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Kinesiology Tape: Guide to Relieving Neck and Shoulder Pain

By
Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP
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Senior therapist applying kinesio tape on a man's neck during the medical treatment in the office

“Individuals with neck and shoulder pain may experience tightened lumps or knots in and around the muscles where the neck and shoulder meet. Can using kinesiology tape for neck and shoulder trigger points help to loosen and release them, restore function, and relieve pain?”

Kinesiology Tape: Guide to Relieving Neck and Shoulder Pain

Kinesiology Tape For Neck and Shoulder Trigger Points

The upper trapezius and levator scapula muscles are where the shoulder and neck come together and are often the location of trigger point formations. These trigger points can cause tension, pain, and muscular spasms in the neck and shoulders. Various treatments for releasing trigger points and alleviating the pain symptoms include therapeutic massage, trigger point release, and chiropractic adjustments in a multidisciplinary treatment approach.

  • Electrical stimulation and ultrasound have often been used to break up the knots, but scientific evidence has shown that these treatments alone are not the most effective. (David O. Draper et al., 2010)
  • Stretching the neck muscles can bring tension relief and help release the knots.
  • Practicing healthy postures helps avoid and prevent symptoms. (Cleveland Clinic. 2019)
  • Kinesiology tape can decrease the pain and spasms and help to release the trigger points.

Therapy

Using kinesiology tape is a form of physical therapy that can be used in various ways.

  • The tape helps lift the upper tissues from underlying tissues to increase circulation and release muscular spasms.
  • It can help improve muscular contractions, decrease swelling, and inhibit pain in injured tissues.
  • Helps stop the trigger points and knots from worsening.
  • The tape can also be used for managing lymphedema.

Usage

To decrease trigger points, individuals can use a specific kinesiology tape strip called a lift strip. Individuals can consult their healthcare provider or physical therapist to show them the various types of strips to learn how to cut them properly.

  • Before using kinesiology tape, consult a healthcare provider or physical therapist to assess the injury and situation.
  • Kinesiology tape is not for everyone, and some people have conditions where the use of kinesiology tape should be avoided altogether.
  • A therapist can evaluate the neck pain and trigger points to determine if the individual should use kinesiology tape.

To use kinesiology tape for neck and shoulder trigger points:

  1. Get comfortable with the neck and shoulders exposed.
  2. Cut one lift strip for each side of the neck, if necessary.
  3. The lift strip should be around 3 to 4 inches long.
  4. Remove the paper backing in the center with the exposed tape in the center, which should look like a band-aid.
  5. Both ends of the lift strip should still have the paper backing on.
  6. Stretch out the kinesiology tape.
  7. Place the stretched tape directly over the trigger points in the upper shoulder area.
  8. Remove the backing on either side of the lift strip and place the ends on without stretching.
  9. Gently rub the tape to help the adhesive adhere.
  • Once the tape has been applied, it can be left there for 2 to 5 days.
  • It’s ok if it gets wet with a bath or shower.
  • Monitor the skin around the tape to watch for redness or other signs of a negative reaction to the tape.
  • Kinesiology taping can be a useful tool to decrease pain and spasms but does not replace professional treatment, prescribed exercises and stretches, and posture retraining.
  • The physical therapy team will teach proper self-care strategies for the individual’s condition.
  • For individuals with neck and shoulder pain and muscle spasms, a trial of kinesiology taping may help alleviate symptoms and improve the overall injury.

The Non-Surgical Approach to Wellness with Chiropractic Care

References

Draper, D. O., Mahaffey, C., Kaiser, D., Eggett, D., & Jarmin, J. (2010). Thermal ultrasound decreases tissue stiffness of trigger points in upper trapezius muscles. Physiotherapy theory and practice, 26(3), 167–172. https://doi.org/10.3109/09593980903423079

Cleveland Clinic. (2019). Knots in Your Neck? How to Try a Trigger Point Massage to Release Them.

Strength and Stability With Gluteus Minimus Muscles

By
Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP
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Man athlete pain and injury back arm and leg at home, sports injury bodybuilder, concept health and beauty. High quality photo

“For individuals experiencing gluteus minimus pain and are unsure where to start to deal with it, can a physical therapist, chiropractor, or general practitioner help diagnose lower extremity pain and develop an appropriate treatment plan?”

Strength and Stability With Gluteus Minimus Muscles

Gluteus Minimus Muscles

The gluteus minimus is the smallest muscle of the gluteal muscles. Combined with the gluteus maximus and gluteus medius, these muscles make up the glutes. The glutes help form the buttocks shape, stabilize the hips, rotate the legs, and raise the thighs. The gluteus minimus and medius specifically support the gluteus maximus’s ability to raise the leg to the side and rotate the thigh inwards. (ScienceDirect. 2011)

Anatomy

  • The gluteus minimus muscles are triangular and lie underneath the gluteus medius near the rotators of the hip joints. The muscles start in the lower ilium region, the upper and largest area of the hip bone that makes up the pelvis and attaches to the femur/thigh bone.
  • The fibers on the top part of the muscle are thick and compact, while the lower fibers are flat and spread out.
  • The superior gluteal nerves and blood vessels separate the gluteus minimus and the medius.
  • The gluteus medius muscles start on the upper ilium region, which covers the gluteus minimus muscle entirely. The location of the gluteus minimus muscles envelopes the sciatic notch or the area in the pelvis that houses the piriformis muscle, superior gluteal vein, and superior gluteal artery, which provide a certain amount of protection.

Function

Movement depends on the location of the femur. The gluteus minimus muscle’s function is to:

  1. Flex
  2. Rotate
  3. Stabilize
  • When the thigh is extended, it helps abduct or swing the leg out away from the body.
  • When the hip bones are flexed, the gluteus minimus rotates the thigh inward with the help of the gluteus medius.
  • The movements are done with the support of the muscle fibers, which contract to move the thigh in both directions. (ScienceDirect. 2011)
  • The gluteus minimus and the medius also stabilize the hips and pelvis during movement and when resting.

Associated Conditions

One of the most common injuries is muscle wearing and tearing, which can cause pain over and around the greater trochanter. This is known as greater trochanteric pain syndrome or GTPS, a condition usually caused by a gluteus medius or minimus tendinopathy, which can include inflammation of the surrounding bursae. (Diane Reid. 2016) For a gluteus minimus tear, the pain/sensations will be felt outside the hip, especially when rolling or applying weight on the affected side. A tear can happen suddenly with no particular activity causing the tear to occur aside from normal use and stress on the muscle. Physical activities like walking may be painful.

Rehabilitation

Treatment depends on the severity of the condition. Usually, rest, ice, and over-the-counter medication can help reduce swelling and pain symptoms. For pain symptoms that are not subsiding, it’s recommended to see a healthcare provider who can run an MRI or X-ray to see the condition of the muscle and rule out other causes of pain. The healthcare provider will refer the patient to a physical therapy team that can evaluate the strength of the gluteus minimus and provide a list of exercises and stretches to help repair the muscle while conditioning the surrounding muscles. (SportsRec. 2017) Depending on the level of pain, sometimes the healthcare provider will prescribe a cortisone injection to the gluteus minimus muscle in conjunction with physical therapy. This will help alleviate the pain so that the physical therapy exercises can be done comfortably, allowing the gluteus maximus muscle to heal properly and strengthen. (Julie M. Labrosse et al., 2010)

The Science of Motion Chiropractic Care

References

ScienceDirect. (2011). Gluteus minimus muscle.

Reid D. (2016). The management of greater trochanteric pain syndrome: A systematic literature review. Journal of orthopaedics, 13(1), 15–28. https://doi.org/10.1016/j.jor.2015.12.006

SportsRec. (2017). Physical therapy exercises for the gluteus minimus.

Labrosse, J. M., Cardinal, E., Leduc, B. E., Duranceau, J., Rémillard, J., Bureau, N. J., Belblidia, A., & Brassard, P. (2010). Effectiveness of ultrasound-guided corticosteroid injection for the treatment of gluteus medius tendinopathy. AJR. American journal of roentgenology, 194(1), 202–206. https://doi.org/10.2214/AJR.08.1215

Turf Toe Injury: How to Recognize the Symptoms and Get Help

By
Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP
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Female martial arts fighter practicing with trainer, punching taekwondo kick pad exercise kicking. Training of kickboxer woman strikes with bare foot mitts punching bag kicking shield.

“For individuals experiencing a turf toe injury, can knowing the symptoms help athletes and non-athletes with treatment, recovery time, and returning to activities?”

Turf Toe Injury: How to Recognize the Symptoms and Get Help

Turf Toe Injury

A turf toe injury affects the soft tissue ligaments and tendons at the base of the big toe under the foot. This condition usually occurs when the toe is hyperextended/forced upward, such as when the ball of the foot is on the ground and the heel is lifted. (American Academy of Orthopaedic Surgeons. 2021) The injury is common among athletes who play sports on artificial turf, which is how the injury got its name. However, it can also affect non-athletes, like individuals working on their feet all day.

  • Recovery time after turf toe injury depends on the severity and the type of activities the individual plans to return to.
  • Returning to high-level sports activities after a severe injury can take six months.
  • These injuries vary in severity but usually improve with conservative treatment. In severe cases, surgery could be required.
  • Pain is the primary issue that stops physical activities after a grade 1 injury, while grades 2 and 3 can take weeks to months to heal completely.

