/10.1210/clinem/dgab042

Weare-Regales, N., Chiarella, S. E., Cardet, J. C., Prakash, Y. S., & Lockey, R. F. (2022). Hormonal Effects on Asthma, Rhinitis, and Eczema. J Allergy Clin Immunol Pract, 10(8), 2066-2073. doi.org/10.1016/j.jaip.2022.04.002

Wilson, S. A., Stem, L. A., & Bruehlman, R. D. (2021). Hypothyroidism: Diagnosis and Treatment. American Family Physician, 103(10), 605-613. www.ncbi.nlm.nih.gov/pubmed/33983002

www.aafp.org/pubs/afp/issues/2021/0515/p605.pdf

Disclaimer

Maintaining a Strong Core with Chair Abdominal Exercises

By
Dr. Alex Jimenez
-
Elderly man practicing yoga asana or sport exercise for legs and hands using chair. Positive mood on sports activities.

For many individuals, getting on the floor to do crunches or other exercises can be difficult due to medical conditions, age, and injuries. Can engaging in chair abdominal exercises at home, work, or anywhere a chair is available help strengthen the upper, lower, and oblique abdominal muscles?

Maintaining a Strong Core with Chair Abdominal Exercises

Chair Abdominal Exercises

Chair abdominal exercises are essential for strengthening the core, maintaining healthy flexibility, mobility, posture, and injury prevention. Incorporating abdominal exercise into one’s day can be easy, regardless of schedule or fitness level.  Various exercises are designed to be performed while seated, making them accessible to everyone, including those with mobility issues or new to exercise.

Benefits

Building and maintaining a solid core is essential for overall health, posture, and daily activities, especially as the body ages. A strong core maintains body balance and stability, prevents falls, protects individuals from back pain, and makes lifting, bending, and walking easier. It allows individuals to stay independent and active. The abdominal muscles are one part of the core, which includes muscles in the back, glutes, pelvic floor, and diaphragm. These are important for keeping the body upright and stable, protecting the spine and organs, and assisting with movements between the ribcage and pelvis. Adding abdominal exercise workouts to a fitness routine is one way to improve overall core strength and stability. Chair-based exercises are convenient and accessible as individuals don’t need specialized machines or equipment, just a sturdy chair and some space. (Frizziero A. et al., 2021)

Chair Workout

Chair abdominal exercises are ideal gentle exercises for older individuals who need to increase their strength and mobility. Because chairs provide stability and safety, these exercises focus on seated movements and are intended for those with limited mobility. Chair abdominal exercises can be adapted and modified to individual preferences and needs, preparing the body for more advanced standing exercises. They improve the ability to perform daily tasks and increase joint mobility, muscle strength, and coordination. To prevent injuries, each exercise session should begin with a warm-up and end with a cool-down.

  • A warm-up could be gentle seated marches, shoulder rolls, and deep breathing exercises.
  • A cool-down can include seated stretches, focusing on the back, neck, and legs to help the body recover and prevent stiffness.

It is recommended that patients talk to a healthcare provider first if they have limited mobility or chronic health issues. Here are some sample exercises.

Sitting Knee Lifts

  • Sit on the edge of the chair with your back straight.
  • Lift your knees toward your chest, engaging the upper abs.
  • Lower them slowly back down.
  • Repeat for 10 to 15 reps.
  • Beginners lift one knee at a time.
  • Lower it and repeat with the other leg.

Sitting Crunches

  • Sit on the edge of the chair.
  • Lean back slightly.
  • Place hands behind your head.
  • Crunch forward, bringing the chest toward your knees.
  • Return to the starting position.
  • Repeat for 10 to 15 reps.
  • Beginners can sit more on the chair and hold the seat for stability.
  • Reduce the range of motion when crunching the chest toward the knees.

Sitting Leg Lifts

  • Sit on the edge of the chair with the back straight.
  • Extend your legs in front of you and lift them together, engaging the lower abdominals.
  • Lower them back down slowly.
  • Repeat for 10 to 15 repetitions.
  • Beginners sit back on the chair and grip the sides.
  • Lift one leg and hold for a count before lowering.
  • Switch legs.

Sitting Scissor Kicks

  • Sit on the edge of the chair and lean back slightly.
  • Extend your legs in front.
  • Alternate lifting each leg up and down in a scissor motion.
  • Perform for 30 seconds to one minute.
  • Beginners tap one heel on the floor between lifts to reduce abdominal tension.

Sitting Side Crunches

  • Sit on the edge of the chair with the back straight.
  • Lift one knee toward the chest while bringing the opposite elbow toward the knee, engaging the obliques.
  • Alternate for 10 to 15 reps per side.
  • Beginners, keep your feet flat on the floor with your hands behind your head.
  • Gently bend to the side, return to the center, and bend to the other side.

Sitting Bicycle Crunches

  • Sit on the edge of the chair and lean back slightly.
  • Lift the feet off the ground.
  • Alternate bringing each knee toward the opposite elbow in a pedaling motion.
  • Perform for 30 seconds to one minute.
  • For beginners, keep the heel gently on the ground while you crunch on the opposite side.
  • For a challenge, slow the motion and hold each twist a few seconds longer to create more tension. (Krzysztofik M. et al., 2019)

Progress

For beginners, start with the easier versions and perform fewer repetitions and shorter durations if needed. Focus on maintaining proper posture and form. As the body gets stronger, increase the number of repetitions or extend the duration of each exercise. Once comfortable, try more challenging chair exercises. Chair abdominal exercises are a simple, effective way to strengthen the core, improve posture, and support overall health. Regularly doing these exercises as part of a well-rounded routine can build a solid core without special equipment. Remember to listen to the body and progress at your own pace to more challenging variations over time to keep building strength.

Injury Medical Chiropractic and Functional Medicine Clinic

Achieving and maintaining fitness requires consistent work and development. Retraining the body and maintaining its optimal health requires daily efforts through exercise. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.

Core Exercises and Back Pain

References

Frizziero, A., Pellizzon, G., Vittadini, F., Bigliardi, D., & Costantino, C. (2021). Efficacy of Core Stability in Non-Specific Chronic Low Back Pain. Journal of functional morphology and kinesiology, 6(2), 37. doi.org/10.3390/jfmk6020037

Krzysztofik, M., Wilk, M., Wojdała, G., & Gołaś, A. (2019). Maximizing Muscle Hypertrophy: A Systematic Review of Advanced Resistance Training Techniques and Methods. International journal of environmental research and public health, 16(24), 4897. doi.org/10.3390/ijerph16244897

The Role of the Iliacus Muscle in Hip Flexion

By
Dr. Alex Jimenez
-
A physical therapist performs lower limb mobilization to a patient

The iliacus muscle is a triangle-shaped muscle in the pelvic bone that flexes and rotates the thigh bone. It works with the other muscles in the hip and thigh to help bend, run, walk, sit, and maintain correct posture. Injuries and common medical conditions can affect its function, causing pain and stiffness. Can physical therapy help?

The Role of the Iliacus Muscle in Hip Flexion

The Iliacus Muscle

The iliacus is one of the body’s most important hip flexor muscles. The iliacus and surrounding muscles work together to produce the stability and range of motion required for bending, dancing, sitting, and walking.

Anatomy

The iliacus muscle is part of a complex muscle system in the hip and pelvis. Two iliacus muscles on each side of the pelvic bone enable the thigh to flex and rotate. They are innervated by the femoral nerve, which provides movement and sensation to the lower limbs. (Bordoni B. and Varacallo M. 2023) The iliacus muscle sits on the wing-shaped ilium and fits into the curved surface of the ilium, called the iliac fossa. The top of the muscle is attached to the upper wings of the ilium or iliac crest. It extends past the hip joint, which connects to the upper thigh bone/femur at the lesser trochanter protrusion. The iliacus is part of a major trio of muscles called the iliopsoas, including the major psoas and minor psoas muscles. These muscles are also attached to the upper femur but extend upward, connecting to the lumbar/lower spine at several attachment points. The iliopsoas also interact with the quadratus lumborum muscle, the deepest muscle of the lower back that starts at the iliac crest and attaches to the lumbar spine at several points. The quadratus lumborum enables flexion and elevation of the spine, while the iliopsoas enable the flexion and rotation of the hip and thigh.

Functions

The iliacus muscle has many functions that include: (Physiopedia, 2024)

  • Flexing and rotating the femur.
  • Helps maintain proper body posture while standing and sitting.
  • Produces hip movement that enables walking, running, and climbing stairs.
  • Provides hip flexion – bringing the knee to the chest.
  • Enables the forward tilt of the pelvis and side-bending.

Conditions

Several conditions can affect the iliacus muscle, specifically from under and/or overuse injuries. These conditions, collectively known as Iliopsoas syndrome, are typically the result of overuse/repetitive strain or injuries. These include:

  • Iliopsoas tendinopathy – which affects tendons.
  • Iliopsoas bursitis – which affects cushioning sacs known as bursae.

Iliopsoas syndrome can affect anyone but is common in:

  • Individuals and athletes who repeatedly use movements that flex the hips.
  • Track-and-field athletes
  • Gymnasts
  • Dancers

Iliopsoas Bursitis

This is the inflammation of the cushioning sac or bursa under the iliacus muscle, which helps the muscle slide over the pelvic bone. Symptoms can range from mild discomfort to pain that radiates through parts of the leg and hips. Runners, skiers, and swimmers are commonly affected, and individuals who regularly have tight hips and individuals with different forms of arthritis can also be affected. Early treatment can prevent the symptoms from worsening. Mild cases can be treated with self-care and stretching to help relieve tightness, rest, ice application, and over-the-counter nonsteroidal anti-inflammatory drugs. In severe cases, treatment options that may be recommended include: (Physiopedia, 2024)

  • Physical therapy
  • Assistant walking devices to relieve pressure – for example, a cane.
  • Corticosteroid steroid injections
  • Prescription anti-inflammatory medications

Iliopsoas Tendinopathy

Another condition affecting the iliacus muscles is iliopsoas tendinopathy, sometimes called snapping hip syndrome, because individuals can hear an audible snapping sound (Davenport KL. 2019). The condition is often experienced by dancers who repeatedly flex and hyperextend their hips and can result in hip and groin pain that gets worse with kicking or rotation. Treatment of iliopsoas tendinopathy can include:

  • Retraining muscle imbalances with strengthening and stretching exercises.
  • If these fail to provide relief, corticosteroid injections may be used. A saline hydro dissection can relieve stress around the tendon by injecting fluids that cushion and release trapped tissues.
  • Tendon release surgery may be recommended when all other options have failed. The surgical release involves severing the tendon to reduce pain and improve the range of motion.

Rehabilitation

Core muscle strengthening is essential to the rehabilitation of iliacus muscle injuries. The iliopsoas is an integral component of the core group and can benefit from stretching and strengthening exercises (Yogateket, 2019)

  • Lunge stretches
  • Straight leg raises
  • Knee-to-chest stretches
  • Standing hip flexion with resistance bands
  • Certain yoga poses can also help and include variations on the bridge pose that encourage hip flexion. (Yoga International, 2024)

Injury Medical Chiropractic and Functional Medicine Clinic

Iliopsoas pain is often felt at the front of the hips, thigh, mid-back, and lower back. Chiropractic care can help with iliacus muscle injuries through:

Evaluation

  • A chiropractor can evaluate the condition and determine if the iliacus muscle is causing pain.

Treatment plan

  • A chiropractor can create a personalized treatment plan that may include exercise instructions, manipulation, and other therapies.

Rehabilitation

  • A chiropractor can create a rehabilitation program to expedite healing.

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.

