Tabata Training: A Complete Guide for Quick and Intense Workouts

group of people with medicine ball training in gym — fitness, sport and exercising concept - group of people with medicine balls training in gym

Can Tabata training help burn more calories during and after workouts for individuals who do interval training?

Table of Contents

Tabata Training

Also known as the Tabata Protocol, Tabata training can bring variety to workouts, burn more calories, and get more out of exercise time. This workout is a form of high-intensity interval training, or HIIT, designed to increase heart rate in the hard anaerobic zone for short periods. The intervals are short, the workouts are fast, and the body benefits. The recommendation is to add Tabata training once a week to see how the body responds.

Protocol Format

This HIIT workout is so effective because of the work-to-rest ratio. Individuals only get 10 seconds of rest between each 20-second session of exercise. That short interval is insufficient to recover fully, but it is great for building endurance and getting in shape. The format consists of:

Twenty seconds of a very high-intensity exercise – sprints, burpees, squat jumps, etc.
Ten seconds of rest.
Repeat eight times for a total of 4 minutes (Emberts, T. et al., 2013)

Energy Systems

Tabata training can improve two of the body’s main energy systems. It targets the anaerobic energy system responsible for short, high-intensity exercises like sprints and the aerobic energy system for endurance exercises like long, slow running. In traditional interval training, moderate intensity and steady-state cardio target the aerobic system. Still, unless the individuals work way out of their comfort zone, they don’t necessarily improve the anaerobic system. (Astorino, T. A. et al., 2012) However, high-intensity interval training with a rest period shorter than the work period can target both systems, providing benefits for athletes and fitness enthusiasts. (Tabata, I. et al., 1996)

Safety Precautions

However, these workouts are not for everyone. Tabata training is advanced and best suited to athletes and experienced fitness enthusiasts. Beginners should start with lighter interval training and gradually work their way up to this level of intensity. Try 20 seconds on/10 seconds off with easier exercises like walking or low-impact moves like marching in place, step touches, or knee lifts.

Workout Tips

Individuals can do Tabata training with almost any activity or cardiovascular machine. This Tabata cardio workout includes a variety of bodyweight exercises that, if done at full intensity, will increase heart rate.

Warm-Up

Before trying this type of workout, ensure the body is thoroughly warmed up for at least 10 minutes.

Start Slow

Individuals new to this type of training start with 5 to 6 cycles of each exercise and increase rest to 20 or 30 seconds.
As the body gets used to the workout and builds stamina, gradually shorten the rest periods and increase the number of cycles.

Rest Between Sets

Individuals who do more than one Tabata set as many workouts call for rest for at least 60 seconds between sets.

Monitor Intensity Frequently

Intensity accumulates through each cycle, peaking at the end of the workout when muscles are tired, and form becomes sloppy, increasing the risk of injury.

Take Rest Days

The recommendation is that the workout be done no more than 1 to 2 times a week, with rest in between, to avoid overtraining and injury.

Listen to your body when doing any high-intensity exercise. High-intensity interval training is very taxing on the body, so it’s easy to overdo it if you’re not careful. If you feel too breathless, extend recovery times or take extra breaks. If you are in pain or discomfort, take a break, try different exercises, or stop for the day.

Injury Medical Chiropractic and Functional Medicine Clinic

Injury Medical Chiropractic and Functional Medicine Clinic treats patients’ injuries and chronic pain syndromes. We focus on improving ability through flexibility, mobility, and agility programs tailored to the individual. We use in-person and virtual health coaching and comprehensive care plans to ensure every patient’s personalized care and wellness outcomes. Our providers use an integrated approach to create customized care plans that include Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine principles. Our goal is to relieve pain naturally by restoring health and function to the body. If he feels the individual needs other treatment, they will be referred to a clinic or physician best suited for them as Dr. Jimenez has teamed up with the top surgeons, clinical specialists, medical researchers, and premier rehabilitation providers to provide our community with the best clinical treatments.

Improving Athletic Performance Through Chiropractic

References

Emberts, T., Porcari, J., Dobers-Tein, S., Steffen, J., & Foster, C. (2013). Exercise intensity and energy expenditure of a tabata workout. Journal of sports science & medicine, 12(3), 612–613.

Tabata, I., Nishimura, K., Kouzaki, M., Hirai, Y., Ogita, F., Miyachi, M., & Yamamoto, K. (1996). Effects of moderate-intensity endurance and high-intensity intermittent training on anaerobic capacity and VO2max. Medicine and science in sports and exercise, 28(10), 1327–1330. doi.org/10.1097/00005768-199610000-00018

Astorino, T. A., Allen, R. P., Roberson, D. W., & Jurancich, M. (2012). Effect of high-intensity interval training on cardiovascular function, VO2max, and muscular force. Journal of strength and conditioning research, 26(1), 138–145. doi.org/10.1519/JSC.0b013e318218dd77

How to Make Ramen Noodles Healthier and More Nutritious

Dr. Alex Jimenez

Are there ways to make ramen noodles healthier for those who enjoy them?

Table of Contents

Ramen Noodles

Instant ramen noodles are dehydrated noodles flavored with powders. They are inexpensive and easy to prepare by adding hot water. However, these packaged noodles are high in fat and sodium. One package of ramen noodles has around 1,330 milligrams of sodium. (U.S. Department of Agriculture, 2019) However, a ramen meal can be made healthier by adding a source of protein and a serving of vegetables.

Nutrition

Ramen noodles have about 190 calories, 27 grams of carbohydrates, and 7 grams of total fat, including 3 grams of saturated fat. Unfortunately, they do not have any health benefits other than containing iron, which is necessary for moving oxygen throughout the body and preventing fatigue and anemia or iron deficiency. (Miller J. L. 2013) Because these noodles are low in fiber and nutrients, which are important factors in losing weight, they do not help with weight loss. The high sodium content can lead to bloating and water retention, which is not helpful when losing weight.

Healthy Ramen Makeover

Individuals can improve their nutritional value by adding ingredients low in calories and high in nutrients. This way, individuals can still have an inexpensive meal that isn’t entirely bad while increasing the volume. Adding chicken and vegetables adds vitamins and protein without much fat. Although each serving is still around 200 calories, it contains only 4.5 grams and less than 2 grams of saturated fat. This also increases the fiber from 1 gram to about 2.5 grams, adding vitamin A, lutein, and B vitamins. (U.S. Department of Agriculture, 2019) Adding vegetables and lean meats adds volume to the meal and helps increase the feeling of being full. (Mayo Clinic, 2024)

Recipe

A recipe for noodles with healthy fats, vitamins, minerals, and fiber.

Package of ramen noodles or cup of noodles.
One cup of cooked chicken breast.
One cup of frozen mixed vegetables like peas, carrots, and onions or a combination.
Prepare the noodles by cooking one package in three cups of boiling water until the noodles are soft.
Add the flavor packet.
Add cooked chicken breast meat and frozen vegetables.
Stir until vegetables are heated thoroughly.
Complete the meal with a small salad dressed with olive oil, vinegar, or light salad dressing.

Try out other Recipes

Try other proteins, vegetables, and flavorings. Shrimp or cooked fish can add healthy omega-3 essential fatty acids (Swanson, D. et al., 2012), or vegetarian protein like tofu or legumes for added protein. Enhance the flavor with sesame oil, mushrooms, bean sprouts, etc. Reduce the amount of powder from the flavoring pack to reduce sodium even more. To compensate for the loss of flavor, try supplementing with garlic, pepper, or favorite herbs. For those who prefer the cups of noodles, remember each cup is two servings. Prepare a cup of hot water and place the noodles on top of cooked vegetables and meat.

Injury Medical Chiropractic and Functional Medicine Clinic

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

Atherosclerosis: The Joint Pain Connections

References

U.S. Department of Agriculture. FoodData Central. (2019). Nissin, Top Ramen, Ramen Noodle Soup, Chicken. Retrieved from fdc.nal.usda.gov/fdc-app.html#/food-details/410139/nutrients

Miller J. L. (2013). Iron deficiency anemia: a common and curable disease. Cold Spring Harbor perspectives in medicine, 3(7), a011866. doi.org/10.1101/cshperspect.a011866

Mayo Clinic. (2024). Weight loss: Feel full on fewer calories. www.mayoclinic.org/healthy-lifestyle/weight-loss/in-depth/weight-loss/art-20044318

Swanson, D., Block, R., & Mousa, S. A. (2012). Omega-3 fatty acids EPA and DHA: health benefits throughout life. Advances in nutrition (Bethesda, Md.), 3(1), 1–7. doi.org/10.3945/an.111.000893

The Power of Osmotic Laxatives: Relieving Constipation Effectively

Dr. Alex Jimenez

man-doctor-and-insurance-report-with-talk-and-sen-2023-11-27-04-49-30-utc_02 — Man, doctor and insurance report with talk and senior professional at a hospital for health. Wellne.

For individuals dealing with constipation issues, can using an osmotic laxative help treat and prevent constipation?