Meaning

A turf toe injury refers to a metatarsophalangeal joint strain. This joint comprises ligaments that connect the bone on the sole of the foot, below the big toe/proximal phalanx, to the bones that connect the toes to the larger bones in the feet/metatarsals. The injury is usually caused by hyperextension that often results from a pushing-off motion, like running or jumping.

Grading

Turf toe injuries can range from mild to severe and are graded as follows: (American Academy of Orthopaedic Surgeons. 2021)

  • Grade 1 – The soft tissue is stretched, causing pain and swelling.
  • Grade 2 – The soft tissue is partially torn. Pain is more pronounced, with significant swelling and bruising, and it is difficult to move the toe.
  • Grade 3 – Soft tissue is completely torn, and symptoms are severe.

Is This What’s Causing My Foot Pain?

Turf toe can be an:

  • Overuse injury – caused by repeating the same motion repeatedly for an extended period, that causes symptoms to worsen.
  • Acute injury – that occurs suddenly, causing immediate pain.

Symptoms can include the following: (Mass General Brigham. 2023)

  • Limited range-of-motion.
  • Tenderness in the big toe and surrounding area.
  • Swelling.
  • Pain in the big toe and surrounding area.
  • Bruising.
  • Loose joints can indicate there is a dislocation.

Diagnosis

If experiencing turf toe symptoms, see a healthcare provider for a proper diagnosis so they can develop a personalized treatment plan. They will perform a physical exam to assess pain, swelling, and range of motion. (American Academy of Orthopaedic Surgeons. 2021) If the healthcare provider suspects tissue damage, they may recommend imaging with X-rays and (MRI) to grade the injury and determine the proper course of action.

Treatment

A healthcare provider will determine the best treatment based on the severity of the injury. All turf toe injuries can benefit from the RICE protocol: (American College of Foot and Ankle Surgeons. Foot Health Facts. 2023)

  1. Rest – Avoid activities that worsen symptoms. This can include using an assistive device like a walking boot or crutches to reduce pressure.
  2. Ice – Apply ice for 20 minutes, then wait 40 minutes before reapplying.
  3. Compression – Wrap the toe and foot with an elastic bandage to support and reduce swelling.
  4. Elevation – Prop the foot above the level of the heart to help decrease swelling.

Grade 1

Grade 1 turf toe is classified by stretched soft tissue, pain, and swelling. Treatments can include: (Ali-Asgar Najefi et al., 2018)

  • Taping to support the toe.
  • Wearing shoes with a rigid sole.
  • Orthotic support, like a turf toe plate.

Grades 2 and 3

Grades 2 and 3 come with partial or complete tissue tearing, severe pain, and swelling. Treatments for more severe turf toe can include: (Ali-Asgar Najefi et al., 2018)

  • Limited weight bearing
  • Using assistive devices like crutches, a walking boot, or a cast.

Other Treatment

  • Less than 2% of these injuries require surgery. It is usually recommended if there is instability in the joint or when conservative treatments are unsuccessful. (Ali-Asgar Najefi et al., 2018) (Zachariah W. Pinter et al., 2020)
  • Physical therapy is beneficial for decreasing pain and improving the range of motion and strength after injury. (American Academy of Orthopaedic Surgeons. 2021)
  • Physical therapy also includes proprioception and agility training exercises, orthotics, and wearing recommended shoes for specific physical activities. (Lisa Chinn, Jay Hertel. 2010)
  • A physical therapist can also help ensure that the individual does not return to physical activities before the injury is fully healed and prevent the risk of re-injury.

Recovery Time

Recovery depends on injury severity. (Ali-Asgar Najefi et al., 2018)

  • Grade 1 – Subjective as it varies depending on the individual’s pain tolerance.
  • Grade 2 – Four to six weeks of immobilization.
  • Grade 3 – Eight weeks minimum of immobilization.
  • It can take up to six months to return to normal function.

Returning To Normal Activities

After a grade 1 turf toe injury, individuals can return to normal activities once the pain is under control. Grades 2 and 3 take longer to heal. Returning to sports activities after a grade 2 injury can take around two or three months, while grade 3 injuries and cases that require surgery can take up to six months. (Ali-Asgar Najefi et al., 2018)

Sports Chiropractic Treatment

References

American Academy of Orthopaedic Surgeons. (2021). Turf toe.

Mass General Brigham. (2023). Turf toe.

American College of Foot and Ankle Surgeons. Foot Health Facts. (2023). RICE protocol.

Najefi, A. A., Jeyaseelan, L., & Welck, M. (2018). Turf toe: A clinical update. EFORT open reviews, 3(9), 501–506. https://doi.org/10.1302/2058-5241.3.180012

Pinter, Z. W., Farnell, C. G., Huntley, S., Patel, H. A., Peng, J., McMurtrie, J., Ray, J. L., Naranje, S., & Shah, A. B. (2020). Outcomes of Chronic Turf Toe Repair in Non-athlete Population: A Retrospective Study. Indian journal of orthopaedics, 54(1), 43–48. https://doi.org/10.1007/s43465-019-00010-8

Chinn, L., & Hertel, J. (2010). Rehabilitation of ankle and foot injuries in athletes. Clinics in sports medicine, 29(1), 157–167. https://doi.org/10.1016/j.csm.2009.09.006

Optimize Muscle Growth: Understand Protein Synthesis

By
Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP
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People at rehabilitation center, woman talking with female rehabilitologist, men training on background. Concept of physical therapy for health and recovery. Consultation before training

“For individuals trying to optimize muscle growth, protein intake is essential. However, the body is limited by how much protein can synthesize to repair and grow muscles. Can knowing protein intake timing, amount, and how to best stimulate muscle growth help achieve better results?”

Optimize Muscle Growth: Understand Protein Synthesis

Muscle Protein Synthesis

Muscle protein synthesis is a physiological process of producing new muscle protein and is an important component of how the body maintains and builds muscle. Muscle growth is achieved with resistance training and protein intake. (Tanner Stokes, et al., 2018)

How Protein Synthesis Works

Protein is the building block of muscles, while protein synthesis is a natural metabolic process in which protein is produced to repair muscle damage caused by exercise. This happens from amino acids binding to skeletal muscle proteins, increasing muscle size. It counteracts muscle protein breakdown (MPB) due to protein loss during exercise. The breakdown of muscles is a necessary part of building muscle. When damaged, muscles will build back larger, so long as enough calories and protein are consumed to repair and grow the muscles. Muscle protein synthesis can be enhanced by increasing protein intake immediately following exercise. Learning to stimulate muscle protein synthesis through exercise and diet can help accelerate muscle growth, expedite recovery, improve physical performance, and increase overall endurance. (Cameron J. Mitchell et al., 2014)

Effects of Exercise

Protein balance describes the relationship between muscle protein breakdown and muscle protein synthesis. When the body is in protein balance, no muscle growth or wasting occurs, and the individual is considered in a healthy state of biological equilibrium/homeostasis, also known as maintenance. To stimulate muscle growth, individuals need to shake up the protein balance. Although it may seem counter-intuitive, exercise can break down muscle protein, but not more than the amount of protein the body can synthesize. (Felipe Damas, et al., 2015) The more intense the workout, the greater the muscle protein synthesis, as the muscle breakdown stimulates the repair and growth of tissues. Scientists measure intensity by the one-repetition maximum – 1-RM – meaning the maximum weight an individual can lift for one repetition. According to a research study, workout intensities of under 40% of the 1-RM will not affect muscle protein synthesis. And intensities greater than 60% will double or triple muscle protein synthesis. (P. J. Atherton, K Smith. 2012)

Food Impact

The relationship between diet and protein balance is not so straightforward. Even with increased protein intake, muscle protein synthesis occurs for a specific period. This is because the body can only utilize a certain amount of the essential amino acids it receives, with anything more being broken down and excreted by the liver. Nutritionists recommend about 1.4 to 2.0 grams of protein per kilogram of body weight per day for building muscle and strength. (Ralf Jäger, et al., 2017) Enough protein can be obtained by focusing on dairy, eggs, lean meats, nuts, and legumes. It is also recommended to consume enough whole grains, healthy fats, fruits, and vegetables to help the body perform and repair properly. For example, carbohydrates are necessary for muscle building as they stimulate insulin release that supports muscle cell protein absorption. (Vandré Casagrande Figueiredo, David Cameron-Smith. 2013) A study looked into response rates in men prescribed 10, 20, or 40 grams of whey protein immediately following resistance training. Researchers noted the following results: (Oliver C. Witard et al., 2014)

  • 10 grams of whey protein – No effect on muscle protein synthesis.
  • 20 grams – Increased muscle protein synthesis by 49%.
  • 40 grams – Increased the muscle protein synthesis by 56% but also caused the excessive accumulation of urea.
  • Consuming 20 grams to 40 grams of whey protein after resistance training also increased other essential amino acids associated with lean muscle growth. (Lindsay S. Macnaughton et al., 2016)
  • Whey protein is a fast-digesting protein.
  • Increased results can be obtained by consuming slower-digesting protein throughout the day.

Muscle gains vary from person to person as everyone’s body is different. Individuals considering consuming protein beyond the recommended dietary intake should consult their doctor or a registered nutritionist to understand the potential benefits and risks.