Hip Labral Tear and Chiropractic Care

References

Bordoni, B., & Varacallo, M. (2024). Anatomy, Bony Pelvis, and Lower Limb, Iliopsoas Muscle. In StatPearls. www.ncbi.nlm.nih.gov/pubmed/30285403

Physiopedia. (2024). Iliacus. www.physio-pedia.com/Iliacus

Physiopedia. (2024). Iliopsoas bursitis. www.physio-pedia.com/Iliopsoas_Bursitis

Davenport KL. (2019). The professional dancer’s hip. Performing Arts Medicine, 77-87. doi.org/https://doi.org/10.1016/B978-0-323-58182-0.00009-2

Yogateket. Lizette Pompa. (2019). Essential yoga body parts. Hip flexor/psoas and yoga. Yogateket. www.yogateket.com/blog/hip-flexor-psoas-and-yoga

Yoga International. Amber Burke. (2024). 8 poses for iliopsoas release. yogainternational.com/article/view/8-poses-for-iliopsoas-release/

Step-by-Step Guide to the Correct Manual Lifting Technique

By
Dr. Alex Jimenez
-
Attentive factory worker picking up cardboard boxes in factory

Incorrect manual handling and lifting is a leading cause of workplace injuries. Can health and safety training help reduce injuries and lost workdays?

Step-by-Step Guide to the Correct Manual Lifting Technique

Correct Manual Lifting Technique

Manually lifting objects using incorrect techniques can lead to acute back injuries, herniated discs, sciatica, and long-term issues like increased risk of reinjury, body misalignment, and chronic back pain. Individuals can prevent spinal disc compression and/or lower back muscle strain by learning to use correct manual lifting techniques. (CDC. The National Institute for Occupational Safety and Health (NIOSH). 2007)

Lifting Guide

Individuals can protect their backs and prevent injury by following simple steps when lifting objects.

Support Base

  • Ensure there is a healthy support base from which to lift.
  • Keep feet shoulder-width apart with one foot slightly in front of the other.

Ask For Help

  • If coworkers or colleagues are available, ask for assistance.
  • If the load is too heavy, ask for help lifting and moving the object/s.

Use Mechanical Assistant Devices

  • Use hand trucks, dollies, or pushcarts whenever possible for uneven and heavy loads.

Squat To Lift Object

  • Bend at the hips and knees only, not the back.
  • Put one knee on the ground to ensure stability before lifting.

Check Posture

  • Looking straight ahead, maintain posture upright with the chest out, shoulders back, and lower back slightly arched.

Lift Slowly

  • Lift with the knees and hips only, gradually straightening the lower back.

Load Positioning

  • Once upright, hold the load close to the body around the stomach.

Move and Maintain Alertness

  • Always take small steps.
  • Maintain alertness as to where you are going.
  • Keep the shoulders square with the hips when changing directions to avoid twisting and losing or shifting balance.

Rest

  • If you are fatigued, set the load/object down and rest for a few minutes until you can fully engage in the task.

Squat To Set Object Down

  • Squat with the knees and hips and set the load down slowly.
  • Avoid quickly rising and jerking movements, and allow the legs, hips, and back muscles to reset.

Planning and Tips

Lifting anything heavy takes planning to prevent muscle spasms, back strain, and other musculoskeletal injuries. Considerations to keep in mind:

Make a Plan Before Lifting

  • Knowing what object/s are being lifted and where they are going will prevent individuals from making awkward movements while holding and carrying something heavy.
  • Set and clear a path.
  • If lifting something with another person, ensure both agree and understand the plan.

Lift Close to The Body

  • Individuals are stronger and more stable lifters if the object is held close to their body rather than at the end of their reach.
  • Make sure there is a firm hold on the object.
  • It is easier to maintain balance close to the body.

Maintain Feet Shoulder-Width Apart

  • Keep the feet about shoulder-width apart.
  • Having a solid base of support is important while lifting.
  • Placing the feet too close together will cause instability while placing them too far apart will hinder movement.
  • Take short steps.

Visualize The Motions Involved and Practice The Motions Before Lifting

  • Think about the motion before lifting.
  • Practice the lifting motion before lifting the object.
  • Focus on keeping the spine straight.
  • Raise and lower to the ground by bending the knees.
  • Avoid bending at the waist or hips.

Tighten the Stomach Muscles

  • Tightening the abdominal muscles will hold the back in a healthy lifting position and help prevent excessive force on the spine.

Lift With the Legs

  • The legs are stronger than the back muscles, so let the leg strength do the work.
  • Lower yourself to the ground by bending the knees, not the back.

Keep Eyes Up

  • Looking slightly upwards will help maintain a better spine position and help keep the back straight.

Avoid Twisting or Bending

  • Face in the direction you are walking.
  • Stop, take small steps, and continue walking if turning is required.

Back Belts

It has become common for many who work in jobs requiring manual lifting to wear back belts or support. However, research does not show that they decrease the risk of a lifting injury. (CDC and The National Institute for Occupational Safety and Health, 2023) Instead, it is recommended that the belt be thought of as a reminder of where the back muscles are positioned to keep the individual aligned, combined with the correct lifting techniques.

Injury Medical Chiropractic and Functional Medicine Clinic

Training the body and maintaining its optimal health for correct manual lifting techniques requires daily efforts through practice, conscious position corrections, and ergonomics. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.

Chiropractic Care For Injury Recovery

References

CDC. The National Institute for Occupational Safety and Health (NIOSH). (2007). Ergonomic Guidelines for Manual Material Handling. (No. 2007-131). Retrieved from www.cdc.gov/niosh/docs/2007-131/pdfs/2007-131.pdf

CDC. The National Institute for Occupational Safety and Health (NIOSH) (2023). Back Belts – Do They Prevent Injury? (No. 94-127). Retrieved from www.cdc.gov/niosh/docs/94-127/

Transforming Fat into Energy: Understanding the Process

By
Dr. Alex Jimenez
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Two engineers wearing hardhats and safety waistcoats sitting on cement beam and resting during break on construction site

How is fat turned into energy to be used as fuel for individuals working to improve their health and physical abilities?

Transforming Fat into Energy: Understanding the Process

Fat Into Energy Conversion

Fat is an essential component of a diet that fuels physical activity, work, exercise, etc. Its calorie density is the highest of all nutrients, and fat’s unlimited storage capacity makes it the body’s largest energy reserve. Fat is essential for longer, slower, lower-intensity endurance physical activities and exercises like walking and cycling.

What Is Fat?

Everything eaten is made up of:

Macronutrients

  • Protein
  • Carbohydrates
  • Fat

Micronutrients

  • Vitamins
  • Minerals

These are converted to energy, helping to fuel all bodily functions.

Dietary fat has been blamed for various health problems, but it is an essential nutrient for optimal health. The adipose tissue/stored fat provides cushion and insulation to internal organs, protects nerves, circulates vitamins A, D, E, and K through the body, and is the largest stored energy reserve. Stored body fat is different from dietary fat. Body fat is only stored when more calories are consumed than used from all foods, not just from dietary fats. There is an optimal level of body fat for health and regular physical and athletic activity.

Types

Researchers and scientists are learning more and more about body fat/adipose tissue and its roles in the body. Two well-known types are white fat and brown fat.

  • Brown fat helps regulate body temperature. (Richard AJ. et al., 2020)
  • White fat is responsible for energy storage and metabolic functions like insulin sensitivity.
  • White fat can transition to brown fat under certain cold temperatures. (Rabiee A. 2020)
  • Beige fat is another type that scientists are still learning about.

When Fat Is Burned

When fat is used as fuel, the fatty acids inside the fat cell are broken down and released into the system as water and carbon dioxide. (MacLean P. S. et al., 2015) The body uses the water for hydration, and the carbon dioxide is exhaled through the lungs. The remaining fat cell shrinks as it is depleted of its fatty acids. The fat into energy conversion also produces heat.

Fat for Fuel

Fat is the main fuel source for long-duration, low—to moderate-intensity physical activities and exercise like endurance sports. Even during high-intensity activities and training, where​ carbohydrates are the main fuel source, the body still needs fat to help access the stored carbohydrates or glycogen. Using fat to fuel activity includes three key components which include:

Digestion

  • Fat is slow to digest and convert into a usable form of energy.
  • The process can take up to six hours.

Transportation

  • After the body breaks down the fat, it needs time to transport it to the working muscles before it can be used as energy.

Conversion

  • Converting stored body fat into energy takes increased oxygen, requiring decreased physical activity and exercise intensity.

This is why timing when and how much fat is consumed is important for its full potential. Eating foods high in fat immediately before or during intense physical work activity or exercise is not recommended. First, the job, chore, or workout will be done before the fat can be used as energy. And second, it can cause uncomfortable gastrointestinal symptoms like nausea, vomiting, and diarrhea.

Fat Loss Optimization

For individuals trying to alter body fat composition, the most important thing is to adopt a safe and effective physical activity and exercise routine and to eat a balanced diet of nutrient-dense foods that provide adequate amounts of macronutrients, including dietary fat.

Macronutrient

Low-carbohydrate and high-fat diets, like the ketogenic and Paleo diets, all work on the same premise: Lower carbohydrate intake, high fat intake, and moderate to high protein intake lead to burning body fat as the primary fuel source while engaging in physical activity or exercising. There is some scientific evidence that long-term low-carb/high-fat diets are safe and may help improve metabolic risk factors for chronic disease. Some studies on these diets have shown them to be beneficial for performance in endurance sports, but several months of adaptation to a low-carb/high-fat diet are required for metabolic changes to occur. (Chang C. K., Borer K., and Lin P. J. 2017))

High-Intensity Interval Training

High-intensity interval training is an efficient way to convert fat to energy. In a study, overweight individuals were able to convert body fat to energy in half the time using HIIT vs. aerobic activity alone (Zhang H. et al., 2017). HIIT specifically converts visceral fat, typically white adipose tissue, often found in the midsection. (Mittal B. 2019) HIIT also helps increase muscle mass and resting metabolism. (Thyfault J. P. and Bergouignan A. 2020) However, any exercise regimen that helps increase muscle mass provides these beneficial effects.

Injury Medical Chiropractic and Functional Medicine Clinic

At Injury Medical Chiropractic and Functional Medicine Clinic, we focus on what works for you to relieve pain, restore function, prevent injury, and better the body. Through research methods and total wellness programs, individuals can condition themselves to excel in physical activity or sports through proper fitness and nutrition. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.

Integrative Medicine and Chiropractic Care

References

Richard, A. J., White, U., Elks, C. M., & Stephens, J. M. (2000). Adipose Tissue: Physiology to Metabolic Dysfunction. In K. R. Feingold, B. Anawalt, M. R. Blackman, A. Boyce, G. Chrousos, E. Corpas, W. W. de Herder, K. Dhatariya, K. Dungan, J. Hofland, S. Kalra, G. Kaltsas, N. Kapoor, C. Koch, P. Kopp, M. Korbonits, C. S. Kovacs, W. Kuohung, B. Laferrere, M. Levy, E. A. McGee, R. McLachlan, M. New, J. Purnell, R. Sahay, A. S. Shah, F. Singer, M. A. Sperling, C. A. Stratakis, D. L. Trence, & D. P. Wilson (Eds.), Endotext. www.ncbi.nlm.nih.gov/pubmed/32255578

Rabiee A. (2020). Beige Fat Maintenance; Toward a Sustained Metabolic Health. Frontiers in endocrinology, 11, 634. doi.org/10.3389/fendo.2020.00634

MacLean, P. S., Higgins, J. A., Giles, E. D., Sherk, V. D., & Jackman, M. R. (2015). The role for adipose tissue in weight regain after weight loss. Obesity reviews : an official journal of the International Association for the Study of Obesity, 16 Suppl 1(Suppl 1), 45–54. doi.org/10.1111/obr.12255

Chang, C. K., Borer, K., & Lin, P. J. (2017). Low-Carbohydrate-High-Fat Diet: Can it Help Exercise Performance?. Journal of human kinetics, 56, 81–92. doi.org/10.1515/hukin-2017-0025

Zhang, H., Tong, T. K., Qiu, W., Zhang, X., Zhou, S., Liu, Y., & He, Y. (2017). Comparable Effects of High-Intensity Interval Training and Prolonged Continuous Exercise Training on Abdominal Visceral Fat Reduction in Obese Young Women. Journal of diabetes research, 2017, 5071740. doi.org/10.1155/2017/5071740

Mittal B. (2019). Subcutaneous adipose tissue & visceral adipose tissue. The Indian journal of medical research, 149(5), 571–573. doi.org/10.4103/ijmr.IJMR_1910_18

Thyfault, J. P., & Bergouignan, A. (2020). Exercise and metabolic health: beyond skeletal muscle. Diabetologia, 63(8), 1464–1474. doi.org/10.1007/s00125-020-05177-6

Achieving and Maintaining a Healthy Posture For A Pain-Free Life

By
Dr. Alex Jimenez
-
Physiotherapy, chiropractor and senior man with back pain or physiotherapist consulting a patient f.