Table of Contents

Osmotic Laxative

Osmotic laxatives can help treat or prevent constipation by increasing the amount of water in the colon, softening stools, and making them easier to pass. Some osmotic laxatives are used for bowel preparation to help clear the colon before a colonoscopy. They are available over the counter and by prescription and can contain different active ingredients, including polyethylene glycol/PEG, lactulose, sorbitol, magnesium citrate, and magnesium hydroxides.

How They Work

Constipation occurs when stools are irregular and hard to pass, as they are usually hard and dry. An osmotic laxative helps relieve constipation by increasing the amount of fluid in the intestines. They pull water from the colon’s wall to the inside, softening stools and making them easier to pass. The term osmotic refers to the movement of fluids through a membrane with the concentration equal on both sides. In individuals with constipation problems, the concentration of water in the colon’s wall and the inside of the colon/lumen is balanced but insufficient to compensate for hard, dry stools. This is especially true of those who don’t drink enough water. Osmotic laxatives alter the balance with substances like salts, sugars, and other organic compounds to encourage water movement into the lumen.

How Are They Different?

Most laxatives are generally used for the treatment of occasional constipation. Osmotic laxatives work differently because they are used to prevent or treat chronic constipation. Other types of laxatives include:

Emollient

These are made with a surfactant called docusate.
Surfactants are substances that draw and spread fats and water.
Docusate increases the passage of water and fats into stools to soften them.

Lubricant

These are made with oily substances, like mineral oil, that help the stool slide through the intestine.

Stimulant

These laxatives relieve constipation by causing the intestines to contract and push out the stools.

Osmotic Laxatives

The common osmotic laxatives are made with different active ingredients that include:

Polyethylene Glycol – PEG

This organic compound is derived from petroleum and can be safely ingested to manage constipation.
Available over the counter.
These include Miralax and GlycoLax.

Lactulose

This is a type of sugar that is not absorbed by the intestine.
Instead, the sugar sits and ferments in the intestines, producing fatty acids that pull water into the lumen.
Available by prescription, including Cephulac, Duphalac, Kristalose, and others.

Sorbitol

This is also a non-absorbable sugar with activation similar to lactulose.
Over-the-counter and prescription versions include Arlex and GeriCare.

Magnesium Citrate

Magnesium citrate is magnesium in salt form combined with citric acid.
The salts help pull water into the lumen.
Over-the-counter versions include Citrate of Magnesia, Citroma, and LiquiPrep.

Magnesium Hydroxide

This milder form of magnesium is sold under the brand Milk of Magnesia.
Milk of Magnesia is also an antacid and is available over the counter.

Potential Side Effects

As with all medications, there can be potential side effects. Most are relatively mild and resolve independently within a few days. Common side effects include:

Abdominal cramping
Bloating
Nausea
Diarrhea
Flatulence

Overusing laxatives can cause dehydration and the loss of electrolytes like sodium, calcium, potassium, minerals the body needs to regulate heartbeat, muscle contractions, and other essential functions. (Tropini, C. et al., 2018) Consult with a healthcare provider to ensure you use any laxative correctly, whether over-the-counter or prescription. For those thinking about using osmotic laxatives, be sure to follow the dosing instructions carefully, avoid complications, and use only when needed. Individuals with chronic constipation should see a healthcare provider so that they can identify the underlying cause. Diet, exercise, and increased fluid intake can sometimes improve the condition. Others may require treatments that extend beyond the use of laxatives.

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to create personalized treatment programs. We passionately focus on treating patients’ injuries and chronic pain syndromes. Using an integrated approach to improve ability through flexibility, mobility, and agility programs tailored to the individual. Our providers use Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine principles. Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers if other treatments are needed. Our goal is to relieve pain naturally by restoring health and function to the body.

Poop Testing: What? Why? and How?

References

Tropini, C., Moss, E. L., Merrill, B. D., Ng, K. M., Higginbottom, S. K., Casavant, E. P., Gonzalez, C. G., Fremin, B., Bouley, D. M., Elias, J. E., Bhatt, A. S., Huang, K. C., & Sonnenburg, J. L. (2018). Transient Osmotic Perturbation Causes Long-Term Alteration to the Gut Microbiota. Cell, 173(7), 1742–1754.e17. doi.org/10.1016/j.cell.2018.05.008

Managing Gluteal Contusion: Rest and Rehabilitation

Dr. Alex Jimenez

Sports, soccer and soccer player with team and soccer ball in power kick while playing on soccer fi.

For individuals and athletes with a gluteal contusion with severe bruising, can a healthcare provider determine if there are any other injuries to underlying structures, including muscle or tendon tears?

Table of Contents

Gluteal Contusion

A gluteal contusion is an injury, in this case, a bruise to the buttocks’ gluteal muscles caused by damage to muscle fibers and blood vessels. A buttock bruise is caused by direct bodily impact, typically from falls, automobile collisions, accidents, bumping into something, or being struck by an object or person. Like all bruises, a gluteal bruise most often results in pain and visible discoloration of the skin at the injury site, varying in severity from grade I to grade III, with higher-graded bruises requiring more time to heal. Most butt bruises can heal on their own with time and rest, but if bruising is severe, individuals may require physical therapy to restore full muscle function.

Symptoms

A contusion is a muscle injury that can affect the body’s skeletal muscles. A gluteal contusion can be painful, with a black and blue mark that changes color over time. Other symptoms may include: (Mount Sinai, 2024)

Tenderness to touch over the injury site
Increased pain with contraction of the glutes
Swelling
Discomfort with sitting

Causes

A contusion occurs from direct trauma and forceful impact on the gluteal muscles, causing damage to underlying blood vessels, muscle fibers, and sometimes bone, resulting in bleeding under the skin. (MedlinePlus, 2016) Direct impacts to the gluteal muscles that can cause a contusion include:

Falls
Car accidents
Direct hits to the buttocks from a piece of sports equipment or person.
Bumping into furniture, a door, or a counter.
Intramuscular injections into the gluteal muscles.
Individuals who take blood thinners or anticoagulant medication have an increased risk of bruising from direct contact injuries.

Diagnosis

A gluteal contusion is usually diagnosed through a physical examination and is generally straightforward to diagnose based on physical appearance, symptoms, and type of injury. Contusions can be graded based on the severity according to the following criteria (Fernandes, T. L. et al., 2015)

Grade I

An injury that affects only a small amount of muscle fibers, resulting in minimal pain, tenderness, and possible swelling.
Causes minimal or no loss of strength in the affected muscle or range of motion limitations.
Muscle use is typically unaffected.

Grade II

An injury that causes significant damage to muscle fibers, resulting in increased pain and impaired muscle contraction.
A small muscle defect can be felt to the touch.
Discoloration increases over the first few days after injury.

Grade III

An injury that involves extensive muscle fiber damage and bleeding across an entire area of a muscle that results in severe, and sometimes total, loss of muscle function.
Causes severe pain and significant discoloration of the skin.

When contusions are larger, deeper, and involve significant blood pooling and swelling, they are called hematomas.
If the bruising is severe, a diagnostic ultrasound, CT scan, or MRI may be used to determine whether any underlying structures are damaged.

Treatment

Contusions are generally mild injuries. Treatment typically involves rest to allow the muscles to heal from the bleeding and the bruising to dissipate.

Applying ice to the injury site can help relieve pain and inflammation.
If the bruising is severe, significant physical activity like sports, dancing, running, jumping, and weight lifting should be avoided until the muscles heal. (Mount Sinai, 2024)
With more severe bruising, contraction and stretching of the glutes are painful and can require longer healing and recovery time.
Physical therapy rehabilitation may be needed for more significant injuries to restore muscle function.

Prognosis

A mild injury usually heals on its own with time and rest. More significant injuries take longer to heal and may require physical therapy to build strength and range of motion if muscle function is affected.

Healing Time and Recovery

Healing and recovery times for gluteal contusions vary depending on the severity of the injury (Fernandes T. L. et al., 2015)

Grade I

Minor injuries that cause minimal discomfort typically heal fully in five days to two weeks.

Grade II

During the first two to three days, contusions develop, increasing discoloration under the skin, and complete healing can take two to three weeks.
Return to sport is typically resumed after a month.

Grade III

Contusions can take up to four to six weeks to heal, often requiring rehabilitation to restore muscle strength and range of motion.

Injury Medical Chiropractic and Functional Medicine Clinic

At Injury Medical Chiropractic and Functional Medicine Clinic, we passionately focus on treating patients’ injuries and chronic pain syndromes. We focus on improving ability through flexibility, mobility, and agility programs tailored to the individual. We use in-person and virtual health coaching and comprehensive care plans to ensure every patient’s personalized care and wellness outcomes. Our providers use an integrated approach to create personalized care plans that include Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine principles. Our goal is to relieve pain naturally by restoring health and function to the body. If he feels the individual needs other treatment, they will be referred to a clinic or physician best suited for them as Dr. Jimenez has teamed up with the top surgeons, clinical specialists, medical researchers, and premier rehabilitation providers to provide our community with the best clinical treatments.