Building A Stronger Body

References

Stokes, T., Hector, A. J., Morton, R. W., McGlory, C., & Phillips, S. M. (2018). Recent Perspectives Regarding the Role of Dietary Protein for the Promotion of Muscle Hypertrophy with Resistance Exercise Training. Nutrients, 10(2), 180. https://doi.org/10.3390/nu10020180

Mitchell, C. J., Churchward-Venne, T. A., Parise, G., Bellamy, L., Baker, S. K., Smith, K., Atherton, P. J., & Phillips, S. M. (2014). Acute post-exercise myofibrillar protein synthesis is not correlated with resistance training-induced muscle hypertrophy in young men. PloS one, 9(2), e89431. https://doi.org/10.1371/journal.pone.0089431

Damas, F., Phillips, S., Vechin, F. C., & Ugrinowitsch, C. (2015). A review of resistance training-induced changes in skeletal muscle protein synthesis and their contribution to hypertrophy. Sports medicine (Auckland, N.Z.), 45(6), 801–807. https://doi.org/10.1007/s40279-015-0320-0

Atherton, P. J., & Smith, K. (2012). Muscle protein synthesis in response to nutrition and exercise. The Journal of physiology, 590(5), 1049–1057. https://doi.org/10.1113/jphysiol.2011.225003

Jäger, R., Kerksick, C. M., Campbell, B. I., Cribb, P. J., Wells, S. D., Skwiat, T. M., Purpura, M., Ziegenfuss, T. N., Ferrando, A. A., Arent, S. M., Smith-Ryan, A. E., Stout, J. R., Arciero, P. J., Ormsbee, M. J., Taylor, L. W., Wilborn, C. D., Kalman, D. S., Kreider, R. B., Willoughby, D. S., Hoffman, J. R., … Antonio, J. (2017). International Society of Sports Nutrition Position Stand: protein and exercise. Journal of the International Society of Sports Nutrition, 14, 20. https://doi.org/10.1186/s12970-017-0177-8

Figueiredo, V. C., & Cameron-Smith, D. (2013). Is carbohydrate needed to further stimulate muscle protein synthesis/hypertrophy following resistance exercise?. Journal of the International Society of Sports Nutrition, 10(1), 42. https://doi.org/10.1186/1550-2783-10-42

Witard, O. C., Jackman, S. R., Breen, L., Smith, K., Selby, A., & Tipton, K. D. (2014). Myofibrillar muscle protein synthesis rates subsequent to a meal in response to increasing doses of whey protein at rest and after resistance exercise. The American journal of clinical nutrition, 99(1), 86–95. https://doi.org/10.3945/ajcn.112.055517

Macnaughton, L. S., Wardle, S. L., Witard, O. C., McGlory, C., Hamilton, D. L., Jeromson, S., Lawrence, C. E., Wallis, G. A., & Tipton, K. D. (2016). The response of muscle protein synthesis following whole-body resistance exercise is greater following 40 g than 20 g of ingested whey protein. Physiological reports, 4(15), e12893. https://doi.org/10.14814/phy2.12893

Pancakes: Nutrition Facts & Health Benefits

By
Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP
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pancakes on plate and on a table

“For individuals wanting to eat pancakes regularly, are there ways to increase pancake nutrition and lower the calorie and carb counts so they can be included in a balanced diet?”

Pancakes: Nutrition Facts & Health Benefits

Pancake Nutrition

This high-carbohydrate meal can provide enough energy to fuel a day’s physical activity.

Nutrition

The following nutrition information is provided for:

  1. Calories – 430.8
  2. Fat – 18.77g
  3. Sodium – 693.9mg
  4. Carbohydrates – 55.9g
  5. Fiber – .75g
  6. Sugars – 8.6g
  7. Protein – 8.64g

Pancakes made with whole-wheat flour offer more fiber and protein. The following is nutrition info for two or three whole-wheat pancakes (150g) made from a mix. (Child Nutrition Recipe Box. 2023)

  1. Calories – 348
  2. Fat – 15g
  3. Sodium – 594mg
  4. Carbohydrates – 45g
  5. Fiber – 6g
  6. Sugars – 6g
  7. Protein – 12g

Carbohydrates

Pancakes will increase carbohydrate intake. The body uses carbohydrates as a primary fuel source, making them an important nutrient. However, most nutritionists suggest that individuals get their daily carbohydrates from nutrient-dense sources. Pancakes typically don’t fall into this category. White flour pancakes do not provide much fiber, and around 60 grams of carbohydrates are consumed in this meal. Substituting whole-wheat flour changes the amount to around 6g of fiber or 20% of the daily recommended value.

Fat

Pancakes can include dairy and eggs and are topped with butter that contributes a significant amount of fat. Pancake mix may contain trans fat. Some brands include partially hydrogenated oils. Health experts recommend that individuals limit or completely avoid foods containing trans fat. If the label ingredient list contains partially hydrogenated ingredients, it is recommended to avoid it. (MedlinePlus. 2022)

Protein

Pancakes may provide some protein, which varies based on the type of flour used. Some brands add protein powder to increase intake.

Vitamins and Minerals

Pancakes and ready mixes are generally made from enriched flour. Enriched foods are those that have had nutrients added during the manufacturing process. In most cases, the nutrients, vitamins, and minerals are stripped away, and then some are added back in during processing. Constantly eating enriched bread products limits diet-friendly fiber and nutrients. The enriched flour in pancakes and added sugar and syrup raise blood sugar levels rapidly and then generate hunger shortly afterward.​

Calories

Total nutrition numbers also depend on serving size. The numbers on the label only apply to a single serving which is just two medium pancakes. Many individuals consume 3-4 medium pancakes and double the amount of butter and syrup as well. This can add up to more than 1,000 calories.

Benefits

Whole-wheat pancakes made with whole-grain flour are more nutritious than pancakes made with white flour and can be a delicious way to eat more whole grains. They can be topped with berries or other fruits for added fiber and nutrients.

Digestion

Whole-wheat pancakes made with whole-grain flour provide significant fiber for healthy digestion. Fiber helps with waste evacuation and has prebiotic compounds that fuel beneficial gut bacteria. (Joanne Slavin. 2013)

Improves Hunger Satisfaction

Whole-grain pancakes taste heartier and include fiber that keeps the body fuller longer than pancakes made with faster-digesting refined flour.

Decreases Risk of Heart Disease

A review of studies examining whole grain consumption and heart disease found that eating whole grains was associated with a reduced risk of heart disease. (Dagfinn Aune, et al., 2016)

Reduces Risk of Obesity

Research suggests that whole grain intake reduces the risk of obesity and could help individuals maintain a stable weight. (Katrina R. Kissock et al., 2021) The fiber will also help keep the fuller longer after the meal.

Helps Prevent Birth Defects

Whole-wheat flour is fortified with folic acid, an important B vitamin during pregnancy. Folic acid decreases the risk of neural tube defects, which can affect the development of the brain or spine. (Centers for Disease Control and Prevention. 2022)

Variations

Nutrients for regular pancakes will vary based on the size.

One made-from-scratch small pancake – 3″ across provides:

  • 30 calories
  • 1 gram of protein
  • 5 grams of carbohydrate
  • 0 grams of fiber
  • 1 gram of sugar

One made-from-scratch medium pancake – 5″ across provides:

  • 93 calories
  • 2 grams of protein
  • 15 grams of carbohydrate
  • 0 grams of fiber
  • 2 grams of sugar

One made-from-scratch large pancake – 7″ across provides:

  • 186 calories
  • 4 grams of protein
  • 30 grams of carbohydrate
  • 1 gram of fiber
  • 5 grams of sugar

Making Pancakes

If pancakes are part of a weekly meal plan, try to keep them lower in sugar, fat, and calories.

  1. Make pancakes from scratch without the mix to avoid any trans fats.
  2. Use whole wheat flour to get fiber to increase hunger satisfaction.
  3. Instead of frying the pancakes in oil or butter, use a quality non-stick pan to reduce fat intake.
  4. Use syrup with no sugar.
  5. Top with blueberries, raspberries, or strawberries.

Eating Right to Feel Better

References

USDA Food Data Central. (2019). Pancakes, plain, prepared from recipe.

USDA FoodData Central. (2019). Butter, without salt.

USDA FoodData Central. (2019). Syrups, table blends, pancake.

Child Nutrition Recipe Box. (2023). Pancakes – USDA recipe for schools.

MedlinePlus. (2022). Facts about trans fat.

Slavin J. (2013). Fiber and prebiotics: mechanisms and health benefits. Nutrients, 5(4), 1417–1435. https://doi.org/10.3390/nu5041417

Aune, D., Keum, N., Giovannucci, E., Fadnes, L. T., Boffetta, P., Greenwood, D. C., Tonstad, S., Vatten, L. J., Riboli, E., & Norat, T. (2016). Whole grain consumption and risk of cardiovascular disease, cancer, and all cause and cause specific mortality: systematic review and dose-response meta-analysis of prospective studies. BMJ (Clinical research ed.), 353, i2716. https://doi.org/10.1136/bmj.i2716

Kissock, K. R., Neale, E. P., & Beck, E. J. (2021). Whole Grain Food Definition Effects on Determining Associations of Whole Grain Intake and Body Weight Changes: A Systematic Review. Advances in nutrition (Bethesda, Md.), 12(3), 693–707. https://doi.org/10.1093/advances/nmaa122

Centers for Disease Control and Prevention. (2022). Folic acid.