Can correcting body misalignments and the elements of unhealthy posture help achieve a healthy posture?

Achieving and Maintaining a Healthy Posture For A Pain-Free Life

Healthy Posture

Maintaining a healthy posture is more important than ever, as individuals from all walks of life realize how practicing awkward and unhealthy postures can wreak havoc on their bodies and quality of life. Unhealthy postures include rounding the upper and lower back, slouching, and forward head posture. Over time, these postures make daily activities more difficult or painful. Mobility, stability, and strengthening exercises can address unhealthy posture problems and issues, along with practicing correct sitting, standing, and resting postural habits to reinforce proper alignment daily. A chiropractic and physical therapy team can treat and train individuals to restore correct and healthy posture.

Body Alignment

Ideal posture involves correct body alignment or how the structural parts, such as the head, trunk, hips, knees, etc., relate to an individual’s form. Whether standing, sitting, lying down, or moving, body parts need to be balanced in relationship to each other to avoid unnecessary stress on the spine and musculoskeletal system. (Bone Health & Osteoporosis Foundation, 2024)

Posture Types

Posture is considered static when sitting or standing still and dynamic when moving. Both are categorized as active postures as they require the activation of stabilizing muscles to deal with gravity and maintain alignment.  Lying down and remaining still is considered an inactive posture, as muscle involvement is minimal. However, both have the potential to be healthy or unhealthy.

Proper Body Alignment

An easy way to check proper alignment while standing is to stand against a wall with the base of the head, shoulder blades, and buttocks flush against the wall, with enough space for a hand wide enough to slide in between the wall and the small of the back. This exercise correctly lines up the head, shoulders, and hips to reduce or eliminate undue stress on the spine. Body balance is the foundation for active and inactive postures concerning workstations, industrial ergonomics, daily activities, and sports. (Mayo Clinic, 2023) Healthy alignment is a standard position in which all body joints are centered and balanced and the most mechanically efficient position for static or dynamic activities. Biomechanical efficiency (the ability to use the body’s muscles and joints to perform movements while minimizing energy use and maximizing output) enables the muscles surrounding the joints to work in balance and efficiently activate, which, in turn, helps reduce strain, tension, and injury. Balanced muscles also conserve energy, leading to better daily stamina.

Development of Imbalances

Individuals develop position and movement habits in joint positioning that have led to imbalanced muscles. When this is the case, some muscles can be chronically stretched, and others become chronically tight, all to hold the body up or move around, which can lead to postural conditions like upper crossed (Physiopedia, 2024) or lower crossed syndrome (Physiopedia, 2024) which often leads to pain and/or mobility issues.

Posture Assessment

The recommended way to determine if one’s posture is healthy or poor is by conducting a posture assessment. The examination looks at joint positions and gathers visual information about the planes into which parts of each joint move and the axes around which those movements occur (Singla D. and Veqar Z., 2014) (Debra Coglianese et al., 2006). In a posture assessment, body alignment is compared with the ideal standard, a plumb line, usually a string with a small weight attached to the bottom to help maintain straightness. The other end of the string is affixed to the ceiling to be used as an accurate reference for correct alignment. (Singla D. and Veqar Z. 2014) During a posture assessment, the patient stands next to the plumb line while the doctor or therapist compares the relative positions of the following areas:

  • Ears
  • Shoulder joint
  • Spine
  • Hip joint
  • Knee joint
  • Ankle joint
  • Feet

Any areas that don’t match the reference can indicate misalignments in one or several regions.

Making Corrections

Chiropractic care can help correct unhealthy posture by realigning the spine and strengthening the musculoskeletal system:

Spinal Adjustments

  • Chiropractors use their hands or instruments to apply controlled force to the spine to realign the vertebrae. This can help relieve pressure on muscles, ligaments, and nerves, which can improve posture.

Corrective Exercises

  • Chiropractors can create custom exercises to strengthen postural muscles and maintain proper alignment.

Massage Therapy

  • Chiropractors can use massage therapy to work on strained ligaments and soft tissue.

Guidance and Training

  • Chiropractors can teach patients how to move to encourage a neutral spine and provide strategies for maintaining healthy posture.
  • A posture corrector or brace can also help teach and engage the correct muscles to achieve proper alignment. However, it should not be relied on long-term because promoting and activating one’s stabilizing muscles is important rather than relying on a brace for prolonged periods.

Injury Medical Chiropractic and Functional Medicine Clinic

Achieving and maintaining proper posture requires consistent work and development. Retraining the body and maintaining its optimal health requires daily efforts through exercise, conscious position corrections, and ergonomics. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.

Upper Cross Syndrome

References

Bone Health & Osteoporosis Foundation. (2024). Proper body alignment. www.bonehealthandosteoporosis.org/patients/treatment/exercisesafe-movement/proper-body-alignment/

Mayo Clinic. (2023). Mayo Clinic Q and A: Proper posture and body alignment. newsnetwork.mayoclinic.org/discussion/mayo-clinic-q-and-a-proper-posture-and-body-alignment/

Physiopedia. (2024). Upper crossed syndrome. www.physio-pedia.com/Upper-Crossed_Syndrome

Physiopedia. (2024). Lower crossed syndrome. www.physio-pedia.com/Lower_Crossed_Syndrome

Singla, D., & Veqar, Z. (2014). Methods of postural assessment used for sports persons. Journal of clinical and diagnostic research: JCDR, 8(4), LE01–LE4. doi.org/10.7860/JCDR/2014/6836.4266

Coglianese, D. (2006). Muscles: Testing and Function With Posture and Pain, ed 5 (with Primal Anatomy CD-ROM). Physical Therapy, 86(2), 304-305. doi.org/https://doi.org/10.1093/ptj/86.2.304

Exploring the Functions and Anatomy of the Axillary Nerve

By
Dr. Alex Jimenez
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Young woman with shoulder pain is being examined by a physiatrist

An axillary nerve injury can cause pain, weakness, and shoulder mobility loss. Can physical therapy help restore and maintain shoulder joint flexibility?

Exploring the Functions and Anatomy of the Axillary Nerve

Axillary Nerve

The axillary nerve, or the circumflex nerve, is a peripheral nerve that runs through the shoulder and supports movement and sensation in the upper limbs. It originates in the neck at the brachial plexus, a network of nerves that extends from the neck and upper torso to the shoulders and arms. Its primary purpose is to supply nerve function to the shoulder joint and three muscles in the arm and also innervates some skin in the region.

Anatomy

Except for the cranial nerves, all the body’s nerves branch off from the spinal cord, emerge from between vertebrae and continue to branch off as they travel to various muscles and other structures. The axillary nerve is named after the axilla, the medical name for the armpit. Individuals have two, one on each side. After leaving the spinal column, the axillary nerve runs behind the axillary artery and continues to the shoulder blade’s lower edge of the subscapularis muscle. It winds back and travels down the arm along the posterior humeral circumflex artery, which then passes through the quadrangular space (a small area of the shoulder blade just above the armpit where there is a gap in the muscles that allows nerves and blood vessels to pass through to the arm before it divides into terminal branches, which are:

Anterior Division

  • Supplies motor innervation to the deltoid’s anterior and middle heads, allowing the arm to abduct or move away from the body.
  • It winds around the neck of the humerus/funny bone, goes beneath the deltoid muscle, and then connects to the forward edge of the deltoid.
  • A few small cutaneous branches serve the skin in that area.

Posterior Division

  • Innervates the teres minor muscles and the lower part of the deltoid.
  • It enters the deep fascia and becomes the superior lateral cutaneous nerve.
  • It then wraps around the lower edge of the deltoid, connects to the skin over the lower two-thirds of the muscle, and covers the long head of the triceps brachii.

Articular Branch

  •  Comes from the trunk of the axillary nerve and enters the glenohumeral joint, which is in the shoulder, below the subscapularis muscle.

Anatomical Variations

In a case report, healthcare providers noted an incidence of the nerve branching directly off the upper trunk of the brachial plexus rather than the posterior cord. (Subasinghe S. K. and Goonewardene S. 2016) In this case, it innervated the subscapularis muscle, latissimus dorsi, and the deltoid and teres minor muscles and also had a communicating branch to the posterior cord. Another case documented multiple abnormalities in the course of the axillary nerve in an individual with pain and severely limited shoulder mobility. (Pizzo R. A. et al., 2019) During reverse shoulder arthroplasty, the surgeon discovered that the axillary nerve ran beside the coracoid process instead of underneath and stayed close to the subscapularis muscle instead of traveling through the quadrangular space. The case noted earlier reports of axillary nerves not running through the quadrangular space. In those cases, the nerve pierced the subscapularis muscle or split into branches before reaching the quadrangular space.

Function

The axillary nerve functions as a motor nerve that controls movement and a sensory nerve that controls sensations like touch or temperature.

Motor

As a motor nerve, the axillary nerve innervates three muscles in the arm and includes:

Deltoid

  • Allows flexing of the shoulder joint and rotating the shoulder inward.

Long Head of the Triceps

  • It runs down the back of the outer arm, allowing straightening, pulling the upper arm toward the body, or extending it backward.
  • The radial nerve can also innervate this muscle.

Teres Minor

  • One of the rotator cuff muscles starts outside the shoulder and runs diagonally along the bottom edge of the shoulder blade.
  • It works with other muscles to allow for the external rotation of the shoulder joint.

Sensory

In its sensory role, the nerve carries information to the brain from the following:

  • Glenohumeral joint or the ball-and-socket joint in the shoulder.
  • The skin on the lower two-thirds of the deltoid muscle through the superior lateral cutaneous branch.

Injuries and Conditions

Problems with the axillary nerve can be caused by injuries anywhere along the arm and shoulder and by disease. Common injuries include:

Dislocations

  • Of the shoulder joint, which can cause axillary nerve palsy.

Fracture

  • Of the surgical neck of the humerus.

Compression

  • This stems from walking with crutches, also known as crutch palsy.

Direct Trauma

  • This can be from an impact sports, work, automobile accident, collision, or laceration.

Added Pressure

  • This can be from wearing a cast or splint.

Surgical Accidental Injury

  • An injury or damage can come from shoulder surgery, especially arthroscopic surgery on the inferior glenoid and capsule.

Quadrangular Space Syndrome

  • This is where the axillary nerve is compressed where it passes through that space, which is most common in athletes who perform frequent overhead motions)

Nerve Root Damage

  • Between the fifth and sixth cervical vertebrae, where the nerve emerges from the spinal cord, which can be caused by traction, compression, spinal disc prolapse, or a bulging disc.