Building a Stronger Body

References

Mount Sinai. (2024). Bruise. www.mountsinai.org/health-library/injury/bruise

MedlinePlus. (2016). Bruises. Retrieved from medlineplus.gov/bruises.html

Fernandes, T. L., Pedrinelli, A., & Hernandez, A. J. (2015). MUSCLE INJURY – PHYSIOPATHOLOGY, DIAGNOSIS, TREATMENT AND CLINICAL PRESENTATION. Revista brasileira de ortopedia, 46(3), 247–255. doi.org/10.1016/S2255-4971(15)30190-7

Using the Oswestry Disability Index to Evaluate Lower Back Pain

Dr. Alex Jimenez

Can the Oswestry Low Back Pain Disability Questionnaire help assess how low back pain impacts individuals’ ability to perform everyday tasks and activities and help physical therapists incorporate the outcome measure into an effective treatment plan?

Oswestry Disability Questionnaire

The Oswestry Disability Questionnaire, also known as the Oswestry Disability Index, provides objective data about an individual’s lower back pain. It determines the severity of the pain and how much it limits their daily activities. The questionnaire is a validated measure backed by research that can be used to justify the need for medical treatment. It includes questions regarding the symptoms and severity of low back pain and how these symptoms interfere with regular activities. Lower back pain can result from various causes (National Institute of Neurological Disorders and Stroke, 2020)

Poor posture
Pregnancy
Low back muscle strain
Muscle imbalances
Bulging discs
Herniated discs
Nerve root compression
Sacroiliac joint dysfunction
Arthritis, including inflammatory types of arthritis like psoriatic arthritis and ankylosing spondylitis.
Lumbar vertebrae compression fractures – usually from trauma or osteoporosis.
Low back surgery – including spinal fusions, discectomies, and laminectomies.
Spinal stenosis
Spondylolisthesis
Scoliosis

How The Questionnaire Works

The Oswestry Disability Questionnaire consists of 10 questions about the impact of lower back pain on daily life. The questions are divided into the following categories: (American Academy of Orthopedic Surgeons, N.D.)

Pain Intensity

How intense is the pain?
If painkillers are used, how much symptom relief do they provide?

Personal Care

Can the patient perform self-care activities like bathing and dressing when experiencing significant pain or limitations?
Whether physical assistance from another person is needed?

Lifting

Can the patient lift objects like weights with or without pain?
Can lifting be performed from the floor or a higher surface like a table if the objects are light, moderate, or heavy?

Walking

If and to what extent does the pain limit the patient’s walking distance and independence?
If an assistive device like a cane or crutches are needed?

Sitting

If so, how much pain limits the patient’s sitting tolerance?

Standing

If so, how much pain limits the patient’s standing tolerance?

Sleeping

If so, how much pain limits a patient’s sleeping duration?
Whether pain medication is needed to help the patient sleep comfortably?

Social Life

If and to what extent a patient’s social activities are limited because of pain symptoms?

Traveling

If so, to what extent does pain limit a patient’s ability to travel?

Employment and/or Homemaking Duties

Does pain limit a patient’s ability to perform job-related and/or household activities, including physically demanding and light duties?

Patients self-report the information and complete it on their own based on their understanding of the extent of their lower back pain and disability.
Each question can be scored between 0 and 5, with 0 indicating no limitations and 5 indicating complete disability.
The scores from all the questions are added together for a cumulative total score of 50 points.

Scores

The Oswestry Disability Questionnaire assesses how much a patient’s lower back pain limits daily activities. This information is used in clinical documentation for medical services. A higher score indicates a greater level of disability, according to the following scoring criteria:

0–4: No disability
5–14: Mild disability
15–24: Moderate disability
25–34: Severe disability
35–50: Completely disabled

Physical therapists must create individualized goals for each patient to develop a treatment plan and receive authorization from insurance companies. One of the most important aspects of a physical therapy goal is that it must be measurable. The Oswestry Disability Questionnaire provides a numerical score to track functional limitations and monitor the range of motion and strength testing. A baseline measurement is taken at the beginning of treatment, and progress is tracked in follow-up visits. A new score is used as a treatment goal. According to a study, the minimal clinically important difference (MCID) for the Oswestry Disability Questionnaire is 12.88. The MCID is the minimum score healthcare providers need to confirm a patient’s progress in function due to treatment. (Johnsen, L. G. et al., 2013)

By tracking changes in the total score before, during, and after treatment, healthcare providers can better assess whether treatment improves symptoms. A decrease in total score by 13 points or more would indicate that treatment is helping to improve a patient’s lower back pain and level of disability. Along with physical examination results, the patient’s score and the severity of symptoms can help healthcare providers determine an appropriate treatment plan.

No Disability

Treatment is unnecessary other than providing advice for lifting mechanics and general physical activity to maintain health.

Mild Disability

Conservative measures, such as physical therapy, exercise, hot or cold therapy, pain medication, and rest, are needed to help alleviate symptoms.

Moderate Disability

More aggressive intervention is needed, which can include extensive physical therapy services and pain management.

Severe Disability

Significant medical intervention is needed, including surgery, pain management, equipment like wheelchairs, and help from a caretaker.

Completely Disabled

Patients are either bedbound or have worsening symptoms, and a caretaker is needed to complete daily activities and self-care tasks.

Injury Medical Chiropractic and Functional Medicine Clinic

Improvements in range of motion, strength, and quality of movement and a decrease in total score can help show the treatment’s positive impact in managing lower back pain. A thorough medical exam and diagnostic tests, such as X-ray, MRI, or EMG, can help determine the underlying causes, discover the cause of the problem, and develop an effective treatment plan. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop personalized treatment programs. Using an integrated approach to treating injuries and chronic pain syndromes to improve flexibility, mobility, and agility and help individuals return to normal activities. Our providers use Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine principles. If other treatments are needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers.

Optimizing Your Wellness

References

National Institute of Neurological Disorders and Stroke. (2020). Low Back Pain Fact Sheet. Retrieved from www.ninds.nih.gov/sites/default/files/migrate-documents/low_back_pain_20-ns-5161_march_2020_508c.pdf

American Academy of Orthopedic Surgeons. (N.D.). Oswestry Low Back Pain Disability Questionnaire. www.aaos.org/globalassets/quality-and-practice-resources/patient-reported-outcome-measures/spine/oswestry-2.pdf

Johnsen, L. G., Hellum, C., Nygaard, O. P., Storheim, K., Brox, J. I., Rossvoll, I., Leivseth, G., & Grotle, M. (2013). Comparison of the SF6D, the EQ5D, and the oswestry disability index in patients with chronic low back pain and degenerative disc disease. BMC musculoskeletal disorders, 14, 148. doi.org/10.1186/1471-2474-14-148

Choosing the Right Rheumatologist for Back Pain

Dr. Alex Jimenez

African american doctor looking at senior woman near spine model in clinic

Back pain is one of the most common reasons for seeking health care. Individuals dealing with back pain but don’t know the cause may have some inflammatory joint disease or autoimmune condition. Can seeing a rheumatologist help?

Table of Contents

Rheumatologist

Depending on what’s causing the back pain, individuals may need to see their primary doctor for a referral. Individuals are recommended to see a rheumatologist if they have back pain that doesn’t come from an injury that doesn’t go away after a few weeks, pain that comes back after treatment, or symptoms that suggest a rheumatic condition. Rheumatologists treat severe or persistent back pain and are experts in autoimmune diseases, including lupus, Sjogren’s syndrome, rheumatoid arthritis, ankylosing spondylitis, axial spondylitis, Psoriatic arthritis, and other forms of inflammatory or autoimmune arthritis.

What Do They Do?

A rheumatologist is an internist or pediatrician who has completed special training in treating conditions that are:

Inflammatory
Autoimmune
Related to painful joint disease

The doctors diagnose, treat, and manage these conditions long-term. Depending on diagnosis and care needs, they may also lead or be part of a team that includes other healthcare providers.

Symptoms

When muscles ache, pain presents, or joints hurt, and especially if there are signs of inflammation that don’t go away, seeing a healthcare provider is recommended. Symptoms of inflammation include:

Redness
Swelling
Pain
Stiffness
Loss of joint function

Usually, to see a rheumatologist, individuals need a referral from their primary care provider and may be referred when:

There is no evidence of a back injury.
At-home therapies like heat application, prescription medications, or physical therapy are unsuccessful.
There is uncertainty about what’s causing the back pain, but I suspect it’s rheumatological.
Blood tests for inflammatory markers or certain antibodies yield abnormal results.
There is a diagnosis of a rheumatic condition and recommend a specialist to manage it.
There is a family history of a rheumatic or autoimmune condition that may cause back pain.
There is a chronic pain condition that later develops back pain (Hospital for Special Surgery, 2023)

Individuals may also be referred to a rheumatologist if their back pain is accompanied by:

Pain in multiple parts of the body
Red, swollen joints
Fatigue
Skin rashes
Fever
Pain and inflammation that come and go (Yale School of Medicine, 2021)
Fingers that turn blue or ache when exposed to the cold
Unexplained weight changes (National Institute of Arthritis and Musculoskeletal and Skin Diseases, 2023)
Dry eyes and mouth

Some types of arthritis can cause permanent, progressive joint damage.