Try Non-surgical Decompression for Sensor Nerve Dysfunction

By
Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP
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Can individuals with sensory nerve dysfunction incorporate nonsurgical decompression to restore sensory-mobility function to their bodies?

Introduction

The spinal column in the musculoskeletal system comprises bones, joints, and nerves that work together with various muscles and tissues to ensure that the spinal cord is protected. The spinal cord is part of the central nervous system where the nerve roots are spread out to the upper and lower body parts that supply sensory-motor functions. This allows the body to move and function without pain or discomfort. However, when the body and spine ages or when a person is dealing with injuries, the nerve roots can become irritated and cause weird sensations like numbness or tingling, often correlating with body pain. This can cause a socio-economic burden on many individuals and, if not treated right away, can lead to chronic pain. To that point, it can lead to many individuals dealing with body extremity pain associated with sensory nerve dysfunction. This causes many individuals dealing with musculoskeletal disorders to start looking for treatment. Today’s article examines how nerve dysfunction affects the extremities and how nonsurgical decompression can help reduce nerve dysfunction to allow mobility back to the upper and lower limbs. We speak with certified medical providers who incorporate our patients’ information to provide nonsurgical solutions like decompression to help individuals with nerve dysfunction. We also inform patients how nonsurgical decompression can restore mobility-sensory to the upper and lower extremities. We encourage our patients to ask intricated and educational questions to our associated medical providers about the pain-like symptoms they are experiencing correlating with the sensory nerve dysfunction. Dr. Alex Jimenez, D.C., utilizes this information as an academic service. Disclaimer.

 

How Nerve Dysfunction Affects The Extremities

Do you experience tingling or numb sensations in your hands or feet that don’t want to go away? Do you feel pain in different back portions that can only be relieved through stretching or resting? Or does it hurt to walk for long distances that you feel like you need to rest constantly? Many pain-like scenarios are associated with sensory nerve dysfunction that can affect the upper and lower extremities. When many individuals experience sensory nerve dysfunction and deal with weird sensations in their extremities, many think it is due to musculoskeletal pain in their neck, shoulders, or back. This is only part of the issue, as many environmental factors can be associated with sensory nerve pain, as the nerve roots are being compressed and agitated, causing sensory nerve dysfunction in the extremities. Since the nerve roots are spread out from the spinal cord, the brain sends the neuron information to the nerve roots to allow sensory-mobility function in the upper and lower extremities. This allows the body to be mobile without discomfort or pain and functional through daily activities. However, when many individuals start to do repetitive motions that cause the spinal disc to be compressed constantly, it can lead to potential disc herniation and musculoskeletal disorders. Since numerous nerve roots are spread to the different extremities, when the main nerve roots are aggravated, it can send pain signals to each extremity. Hence, many people are dealing with nerve entrapment that leads to lower back, buttock, and leg pain that can affect their daily routine. (Karl et al., 2022) At the same time, many people with sciatica are dealing with sensory nerve dysfunction that affects their walking ability. With sciatica, it can be associated with spinal disc pathology and causes many individuals to seek treatment. (Bush et al., 1992)

 

Sciatica Secrets Revealed-Video

Sciatica Secrets Revealed! | El Paso, Tx (2023)

When it comes to looking for treatment to reduce sensory nerve dysfunction, many individuals will opt for nonsurgical solutions to minimize the pain-like symptoms and reduce the pain signals that are causing the upper and lower extremities to suffer. Nonsurgical treatment solutions like decompression can help restore sensory nerve function through gentle traction by causing the spinal disc to lay off the aggravated nerve root and start the body’s natural healing process. At the same time, it helps reduce musculoskeletal disorders from returning. The video above shows how sciatica associated with sensory nerve dysfunction can be decreased through nonsurgical treatments to allow the body’s extremities to feel better.

Nonsurgical Decompression Reducing Nerve Dysfunction

Nonsurgical treatments can help reduce low back pain associated with sensory nerve dysfunction to restore sensory-motor function to the upper and lower extremities. Many individuals who incorporate nonsurgical treatments like decompression as part of their health and wellness routine can see improvement after consecutive treatment. (Chou et al., 2007) Since many healthcare practitioners incorporate nonsurgical treatments like decompression into their practices, there has been quite an improvement in pain management. (Bronfort et al., 2008) 

 

 

When many individuals start to use nonsurgical decompression for sensory nerve dysfunction, many will see improvement in their pain, mobility, and activities of their daily living. (Gose et al., 1998). What spinal decompression does for the nerve roots is that it helps the affected disc that is aggravating the nerve root, pulls the disc back to its original position, and rehydrates it. (Ramos & Martin, 1994) When many individuals start thinking about their health and wellness, nonsurgical treatments can be effective for them due to their affordable cost and how they can be combined with other therapies to manage better the pain associated with nerve dysfunction affecting their body extremities.

 

References

Bronfort, G., Haas, M., Evans, R., Kawchuk, G., & Dagenais, S. (2008). Evidence-informed management of chronic low back pain with spinal manipulation and mobilization. Spine J, 8(1), 213-225. https://doi.org/10.1016/j.spinee.2007.10.023

Bush, K., Cowan, N., Katz, D. E., & Gishen, P. (1992). The natural history of sciatica associated with disc pathology. A prospective study with clinical and independent radiologic follow-up. Spine (Phila Pa 1976), 17(10), 1205-1212. https://doi.org/10.1097/00007632-199210000-00013

Chou, R., Huffman, L. H., American Pain, S., & American College of, P. (2007). Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Ann Intern Med, 147(7), 492-504. https://doi.org/10.7326/0003-4819-147-7-200710020-00007

Gose, E. E., Naguszewski, W. K., & Naguszewski, R. K. (1998). Vertebral axial decompression therapy for pain associated with herniated or degenerated discs or facet syndrome: an outcome study. Neurol Res, 20(3), 186-190. https://doi.org/10.1080/01616412.1998.11740504

Karl, H. W., Helm, S., & Trescot, A. M. (2022). Superior and Middle Cluneal Nerve Entrapment: A Cause of Low Back and Radicular Pain. Pain Physician, 25(4), E503-E521. https://www.ncbi.nlm.nih.gov/pubmed/35793175

Ramos, G., & Martin, W. (1994). Effects of vertebral axial decompression on intradiscal pressure. J Neurosurg, 81(3), 350-353. https://doi.org/10.3171/jns.1994.81.3.0350

Disclaimer

Tips for Improving Sleeping Mobility After Injury, Illness or Surgery

By
Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP
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Female doctor and male patient Physical therapy is being done at the hospital.

“Individuals in post-surgery recovery or dealing with illness or an injury can experience weakened muscles and endurance that can cause temporary loss of sleeping mobility and inability to move around normally because of weakness, decreased range of motion, or pain. Can they benefit from physical therapy to help get back to normal functional mobility?”

Tips for Improving Sleeping Mobility After Injury, Illness or Surgery

Sleeping Mobility

For individuals who are hospitalized or homebound from injury, illness, or surgical recovery, a physical therapist will assess various areas of functional mobility. These include transfers – from sitting to standing positions, walking, and sleeping mobility. Sleeping mobility is the ability to perform specific motions while in bed. A therapist can assess sleeping or bed mobility and recommend strategies and exercises to improve movements. (O’Sullivan, S. B., Schmitz, T. J. 2016) A therapist may have the individual use specific devices, like an over-the-bed trapeze or a sliding board, to help move around.

Bed and Sleeping Mobility

When a physical therapist checks mobility, they will assess various motions that include: (O’Sullivan, S. B., Schmitz, T. J. 2016)

  • Moving from sitting to lying down.
  • Moving from lying down to sitting up.
  • Rolling over.
  • Scooting or sliding up or down.
  • Scooting or sliding sideways.
  • Twisting.
  • Reaching.
  • Raising the hips.

All of these movements require strength in different muscle groups. By checking out individual motions in sleeping mobility, a therapist can work out specific muscle groups that may be weak and require targeted exercises and stretches to restore mobility to normal. (O’Sullivan, S. B., Schmitz, T. J. 2016) Individuals visiting a therapist in an outpatient clinic or rehabilitation area may have the individual work on sleeping mobility on a treatment table. The same motions on the treatment table can be done in the bed.

Importance

The body is meant to move.

For individuals who cannot move comfortably on their bed, the body may suffer disuse atrophy or the wasting away of muscular strength, which can lead to increased difficulties. Not being able to move can also lead to pressure ulcers, especially for individuals who are severely deconditioned and/or remain in one position for a long period. Skin health may start to break down, leading to painful wounds that require specialized care. Being able to move around in bed can help prevent pressure ulcers. (Surajit Bhattacharya, R. K. Mishra. 2015)

Improvement

A physical therapist can prescribe specific exercises to strengthen muscle groups and improve sleeping mobility.  The muscles include:

  • Shoulder and rotator cuff muscles.
  • Triceps and biceps in the arms.
  • Gluteus muscles of the hips.
  • Hamstrings
  • Quadriceps
  • Calf muscles

The shoulders, arms, hips, and legs work together when moving the body around the bed.