Systemic Neurological Disorders

  • Example – multiple sclerosis

Erb’s Palsy

  • A condition often is the result of a birth injury called shoulder dystocia, in which a baby’s shoulder/s becomes stuck during childbirth.

Axillary Nerve Palsy

  • Damage can result in a type of peripheral neuropathy that can cause weakness in the deltoid and teres minor muscles.
  • This can result in losing the ability to lift the arm away from the body and weakness in various shoulder movements.
  • If the damage is severe enough, it can cause paralysis of the deltoid and other minor muscles, resulting in flat shoulder deformity, in which individuals cannot lay their shoulders flat when lying down.
  • Axillary nerve damage also can lead to a change, reduction, or loss of sensation in a small part of the arm just below the shoulder.

Nerve Injury Statistics

  • Three times more common in men than women.
  • It may be present in as many as 65% of shoulder injuries.
  • The risk of injury due to dislocation is significantly increased after age 50.

Tests

If a healthcare provider suspects a problem with axillary nerve function, they’ll test the shoulder’s range of motion and skin sensitivity. A difference in the range of motion between the shoulders can indicate a nerve injury. Individuals may be sent for electromyography and a nerve conduction study to verify nerve palsy. In some cases, an MRI and/or X-rays may be ordered, especially if the cause of possible nerve damage is unknown.

Rehabilitation

Depending on the severity and cause of the injury, non-surgical treatments may be recommended, with surgery as a last resort. Non-surgical treatment can include some combination of immobilization, rest, ice, physical therapy, and anti-inflammatory meds. Physical treatment typically lasts about six weeks and focuses on strengthening and stimulating the muscles to prevent joint stiffness, which can impair long-term function.

Surgery

If conservative treatments don’t work, surgery may be recommended, especially if several months have passed without improvement. Surgical outcomes are generally better if surgery is performed within six months of the injury, and regardless of the time frame, the prognosis is considered positive in about 90% of cases. Surgical procedures performed for axillary nerve dysfunction or injury include:

Neurolysis

  • This procedure involves targeted damage/degeneration of nerve fibers, interrupts the nerve signals, and eliminates pain while the damaged area heals.

Neurorrhaphy

  • This procedure stitches a severed nerve back together.

Nerve Grafting

  • Grafting involves transplanting a portion of another nerve, usually the sural nerve, to reconnect severed nerves.
  • This helps, especially when the damaged portion is too large to be repaired by neurorrhaphy.
  • It allows a pathway for signals and encourages the regrowth of nerve axons.

Neurotization or Nerve Transfer

  • Similar to grafting but used when the nerve is too damaged to heal.
  • This procedure involves transplanting a healthy but less important nerve, or a portion of a nerve, to replace the damaged one and restore function.

Injury Medical Chiropractic and Functional Medicine Clinic

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.

Shoulder Pain Chiropractic Treatment

References

Subasinghe, S. K., & Goonewardene, S. (2016). A Rare Variation of the Axillary Nerve Formed as Direct Branch of the Upper Trunk. Journal of clinical and diagnostic research : JCDR, 10(8), ND01–ND2. doi.org/10.7860/JCDR/2016/20048.8255

Pizzo, R. A., Lynch, J., Adams, D. M., Yoon, R. S., & Liporace, F. A. (2019). Unusual anatomic variant of the axillary nerve challenging the deltopectoral approach to the shoulder: a case report. Patient safety in surgery, 13, 9. doi.org/10.1186/s13037-019-0189-1

The Role of Vastus Lateralis in Knee Extension and Stability

By
Dr. Alex Jimenez
-
Male rehabilitologist using special massage gun to reduce muscle stiffness and tension and improve blood flow in the massaged muscles

The vastus lateralis is a muscle on the outside part of the thigh. Injuries to the muscle include strains, tendinitis, femoral nerve compression, and others. Can rehabilitation like heat and ice, massage, and strength and mobility exercises help individuals return to normal activities and function?

The Role of Vastus Lateralis in Knee Extension and Stability

Vastus Lateralis Muscle

The vastus lateralis is the largest of the four quadriceps muscles on the thigh’s outer portion. The vastus lateralis helps extend the knee joint and maintain the knee position when walking or running. The vastus lateralis functions to work with the other quad muscles to help extend the knee joint.

Anatomy

Most muscles are attached to bone points of attachment, called the origin and insertion points. The vastus lateralis origin and insertion points are as follows (Vieira, EPL. 2017)

Origin

  • The origin is on the upper inter-trochanteric line of the femur or thigh bone.
  • It also arises from the base of the greater trochanter and the linea aspera, the supracondylar ridge, and the lateral intermuscular septum.

Insertion

  • From its origin, the muscle courses down the lateral thigh and inserts as part of the lateral quadriceps tendon on the tibial tubercle, an elevated portion of the upper shin.
  • The muscle is a large, flat structure with different attachments and a flat aponeurosis or sheath of connective tissue on the outer thigh.
  1. The femoral nerve from lower back levels two, three, and four controls or innervates the muscle.
  2. Blood supply to the muscle goes through the lateral circumflex femoral artery of the upper thigh.

Function

The muscle works with the other quadriceps muscles to extend or straighten the knee. The quads are responsible for functional activities like walking, running, climbing stairs, and getting up from a seated position. The vastus lateralis and the iliotibial band, which courses down the lateral thigh next to this muscle, form the lateral wall of the thigh. The vastus lateralis is on the opposite side of the vastus medialis muscle on the inner portion of the thigh. These muscles work together to maintain the appropriate position of the patella/kneecap in the femoral groove of the thigh bone. Malfunctioning these muscles properly can lead to knee pain from patellofemoral stress syndrome. (American Academy of Orthopaedic Surgeons, 2024)

Conditions

Many different injuries and conditions can affect the vastus lateralis and quad muscles, especially in athletes or active individuals. These injuries can cause vastus lateralis pain and other problems. (Timothy J. Von Fange, 2024) Some of the injuries and conditions include:

Patellofemoral Stress Syndrome – PFSS

  • This occurs when the kneecap tracks improperly in the femoral groove of the knee joint.
  • This leads to pain and difficulty when walking and running.

Vastus Lateralis Strain

  • A sudden force on the thigh can cause the quad muscle to be strained.
  • If the vastus lateralis suffers a pull injury, individuals may have pain, muscle swelling, thigh bruising, and walking difficulties.

Patellar Tendinitis

  • Irritation of the quad tendon that courses over the kneecap can cause patellar tendinitis.

Femoral Nerve Compression Weakness

  • The femoral nerve may become pinched or irritated from a herniated disc, lumbar stenosis, or arthritis.
  • Pain, numbness, tingling, or weakness in the thigh may result.

Iliotibial Band Friction Syndrome

  • Tight or weak muscles can irritate the IT band, and the vastus lateralis muscle can be affected.

Injury Rehabilitation

Injury to the vastus lateralis or quad muscles can cause pain, swelling of the thigh, or limited walking ability. Various treatments are available to help expedite recovery. A primary healthcare provider may recommend working with a physical therapy team. Self-care techniques can include:

Heat and Ice

  • Ice may be applied to the lateral thigh the first few days after injury to control pain and decrease swelling and inflammation.
  • Ice should be applied for 10 to 15 minutes.
  • Individuals may switch to heat two to three days after to promote circulation and improve tissue mobility.
  • Heat should be applied for 10 to 15 minutes.

Massage

  • Massage can help decrease pain and promote circulation.
  • Massage techniques can improve tissue mobility before stretching to help improve quadriceps motion.

Exercises and Stretching

A physical therapy team will prescribe certain exercises and stretches to help regain strength and range of motion. After an injury, quad stretching can improve the mobility and function of the muscle group.

Prone Towel Quad Stretch

  • Lie on your stomach and place a towel or strap around the ankle.
  • Bend the knee up, and gently pull on the towel to bend the knee fully.
  • A pulling sensation should be felt in the front of the thigh.
  • Hold the stretch for 30 seconds and release.
  • Repeat three times.

Half-kneeling Quad and Hip Flexor Stretch

  • Kneel on one knee.
  • Slowly move forward until a stretch is felt in the front of the hip and thigh.
  • Hold this position for 30 seconds.
  • Relax back to the starting position.
  • Repeat three times.

Back Exercises

If femoral nerve irritation coming from the lower back is causing thigh pain or weakness, exercises to release the nerve may be helpful and can include:

  • Prone press-ups
  • Supine lumbar flexion
  • Lumbar side glides

The exercises are designed to relieve pressure on the lumbar nerve, and postural correction exercises may be performed to maintain decompression.

Strengthening

Weakness to the vastus laterals and quads may be causing injury, and strengthening exercises may be prescribed during rehabilitation and can include:

  • Hip-strengthening exercises
  • Straight leg raises
  • Leg extension exercises
  • Lunges
  • Squats

Strengthening exercises should be done two to four times weekly with appropriate rest between sessions.

Functional Training

A physical therapist may recommend functional training to restore normal function. (Ramírez-delaCruz, M. et al., 2022)

  • Balance exercises and sport-specific plyometric training may be recommended to ensure the quad functions normally.
  • Most quadriceps and vastus lateralis muscle injuries heal within six to eight weeks.
  • Recovery may be shorter or longer depending on the nature of the injury.

Injury Medical Chiropractic and Functional Medicine Clinic

By understanding the anatomy and function of the vastus lateralis muscle, a healthcare provider can help individuals understand their specific injury and develop a treatment program to rehabilitate the muscle properly. At Injury Medical Chiropractic and Functional Medicine Clinic, we focus on what works for you and strive to develop fitness and better the body through research methods and total wellness programs. These natural programs use the body’s ability to achieve improvement goals, and athletes can condition themselves to excel in their sport through proper fitness and nutrition. Our providers use an integrated approach to create personalized programs, often including Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine principles.

Knee Injury Chiropractor

References

Vieira EPL. (2017). Anatomic study of the portions long and oblique of the vastus lateralis and vastus medialis muscles. J Morphol Sci., 28(4), 0-. www.jms.periodikos.com.br/article/587cb49f7f8c9d0d058b47a1/pdf/jms-28-4-587cb49f7f8c9d0d058b47a1.pdf

American Academy of Orthopaedic Surgeons. (2024). Patellofemoral pain syndrome. orthoinfo.aaos.org/en/diseases–conditions/patellofemoral-pain-syndrome/

Timothy J Von Fange. (2024). Quadriceps muscle and tendon injuries. UpToDate. www.uptodate.com/contents/quadriceps-muscle-and-tendon-injuries/print

Ramírez-delaCruz, M., Bravo-Sánchez, A., Esteban-García, P., Jiménez, F., & Abián-Vicén, J. (2022). Effects of Plyometric Training on Lower Body Muscle Architecture, Tendon Structure, Stiffness, and Physical Performance: A Systematic Review and Meta-analysis. Sports medicine – open, 8(1), 40. doi.org/10.1186/s40798-022-00431-0

Beginner Workouts: Start Your Fitness Journey with Ease

By
Dr. Alex Jimenez
-
Couple doing triceps dips on living room couch while working out together at home

Can beginner workouts help individuals who want to improve their health by helping them lose weight and improve their quality of life?

Beginner Workouts: Start Your Fitness Journey with Ease

Beginner Workouts

Individuals new to exercise do not need to go through intense workout sessions to gain the benefits of physical activity. Basic exercises and beginner workouts that can be done at home or outdoors, whichever is better or more convenient, are recommended when starting a fitness regimen to lose weight and improve overall health.