Conditions

Conditions that can affect the spine and cause back pain and are treated by a rheumatologist include: (Johns Hopkins Medicine, 2024)

Rheumatoid arthritis (RA)

This often starts in smaller joints of the hands and feet and later moves to the neck and/or back.
It can also affect different body organs and have systemic symptoms.

Ankylosing Spondylitis (AS)

Primarily a disease of the spine, it may also impact the shoulders, hips, knees, and ankles.
Systemic symptoms, including fever and fatigue, can manifest.

Axial Spondylitis

This primarily affects the spine, chest, and pelvis.
It may also cause problems with the connective tissue, eyes, bowel, and skin.

Psoriatic Arthritis (PsA)

Pain in the lower back is common, especially in severe cases.
It can affect other joints and cause psoriasis.

Reactive Arthritis

This is a reaction to infection.
It is more common in the limbs, hands, and feet joints but can involve the spine.

Enteropathic Arthritis

This mainly affects the spine but can include other joints.
It is associated with inflammatory bowel disease.

Autoimmune diseases that don’t specifically target the spine but can also cause back pain include:

Lupus
Sjögren’s syndrome
Hashimoto’s thyroiditis

Finding a Doctor

Individuals may be fine with their primary healthcare provider’s choice regarding which rheumatologist to see. However, they may want to research other options to ensure the right rheumatologist is chosen. Things to look at include:

Search online medical directories.
Visit the websites of the doctors being considered to learn more about their training, approach, and specialties.
Check online reviews.
Check on health insurance coverage.
Ask members of the healthcare team, friends, and family for recommendations.
Contact rheumatologists’ offices to see if they are accepting new patients.
Once decided, pass along the information to the primary care doctor so they can make the referral.

Preparing For The Initial Visit

Before seeing a new rheumatologist, take a few minutes to prepare so you can make the most of the appointment. Individuals will want to have:

A list of back-related symptoms, including frequency and severity.
A list of what makes symptoms better or worse.
A copy of recent test results and records from other doctors.
Individuals can ask their provider/s to send their medical information to the rheumatologist’s office in advance.
A list of treatments that have been tried and how well they worked.
A list of all medications, over-the-counter and prescription, supplements, and herbal products taken.
A list of medication allergies.
Complete medical history and family history of potentially related diseases.
A list of any questions regarding conditions, treatment, etc.
If possible, fill out any paperwork for the new office beforehand to save time on the appointment day.

Injury Medical Chiropractic and Functional Medicine Clinic

Talking with a healthcare provider is important. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop personalized treatment programs. Using an integrated approach to treating injuries and chronic pain syndromes to improve flexibility, mobility, and agility and help individuals return to normal activities. If other treatments are needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers.

Quick Patient Initiation Process

References

Hospital for Special Surgery. (2023). What Is a Rheumatologist and What Conditions Do They Treat? www.hss.edu/conditions_what-is-a-rheumatologist.asp#when

Yale University School of Medicine. Dee, J. E. (2021). 5 reasons why a patient should see a rheumatologist. medicine.yale.edu/news-article/5-reasons-to-see-a-rheumatologist/

National Institute of Arthritis and Musculoskeletal and Skin Diseases. (2023). Autoimmune diseases. Retrieved from www.niams.nih.gov/health-topics/autoimmune-diseases

Johns Hopkins Medicine. (2024). Spinal arthritis (arthritis in the back or neck). www.hopkinsmedicine.org/health/conditions-and-diseases/spinal-arthritis

Household Tasks and Back Health: Ergonomic Tips

Dr. Alex Jimenez

Cleaning and dancing in apartment — Happy young couple dancing and cleaning the house using vacuum and mop.

It can be challenging for individuals trying to keep their homes clean with chronic back pain. Can learning and proper body mechanics help manage household responsibilities without aggravating pain symptoms?

Table of Contents

Household Chores

Household-related back problems usually occur because we don’t take the time to consider how to move and perform the tasks from a musculoskeletal perspective to avoid and prevent injuries. Most ergonomic tips for household chores revolve around the same ideas for athletes and fitness enthusiasts: maintain a neutral spine, avoid twisting when possible, strengthen the body’s core, take regular breaks, stretch, and don’t overdo it. A healthy body mechanics system works for those who garden as well. Using strategies like cleaning a little here and there instead of taking an entire day whenever possible and organizing tools ahead of time along with training oneself how to perform them in a way that the spine, back muscles, and the entire body are protected from injury, pain, sciatica, or re-injury. However, implementing proper body mechanics requires a willingness to become aware of how each task is performed and to retrain the body where necessary to a healthier method/technique and a happier household.

Vacuuming

Vacuuming is one of those chores that can quickly lead to a habitual bent-over posture. This is not recommended for the spine’s health; slouching, whether from a position held for a sustained period of time or an activity that requires repetition, can lead to problems with the intervertebral discs and pain symptoms. (Nazari J., Pope M. H., and Graveling R. A. 2012) Another posture that individuals tend to engage in is vacuuming with an overly straight back. Like slouching, keeping the spine rigidly over-extended while vacuuming can irritate the spine and cause muscle spasms. It can also increase the normal low back curve, which, in turn, may lead to extra tightness and a painful back.

Vacuuming with healthy body mechanics includes employing a minimal lunge that stays pain-free and does not extend beyond the comfortable position. Individuals should place one foot in front of the other for a short distance. The stance is similar to the way fencers position themselves. This allows a shift forward and back during the vacuuming process instead of bending or rounding over at the spine. For those with sacroiliac joint issues, the forward placement of one leg may be more comfortable than the forward placement of the other. Try out and use the side that feels comfortable, and stick with that. Do not work in pain or through the pain. Switching legs and/or arms can help avoid muscle fatigue or injury triggers. Place the non-vacuuming hand on the thigh in front to help take the weight and pressure off the back. Maintain the pelvis in a level position when working. Another strategy for those who can get up and down from the floor without trouble is to vacuum while kneeling on one knee. This brings the body’s center of mass closer to the floor, reducing the degree to which the body has to deal with the force of gravity. Kneeling while vacuuming may also help prevent rounding over at the spine.

Dusting

When dusting, reduce the load off the back by propping the inactive arm on the item or area being cleaned. Alternatively, prop the arm on the thigh.

Laundry

In a large household, it is very easy to overdo laundry and trying to finish up as much as possible can lead to pain symptoms and injuries. If possible, break up the loads that must be lifted or carried into smaller bundles that weigh less. This can mean more loads, but the strategy protects the back and spine. Avoid extremes in the spinal position; don’t round over at the spine or keep it rigid and over-extended. Lift with the legs and protect the discs. Adjustments that can be made to the basic lift with the leg and not the back strategy include putting the laundry basket on a table or chair that is preferably the same height as the washer or dryer. This will minimize bending. To relieve pressure on the back, use one hand to load the washer, dryer, or laundry basket while using one of the appliances to prop the other hand.

Dishes

During dishwashing, use a small step stool or box to help prevent injury and/or relieve pain. Place it in the cabinet under the sink and rest one foot on it. This strategy can work well for those with sacroiliac joint problems, especially if the foot on the pain-free side is the one placed on the box or stool. Ensuring foot placement reduces pain and discomfort and does not cause pain. Using a box or stool can also help with core stability. Core stability is one of the best ways, in general, to prevent injury and keep low back pain away. (Coulombe B. J., Games K. E., Neil E. R., and Eberman L. E. 2017) As the box is directly under the sink, the body has to firmly position itself against the counter, providing stability during the task. The box or stool will contract the pelvic and hip muscles and strengthen the core.

Sweeping

Many sweep, mop, and rake with their spines, which can be counterproductive to health, as twisting and bending simultaneously is a known risk factor for a herniated disc. (Shimia, M. et al., 2013) Use the arms and legs instead of overly involving the back during sweeping and raking. The idea is to reach and pull the broom or sweeper with the arms rather than twisting around to reach all the areas working with one leg in front of the other. When needing to change directions, pivot on the back leg, keeping the trunk relaxed, equivalent to a tai chi movement. Or, turn the whole body in different directions by taking small steps. Taking small steps or pivoting on the back leg to change the direction of the trunk and arms protects from overuse and extensive wear and tear.

Adjustments for a new method of household sweeping and raking include:

Sweeping or raking about 1 to 2 feet in front to avoid overreaching and strain.
Maintaining the spine in one long, flexible, but unbroken line.
The head, shoulders, rib cage, pelvis, knees, and feet should always face the same direction and be vertically balanced relative to one another.
This will mean changing directions by pivoting the back leg or moving the whole body around, taking small steps.
Consider using an ergonomically designed broom, sweeper, mop, rake, and other household tools. This will be a bend in the handle or stem to help avoid bending.