Various Exercises

To improve bed movement, physical therapy exercises can include:

  • Upper extremity exercises
  • Lower trunk rotation
  • Glute exercises
  • Bridges
  • Leg raises
  • Short arc quads
  • Ankle pumps

Physical therapists are trained to assess these motions and functions and prescribe treatments to improve body movement. (O’Sullivan, S. B., Schmitz, T. J. 2016) Maintaining appropriate physical fitness can help the body stay active and mobile. Performing mobility exercises prescribed by a physical therapist can keep the right muscle groups working properly, and working with a physical therapist can ensure the exercises are correct for the condition and are performed properly.

Optimizing Your Wellness

References

O’Sullivan, S. B., Schmitz, T. J. (2016). Improving Functional Outcomes in Physical Rehabilitation. United States: F.A. Davis Company.

Bhattacharya, S., & Mishra, R. K. (2015). Pressure ulcers: Current understanding and newer modalities of treatment. Indian journal of plastic surgery : official publication of the Association of Plastic Surgeons of India, 48(1), 4–16. https://doi.org/10.4103/0970-0358.155260

Wearable Weights: Get Fit & Achieve Health Goals Easily

By
Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP
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Young smiling woman wearing leather ankle straps prepares to exercise on fitness machine in the gym. Fitness, sport, training, people concept.

“For individuals wanting to improve their fitness routine, can incorporating wearable weights and knowing how to use them effectively help achieve health goals?”

Wearable Weights: Get Fit & Achieve Health Goals Easily

Wearable Weights

Adding wearable weights allows individuals to use their body weight with added resistance. This can add strength training to a routine but can also be used during walks or runs to increase cardiovascular health and aid in weight loss. Research studies have found that wearing a weighted vest reduces body weight and fat mass. This is because heavier loads increase energy expenditure for the increase in physical workload. (Claes Ohlsson, et al., 2020)

Benefits

Wearable weights are easy to use.

  • Depending on the type, they are compact and can be taken on the go.
  • Wearing weights is an option for individuals with injuries or degenerative joint disease like arthritis that makes it difficult to hold or move weights.
  • Exercise has been proven to be a useful tool for treating osteoarthritis. (Lei Chen, Yan Yu. 2020)
  • There is no age limit for wearable weights.
  • Because many are only a few pounds, they are available to anyone from adolescents to the elderly.
  • Anyone can benefit from the different types of wearable weights.

Types

Three main types of wearable weights include wrist weights, ankle weights, and weighted vests.

  • Wrist weights can replace dumbbells in some cases.
  • They are typically between 1 to 10 pounds.
  • Ankle weights can provide extra resistance to leg motions.
  • They can be found from 1 pound up to 20 pounds.
  • Weighted vests provide a full-body challenge.
  • The weight choices for them vary, as most contain pockets where weight can be increased or decreased.

Using The Weights

Individuals can use wearable weights as a complement to strength and cardiovascular regimens. Beginners will want to start with lighter weights worn for less time. As the body becomes stronger, it’s important to increase the weight to see results.

Ankle Weights

  • Ankle weights can be used during a strength training workout to add resistance to lower body exercises.
  • As the body ages, it becomes more important to decrease the risk of falls by increasing lower limb and trunk strength.
  • Wearing ankle weights is recommended to build strength, especially in older adults. (Hiroyasu Akatsu, et al., 2022)
  • Individuals can wear them during a walk or run to increase the challenge.
  • They can be used for a high-level core workout.

Wrist Weights

  • Wrist weights can be used like dumbbells and worn during a walk or a run.
  • Research shows that walking with wrist weights can improve walking gait. (Hyung Suk Yang, et al., 2018)
  • Wearing weights on the wrists generates a higher energy expenditure, which allows one to add intensity to a walk or run without having to increase speed. (Catherine T. Campaña, Pablo B Costa. 2017)

Weighted Vests

  • Wearing a weighted vest during workouts will create a full-body challenge.
  • They can be used while walking or running and automatically add more difficulty.
  • Another way to utilize a weighted vest is to wear it while completing a regular workout.
  • Whether doing HITT, strength training, etc, individuals can wear a weighted vest.
  • The weight should be evenly distributed to prevent any injuries or functional disorders to the lower body.
  • Studies show no change in gait or an increased risk of injury when used correctly. (Christopher J. Gaffney, et al., 2022)

Individuals want to talk to a healthcare provider before beginning a new fitness program, and adding weights is no different, especially if there are any current or past injuries.

Is Motion Key To Healing?

References

Ohlsson, C., Gidestrand, E., Bellman, J., Larsson, C., Palsdottir, V., Hägg, D., Jansson, P. A., & Jansson, J. O. (2020). Increased weight loading reduces body weight and body fat in obese subjects – A proof of concept randomized clinical trial. EClinicalMedicine, 22, 100338. https://doi.org/10.1016/j.eclinm.2020.100338

Chen, L., & Yu, Y. (2020). Exercise and Osteoarthritis. Advances in experimental medicine and biology, 1228, 219–231. https://doi.org/10.1007/978-981-15-1792-1_15

Akatsu, H., Manabe, T., Kawade, Y., Masaki, Y., Hoshino, S., Jo, T., Kobayashi, S., Hayakawa, T., & Ohara, H. (2022). Effect of Ankle Weights as a Frailty Prevention Strategy in the Community-Dwelling Elderly: A Preliminary Report. International journal of environmental research and public health, 19(12), 7350. https://doi.org/10.3390/ijerph19127350

Yang, H. S., James, C. R., Atkins, L. T., Sawyer, S. F., Sizer, P. S., Jr, Kumar, N. A., & Kim, J. (2018). Effects of arm weight on gait performance in healthy subjects. Human movement science, 60, 40–47. https://doi.org/10.1016/j.humov.2018.05.003

Campaña, C. T., & Costa, P. B. (2017). Effects of walking with hand-held weights on energy expenditure and excess postexercise oxygen consumption. Journal of exercise rehabilitation, 13(6), 641–646. https://doi.org/10.12965/jer.1735100.550

Gaffney, C. J., Cunnington, J., Rattley, K., Wrench, E., Dyche, C., & Bampouras, T. M. (2022). Weighted vests in CrossFit increase physiological stress during walking and running without changes in spatiotemporal gait parameters. Ergonomics, 65(1), 147–158. https://doi.org/10.1080/00140139.2021.1961876

Unhealthy Posture: What Causes It and How to Counteract It

By
Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP
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Shot of a young businesswoman experiencing back pain while working at her desk in a modern office.

“Many individuals attribute, to some degree, their neck or back pain to unhealthy posture. Can knowing the causes and underlying factors help guide lifestyle adjustments and seeking medical rehabilitative treatment?”

Unhealthy Posture: What Causes It and How to Counteract It

Unhealthy Posture Causes

Numerous factors can cause individuals to practice unhealthy postures regularly.

Practicing healthy posture is a form of exercise where the muscles support the skeleton in stable and efficient alignment that is present in stillness and movement.

Injury and Muscle Guarding

  • After an injury, muscles can spasm to protect the body and help stabilize injuries and protect against further injury.
  • However, movements become limited and can lead to pain symptoms.
  • Prolonged muscle spasms lead to weakened muscles over time.
  • The imbalance between muscles guarding the injury and those still operating normally can lead to posture problems.
  • Musculoskeletal treatment with massage, chiropractic, and physical therapy can help restore optimal functioning.

Muscle Tension and Weakness

  • If certain muscle groups become weak or tense, posture can be affected, and pain symptoms can develop.
  • Muscle weakness or tension can develop when individuals hold a prolonged position day after day or when performing routine tasks and chores in a way that places tension on the muscles or uses them in an unbalanced way.
  • A study found how muscle tension, strength, and flexibility affect posture. Dariusz Czaprowski, et al., 2018)
  • Postural retraining and physical therapy adjustments can help strengthen the muscles and relieve pain symptoms.

Daily Habits

  • As individuals find ways to accommodate muscle spasms, weakness, tension, and/or imbalances, the mind and body can forget and abandon healthy posture.
  • The body then begins compensating using alternate, awkward, and counterproductive muscle contractions and stretching that compromise body and spinal alignment.

Use of Technology

  • Technology – whether sitting at a desk/workstation, using a tablet or cell phone, or working with several devices can gradually shift the body out of alignment. (Parisa Nejati, et al., 2015)
  • Individuals constantly looking down at their phone may develop a text neck, a condition in which the neck is held in flexion or forward tilting too long, which can lead to pain.

Mental Attitude and Stress

  • Individuals under stress or are experiencing stressful situations can begin to have posture problems. (Shwetha Nair et al., 2015)
  • Stress can contribute to over-contracting muscles, which can cause muscle tension, shallow breathing, posture problems, and pain symptoms.
  • Being aware of body position and correcting and adjusting posture can help to counteract stress. (Shwetha Nair et al., 2015)

Footwear Choice and They Are Worn

  • Footwear can affect body posture.
  • High heels shift the body’s weight forward, which can cause misalignment. (Anniele Martins Silva, et al., 2013)
  • Wearing down the outside or inside of the shoes faster from things like weight-bearing habits will imbalance kinetic forces that translate up the ankle, knee, hip, and lower back leading to pain symptoms in any or all of these joints.

Heredity and Genetics

  • Sometimes the cause is hereditary.
  • For example, Scheuermann’s disease is a condition in which adolescent males develop a pronounced kyphosis curve in the thoracic spine. (Nemours. KidsHealth. 2022)

Consult Injury Medical Chiropractic and Functional Medicine Clinic for an evaluation, and let us help you by developing a personalized treatment and rehabilitation program.