Health Benefits

Basic exercise sessions are the building blocks of a fitness program. They encourage habits that lead to significant weight loss and lifelong weight management skills. Here are a few workouts considered easy because they don’t require gym equipment, their intensity can be adjusted to match an individual’s physical activity level, and some can be done from a chair or bed for those who have trouble standing for long periods. Exercising offers immediate benefits, including increasing brain health and improving mood and long-term effects like decreased disease risk. (Centers for Disease Control and Prevention, 2024)

Easy Exercises

For individuals who are completely new to exercise, low-intensity activity sessions can help burn more calories so long as they don’t compensate for the hunger that the physical activity creates by eating more. Combining diet with exercise is essential if weight loss is the goal. This can involve learning to eat lean protein, fruit, and vegetables and watching portion sizes. Studies of low-intensity exercise show the body burns fat when performing basic exercise and physical activities. (Lee D. et al., 2021) Another study looked at the effect of beginner workouts on cortisol levels. Cortisol is a hormone associated with abdominal weight gain when levels stay elevated for long periods. The study found that low-intensity exercise decreased circulating cortisol levels. (Gerber M. et al., 2020) Beginner exercises to lose weight also help individuals (Vina J. et al., 2012)

  • Increase self-confidence
  • Decrease stress levels
  • Improve sleep
  • Establish healthy habits
  • Burn calories to stimulate weight loss and sustain weight management.
  • Develop strong muscles

Basic exercise remains a core component of fitness programs for many. This includes individuals with type 2 diabetes, metabolic syndrome, and cardiovascular disease. (Apostolopoulos V. et al., 2014)

Easy Workouts

Types of beginner workouts include:

  • Bodyweight training
  • Chair workouts
  • Dancing workouts
  • Online workouts
  • Shadowboxing
  • Stairclimbing
  • Aqua jogging
  • Biking
  • Walking
  • Gardening and yard work

At-Home

Set short-term goals to complete three workouts during the first week, then gradually add workout days until you can perform some form of physical activity on most days. The type of exercise chosen is less important than the consistency of the program.

Bodyweight Training

  • No special gym equipment is needed to burn calories and build stronger muscles.
  • Take 10 to 15 minutes for five incline push-ups against a surface that allows the body to be at an incline, such as a countertop, bathroom sink, etc.
  • Five chair squats
  • Five walking lunges or stationary lunges, holding on to a countertop for support.
  • Repeat the sequence two to three times.

Chair Workout

  • Individuals who are uncomfortable standing for long periods use a sturdy chair and complete 10 to 15 minutes of movement with a seated workout several times weekly.

Dancing

  • Put on music and dance for 15 to 30 minutes.
  • No choreography is necessary.
  • The important thing is to move to the music.

Online Workouts

  • Many online workouts are free, and most offer easy workouts for beginners.

Shadowboxing

  • Shadowboxing is easy, with no equipment required, and it helps to decrease stress.

Stairclimbing

  • Take 10 minutes to walk up and down a flight of steps.
  • Those who don’t have a staircase available can use a step or platform.

Outdoors

Exercising outside provides extra perks. There are stress-relieving benefits to breathing fresh air and enjoying the outdoors.

Aqua Jogging

  • Try pool running or aqua jogging for those with joint pain when walking for long periods.
  • Floatation devices keep the upper body afloat.
  • Once in the water, walk without letting your feet touch the bottom of the pool.
  • If no floatation device is available, individuals can walk in the water with their feet on the pool floor.

Biking

  • Take a leisurely spin around the neighborhood
  • Ride on a continuous path or track requiring 20 to 30 minutes of pedaling.

Walking

  • A 30-minute walk workout can be counted as daily exercise.
  • Walk slowly for five minutes.
  • Pick up the pace for 20 minutes
  • Cool down and walk slowly for five minutes.

Gardening or Yard Work

  • Spending time in the garden or yard is a great way to work muscles and burn calories.
  • Digging, weeding, raking, and mowing are all recommended activities that count as exercise for beginners.

Injury Medical Chiropractic and Functional Medicine Clinic

Remember, as a beginner, the point is to get the body moving, establish a workout routine, and gradually build confidence to increase exercise enjoyment and health benefits. Workouts for beginners, especially those who still need to maintain an exercise program, are designed to develop life-long habits of well-being. At Injury Medical Chiropractic and Functional Medicine Clinic, we focus on what works for you and strive to develop fitness and better the body through research methods and total wellness programs. These natural programs use the body’s ability to achieve improvement goals, and athletes can condition themselves to excel in their sport through proper fitness and nutrition. Our providers use an integrated approach to create personalized programs, often including Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine principles.

Exercise Prescription

References

Centers for Disease Control and Prevention. (2024). Benefits of Physical Activity. Retrieved from www.cdc.gov/physical-activity-basics/benefits/?CDC_AAref_Val=https://www.cdc.gov/physicalactivity/basics/pa-health/index.htm

Lee, D., Son, J. Y., Ju, H. M., Won, J. H., Park, S. B., & Yang, W. H. (2021). Effects of Individualized Low-Intensity Exercise and Its Duration on Recovery Ability in Adults. Healthcare (Basel, Switzerland), 9(3), 249. doi.org/10.3390/healthcare9030249

Gerber, M., Imboden, C., Beck, J., Brand, S., Colledge, F., Eckert, A., Holsboer-Trachsler, E., Pühse, U., & Hatzinger, M. (2020). Effects of Aerobic Exercise on Cortisol Stress Reactivity in Response to the Trier Social Stress Test in Inpatients with Major Depressive Disorders: A Randomized Controlled Trial. Journal of clinical medicine, 9(5), 1419. doi.org/10.3390/jcm9051419

Vina, J., Sanchis-Gomar, F., Martinez-Bello, V., & Gomez-Cabrera, M. C. (2012). Exercise acts as a drug; the pharmacological benefits of exercise. British journal of pharmacology, 167(1), 1–12. doi.org/10.1111/j.1476-5381.2012.01970.x

Apostolopoulos, V., Borkoles, E., Polman, R., & Stojanovska, L. (2014). Physical and immunological aspects of exercise in chronic diseases. Immunotherapy, 6(10), 1145–1157. doi.org/10.2217/imt.14.76

Managing Nerve Root Encroachment with Surgical Decompression

By
Dr. Alex Jimenez
-
Male doctor explaining spinal anatomy with vertebral column model to patient in clinic. High quality photo

Individuals experiencing persistent pain, weakness, numbness, and tingling in the back could be suffering from nerve root encroachment. Could surgery ease nerve compression and improve symptoms for persistent and severe cases?

Managing Nerve Root Encroachment with Surgical Decompression

Surgical Decompression

The pain, weakness, numbness, and tingling associated with nerve root encroachment are usually first treated with non-surgical therapies that include:

  • Anti-inflammatory medications
  • Physical therapy

This can be enough to address the irritation of the spinal nerve root. But when cases become severe, surgical decompression may be recommended and necessary. It can be done in a couple of different ways.

Causes and Symptoms

Vertebrae are bones in the spine. Small openings called foramina allow a spinal nerve root to pass through on each side of the vertebra. When nerve root encroachment is present, the spinal nerve root gets compressed, pinched, and trapped, which can cause peripheral symptoms such as numbness, tingling, pain, or weakness to develop. Nerve root encroachment is typically caused by normal aging degenerative wear and tear changes in the vertebrae. (Choi Y. K. 2019) These degenerative changes can include:

  • Facet joint hypertrophy
  • Ligament and bone hypertrophy
  • Disc disorders
  • Formation of bone spurs or osteophytes.

If these degenerative changes progress, they can encroach and compress a nerve root, leading to peripheral symptoms. (Choi Y. K. 2019)

When Surgery Is Recommended

When symptoms occur, initial treatment will involve:

  • Physical therapy
  • Chiropractic realignment
  • Massage therapies
  • Rest
  • Lifestyle adjustments
  • Nonsteroidal anti-inflammatories – NSAIDs
  • Corticosteroid injections into the spine

If conservative therapies don’t fully heal or improve symptoms or there are neurological problems like difficulty with balance or walking, then surgery may be recommended. Severe pain that limits normal function is an indication for surgery, and rapidly progressive weakness of the arms and/or legs or signs of cauda equina syndrome are indications for emergency surgery.

Surgery Options

Different types of spinal surgery may be performed. A neurosurgeon will decide the best procedure for each patient based on their case, age, medical conditions, and other factors. Specific spinal surgical decompression depends on what is causing the nerve compression. In most cases, it involves removing bone or tissue to relieve nerve pressure or provide support to stabilize the joint. The most common types of surgical decompression include: (Mayo Clinic Health System, 2022)

  • Laminectomy
  • Discectomy
  • Laminotomy
  • Foraminotomy
  • Fusion

Spinal surgical goals are to: (American Association of Neurological Surgeons, 2024)

  • Decompress pressure on the nerve roots.
  • Relieve pressure on the nerve roots.
  • Maintain the stability and alignment of the spine.
  • Improve the stability and alignment of the spine.

Anterior Surgery

The anterior approach to surgery means that the spine is accessed through the anterior/front of the spine. In this surgery, one or more discs and bone spurs may be removed through an incision in the front of the neck. (American Association of Neurological Surgeons, 2024) For example, an anterior cervical discectomy may alleviate pressure on one or more nerve roots in the neck. With an anterior lumbar interbody fusion, a surgeon removes a degenerative disc in the lower spinal area by going through a patient’s lower abdomen. (American Association of Neurological Surgeons, 2024) After the disc is removed, a structural device, usually made of bone, fills the space where it once was. This device encourages bone healing and helps the vertebrae’s bodies fuse.

Posterior Surgery

Posterior surgery means the spine is accessed through the posterior/back of the spine. An example is removing a thickened ligament, bone spur, or disc material in the neck. To do this, a small incision in the back of the neck may be made to remove part of the back of the vertebrae called the lamina. This is called a posterior cervical laminectomy. (American Association of Neurological Surgeons, 2024) A posterior lumbar interbody fusion removes a degenerative disc by going through the back. (American Association of Neurological Surgeons, 2024) Like the anterior approach, a structural device often contains bone to fill the space where the disc once was to fuse the bones.

Potential Risks

As with any surgery, it’s important that the individual and their healthcare provider carefully discuss the benefits and risks. Spinal surgical decompression includes: (Proietti L. et al., 2013)

  • Bleeding
  • Blood clots
  • Surgical site infection
  • Urinary tract infection
  • Lung infection
  • Intestinal blockage

There are also specific risks to the area of the spine being operated on and how it is surgically approached. For example, a cervical anterior procedure may injure the esophagus, trachea, or carotid artery. Likewise, damage to the C5 nerve root/C5 palsy can occur from cervical spinal decompressive surgery. This complication causes weakness, numbness, and pain in the shoulders. (Thompson S. E. et al., 2017) The spinal cord may also be injured during surgery and result in paralysis, although this is rare. (American Association of Neurological Surgeons, 2024)

Injury Medical Chiropractic and Functional Medicine Clinic

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.