Injury Chiropractic and Functional Medicine Clinic

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop personalized treatment programs. We focus on what works for you and use an integrated approach to treating injuries and chronic pain syndromes to improve flexibility, mobility, and agility, relieve pain, and help individuals return to normal activities. Our providers use Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine principles. Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers if other treatments are needed.

Heel Spurs

References

Nazari, J., Pope, M. H., & Graveling, R. A. (2012). Reality about migration of the nucleus pulposus within the intervertebral disc with changing postures. Clinical biomechanics (Bristol, Avon), 27(3), 213–217. doi.org/10.1016/j.clinbiomech.2011.09.011

Coulombe, B. J., Games, K. E., Neil, E. R., & Eberman, L. E. (2017). Core Stability Exercise Versus General Exercise for Chronic Low Back Pain. Journal of athletic training, 52(1), 71–72. doi.org/10.4085/1062-6050-51.11.16

Shimia, M., Babaei-Ghazani, A., Sadat, B. E., Habibi, B., & Habibzadeh, A. (2013). Risk factors of recurrent lumbar disk herniation. Asian journal of neurosurgery, 8(2), 93–96. doi.org/10.4103/1793-5482.116384

Exploring Antalgic Gait: Causes and Solutions

Dr. Alex Jimenez

Mature woman exercising on physical therapy in rehab center — Stroke female patient learning how to walk with walking stick while therapist next to her helping in rehabilitation room

Individuals walking with a limp that results in pain could have an antalgic gait, an abnormal walking pattern commonly seen in emergency clinics and primary care offices. Can recognizing the symptoms help healthcare providers develop an effective treatment for the underlying cause?

Table of Contents

Antalgic Gait

Limping and having an antalgic gait usually indicate a larger issue within the leg or lower back. It is the most common type of abnormal gait. There are various causes of antalgic gait, including acute injuries and gradually progressing medical conditions. The most common causes include osteoarthritis in one of the leg’s joints, lumbar radiculopathy, or an injury to a ligament or tendon. Paying attention to when the limping occurs, and any accompanying symptoms can help determine its origins.

Walking

When limping, the stance phase during walking is shorter than the swing phase. To compensate for the imbalance, individuals may widen their legs apart to provide a support base. In severe cases, an individual may swing their leg irregularly or take several side steps.

Causes and Symptoms

Antalgic gait can be caused by pain in any part of the lower extremity. Limping when walking may be a primary concern but is rarely the only complaint. Other associated symptoms may also be present, depending on the cause. These include:

Limited range of motion
Joint stiffness
Muscular weakness
Numbness and tingling
Pain
Swelling
Leg instability or buckling
Clicking or popping

Common Causes include:

Hip, knee, and/or Foot problems

When the hip, knee, ankle, or foot joints are injured or have some issue, walking can be painful and lead to a limp.

Sprains, Strains, or Soft-tissue Injuries

Sprains, strains, and soft-tissue injuries can result from acute injury or chronic, repetitive activities over time. (Pirker W. and Katzenschlager R. 2017) Sprains affect the body’s ligaments, while strains impact muscle tendons. However, sprains and strains occur when the impacted structure is overstretched or partially torn. The damage can lead to pain and antalgic gait. An injury to several other soft-tissue structures, including a bursa or fluid-filled sacs that reduce friction, meniscus, or fat pad, can also lead to limping. Symptoms typically include swelling, pain, and limited range of motion. More severe injuries can also make the leg feel unstable and cause it to give way when walking. Sometimes, bruising can also occur in the area of the injury. (American Academy of Orthopaedic Surgeons, 2020)

Osteoarthritis

Osteoarthritis occurs when the smooth, articular cartilage that lines the ends of bones begins to thin and deteriorate. This can alter the normal movement of a joint and lead to pain. Osteoarthritis symptoms gradually progress, affect individuals over 50, and worsen after periods of sedentary activity (Arthritis Foundation, Osteoarthritis, N.D.) Typically, it results in pain, stiffness, clicking, and occasionally swelling in the affected joint. These symptoms are usually worse in the morning and at the end of a long activity day. Moving around and warming the joint improves osteoarthritis symptoms. (Arthritis Foundation, Osteoarthritis, N.D.)

Lower Back Radiculopathy

Lumbar radiculopathy is when the nerve roots branching off the spine’s lower region become compressed or inflamed. This can occur because of disc issues like bulging, degeneration, herniation, bone spurring, or, rarely, a growth or tumor. (Johns Hopkins Medicine, 2024) Because these nerves control movement, sensation, and strength in the legs and feet, irritation in one can lead to limping. (Yokogawa N. et al., 2015) The antalgic gait from this condition frequently comes on suddenly and is commonly accompanied by back pain symptoms. This can include shooting pain and paresthesia in the leg. Depending on which nerve is involved, individuals may also experience muscular weakness in certain areas of the lower extremity. Sometimes, the affected leg feels like it will buckle while standing or walking. (Johns Hopkins Medicine, 2024)

Other causes include:

Broken bones
Tumors
Infections
Blood clots
Vascular issues

Treatment

Treatment for antalgic gait depends on the underlying cause but can include:

Rest, ice, and elevation are important for injuries. Individuals can control their initial symptoms by icing, elevating the leg, and resting from irritating activities.
Activity modifications
Antibiotics for infections
Pain relievers
Anti-inflammatories
Physical therapy is also frequently initiated to strengthen the core and alleviate walking symptoms.
Chiropractic realignment
Non-surgical decompression
Acupuncture
A corticosteroid injection or joint replacement surgery may prove necessary in more advanced cases. (Arthritis Foundation, Osteoarthritis, N.D.)
A spinal injection or surgery can reduce the pressure on the nerve root if conservative interventions fail to improve antalgic gait patterns. (Johns Hopkins Medicine, 2024)
Crutches, canes, walkers, or assistive devices can reduce pressure traveling through an affected joint and improve overall walking quality. A study found that using a cane for two months helped reduce pain and improve function in individuals with knee osteoarthritis. (Fang M. A. et al., 2015)

Injury Medical Chiropractic and Functional Medicine Clinic

Though it can be tempting to ignore the limp and push through it, discussing the condition with a healthcare provider is important. A thorough medical exam and diagnostic tests, such as X-ray, MRI, or EMG, can help determine the underlying causes of a limp, help discover the cause of the problem, and help improve the quality of walking. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop personalized treatment programs. Using an integrated approach to treating injuries and chronic pain syndromes to improve flexibility, mobility, and agility and help individuals return to normal activities. Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers if other treatments are needed.

Chiropractic and Integrative Healthcare

References

Pirker, W., & Katzenschlager, R. (2017). Gait disorders in adults and the elderly : A clinical guide. Wiener klinische Wochenschrift, 129(3-4), 81–95. doi.org/10.1007/s00508-016-1096-4

Arthritis Foundation. (N.D.). Osteoarthritis. www.arthritis.org/diseases/osteoarthritis

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

Johns Hopkins Medicine. (2024). Radiculopathy. www.hopkinsmedicine.org/health/conditions-and-diseases/radiculopathy

Yokogawa, N., Toribatake, Y., Murakami, H., Hayashi, H., Yoneyama, T., Watanabe, T., & Tsuchiya, H. (2015). Differences in Gait Characteristics of Patients with Lumbar Spinal Canal Stenosis (L4 Radiculopathy) and Those with Osteoarthritis of the Hip. PloS one, 10(4), e0124745. doi.org/10.1371/journal.pone.0124745

Fang, M. A., Heiney, C., Yentes, J. M., Harada, N. D., Masih, S., & Perell-Gerson, K. L. (2015). Effects of contralateral versus ipsilateral cane use on gait in people with knee osteoarthritis. PM & R : the journal of injury, function, and rehabilitation, 7(4), 400–406. doi.org/10.1016/j.pmrj.2014.09.018

White Rice: An Essential Fuel for Athletes and Bodybuilders

Dr. Alex Jimenez

Closeup shot of cooked rice on a wooden plate with some parsley leaves and wooden chopsticks — A closeup shot of cooked rice on a wooden plate with some parsley leaves and wooden chopsticks

Can eating white rice as a primary carbohydrate source provide quick energy and glycogen replenishment for athletes and bodybuilders who require high volumes of carbohydrates for fuel and muscle recovery?

Table of Contents

Sports Nutrition White Rice

Athletes and bodybuilders often eat white rice to restore mass amounts of glycogen after an intense workout, race, or game. Brown rice is nutritious and recommended for overall health, but athletes and bodybuilders incorporate further nutritional guidelines for added fuel and performance. White rice is a starchy grain used by more than half the world’s population because of its versatility, availability, and ability to adapt to various flavors and seasonings. Its chewiness and soft texture add substance to and complement many meals.