The Path To Healing

References

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

Nejati, P., Lotfian, S., Moezy, A., & Nejati, M. (2015). The study of correlation between forward head posture and neck pain in Iranian office workers. International journal of occupational medicine and environmental health, 28(2), 295–303. https://doi.org/10.13075/ijomeh.1896.00352

Nair, S., Sagar, M., Sollers, J., 3rd, Consedine, N., & Broadbent, E. (2015). Do slumped and upright postures affect stress responses? A randomized trial. Health psychology : official journal of the Division of Health Psychology, American Psychological Association, 34(6), 632–641. https://doi.org/10.1037/hea0000146

Silva, A. M., de Siqueira, G. R., & da Silva, G. A. (2013). Implications of high-heeled shoes on body posture of adolescents. Revista paulista de pediatria : orgao oficial da Sociedade de Pediatria de Sao Paulo, 31(2), 265–271. https://doi.org/10.1590/s0103-05822013000200020

Nemours. KidsHealth. (2022). Scheuermann’s kyphosis.

Discover How Friction Massage Can Help Improve Scar Tissue

By
Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP
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Shoulder pain, physical therapy and chiropractor with patient, injury and healthcare with help and .

“For individuals having difficulty moving or functioning normally due to injury, surgery, or illness, can a chiropractic and physical therapy team help expedite recovery?”

Discover How Friction Massage Can Help Improve Scar Tissue

Friction Massage

Individuals may develop scar tissue or tissue adhesions that limit normal motion after injury or surgery. A pain management team may use various treatments and modalities and may incorporate friction massage as part of a rehabilitation treatment plan. Friction massage, also known as transverse friction or cross friction massage, is a technique used to help improve scar tissue and adhesion mobility to move better and decrease the negative effects. The therapist uses their fingers to massage the scar in a direction that is at right angles to the scar line. It is a specialized technique that breaks up tissue adhesions that are limiting normal movement in the skin and underlying tissues. (Haris Begovic, et al., 2016)

Scar Tissue and Adhesions

For individuals who require surgery due to an injury or an orthopedic condition, their doctor will cut into the skin, tendons, and muscle tissue during the operation. Once sutured and healing has begun, scar tissue forms. Healthy tissue is made up of collagen that is comprised of cells that are arranged in a regular pattern. Healthy collagen is strong and can resist forces when tissues are pulled and stretched. (Paula Chaves, et al., 2017)

During the healing process after an injury, the collagen cells are laid down in a haphazard pattern and form scar tissue. The random accumulation of cells becomes tight and does not react well to tension and stretching forces. (Qing Chun, et al., 2016) The body can form scar tissue after a soft tissue injury, like a muscle or tendon strain. (Qing Chun, et al., 2016)

If a muscle or tendon gets strained the body will generate new collagen during the healing. The new collagen is laid down in a random fashion, and scar tissue or tissue adhesions can form that can limit the normal range of motion. Healthy tissue stretches and glides as the body moves. Scar tissue is rigid. At the site of the scar tissue, there can be some movement, but it is tight, less pliable, and can be painful. If scar tissue or adhesions are limiting motion, cross-friction massage can improve tissue gliding and sliding. This process is referred to as remodeling.

Massage Objectives

The objectives and goals of friction massage to adhesions or scar tissue may include:

  • Stimulation of nerve fibers to decrease and relieve pain.
  • Increase blood circulation to the tissues.
  • Working the affected tissue to break up scarring.
  • Collagen fibers tissue realignment.
  • Improve mechanoreceptor activity.

Massage Technique

Friction massage treatment follows a specific technique: (Paula Chaves, et al., 2017)

  • The entire area of scar tissue or adhesion should be treated.
  • If the scar tissue is in a muscle, it should be relaxed.
  • If the scar tissue is in a tendon sheath, that tendon should be slightly stretched during the procedure.
  • The therapist places two or three fingers over the scar or adhesion and moves their fingers perpendicular to the scar to smooth the collagen fibers down.
  • The fingers and underlying tissues move together.
  • The massage should feel deep and uncomfortable but not painful.
  • There may be some pain, but should remain within the individual’s tolerance.
  • If the massage is too painful, less pressure may be used.
  • After several minutes the therapist will assess the tissue mobility.
  • Specific stretches may be done to elongate the scar tissue or adhesions.
  • At-home exercises and stretches may be prescribed to maintain flexibility.

Contraindications

There are situations where friction massage should not be used and can include: (Paula Chaves, et al., 2017)

  • Around an active open wound.
  • If there is a bacterial infection.
  • Areas with decreased sensation.
  • If calcification is present in the muscle or tendon tissue.

The therapist will explain the procedure and inform of the goals and risks associated with it.

Diagnoses Treated

Diagnoses that can be treated with friction massage can include: (Paula Chaves, et al., 2017)

  • Muscle tears or strains.
  • For tendonitis or tendinopathy.
  • After a tendon tear.
  • Adhesive capsulitis in the shoulder/frozen shoulder.
  • Joint contracture.
  • Ligament tears.
  • Scar tissue buildup after surgery or trauma.

Friction massage is a popular technique used in physical therapy, but some research suggests it is not any more effective than other rehabilitation techniques. One study found that static stretches and exercises were more effective than massage in improving tissue length and strength in uninjured soccer players. Other studies have supported this, but individuals may find that the massage helps improve injured tissues’ movement as well. (Mohammed Ali Fakhro, et al. 2020)

The main goal of any treatment in physical therapy is to help the individual regain movement and flexibility. Friction massage, combined with targeted stretches and exercises, can help individuals expedite recovery and get back to normal.

Chiropractic Care After Accidents and Injuries

References

Begovic, H., Zhou, G. Q., Schuster, S., & Zheng, Y. P. (2016). The neuromotor effects of transverse friction massage. Manual therapy, 26, 70–76. https://doi.org/10.1016/j.math.2016.07.007

Chaves, P., Simões, D., Paço, M., Pinho, F., Duarte, J. A., & Ribeiro, F. (2017). Cyriax’s deep friction massage application parameters: Evidence from a cross-sectional study with physiotherapists. Musculoskeletal science & practice, 32, 92–97. https://doi.org/10.1016/j.msksp.2017.09.005

Chun, Q., ZhiYong, W., Fei, S., & XiQiao, W. (2016). Dynamic biological changes in fibroblasts during hypertrophic scar formation and regression. International wound journal, 13(2), 257–262. https://doi.org/10.1111/iwj.12283

Fakhro, M. A., Chahine, H., Srour, H., & Hijazi, K. (2020). Effect of deep transverse friction massage vs stretching on football players’ performance. World journal of orthopedics, 11(1), 47–56. https://doi.org/10.5312/wjo.v11.i1.47

Nonsurgical Tips & Tricks To Reduce Low Back Pain

By
Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP
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Can individuals with low back pain find nonsurgical solutions to restore lumbar mobility and stability to the lower limbs?

Introduction

As one of the top three common problems that many young and older adults experience at some point in their lives, low back pain can have a huge impact on their routine. Back pain can often be due to normal factors like lifting heavy objects, being in a reclined position, or being physically inactive. Other times, it can be due to traumatic injuries, musculoskeletal disorders, or physical injuries. When many people are dealing with low back pain, many will often take over-the-counter medication to reduce the pain-like symptoms that they are experiencing. However, that is only a temporary solution, as the pain does come back through repetitive motions that can lead to a life of disability. To that point, many individuals, especially working adults, will have to call off work to get their lower back pain treated. This causes a socio-economic burden for many, and it can be miserable. Today’s article will examine what causes back pain and how various nonsurgical tips and tricks can reduce low back pain. We speak with certified medical providers who incorporate our patients’ information to provide multiple nonsurgical solutions to ease low back pain in many individuals. We also inform our patients of tips and tricks to reduce common back pain symptoms causing lumbar issues. We encourage our patients to ask intricated and educational questions to our associated medical providers about the pain-like symptoms they are experiencing correlating with the lower back. Dr. Alex Jimenez, D.C., utilizes this information as an academic service. Disclaimer.

 

What Causes Back Pain?

 

Do you feel constant aches or pains in your lower back after a long workday? Do you feel stiffness in your lower back muscles that hurts when stretched? Or are you in constant pain that you are unable to function throughout the entire day? Many of these scenarios that people are experiencing are correlated with low back pain. Since the back in the musculoskeletal system is a complicated structure consisting of bones, joints, ligaments, and muscles, it can succumb to various injuries, sprains, and aches, leading to lower back pain. Many individuals dealing with back pain are non-specific and can affect the state of the lumbar spinal discs. When many individuals have various physical activities, they will have disc abnormalities and low back pain. (Jensen et al., 1994) At the same time, many individuals will notice that a series of sequelae develop various pain-like symptoms that are taken into account and cause functional loss associated with acute or chronic lower back pain that can affect the lower limbs. (Hoy et al., 2014) Some of the other causes of low back pain can be musculoskeletal symptoms that can lead to a life of disability. (Malik et al., 2018) More often than not, many individuals dealing with lower back pain do recover; however, after a while, reoccurrence of lower back pain is common when the same repetitive motions are being performed and when people who had lower back pain in previous encounters will deal with chronic pain and disability. (Hartvigsen et al., 2018) Luckily, numerous treatments can help reduce the pain, like the effects of low back pain, help restore mobility to the lumbar spine, and stabilize the lower limbs.