The Non-Surgical Solution

References

Choi Y. K. (2019). Lumbar foraminal neuropathy: an update on non-surgical management. The Korean journal of pain, 32(3), 147–159. doi.org/10.3344/kjp.2019.32.3.147

Mayo Clinic Health System. (2022). Decompress and stabilize: understanding types of back surgery. Speaking of Health. www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/understanding-types-of-back-surgery

American Association of Neurological Surgeons. (2024). Cervical spine. www.aans.org/patients/conditions-treatments/cervical-spine/

American Association of Neurological Surgeons. (2024). Lumbar spinal stenosis. www.aans.org/patients/conditions-treatments/lumbar-spinal-stenosis/

Proietti, L., Scaramuzzo, L., Schiro’, G. R., Sessa, S., & Logroscino, C. A. (2013). Complications in lumbar spine surgery: A retrospective analysis. Indian journal of orthopaedics, 47(4), 340–345. doi.org/10.4103/0019-5413.114909

Thompson, S. E., Smith, Z. A., Hsu, W. K., Nassr, A., Mroz, T. E., Fish, D. E., Wang, J. C., Fehlings, M. G., Tannoury, C. A., Tannoury, T., Tortolani, P. J., Traynelis, V. C., Gokaslan, Z., Hilibrand, A. S., Isaacs, R. E., Mummaneni, P. V., Chou, D., Qureshi, S. A., Cho, S. K., Baird, E. O., … Riew, K. D. (2017). C5 Palsy After Cervical Spine Surgery: A Multicenter Retrospective Review of 59 Cases. Global spine journal, 7(1 Suppl), 64S–70S. doi.org/10.1177/2192568216688189

Staying Hydrated: Key to a Healthy Body and Mind

By
Dr. Alex Jimenez
-

Can individuals maintain proper hydration levels in their bodies to prevent spinal pain and other musculoskeletal conditions?

Introduction

When making small changes to better their health and wellness, many understand that eating nutritional foods, exercising, and finding ways to reduce the pain and stress that environmental factors have affected the body. However, there is also another crucial component to a person’s health and wellness, and that is staying hydrated. Many individuals sometimes don’t realize that the human body contains about 60% of the water, which helps every vital organ, muscle, tissue, and vertebra in the body to function. However, many individuals who do not consume enough water due to a stressful event, exercising, or just wanting to drink sugary drinks will feel pain and discomfort in their bodies. This can range from mild headaches to back pain. Today’s article focuses on what spinal pain correlates with the back, why staying hydrated can reduce spinal pain and ways to stay hydrated. We talk with certified associated medical providers who inform our patients to maintain proper hydration to reduce the chances of spinal pain affecting their bodies. While asking their associated medical provider intricate questions, we advise patients to incorporate daily hydration levels as part of their routine to reduce the chances of spinal pain from returning. Dr. Alex Jimenez, D.C., includes this information as an academic service. Disclaimer.

 

Spinal Pain Is Correlated With The Back

Do you feel constant aches or pains after a stressful day? Do you feel like chugging gallons of water but still feel thirsty? Or have you been noticing that you have been dealing with limited mobility that has been causing you pain and discomfort in your lower back? These pain-like scenarios are multifactorial and can correlate with spinal pain affecting the back. Now, many people wonder why spinal pain is associated with back pain. The spine is crucial in allowing the individual to be upright and move around during daily activities. The spinal vertebrae discs are between the bones, which would enable shock absorption when a person twists, bends, or flexes so the bones don’t rub together. However, when the body ages, the spine does, too, which causes the intervertebral disc to gradually fall and change the dynamics of the affected spine segments. (Kos et al., 2019) To that point, when the intervertebral disc becomes compressed due to degeneration, it can lead to the development of back pain.

 

 

Since low back pain is a multifactorial musculoskeletal condition, many individuals often develop low back pain from numerous environmental risk factors like physical labor, excessive sitting or standing, poor dieting, and physical inactivity, which can cause individuals to have a loss of sensation, reduced reflexes, limited range of movements and tenderness can affect a person’s gait and posture. (Kabeer et al., 2023) When the spinal discs are being compressed, the water inside the disc becomes dehydrated and is linked to lower back pain. (Cheung et al., 2023) When the spinal discs are dehydrated in the spine due to improper hydration, it can lead to immobility, cause the disc to degenerate, and cause spinal structural defects that cause the surrounding muscles and tissues to have biomechanical instability and inflammation. (Hauser et al., 2022) When the body starts dehydrating, it retrieves water from the spine and other parts to sustain life and keep the vital organs functioning.

 

Eating Right To Feel Better- Video

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

Why Staying Hydrated Can Reduce Spinal Pain

 

Proper hydration is key to reducing the chances of spinal pain. By staying hydrated with plain, pure water, individuals can stay focused, remove toxins from the body, aid in weight reduction, and reduce muscle and low back pain. (Nsiah-Asamoah & Buxton, 2021) Drinking at least 64 ounces of water a day can rehydrate the body and prevent future issues that can cause pain. Proper hydration allows the body to maintain cell activity and regulate body temperature, reducing the chances of pain affecting the body.

 

Ways to Stay Hydrated

There are ways to stay hydrated and allow the body to have proper hydration levels. Incorporating hydrating fruits and vegetables can help aid in proper hydration as these fruits and vegetables contain about 90% water and the essential nutrients. Additionally, when individuals try to get their hydration levels back up, they are encouraged to drink more fluids as they prefer, especially if they feel unwell. This is to ensure that the body is hydrated enough so that individuals can receive subcutaneous or intravenous fluid supplements combined with regular fluid intake. (Li et al., 2023) Another way many individuals can stay hydrated is to combine non-surgical treatments like chiropractic care and spinal decompression to help realign and lengthen the spine to reduce unwanted pressure on the spinal discs and rehydrate them. The combination of non-surgical treatments and drinking plenty of hydrating fluids can help many individuals dealing with back pain associated with the spine as they start to make small changes to their routine and can live a life pain-free.

 

References

Cheung, S. T. Y., Cheung, P. W. H., & Cheung, J. P. Y. (2023). Why Are Some Intervertebral Discs More Prone to Degeneration?: Insights Into Isolated Thoracic “Dysgeneration”. Spine (Phila Pa 1976), 48(12), E177-E187. doi.org/10.1097/BRS.0000000000004632

Hauser, R. A., Matias, D., Woznica, D., Rawlings, B., & Woldin, B. A. (2022). Lumbar instability as an etiology of low back pain and its treatment by prolotherapy: A review. J Back Musculoskelet Rehabil, 35(4), 701-712. doi.org/10.3233/BMR-210097

Kabeer, A. S., Osmani, H. T., Patel, J., Robinson, P., & Ahmed, N. (2023). The adult with low back pain: causes, diagnosis, imaging features and management. Br J Hosp Med (Lond), 84(10), 1-9. doi.org/10.12968/hmed.2023.0063

Kos, N., Gradisnik, L., & Velnar, T. (2019). A Brief Review of the Degenerative Intervertebral Disc Disease. Med Arch, 73(6), 421-424. doi.org/10.5455/medarh.2019.73.421-424

Li, S., Xiao, X., & Zhang, X. (2023). Hydration Status in Older Adults: Current Knowledge and Future Challenges. Nutrients, 15(11). doi.org/10.3390/nu15112609

Nsiah-Asamoah, C. N. A., & Buxton, D. N. B. (2021). Hydration and water intake practices of commercial long-distance drivers in Ghana: what do they know and why does it matter? Heliyon, 7(3), e06512. doi.org/10.1016/j.heliyon.2021.e06512

Disclaimer

Meeting the Daily Vegetable Consumption Guidelines

By
Dr. Alex Jimenez
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Portrait of young nutritionist woman holding a bowl of natural and organic fruits and vegetables standing at medical consultation. Healthy lifestyle and nutrition concept.

Does an individual’s ideal daily intake of vegetables depend on age, sex, and activity level?

Meeting the Daily Vegetable Consumption Guidelines

Daily Serving of Vegetables

Vegetables are ​vital to a healthy diet. Every type offers various nutrients in a unique combination of vitamins, minerals, and phytochemicals. Plus, they are low in fat and calories and packed with fiber. The U.S. Department of Agriculture and other health organizations recommend eating a variety for optimal health. An age guide recommends the number of cups of vegetables that babies and older adults should consume daily. The U.S. Centers for Disease Control and Prevention reports that very few individuals meet the vegetable consumption guidelines, putting them at risk for chronic diseases like diabetes and heart disease. (U.S. Centers for Disease Control and Prevention, 2017)

What Is a Serving?

Current Dietary Guidelines recommend 2 1/2 cups of vegetables or nine servings daily. However, the amount varies by age. Serving sizes are also based on the type of vegetable. Overall, individuals are recommended to consume a variety each day. For most vegetables, a serving equals the amount that will fill one measuring cup. However, a serving of raw leafy greens like spinach and lettuce is two cups (U. S. Department of Agriculture, 2020), and eight ounces of vegetable juice also counts as one cup serving. For those who don’t have a measuring cup or kitchen scale, here are some one-cup equivalents for certain vegetables.

  • One large tomato
  • One medium potato
  • One large ear of corn
  • One large sweet pepper
  • One large sweet potato
  • Two medium carrots
  • Five or six broccoli florets

Another way is to use tablespoons—one cup contains around 16 tablespoons, which can be used when calculating servings for babies, toddlers, and young children.

Babies

Most babies are ready to eat solid foods between four and six months. There’s no ideal order, so starting with vegetables is fine. Starting babies with foods like peas, carrots, and squash could help encourage a preference for these foods that will carry on into adulthood, as babies tend to gravitate toward sweet flavors and may only want applesauce and pears, which could lead to not wanting to eat vegetables. It is recommended to start with a few teaspoons at a time. Eventually, they will eat about three or four tablespoons of baby food, like cereal or purees, a few times a day, which can fill about half a cup.

Toddlers 2-3

Toddlers age two to three should consume one cup of vegetables each day. If that sounds like a lot, remember that one cup can be spread throughout the day—it doesn’t have to be finished in a single meal. It also means one cup of various vegetables, not just one type. For example, some baby carrots during breakfast, steamed broccoli for lunch, and roasted sweet potatoes with dinner. Each serving can include four tablespoons that will become one serving. And if the only vegetable the toddler will eat is corn, that’s okay. There are also ways to disguise vegetables so they will eat them, like spinach or kale, which can disappear into a fruit smoothie. Children under five can choke on uncooked fruits and vegetables, so make sure whatever form is safe.

Young Children 4-8

Boys and girls in this age group should eat one and a half cups of vegetables daily. Regarding preparation, it’s fine to eat raw and cooked veggies. However, four-year-olds are still at risk of choking on raw vegetables. Cut carrots, bell peppers, and other vegetables into pieces no larger than a half-inch long so they won’t get stuck in their throat if inadvertently swallowed without chewing properly. And steamed, baked, and roasted vegetables are the healthiest.

Tweens 9-13

During the tween years, nutritional needs vary slightly based on sex. The recommended daily amount for girls is at least two cups. For boys, the recommendation is at least two and a half cups. Tweens of either gender who are especially active benefit from eating more than the suggested minimum. Research shows that boys eat fewer vegetables and fruits than girls. (Bere E. et al., 2008) Offer as much variety of vegetables and ways to prepare to find the ones they enjoy most.

Teens 14-18

Teenage girls should eat at least two and a half cups of vegetables daily, and boys eat at least three cups. Active teens who get 30 minutes of exercise daily may need more. However, it can be harder to monitor their vegetable intake as kids get older and spend more time eating away from home. In all family meals, try to include a variety of healthy prepared vegetables like:

  • Raw in salads
  • Steamed
  • Roasted
  • Baked as a side dish
  • Folded into omelets
  • Added to soups and stews
  • Layered on pizzas

Make it easy for teenagers to have vegetables between meals.  Pre-cut carrots, celery, and bell peppers can be kept front and center in the fridge alongside hummus or guacamole for dipping.

Young Adults 19-30

The recommended daily amount of vegetables for individuals ages 19 to 30 is the same as for teens: at least three cups daily for men and at least two and a half cups for women. Those who exercise should include more. If a busy lifestyle makes getting all the vegetables needed difficult, take advantage of options like smoothies, including vegetables, pre-tossed salads, and prepped-for-cooking vegetables at the store. They may be more expensive, but if the time saved makes it easier to eat vegetables, it may be worth it, and eventually, individuals will learn how to prepare their own. Kitchen gadgets, like a smoothie blender, can help with faster preparations.