Bodybuilders

Athletes and bodybuilders need macronutrients to fuel extreme training and replenish depleted glycogen stores. Carbohydrate-rich foods like white rice are high on the glycemic index (a score for how foods affect blood sugar and insulin levels) and provide a readily available source of carbohydrates for muscle glycogen synthesis. (Thomas, D. E. et al., 1991) White rice is considered excellent sports nutrition for athletes. (Melin, A. et al., 2016) Although white rice is considered less nutritious than brown rice, athletes and weightlifters consume it as part of their specifically developed nutrition plans. One of the most popular meals is a bowl of white rice combined with grilled chicken breast, providing lean protein. Endurance runners often load up on carbohydrates like white rice before marathons. Strenuous workouts deplete sugar/glycogen in the muscles. Eating the right carbohydrates is important to replenish those stores. Knowing how to improve carbohydrate availability during prolonged exercise is essential for athletes. (Burke, L. M. et al., 2011)

Fuel and Muscle Recovery

The high glycemic value of white rice provides quick fuel for hard workouts and expedites muscle recovery. It does not have the negative effects of potential gastrointestinal issues, allergy symptoms, or blocking the ability to absorb micronutrients. Brown rice contains phytic acid(located in the grain’s bran), an antinutrient that binds to essential minerals like iron, zinc, calcium, and magnesium and prevents the body from absorbing them. The milling process to change brown rice to white removes the phytate. Research is ongoing on degrading phytic acid in brown rice and whole grains, and some studies have found antioxidant benefits in phytate. This could increase the amount of carbohydrates that are safe for athletes. (Liang, J. et al., 2008)

Safe Carbohydrate

Athletes and bodybuilders with food sensitivity may have issues eating whole grains, as brown rice has more fiber. Extreme exercise requires a surplus of carbohydrates. For prolonged exercise lasting more than two hours, athletes should consume 60 grams per hour of carbohydrates. White rice is considered safe to consume before exercise as it is easy on the stomach and has been shown to meet sports nutrition recommendations.

Workouts

Rice contains more carbohydrates than potatoes for the same serving size. Parboiled, converted, and instant white rice can be eaten pre- and post-workout meals, ensuring the body is thoroughly fueled for training, competition, and recovery. However, white rice may not be the best option for sedentary individuals.

Brown Rice

Brown rice is healthier for bodybuilders who train less than four days per week or have a metabolic disease.
Brown rice is a nutrient-dense food recommended for everyday active individuals who can tolerate whole grains and is a rich source of fiber and nutrients essential for a well-balanced healthy diet.

Injury Medical Chiropractic and Functional Medicine Clinic

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop personalized programs. We focus on what works for you to enhance fitness and improve the body through research methods and total wellness programs. These programs strive to achieve improvement goals, and athletes can condition themselves to excel through proper fitness and nutrition. Our providers use Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine principles. An integrated approach improves flexibility, mobility, and agility. If further training or treatments are needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, trainers, medical researchers, and rehabilitation providers.

Sports Nutrition and Dietitian

References

Thomas, D. E., Brotherhood, J. R., & Brand, J. C. (1991). Carbohydrate feeding before exercise: effect of glycemic index. International journal of sports medicine, 12(2), 180–186. doi.org/10.1055/s-2007-1024664

Melin, A., Tornberg, Å. B., Skouby, S., Møller, S. S., Faber, J., Sundgot-Borgen, J., & Sjödin, A. (2016). Low-energy density and high fiber intake are dietary concerns in female endurance athletes. Scandinavian journal of medicine & science in sports, 26(9), 1060–1071. doi.org/10.1111/sms.12516

Burke, L. M., Hawley, J. A., Wong, S. H., & Jeukendrup, A. E. (2011). Carbohydrates for training and competition. Journal of sports sciences, 29 Suppl 1, S17–S27. doi.org/10.1080/02640414.2011.585473

Liang, J., Han, B. Z., Nout, M. J., & Hamer, R. J. (2008). Effects of soaking, germination and fermentation on phytic acid, total and in vitro soluble zinc in brown rice. Food chemistry, 110(4), 821–828. doi.org/10.1016/j.foodchem.2008.02.064

Hamstring Pain behind the Knee: Symptoms and Solutions

Dr. Alex Jimenez

brunette physiotherapist stretching leg of man training in rehabilitation center

Individuals dealing with symptoms like sudden pain, weakness, and tenderness in the back of the knee could have a hamstring injury. Can knowing the symptoms and performing self-care help bring relief?

Hamstring Pain Behind The Knee

The hamstrings consist of three long muscles that run down the back of the thigh, cross over the back of the knee, and connect to bones in that area. A hamstring injury, such as a strain or tear, tendonitis, or biceps femoris tendinopathy, can cause pain in the back of the knee, difficulty bending the knee, swelling, and bruising. A hamstring strain occurs when the muscle is stretched too far or torn completely. This can happen from sudden, forceful movements or overstretching. Hamstring tendonitis develops over time, usually after a sudden increase in activity, when the hamstring tissue cannot recover from too much loading. Pain is often felt after physical activity and exercise and, in severe cases, during the activity or throughout the day. Biceps femoris tendinopathy can also cause pain in the back of the knee. Strains, tendonitis, bursitis, and muscle tears are all possible explanations for a hamstring injury that leads to pain behind the knee. Discussing pain symptoms with a healthcare provider is recommended, especially if it occurs suddenly during physical activity or exercise. They can help identify the exact cause and offer guidance for rehabilitation, including physical therapy referrals.

Causes and Triggers

Individuals may experience hamstring pain behind the knee when the muscles in that area are overworked, inflamed, or injured, such as from activities like running, walking, dancing, soccer, or basketball. Possible types of injuries and their causes.

Tendonitis

The hamstring tendons connect behind the knee.
When the tendons become inflamed due to overuse, they can lead to swelling and pain that worsen with activity. (National Library of Medicine, 2017) (American Academy of Orthopaedic Surgeons, 2020)

Strain or Tear

A muscle strain occurs when the muscle is stretched too much, and the fibers tear.
A hamstring strain is also called a pulled hamstring. (American Academy of Orthopaedic Surgeons, 2021)

Bursitis

This is inflammation of tiny fluid-filled sacs that help cushion joints during movement.
Inflammation from bursitis can affect the nerves within the hamstring, resulting in pain. (American Academy of Orthopaedic Surgeons, 2020)

Pes anserine

This is a specific type of bursitis which affects the knee tendons. (American Academy of Orthopaedic Surgeons, 2021)

Muscle Overload

A primary cause of muscle strain occurs when the muscle is stretched too far or has to handle a sudden force like sprinting or kicking. (American Academy of Orthopaedic Surgeons, 2021)

Severe Cases

Most causes of pain behind the knee are easily treatable at home with self-care and rest. However, it can be more severe, signaling a blood clot, infection, torn muscle or tendon/ligament. Hamstring knee pain may be serious if any of the following is experienced (American Academy of Orthopaedic Surgeons, 2021)

Sudden pain during physical activity, often during a full stride.
Feeling a pop or sharp pain that causes falling or limping.
Pain that worsens over time and prevents or hinders walking or exercising as normal.

If pain is severe and does not improve with rest and anti-inflammatory medications, evaluation by a healthcare professional is necessary.

Assesses Hamstring Pain

A healthcare provider will ask about symptoms and injury, including what happened when the pain began. They will perform a physical examination, which may include pressing on the back of the thigh to look for swelling, bruising, tenderness, or bunched-up muscles. (American Academy of Orthopaedic Surgeons, 2021) The healthcare provider will ask the patient to perform specific resisted movements, such as the manual muscle test, and measure the range of motion. Diagnostic testing includes an X-ray or MRI to determine the degree of the injury and which soft tissues or bones may be involved.

Self-Care

The first line of treating hamstring knee pain is the RICE protocol, which includes: (Mount Siani, 2024)

Rest

Stop any activity that causes symptoms and pain.
A healthcare provider may recommend crutches or a knee scooter in severe cases.

Ice

Apply cold packs to the swollen or painful area for 20 minutes throughout the day.

Compression

A knee brace, wrap, or bandage that applies gentle pressure to the injured area can help reduce and prevent swelling.

Elevation

Lifting the leg higher than the heart will help reduce swelling and blood accumulation.
Individuals may need to lie on a bed or sofa and elevate their legs with pillows.

Individuals can use at-home pain relievers like acetaminophen or NSAIDs like ibuprofen or naproxen. Over time, and depending on the severity of the injury, a healthcare provider will advise on gentle hamstring stretches and how to ease back into physical activity.

Professional Therapy and Surgical Treatments

Depending on the severity of the condition, a healthcare provider may recommend additional interventions, that include (American Academy of Orthopaedic Surgeons, 2021)

Immobilization

A healthcare provider will advise immobilizing the knee to help with muscle healing, which could involve wearing a knee brace or using crutches.

Physical therapy

A healthcare provider may refer the patient to a physical therapist, who will perform a personalized evaluation and prescribe targeted exercises to heal the injury and regain strength, flexibility, and movement.