 

Diabetic Back Pain Explained- Video

Diabetic Back Pain Explained and How Chiropractic Care Can Help! | El Paso, Tx (2023)

Have you been experiencing muscle stiffness and aches in your lower back that are affecting your lower limbs? Did you lift a heavy object that caused you to strain your back muscles and make it difficult to work? Or were you bending over to pick up an object or tie your shoes so your back muscles are aching? When many individuals are dealing with low back pain from these various scenarios, it can lead to a life of disability and misery when not treated right away. Since low back pain is a pervasive musculoskeletal disorder, many individuals have different diagnoses, which can make it difficult to treat. (Deyo et al., 1990) However, there are numerous ways that many people dealing with low back pain can find the relief they deserve. Many people will often seek various treatments that can reduce low back pain and help them regain their spinal mobility so they can get back to their daily routine. The video above explains how back pain can be associated with autoimmune disorders like diabetes and how various treatments can help reduce pain-like symptoms.

Nonsurgical Tips & Tricks To Reduce Low Back Pain

When it comes to reducing and treating low back pain, many individuals will begin to seek treatment to reduce their low back pain. Many will often go to nonsurgical treatments since they are cost-effective and can be combined with other therapies to relieve musculoskeletal pain. Nonsurgical treatments can range from spinal decompression and chiropractic care to spinal manipulation. (Chou et al., 2017) When many people are finding relief for their lower back pain, some tips and tricks that many people can do to prevent it from flaring up include:

  • Maintaining a healthy weight and diet
  • Slowly incorporating exercises 
  • Avoid prolonging activity
  • Stretch
  • Sleep on a medium-firm mattress
  • Continue nonsurgical treatments to reduce the chances of low back pain returning
  • Maintain good posture

With these tips and tricks, many individuals will begin to notice their lower back pain reducing and promote healthy lifestyle choices.

References

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

Deyo, R. A., Cherkin, D., & Conrad, D. (1990). The Back Pain Outcome Assessment Team. Health Serv Res, 25(5), 733-737. https://www.ncbi.nlm.nih.gov/pubmed/2147670

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1065661/pdf/hsresearch00081-0050.pdf

Hartvigsen, J., Hancock, M. J., Kongsted, A., Louw, Q., Ferreira, M. L., Genevay, S., Hoy, D., Karppinen, J., Pransky, G., Sieper, J., Smeets, R. J., Underwood, M., & Lancet Low Back Pain Series Working, G. (2018). What low back pain is and why we need to pay attention. Lancet, 391(10137), 2356-2367. https://doi.org/10.1016/S0140-6736(18)30480-X

Hoy, D., March, L., Brooks, P., Blyth, F., Woolf, A., Bain, C., Williams, G., Smith, E., Vos, T., Barendregt, J., Murray, C., Burstein, R., & Buchbinder, R. (2014). The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis, 73(6), 968-974. https://doi.org/10.1136/annrheumdis-2013-204428

Jensen, M. C., Brant-Zawadzki, M. N., Obuchowski, N., Modic, M. T., Malkasian, D., & Ross, J. S. (1994). Magnetic Resonance Imaging of the Lumbar Spine in People without Back Pain. New England Journal of Medicine, 331(2), 69-73. https://doi.org/10.1056/nejm199407143310201

Malik, K. M., Beckerly, R., & Imani, F. (2018). Musculoskeletal Disorders a Universal Source of Pain and Disability Misunderstood and Mismanaged: A Critical Analysis Based on the U.S. Model of Care. Anesth Pain Med, 8(6), e85532. https://doi.org/10.5812/aapm.85532

Disclaimer

Common Mistakes That Can Hinder Muscle Growth

By
Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP
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Health smoothie, couple and fitness nutritionist with fruit, healthy food and smile at home. Nutrit.

“For individuals trying to build muscle but are not seeing results, can knowing factors like what foods to eat, how to work out, and genetics help achieve meaningful muscle gains?”

Common Mistakes That Can Hinder Muscle Growth

Muscle Growth Nutritional Mistakes

Muscle growth is an important element of overall fitness and health. Individuals can make nutritional mistakes like not eating enough protein or carbohydrates and not properly hydrating themselves which can prevent them from gaining muscle. Factors that contribute to muscle building, include:

  • Nutrition
  • Genetics
  • Training

Individuals who want to increase muscle mass more efficiently can rework these issues to maintain consistency and commitment to exercise and nutrition. Benefits include:

  • Building muscle helps strengthen bones
  • Improves balance
  • Decreases the risk of cardiovascular disease and diabetes.

Building muscle enhances strength and speed and can also reduce the risk of injuries or falls as you age. (American College of Sports Medicine. 2017)

Factors

Experts point out some common mistakes that can hinder muscle growth, like not eating enough protein, not consuming enough calories, overtraining, or practicing improper form and technique. As everybody is different there is no one-size-fits-all approach to building muscle or hypertrophy. These include:

Genetics

  • An individual’s genes contribute to how easy or difficult it can be to build muscle.
  • Some individuals have a higher proportion of fast-twitch muscle fibers, which increases growth potential.
  • The natural distribution of muscle and body fat also varies and can affect the rate and location of muscle growth.
  • There are also differences in individual recovery capabilities that can influence the frequency and intensity of training sessions.

Nutrition

  • Nutrition matters when trying to build muscle. Individuals need to eat enough protein for muscle repair and growth.
  • Individuals may need to consume more calories than they burn to create energy stores.
  • At the same time, individuals need to consume enough carbohydrates and healthy fats to fuel workouts and recovery.

Training

  • Gaining muscle requires regular resistance or strength training exercises.
  • These exercises cause micro tears in muscle fibers, which then repair and grow back stronger and larger.
  • Effective resistance training includes – consistency, intensity, recovery, and progressive overload.
  • Progressive overload means gradually increasing the weight, frequency, or number of repetitions in an exercise routine to challenge the muscles.

Muscle Strength for Healthy Aging

  • Research shows that performing exercises that build muscle mass can slow age-related cognitive decline and decrease the risk of neurodegenerative diseases like Alzheimer’s disease and dementia. (Joseph Michael Northey, et al., 2018)
  • Muscle-building exercise can also improve heart health and lower the risk of cardiovascular diseases. (Johns Hopkins Medicine. 2023)

Nutritional Mistakes

When trying to gain muscle, challenges can affect progress. Some of the most common mistakes that can delay or set back muscle growth and recommendations include.

Not Enough Protein

  • Eating protein like lean meats, dairy products, and seafood, is crucial for muscle repair and growth.
  • Not consuming enough protein makes the body unable to grow muscles, and you’ll see suboptimal improvements.
  • Get enough protein from various sources like beef, lamb, chicken, turkey, fish, eggs, dairy, legumes, and plant-based proteins.
  • However, there is a limit to how much protein the body can use effectively at one time for muscle protein synthesis.
  • It is recommended to distribute protein intake evenly throughout the day, aiming for about 20 to 30 grams of high-quality protein in each meal.

Not Enough Calories

  • Muscles need calories to grow.
  • If the body is in a caloric deficit, the ability to grow muscle is limited.
  • Insufficient calorie intake can create energy deficits, making the body use muscle for energy instead of growing.
  • To fix this, individuals need to consume more calories than calories burned.
  • It can be helpful to track calorie intake with an application to make adjustments as needed.
  • Individuals having trouble increasing their calorie intake or there are questions about what the body needs, consult with a registered dietitian or nutritionist.

Not Enough Carbs

  • Carbohydrates are the body’s main energy source during high-intensity workouts.
  • Not consuming enough can lead to decreased performance and slower recovery.
  • Recommendations include consuming a variety of whole grains and minimally processed carbohydrates, such as brown rice, potatoes, sweet potatoes, oats, and quinoa.
  • For individuals doing regular, moderate-to-intense training, carbohydrate recommendations can range from 3 to 7 grams per kilogram of body weight per day.
  • For individuals doing endurance or intense frequency training routines may need to increase this range.

Not Hydrating Enough

  • Water is necessary for all bodily functions, including muscle contraction and repair.
  • Dehydration comes with symptoms like muscle cramps, fatigue, and decreased exercise performance. (Centers for Disease Control and Prevention. 2022)
  • For individuals who are not sure how much water they need? Recommendations include using half of an individual’s body weight as a starting point to figure out how many ounces to drink per day.
  • For example, individuals who weigh 140 pounds can set a baseline hydration goal of 70 ounces of water/8 cups per day which can be adjusted according to activities.

Water Intake Recommendations

  • The recommended total fluid intake from food and drink varies by age and sex. The general recommendations are around:
  • 11.5 cups per day for women
  • 15.5 cups for adult men
  • For just water, women need around 9 cups of fluid per day, and men need around 13 cups to replace fluids that are lost throughout the day.
  • However, the exact amount of water needed to stay properly hydrated also depends on an individual’s activity level and overall health. (Academy of Nutrition and Dietetics. 2022)
  • To prevent dehydration, sip water consistently throughout the day, especially before, during, and after workouts.
  • Foods with a high water content like certain fruits can help achieve daily hydration goals.