Adults 31-50

As with young adults, the amount of vegetables should be at least two and a half cups daily for women, three cups for men, and more for those who work out or are physically active.

Older Adults 51-Up

Because the body’s metabolism slows down, individuals 51 and older are advised to cut calories to prevent weight gain. This also applies to calories from vegetables. Women 51 and older should consume around two cups of vegetables daily, and men should consume around two and a half cups. Active older adults should continue to factor in the amount of physical activity with vegetable intake. Individuals should talk to their doctor or see a nutritionist if they want more specific guidance on what to include in their diet.

Injury Medical Chiropractic and Functional Medicine Clinic

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

Nutrition Fundamentals

References

U.S. Centers for Disease Control and Prevention. (2017). Only 1 in 10 adults get enough fruits or vegetables. Retrieved from archive.cdc.gov/#/details?url=https://www.cdc.gov/media/releases/2017/p1116-fruit-vegetable-consumption.html

U. S. Department of Agriculture. (2020). Vegetables. Retrieved from www.myplate.gov/eat-healthy/vegetables

Bere, E., Brug, J., & Klepp, K. I. (2008). Why do boys eat less fruit and vegetables than girls?. Public health nutrition, 11(3), 321–325. doi.org/10.1017/S1368980007000729

Effectively Managing Peptic Ulcers: Tips and Remedies

By
Dr. Alex Jimenez
-
Confident female doctor with medical stethoscope introducing and explaining treatment guidelines, medication, care, therapy to patients. concept of treatment, service, consultation, health insurance

For individuals with chronic pain conditions, what are the risks of developing peptic ulcers?

Effectively Managing Peptic Ulcers: Tips and Remedies

NSAIDs and Peptic Ulcers

A peptic ulcer is a sore in the lining of the stomach or duodenum, the first area of the small intestine. The most common symptom is a burning stomach pain that may come and go for several days or weeks. Other symptoms include:

  • Feeling full
  • Feeling bloated
  • Belching
  • Heartburn
  • Nausea
  • Stress and spicy foods can worsen ulcers but do not cause them.

A peptic ulcer is a sore that occurs in the mucosal lining of the stomach, small intestine, or esophagus. It is caused by stomach acids or other digestive juices damaging the stomach or duodenum lining. When the ulcer is in the stomach, it might also be called a gastric ulcer. The acid can create a painful open sore that may bleed. The most common cause of a peptic ulcer is a type of bacteria called Helicobacter pylori (H. pylori). A second, less common cause of peptic ulcers is the use of non-steroidal anti-inflammatory medications or NSAIDs like aspirin, ibuprofen, and naproxen. (Fashner J. & Gitu A. C. 2015) Using over-the-counter NSAIDs for the occasional headache or achy back won’t cause a peptic ulcer. Rather, peptic ulcer disease is something that can occur with longer-term use, especially at high doses, such as for chronic pain associated with arthritis or other inflammatory conditions. (National Institute of Diabetes and Digestive and Kidney Diseases, 2022)

NSAIDs and Ulcer Development

NSAIDs can cause ulcers because they can interfere with the stomach’s ability to protect itself from gastric acids as they slow the production of protective mucus in the stomach and change its structure. (National Institute of Diabetes and Digestive and Kidney Diseases, 2022) While these acids are vital to the digestive process, they can compromise the stomach’s protective barriers. The stomach has three protections against gastric acid:

  • Foveolar cells that line the stomach produce a protective mucus.
  • Bicarbonate is produced by the foveolar cells, which help neutralize stomach acid.
  • Blood circulation aids in repairing and renewing cells in the stomach’s mucosal layer.

Specific lipids called prostaglandins, which the body makes, affect pain receptors. NSAIDs work to reduce pain by blocking enzymes involved in the production of certain prostaglandins. Prostaglandins also protect the stomach’s mucosal layer, which can be broken when depleted. Suppressing the body’s natural defenses against gastric acids can lead to inflammation in the stomach lining. Over time, this can cause a capillary blood vessel to rupture, causing bleeding and the development of an open, ulcerative sore. (Bjarnason I. et al., 2018)

Symptoms

A peptic ulcer may cause symptoms in the digestive tract, but some individuals may have no symptoms. The most common symptom is upper abdominal pain, which can feel dull or burning. The pain can range in severity, with some experiencing mild discomfort and others having severe pain. Most of the time, the pain will occur after a meal, but it might also happen at night for some. It could go on from a few minutes to a few hours. (National Institute of Diabetes and Digestive and Kidney Diseases, 2022)  Other symptoms are less common but can include:

  • Bloating
  • Burping
  • Gas
  • Nausea
  • Vomiting
  • Loss of appetite
  • Weight loss
  • Feeling sick in the stomach.
  • Feeling full after even a small meal.

In rare cases, individuals with peptic ulcers may see blood in their stool or have black stools because blood is present. Blood coming from one or more peptic ulcers could also be visible in vomit. Call a healthcare provider right away if there is blood in stool or vomit, as this can be a sign of excessive bleeding or other serious problems. (National Institute of Diabetes and Digestive and Kidney Diseases, 2022)

Diagnosis

When peptic ulcer symptoms occur, a healthcare provider may order several tests to determine the cause. For individuals who are receiving NSAIDs for chronic pain, a healthcare provider may already have a high suspicion that the medication is the cause or is contributing to peptic ulcer disease. Because infection with H. pylori is the most common cause, it is normally ruled out through a breath, blood, or stool test. (National Institute of Diabetes and Digestive and Kidney Diseases, 2022) Tests to look for ulcers inside the upper digestive tract can include:

Upper GI Series

  • Patients drink a barium substance to help the internal organs appear on imaging.
  • A series of X-rays are taken.

Upper Endoscopy

Risk Factors

All NSAIDs have the potential to cause indigestion, gastric bleeding, and ulcers. However, some individuals are more susceptible to developing peptic ulcer disease than others. Peptic ulcers caused by NSAIDs are more likely to occur in individuals who: (National Institute of Diabetes and Digestive and Kidney Diseases, 2022)

  • Are 70 or older
  • Have a history of ulcers
  • Take corticosteroids
  • Take high-dose NSAIDs
  • Take NSAIDs regularly for a long time
  • Take more than two types of NSAIDs
  • Use aspirin daily, including low-dose aspirin, for cardioprotective purposes.
  • Take blood thinners
  • Drink alcohol regularly
  • Smoke

Studies suggest that 25% of those who use NSAIDs long-term will develop an ulcer, but only a small percentage will go on to develop serious complications. (Lanza F. L. et al., 2009)

Treatment

NSAID-induced ulcers usually heal once the NSAID is stopped. Certain treatments may be recommended to expedite the healing process depending on the severity of the peptic ulcer. In severe cases, surgery may be recommended to repair the damage.

Medications

A healthcare provider may recommend taking one or more medications. Over-the-counter options may include:

Prescription Medications

These might be recommended and can include the following:

The bigger problem for individuals is how to manage pain when the medications are discontinued. For individuals with chronic pain, this may require the help of a physical therapy team, including a pain management healthcare provider. Certain medications called COX inhibitors could be used to control pain for some. COX inhibitors have been shown to work for pain relief and are associated with fewer digestive side effects than other types of NSAIDs. These meds have also been shown to have cardiovascular side effects, however, so it’s usually recommended they be used at the lowest dosage. (Scarpignato C. et al., 2015)

Lifestyle Adjustments

Lifestyle adjustments may be recommended to heal peptic ulcers, including:

  • Avoiding foods that worsen symptoms.
  • Avoiding caffeine
  • Avoiding alcohol
  • Quitting smoking

Surgery

In some cases, surgery may be recommended, but this is more often the case when there are complications as a result of the ulcer, such as:

Prevention

Avoiding long-term and high-dose use of NSAIDs or not using these medications can help protect and prevent peptic ulcers. For individuals who have to take an NSAID due to a condition they are trying to manage, a healthcare provider may prescribe one of the meds used to treat peptic ulcers to prevent them from occurring. Some believe that spicy food and stress cause ulcers, but that has been discredited. (Cleveland Clinic, 2022) Most individuals who take NSAIDs will not experience peptic ulcer disease. (Drini M. 2017) However, those who have chronic pain and who are receiving high doses should be aware of the potential.

Injury Medical Chiropractic and Functional Medicine Clinic

Individuals who have any concerns about the use of NSAIDs and how the digestive system will be affected should ask a healthcare provider if there are ways to prevent ulcers and if those measures should be implemented while receiving high doses of NSAIDs. Left untreated, ulcers can lead to complications, which is why it is important to get a diagnosis and receive treatment. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign naturally.

Root Causes of Gut Dysfunction

References

Fashner, J., & Gitu, A. C. (2015). Diagnosis and Treatment of Peptic Ulcer Disease and H. pylori Infection. American family physician, 91(4), 236–242.

National Institute of Diabetes and Digestive and Kidney Diseases. (2022). Peptic ulcers (stomach ulcers). Retrieved from www.niddk.nih.gov/health-information/digestive-diseases/peptic-ulcers-stomach-ulcers

Bjarnason, I., Scarpignato, C., Holmgren, E., Olszewski, M., Rainsford, K. D., & Lanas, A. (2018). Mechanisms of Damage to the Gastrointestinal Tract From Nonsteroidal Anti-Inflammatory Drugs. Gastroenterology, 154(3), 500–514. doi.org/10.1053/j.gastro.2017.10.049

Lanza, F. L., Chan, F. K., Quigley, E. M., & Practice Parameters Committee of the American College of Gastroenterology (2009). Guidelines for prevention of NSAID-related ulcer complications. The American journal of gastroenterology, 104(3), 728–738. doi.org/10.1038/ajg.2009.115

Begg, M., Tarhuni, M., N Fotso, M., Gonzalez, N. A., Sanivarapu, R. R., Osman, U., Latha Kumar, A., Sadagopan, A., Mahmoud, A., & Khan, S. (2023). Comparing the Safety and Efficacy of Proton Pump Inhibitors and Histamine-2 Receptor Antagonists in the Management of Patients With Peptic Ulcer Disease: A Systematic Review. Cureus, 15(8), e44341. doi.org/10.7759/cureus.44341

Scarpignato, C., Lanas, A., Blandizzi, C., Lems, W. F., Hermann, M., Hunt, R. H., & International NSAID Consensus Group (2015). Safe prescribing of non-steroidal anti-inflammatory drugs in patients with osteoarthritis–an expert consensus addressing benefits as well as gastrointestinal and cardiovascular risks. BMC medicine, 13, 55. doi.org/10.1186/s12916-015-0285-8

Lee, C. W., & Sarosi, G. A., Jr (2011). Emergency ulcer surgery. The Surgical clinics of North America, 91(5), 1001–1013. doi.org/10.1016/j.suc.2011.06.008

Cleveland Clinic. (2022). Can stress give you an ulcer? health.clevelandclinic.org/can-stress-give-you-an-ulcer

Drini M. (2017). Peptic ulcer disease and non-steroidal anti-inflammatory drugs. Australian prescriber, 40(3), 91–93. doi.org/10.18773/austprescr.2017.037

Concussion Tests: Noninvasive Assessment of Brain Function

By
Dr. Alex Jimenez
-
in a modern clinic in a small therapist s office, a young girl doctor with a stethoscope conducts an appointment with a young guy patient diagnosing a problem

What type of concussion tests are there to help establish the extent of head injuries and help assess improvement during recovery?

Concussion Tests: Noninvasive Assessment of Brain Function

Concussion Tests

A concussion is a temporary change in brain function that occurs from a traumatic brain injury or TBI. It can cause problems with thinking and mood and can take weeks to years to heal. Concussion tests are done after a suspected head injury and are also used after diagnosis to assess healing progress. They are noninvasive tests that measure brain functions. Several tests vary in how they are given and what they measure.