Surgery

Tendon avulsion injuries are when the hamstring tendon completely tears away from the bone, and surgery is required to reattach the tendon.

Platelet-rich plasma – PRP

Platelet-rich plasma has become an additional treatment for hamstring muscle strain or tendonitis. (Seow D. et al., 2021)
The treatment involves injecting a solution from the patient’s blood into the muscle to heal the injury.

Recovery

Predicting how long a hamstring injury takes to heal and how long the pain will linger depends on the type, location, and severity. The most severe type is the hamstring coming unattached around the knee. This surgical repair and rehabilitation take at least three months before returning to sports and exercise (American Academy of Orthopaedic Surgeons, 2021). Lesser injuries like tendonitis or a mild strain can take less time to heal. However, it’s essential to avoid reinjuring the area so the condition does not become chronic. This includes: (American Academy of Orthopaedic Surgeons, 2021)

Stretching to encourage and maintain flexibility.
Fixing muscle imbalances between the quadriceps and hamstring.
Endurance and conditioning.
Avoiding overuse.

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop personalized treatment programs. We focus on what works for you and use an integrated approach to treating injuries and chronic pain syndromes to improve flexibility, mobility, and agility, relieving pain and helping individuals return to normal activities. If other treatments are needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers. Our providers use Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine principles.

Chiropractic Care for Leg Instability

References

National Library of Medicine. (2017). Tendinitis Also called: Tendonitis. Retrieved from medlineplus.gov/tendinitis.html

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

American Academy of Orthopaedic Surgeons. OrthoInfo. (2021). Hamstring muscle injuries. orthoinfo.aaos.org/en/diseases–conditions/hamstring-muscle-injuries/

American Academy of Orthopaedic Surgeons. OrthoInfo. (2021). Pes aserine (knee tendon) bursitis. orthoinfo.aaos.org/en/diseases–conditions/pes-anserine-knee-tendon-bursitis/

Mount Siani. (2024). Hamstring strain – aftercare. www.mountsinai.org/health-library/selfcare-instructions/hamstring-strain-aftercare

Seow, D., Shimozono, Y., Tengku Yusof, T. N. B., Yasui, Y., Massey, A., & Kennedy, J. G. (2021). Platelet-Rich Plasma Injection for the Treatment of Hamstring Injuries: A Systematic Review and Meta-analysis With Best-Worst Case Analysis. The American journal of sports medicine, 49(2), 529–537. doi.org/10.1177/0363546520916729

Adjusting Your Work Office Chair to Alleviate Back and Hip Pain

Dr. Alex Jimenez

This Tension Is Tiring Me Out — An attractive business woman suffering from back pain while working on computer in a modern office.

Individuals who sit in an office chair for a long period naturally tend to slouch over or slouch down into the chair. This posture can overstretch the spinal ligaments, strain the discs and surrounding structures in the spine, and contribute to or worsen back pain. Can the right office chair settings help relieve and prevent future injuries?

Table of Contents

Work Office Chair

Sitting in an office chair for prolonged periods can cause lower back pain or worsen an existing back problem. The main reason behind this is that sitting is a static posture that increases stress in the back, shoulders, arms, and legs, putting pressure on the back muscles and spinal discs. Over time, incorrect sitting posture can damage the spinal structures. Most office chair customers base their decisions on availability, color, style, and price. However, it’s recommended that individuals learn about fitting seating equipment to their height, frame, or any condition, such as back or hip pain. The controls on or under the armrests and at the bottom of the chair seat, including the levers, paddles, and knobs, are there for a reason. Here are some recommendations for adjusting their work office chair to decrease back and hip pain.

Height Adjustment

The chair’s height affects the quadriceps, psoas, and hamstring muscles, which are important in posture-related back pain. Height adjustment is the primary way to change the angle of the hip joint while sitting. This angle affects the position of the pelvis and the degree of curve in the lower back, which can alter the spine’s normal alignment. (De Carvalho D. et al., 2017) Adjusting the chair’s height can provide a reference for other chair and workstation adjustments.

Back Angle

The hip angle is how close (increased hip flexion) or how far away (less hip flexion) the trunk is to the top of the thigh when sitting. Adjusting chair height can control the angle of the hip joint. When adjusting the height, adjust the degree of flexion at the hip joint to ensure ideal alignment for the individual body frame. A recent study measured the load that sitting has on simulated spinal discs. Researchers concluded that pressure on the spine can be relieved with a more open angle between the trunk and the thigh, that is, the hip joint angle. (Rohlmann A. et al., 2011) The backrest, seat tilt, and lumbar support features help maintain a pain-free back and relieve pressure and tension in the lower back and should be utilized.

Seat Depth

A kitchen chair, for example, may have no back supports or armrests to assist with posture and angle. (Holzgreve F. et al., 2022) When sitting, the individual’s back should be against the back of the work office chair for the best support and a healthy posture. Individuals will want to check and see how concave the seat surface is. If there is a prominent curve, this will cause the back to be rounded when sitting, which can become uncomfortable and lead to back pain. A chair with built-in support or a pillow can help adjust the depth. This means that chair size matters, as different people will need seats of varying depths to match their musculoskeletal structure.

Seat Height

Another way to understand the hip joint angle is to compare the height of the knees to the height of the hips. This is usually the easiest way to assess whether the chair height is right while adjusting. When the seat is right, the feet will be flat on the floor. The feet should reach the floor without causing pressure on the back of the thighs. Individuals with dangling feet, which may be because of their height, should place a footrest or thick book under them. The knees should be approximately level with or lower than the hips. In this case, the level is a 90-degree angle between the hip and trunk, which is stress-free on the hips and back.

Risks

Chair Too High

For individuals who can’t reach their feet to the floor, the chair is probably too high. The Occupational Safety and Health Administration (OSHA) says this is potentially hazardous because it can lead to scooting forward and forgoing the backrest’s support (United States Department of Labor, N.D.) Sitting like this is considered an awkward posture and a risk factor for work-related musculoskeletal disorders (MSD). Musculoskeletal disorders and symptoms caused by awkward sitting posture include muscle fatigue, swelling, pain, numbness, or decreased circulation. (Ng, P. K., Jee, K. S. and Lim, S. Y. 2016)

Chair Too Low

If the knees are higher than the hips, the chair is probably too low, causing extreme flexion in the hip joints. Most individuals’ backs can’t handle this well because their hip muscles are not flexible enough. If sitting with knees higher than hips, the position can cause lower back pain.

Taking Breaks

No matter how comfortable a work office chair is, prolonged static posture is unhealthy for the spine and is a common contributor to back problems and muscle strain. Remember to stand, stretch, and walk for at least a minute or two every half hour to prevent the back from staying in one position for a long period. A quick stretch or minimal movement, like a quick walk, will help. A longer walk will help even more, promoting blood circulation to supply nutrients to all the spinal structures.
Moving and stretching regularly throughout the day will help keep the joints, ligaments, muscles, and tendons loose and promote comfort, relaxation, and the ability to focus productively.

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop personalized treatment programs. An integrated approach to treating injuries and chronic pain syndromes improves flexibility, mobility, and agility, relieving pain and helping individuals return to normal activities. If other treatments are needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers.

Low Back Pain: Impact and Chiropractic Solutions

References

De Carvalho, D., Grondin, D., & Callaghan, J. (2017). The impact of office chair features on lumbar lordosis, intervertebral joint and sacral tilt angles: a radiographic assessment. Ergonomics, 60(10), 1393–1404. doi.org/10.1080/00140139.2016.1265670

Rohlmann, A., Zander, T., Graichen, F., Dreischarf, M., & Bergmann, G. (2011). Measured loads on a vertebral body replacement during sitting. The spine journal : official journal of the North American Spine Society, 11(9), 870–875. doi.org/10.1016/j.spinee.2011.06.017

Holzgreve, F., Maurer-Grubinger, C., Fraeulin, L., Bausch, J., Groneberg, D. A., & Ohlendorf, D. (2022). Home office versus ergonomic workstation – is the ergonomic risk increased when working at the dining table? An inertial motion capture based pilot study. BMC musculoskeletal disorders, 23(1), 745. doi.org/10.1186/s12891-022-05704-z

United States Department of Labor. (N.D.). Computer workstations eTool. Retrieved from www.osha.gov/etools/computer-workstations

Ng, P. K., Jee, K. S. & Lim, S. Y. (2016). Development of Ergonomics Guidelines for Improved Sitting Postures in the Classroom among Malaysian University Students. American Journal of Applied Sciences, 13(8), 907-912. doi.org/10.3844/ajassp.2016.907.912

The Importance of Stability Running Shoes for Pronation Control

Dr. Alex Jimenez

male and female runners running urban race together

Could stability running shoes help correct foot pronation for runners, athletes, and physically active individuals who tend to have foot pronation issues?