Not Enough Healthy Fats

  • Not consuming enough healthy fats can cause the body to not be able to produce enough hormones that support muscle growth.
  • Relying on supplements instead of getting nutrients from whole foods can also lead to nutritional deficiencies and imbalances.
  • Eating too many protein bars or shakes can also cause gastrointestinal side effects. (National Capital Poison Center. 2023)
  • Recommendations are to add more healthy fats, like avocados, nuts, seeds, fatty fish, and olive oil.

Forgetting Post-Workout Nutrition

  • After working out, the body is ready to absorb nutrients and start the process of muscle repair and growth.
  • The body needs nutrients to activate the recovery post-exercise
  • When the body lacks nutrition after a workout it can slow muscle growth and cause fatigue.
  • Recommendations are to pack a balance of protein and carbohydrates to refuel right after a workout.

Training Mistakes

  • Undertraining or performing low-intensity workouts can also slow down muscle growth.
  • Individuals who are not overloading their muscles – for example, using weights that are too light – will not break them down so they can grow bigger and stronger.
  • A lack of microdamage means muscle growth will be slower.
  • Muscle overload also requires rest.
  • Recommendations are to take at least one day of rest per week and avoid strength training in the same muscle group two days in a row.
  • When creating a lifting plan, be sure to include compound exercises like squats, deadlifts, and bench presses.
  • These exercises work with multiple muscle groups and are recommended for building strength and muscle.
  • A training routine should include a variety of compound movements, like lunges, split squats, leg presses, pull-downs, upright rows, and push-ups.
  • If unsure of which compound exercises to include, consult a personal trainer, physical therapist, or sports chiropractor.

Military Training and Chiropractic Care

References

American College of Sports Medicine. (2017). Resistance training and injury prevention.

Northey, J. M., Cherbuin, N., Pumpa, K. L., Smee, D. J., & Rattray, B. (2018). Exercise interventions for cognitive function in adults older than 50: a systematic review with meta-analysis. British journal of sports medicine, 52(3), 154–160. https://doi.org/10.1136/bjsports-2016-096587

Johns Hopkins Medicine. (2023). Exercise and the heart.

Centers for Disease Control and Prevention. (2022). Water and healthier drinks.

Academy of Nutrition and Dietetics. (2022). How much water do you need?

National Capital Poison Center. (2023). Do protein bars give you gas?

Learn Everything About Lumbar Disc Degeneration Pathology

By
Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP
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Can healthcare providers help many individuals with lumbar disc degeneration find relief through spinal decompression treatments?

Introduction

Many individuals often do everyday motions that can allow the spine to bend, twist, and turn in various ways without feeling pain and discomfort. However, as the body ages, so does the spine, as the spinal discs begin the natural process of degeneration. Since the spinal discs in the spinal column absorb the vertical pressure weight, it stabilizes the upper and lower extremities and provides motion. To that point, when many individuals suffer from various injuries or environmental factors that cause the spinal disc to be compressed, it can lead to low back issues that cause pain and discomfort when a person is doing an activity. Since low back pain is one of the three most common problems that many people worldwide have dealt with, it can become a socio-economic issue that can lead to a life of disability and misery. Low back pain is often correlated with disc degeneration, and the surrounding ligaments and muscle tissues can affect the upper and lower extremities. This causes referred pain to the different musculoskeletal groups, causing many people to seek treatment that can not only be affordable but also effective in reducing the pain. Today’s article looks at the anatomy of the lumbar disc, how disc degeneration affects the lumbar spine, and how spinal decompression can reduce lumbar disc degeneration from causing more pain to the lower back. We speak with certified medical providers who incorporate our patients’ information to provide numerous treatment plans to ease the pain-like symptoms associated with lumbar disc degeneration causing low back pain. We also inform our patients that there are non-surgical options to reduce these pain-like issues correlated with disc degeneration and restore lumbar mobility to the body. We encourage our patients to ask intricated and educational questions to our associated medical providers about the pain-like symptoms they are experiencing correlating with the lower back. Dr. Alex Jimenez, D.C., utilizes this information as an academic service. Disclaimer.

 

The Anatomy Of The Lumbar Disc

Do you feel tension or stiffness in your lower back after waking up in the morning? Do you feel sudden or gradual pain from bending down to lift a heavy object that is affecting your lower back? Or do you feel the pain in one location or another in your back that is causing you pain and discomfort in your lumbar spinal region? Many of these pain-like issues are often correlated with disc degeneration combined with low back pain. The spinal disc’s anatomy comprises three elements that work together in a specific pattern to resist forces placed in the lumbar spine. (Martin et al., 2002) Since the lumbar spine is the thickest portion of the back, the spinal disc supports the upper body’s weight while stabilizing the lower body. However, the spinal disc will shrink over time when the body ages. Since degeneration is a natural process, many individuals will begin to feel less mobile, which can cause many issues within the lumbar spine.

 

How Disc Degeneration Affects The Lumbar Spine

 

When disc degeneration occurs in the lumbar spine, the spinal disc begins to decrease in volume, and the nutrients that hydrate the disc start to deplete and become compressed. When disc degeneration affects the lumbar spine, the nerve roots from the central system are affected. They can be associated with any particular group of pathological conditions that may irritate the surrounding nerves and produce pain-like symptoms. (Bogduk, 1976) To that point, this causes referred pain in the lower limbs and radiating pain in the lower back. At the same time, glycosphingolipid antibodies are activated in the immune system, causing inflammatory effects. (Brisby et al., 2002) When people are dealing with low back pain associated with disc degeneration, many people will feel their lower back lock up, causing limited mobility and stiffness. At the same time, the surrounding muscle and soft tissues are overstretched and tightened. The spinal disc will also affect the nerve fibers surrounding the spine, leading to nociceptive lower back pain. (Coppes et al., 1997) However, many individuals can find available treatments to reduce low back pain associated with disc degeneration.

 

An Overview Of Spinal Decompression- Video

Spinal Decompression in Depth | El Paso, Tx (2023)

Spinal Decompression Can Reduce Lumbar Disc Degeneration

Many individuals can seek out non-surgical treatments to reduce low back pain associated with disc degeneration as it is cost-effective and, through consecutive treatments, can start feeling better. Some non-surgical treatments like spinal decompression can help rehydrate the spinal disc through gentle traction and promote natural healing. Spinal decompression can be manual or mechanical, using negative pressure to increase disc height. (Vanti et al., 2021) This allows many individuals to feel the relief they deserve and feel better over time. Spinal decompression can reduce disc degeneration, stabilize the lumbar spine, and help regain spinal mobility back to the lower portions. (Daniel, 2007) When many individuals begin to take care of their bodies and reduce the chances of low back pain from returning to cause more issues to the back.

 

References

Bogduk, N. (1976). The anatomy of the lumbar intervertebral disc syndrome. Med J Aust, 1(23), 878-881. https://www.ncbi.nlm.nih.gov/pubmed/135200

Brisby, H., Balague, F., Schafer, D., Sheikhzadeh, A., Lekman, A., Nordin, M., Rydevik, B., & Fredman, P. (2002). Glycosphingolipid antibodies in serum in patients with sciatica. Spine (Phila Pa 1976), 27(4), 380-386. https://doi.org/10.1097/00007632-200202150-00011

Coppes, M. H., Marani, E., Thomeer, R. T., & Groen, G. J. (1997). Innervation of “painful” lumbar discs. Spine (Phila Pa 1976), 22(20), 2342-2349; discussion 2349-2350. https://doi.org/10.1097/00007632-199710150-00005

Daniel, D. M. (2007). Non-surgical spinal decompression therapy: does the scientific literature support efficacy claims made in the advertising media? Chiropr Osteopat, 15, 7. https://doi.org/10.1186/1746-1340-15-7

Martin, M. D., Boxell, C. M., & Malone, D. G. (2002). Pathophysiology of lumbar disc degeneration: a review of the literature. Neurosurg Focus, 13(2), E1. https://doi.org/10.3171/foc.2002.13.2.2

Vanti, C., Turone, L., Panizzolo, A., Guccione, A. A., Bertozzi, L., & Pillastrini, P. (2021). Vertical traction for lumbar radiculopathy: a systematic review. Arch Physiother, 11(1), 7. https://doi.org/10.1186/s40945-021-00102-5

 

Disclaimer

Managing Chronic Sciatica Symptoms: A Multidisciplinary Plan

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

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

Managing Chronic Sciatica Symptoms: A Multidisciplinary Plan

Chronic Sciatica

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

Advanced Sciatica Symptoms

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

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

Disabling Sciatica Treatment Options

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

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

Discectomy

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

Laminectomy

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

Foraminotomy

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

Spinal Fusion

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

Daily Relief Management for Advanced Sciatica

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

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

Healing Chronic Sciatica

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

Pain Specialist Treatment Plan Development

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

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

Sciatica Causes and Treatments

References

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

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

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

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

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

Hospital for Special Surgery. (2023). Sciatica.

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

Pain Management Specialists: The Multidisciplinary Approach

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

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

Pain Management Specialists: The Multidisciplinary Approach

Pain Management Specialists

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

Specialists

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

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

Other Medical Specialties

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

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

  • Anesthesiology
  • Physical rehabilitation
  • Psychiatry
  • Neurology

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

Management Goals

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

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

A pain management clinic will go through the following:

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

Individuals who do well with a pain management program

Individuals who have:

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

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

Chiropractic Care for Leg Instability

References

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

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

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

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

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

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