Tests

A mild or moderate traumatic brain injury can cause damage to the brain that is not detectable with brain imaging tests. However, the damage can cause serious symptoms, including headaches, emotional changes, difficulty concentrating, and memory problems. (Haider M. N. et al., 2021) The effects of a concussion can be hard to describe, but concussion testing can help identify and quantify these changes. For individuals who don’t have time to heal or experience further brain injuries while recovering, the effects can be prolonged and worsen. This is one reason why concussion testing is vital to get a diagnosis and follow medical recommendations to avoid further injury to the brain. Diagnosis can help set goals, adjust, and assess how the effects improve over time. With improvement, individuals can participate in rehabilitation and follow their doctor’s instructions for gradually returning to work, school, and other activities.

Measurements

Concussion tests can measure subtle aspects of brain function, like visual or auditory perception and response speed (Joyce A. S. et al., 2015). The damage sustained can impair these abilities, like slow decision-making. A traumatic brain injury can be associated with serious injuries, like a skull fracture, swelling, bruise, or bleeding in the brain. These injuries can be detected with imaging tests and often require surgery or other interventions. Brain damage from bleeding or swelling would cause focal neurological symptoms and signs, including partial vision loss, numbness, and weakness. Individuals can have a concussion along with detectable brain injuries or in the absence of detectable brain injuries.

Types of Tests

There are several types of concussion tests. Individuals may have one or more of these, depending on the standard test that is used in their school, sports league, or by their doctor. These can include:

Online Checklists

  • Several different online checklists are available for concussion screening.
  • These tests may include questions about symptoms and are often used as self-tests but are not intended to replace an evaluation by a medical professional.

Baseline and Post-Injury Tests

  • Many schools and sports leagues conduct preseason skill measurements, including memory tests or tests of speed and accuracy, either in an interview form or with computer testing.
  • Individuals might be asked to retake the test that is used as a comparison if they have experienced a traumatic brain injury.

Standardized Assessment of Concussion – SAC

  • This five-minute test can be done on the sidelines after a sports injury or later.
  • It evaluates orientation, immediate memory, neurologic function, concentration, and delayed recall. (Kaufman M. W. et al., 2021)

King-Devick Concussion Test

  • This two-minute test can be performed on the sidelines after a sports injury or later to assess language, eye movement, and attention. (Krause D. A. et al., 2022)

Post-Concussion Symptom Scale

  • This test includes 22 questions involving neurocognitive factors, including difficulty concentrating or remembering, physical symptoms like headaches and dizziness, and emotional symptoms like sadness or irritability. (Langevin P. et al., 2022)

Sport Concussion Assessment Tool – SCAT

  • This test includes an on-field assessment noting concussion symptoms, memory assessment using Maddocks questions (a short list of specific questions), Glasgow Coma Scale (GCS), and cervical spine assessment.
  • An off-field assessment involves the evaluation of cognitive, neurological, balance, and delayed recall. (Kaufman M. W. et al., 2021)

Buffalo Concussion Physical Examination – BCPE

  • A modified physical examination that assesses neck tenderness and range of motion, head, jaw, and face abnormalities, eye movements examination, and coordination. (Haider M. N. et al., 2021)
  • After a concussion, individuals will also have a physical examination, including a full neurological examination, in a doctor’s office.

Results

A doctor will diagnose based on symptoms, physical examination, and concussion test results. For example, for individuals who have broken several bones and are taking powerful pain medications, concussion test results can be abnormal even if they did not experience a concussion. The results of concussion testing can be compared with results before the head injury. Often, baseline testing is required for participation in certain sports leagues at professional and amateur levels. A low score can indicate that head injury has impaired brain function. Sometimes, testing can be done within a few hours of the head trauma and then again a few days later. Responses of individuals who did not have measurements taken before a head injury can be compared with the average results of people their age.

Injury Medical Chiropractic and Functional Medicine Clinic

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.

Lumbar Spine Injuries in Sports: Chiropractic Healing

References

Haider, M. N., Cunningham, A., Darling, S., Suffoletto, H. N., Freitas, M. S., Jain, R. K., Willer, B., & Leddy, J. J. (2021). Derivation of the Buffalo Concussion Physical Examination risk of delayed recovery (RDR) score to identify children at risk for persistent postconcussive symptoms. British journal of sports medicine, 55(24), 1427–1433. doi.org/10.1136/bjsports-2020-103690

Joyce, A. S., Labella, C. R., Carl, R. L., Lai, J. S., & Zelko, F. A. (2015). The Postconcussion Symptom Scale: utility of a three-factor structure. Medicine and science in sports and exercise, 47(6), 1119–1123. doi.org/10.1249/MSS.0000000000000534

Kaufman, M. W., Su, C. A., Trivedi, N. N., Lee, M. K., Nelson, G. B., Cupp, S. A., & Voos, J. E. (2021). The Current Status of Concussion Assessment Scales: A Critical Analysis Review. JBJS reviews, 9(6), e20.00108. doi.org/10.2106/JBJS.RVW.20.00108

Krause, D. A., Hollman, J. H., Breuer, L. T., & Stuart, M. J. (2022). Validity Indices of the King-Devick Concussion Test in Hockey Players. Clinical journal of sport medicine: official journal of the Canadian Academy of Sport Medicine, 32(3), e313–e315. doi.org/10.1097/JSM.0000000000000938

Langevin, P., Frémont, P., Fait, P., & Roy, J. S. (2022). Responsiveness of the Post-Concussion Symptom Scale to Monitor Clinical Recovery After Concussion or Mild Traumatic Brain Injury. Orthopaedic journal of sports medicine, 10(10), 23259671221127049. doi.org/10.1177/23259671221127049

Preventing and Treating Elbow Pain Caused From Lifting

By
Dr. Alex Jimenez
-
Caucasian Men Buying Large Wooden Flower Pot.

Elbow pain from lifting is a common symptom among individuals who lift weights, heavy objects, children, grocery bags, etc. Depending on the underlying cause, can conservative treatments relieve and heal elbow pain?

Preventing and Treating Elbow Pain Caused From Lifting

Elbow Pain Caused By Lifting

Elbow pain from lifting can result from weight training, repetitive daily tasks, or job duties like lifting small children or heavy objects. Pain can manifest at the sides or the front of the elbow. Most minor injury cases can be treated with ice, rest, and medications at home. However, pain after lifting can also be a sign of a serious injury, such as a tendon rupture/tear.

Minor Pain From Lifting

Lifting puts pressure on the tendons connecting the wrist and upper arm to the bones in the elbow joint. Minor elbow pain can occur from temporary inflammation in any of these structures after lifting an object. Tendonitis occurs when a tendon becomes inflamed, often from overuse or lifting something too heavy, and ranges from mild to severe. Mild tendonitis typically causes pain during the activity and improves with rest. (American Academy of Orthopaedic Surgeons, 2020) Common forms of tendonitis include:

  • Tennis elbow – tendonitis on the outside of the elbow
  • Golfer’s elbow – tendonitis on the inside of the elbow.
  • Biceps tendonitis – at the front of the elbow. (Kheiran A. Pandey, A. & Pandey R. 2021)

Self-Care

Self-care can help reduce elbow pain after lifting and include: (American Academy of Orthopaedic Surgeons, 2020)

Ice

  • Add ice to the affected area for up to 20 minutes daily to decrease elbow pain.

Rest

  • Avoid lifting heavy objects as much as possible when pain is present.

Wearing A Brace

  • If the pain is at the tendons on the inside or outside of your elbow, try wearing a wrist brace to limit the use of your wrist muscles that connect to this area.

Stretching

Gently stretching the wrist flexors and extensors can help reduce elbow pain after lifting. Stretches can be performed several times daily, even after symptoms have resolved. (American Academy of Orthopaedic Surgeons, 2024)

  • Hold the arm out in front with the palm down. Keep the elbow straight.
  • Bend the wrist down so that the fingers are pointing toward the ground.
  • With the other hand, gently pull the wrist further down until a stretch is felt along the back of the forearm.
  • Hold this position for 15 seconds.
  • Repeat five times.
  • Next, bend the wrist upward so the fingers point toward the ceiling.
  • Using the other hand, gently pull the hand backward until the stretch is felt along the front of the forearm.
  • Hold for 15 seconds.
  • Repeat five times.

Medication

Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) can help manage elbow pain caused from lifting and include: (American Academy of Orthopaedic Surgeons, 2023)

  • Advil/Motrin – ibuprofen
  • Aleve – naproxen
  • Bayer – aspirin
  • Tylenol – acetaminophen

Healing

Mild cases can improve after a few days of self-care, whereas more pronounced elbow symptoms can take several weeks, months, or even a year. (Kheiran A. Pandey, A. & Pandey R. 2021) If self-care doesn’t work, physical therapy may be recommended. A physical therapy team can use various modalities and treatments to help reduce pain and inflammation from elbow injuries. The therapy can include targeted exercises to strengthen weak muscles and stretch tight muscles that might contribute to the condition. In addition, the therapy team will help individuals modify their lifting technique to help prevent further injury.

Moderate to Severe Elbow Pain

In addition to sharp, severe pain, serious elbow pain caused from lifting have distinct symptoms, including: (American Academy of Orthopaedic Surgeons, 2022)

  • Bruising
  • Swelling
  • Elbow weakness that suddenly happens.

A biceps tendon rupture is a rare but serious injury usually caused from lifting. In addition to other visible signs of the injury, there will be a bulge at the top of the upper arm because the muscle bunches up as it is no longer attached to the elbow. (American Academy of Orthopaedic Surgeons, 2022) Individuals may hear an audible popping sound if an elbow ligament or tendon gets torn while lifting. (Johns Hopkins Medicine, 2024)

Treatment

Treatment depends on the severity of the injury, but most cases resolve on their own with rest and, if necessary, physical therapy. Conditions that cause severe pain require orthopedic surgeon expertise. These physicians specialize in treating musculoskeletal system injuries. Imaging such as X-rays, MRIs, or CT scans are often used to determine the extent of damage. Individuals with tendon or ligament tears in the elbow may need surgery to regain full range of motion and strength in their arm. After surgery, physical therapy will help restore function.

Injury Medical Chiropractic and Functional Medicine Clinic

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other associated medical professionals to integrate a treatment plan to improve the body’s flexibility and mobility and resolve musculoskeletal issues.

Shoulder Pain Chiropractic Treatment

References

American Academy of Orthopaedic Surgeons. (2020). Sprains, strains, and other soft-tissue injuries. orthoinfo.aaos.org/en/diseases–conditions/sprains-strains-and-other-soft-tissue-injuries/

Kheiran, A., Pandey, A., & Pandey, R. (2021). Common tendinopathies around the elbow; what does current evidence say?. Journal of clinical orthopaedics and trauma, 19, 216–223. doi.org/10.1016/j.jcot.2021.05.021

American Academy of Orthopaedic Surgeons. (2024). Therapeutic exercise program for epicondylitis (tennis elbow/golfer’s elbow). orthoinfo.aaos.org/globalassets/pdfs/2024-therapeutic-exercise-program-for-lateral-and-medial-epicondylitis.pdf

American Academy of Orthopaedic Surgeons. (2023). What are NSAIDs? orthoinfo.aaos.org/en/treatment/what-are-nsaids/

American Academy of Orthopaedic Surgeons. (2022). Biceps tendon tear at the elbow. orthoinfo.aaos.org/en/diseases–conditions/biceps-tendon-tear-at-the-elbow

Johns Hopkins Medicine. (2024). Ulnar collateral ligament. www.hopkinsmedicine.org/health/conditions-and-diseases/ulnar-collateral-ligament-ucl-injuries-of-the-elbow

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