Table of Contents

Stability Running Shoes

Stability is having firm, steady balance in the feet and ankles. Individuals with flat feet or feet that tend to pronate or turn inward can seriously compromise their running stability, potentially increasing their risk of injury and making running uncomfortable. Stability running shoes can help because they stabilize the feet and ankles that roll inward. They combine the right alignment, arch support, and cushioning, and this specialty footwear helps hold the feet and ankles steady and can help maintain a straight gait.

Pronation

Pronation occurs when the foot and/or ankle roll inward when running or walking. It’s a common issue, typically caused by pushing off the ground with a big toe and a second toe. Arches can be excessively strained when pronation or overpronation occurs, resulting in ankle or shin pain. Eventually, overpronation can even cause the feet to flatten. Many runners find that the instability of an inward-rolling foot makes them more prone to strained muscles or falls. However, a study determined that foot pronation was not associated with increased injury risk in novice runners wearing non-specialty shoes. (Nielsen R. O. et al., 2014) However, another study found that foot pronation contributed to joint loading or increased stress on the joints of the lower limbs after long-distance running. (Mei Q. et al., 2019) This extra stress could be a factor in the development of osteoarthritis.

Supination

In contrast to pronation, some runners experience the opposite problem of supination. Supination occurs when the ankle or foot rolls outward from the center, which can cause pain or injury as it increases the likelihood of ankle rolls or sprains.

Features

Stability running shoes with the right features can help stabilize the feet and ankles for safer, more efficient running. This could make a major difference in how individuals feel after a run. For example, those with weak ankles should look for ankle support shoes with motion control, arch support, and grippy traction. Stabilizing shoes offer the following structural supports.

Arch Support

The foot is less likely to turn inward with a firm, high arch support.

Midsole Cushioning

Like arch support, cushioning the entire mid-section of the foot helps hold it steady.
For example, in walking shoes for flat feet, extra supportive cushioning in the midfoot helps prevent further arch collapse.
Stability running shoes may advertise having bars, rails, or medial posts to help maintain balance and reduce pronation.

Heel Cups and Heel Counters

A deep heel cup sits under the heel, correctly aligning the foot and ankle.
Heel counters are hard plastic inserts that reinforce the back of a running shoe, increasing overall support and holding the foot in place.

Wider Base

A wider platform underneath the foot is another key to preventing the inward rolling of overpronation.
It’s a common feature of walking shoes for seniors that provide stability for balance issues.

Choose the Right Shoes

Selecting the best shoe for pronation issues does not have to be complex. At many athletic stores, customers start with an in-store gait, foot shape, and running style assessment. Overpronators should look for a shoe with at least some of the features listed, such as arch support, cushioning, heel cups, counters, or a wide base. For narrow or wide feet, seek out shoes made specifically for these issues. In any running shoe, comfort is the number one priority. The feet should feel firmly supported with no pinching, and the toe shoes should have plenty of wiggle room and be able to lace up without hassle.

Benefits

Stability running shoes may also improve performance. A well-cushioned, well-fitting stability shoe can enhance running comfort, making workouts more enjoyable. When running without pain, individuals are more likely to continue running long-term. A stability shoe that prevents overpronation can improve form, allowing faster and more efficient running. A study in the Journal of Orthopaedic and Sports Physical Therapy explored the potential of motion-control shoes, which are somewhat more stabilizing than stability shoes regarding running injuries. The authors concluded that these shoes may reduce the risk of injuries related to overpronation. (Willems T. M. et al., 2021) Another study compared stability shoes to neutral and motion-control shoes in female runners with various degrees of foot pronation. Those who ran in stability shoes missed the fewest days of training, an indicator that they experienced fewer injuries, but those who wore stability shoes reported more pain while running than those who wore neutral shoes. (Ryan M. B. et al., 2011)

Conclusion

Stability running shoes might be the solution for jogging pain and injuries. The only way to find out is to try them for yourself. Look for footwear with sturdy arch support, plenty of cushioning in the midsole, heel support, and a wide sole. At Injury Medical Chiropractic and Functional Medicine Clinic, we focus on what works for you and strive to create fitness and better the body through research methods and total wellness programs. These programs use the body’s ability to achieve improvement goals, and athletes can condition themselves to excel through proper fitness and nutrition. Our providers use an integrated approach to create personalized programs, including Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine principles.

Correct Foot Pronation

References

Nielsen, R. O., Buist, I., Parner, E. T., Nohr, E. A., Sørensen, H., Lind, M., & Rasmussen, S. (2014). Foot pronation is not associated with increased injury risk in novice runners wearing a neutral shoe: a 1-year prospective cohort study. British journal of sports medicine, 48(6), 440–447. doi.org/10.1136/bjsports-2013-092202

Mei, Q., Gu, Y., Xiang, L., Baker, J. S., & Fernandez, J. (2019). Foot Pronation Contributes to Altered Lower Extremity Loading After Long Distance Running. Frontiers in physiology, 10, 573. doi.org/10.3389/fphys.2019.00573

Willems, T. M., Ley, C., Goetghebeur, E., Theisen, D., & Malisoux, L. (2021). Motion-Control Shoes Reduce the Risk of Pronation-Related Pathologies in Recreational Runners: A Secondary Analysis of a Randomized Controlled Trial. The Journal of orthopaedic and sports physical therapy, 51(3), 135–143. doi.org/10.2519/jospt.2021.9710

Ryan, M. B., Valiant, G. A., McDonald, K., & Taunton, J. E. (2011). The effect of three different levels of footwear stability on pain outcomes in women runners: a randomised control trial. British journal of sports medicine, 45(9), 715–721. doi.org/10.1136/bjsm.2009.069849

Improve Physical and Emotional Health with a Hatha Yoga Class

Dr. Alex Jimenez

For individuals dealing with stress, back and neck pain, and wanting to improve overall health, can trying a Hatha yoga class help?

Hatha Yoga Class

A yoga class is great for moms, athletes, or anyone interested in low-impact exercise. Today, many practice yoga for its mind and body, health and wellness benefits. Research shows that hatha yoga helps to reduce stress, relieve back and arthritis pain, support healthy habits, and improve emotional health. (National Center for Complementary and Integrative Health, 2023) Hatha classes stretch, unwind, and release tension, providing a healthy outlet for hectic lifestyles.

What Is It?

In Sanskrit, Hatha translates to force. Hatha yoga focuses on posture and breathing techniques to channel energy. Classes last 45 to 90 minutes and consist of breathing, poses, and meditation.

Benefits

Dozens of peer-reviewed studies have been analyzed, and evidence has been found to suggest that yoga may benefit the following conditions. (National Center for Complementary and Integrative Health, 2023)

Anxiety and Depression

Yoga can help relieve everyday anxiety and depressive symptoms.
However, it may not be effective for clinically diagnosed mental health conditions.
The reviews and published studies on yoga did not find conclusive evidence to support its effectiveness in managing anxiety disorder, depression, or PTSD.

Arthritis and Fibromyalgia

According to the NCCIH, there is limited evidence to support yoga’s benefits for osteoarthritis, rheumatoid arthritis, and fibromyalgia.

Back Pain

The American College of Physicians recommends yoga as a non-pharmacological back pain treatment. (Qaseem A. et al., 2017)
A review of studies found that yoga improves low-back pain and function with both short-term and intermediate-term benefits, and its effects are similar to those of other types of exercise. (Skelly A. C. et al., 2020)

Balance

According to 11 out of 15 reviewed studies, yoga helps to improve balance in generally healthy individuals.

Emotional Health

Yoga has a positive impact on mental health. Ten out of 14 studies reviewed showed benefits in improving resilience or general mental well-being.

Menopause

Yoga can relieve physical and psychological symptoms of menopause, including hot flashes, according to the review of 1,300 study participants.

Mindfulness

In a survey of 1,820 young adults, participants attributed increased mindfulness, motivation to participate in other forms of activity, and eating healthier. (Watts A. W. et al., 2018)

Multiple Sclerosis

The NCCIH reports showed that yoga had short-term benefits on mood and fatigue in individuals with multiple sclerosis.
However, it did not affect muscle function, cognitive function, or quality of life.

Neck Pain

A 2019 meta-analysis, including ten studies and a total of 686 subjects, found that yoga can reduce neck pain intensity and disability pain while also improving the range of motion. (Li Y. et al., 2019)

Sleep

Several studies have found yoga can improve sleep quality and duration.
Populations found to experience sleep benefits include cancer patients, older adults, individuals with arthritis, pregnant women, and women experiencing menopause symptoms.

Stress Management

Yoga improved physical or psychological stress-related measures in 12 of 17 studies reviewed.

What to Expect

There are several different styles of yoga to choose from. Classes labeled yoga are likely the Hatha variety. Hatha is a gentle style that focuses on static poses and is great for beginners. However, it can still be physically and mentally challenging. Practitioners should wear athletic clothes and sports bras for maximum comfort and ease of movement. Each class varies depending on the instructor, but most last between 45 and 90 minutes.

Class Breakdown

Classes typically start with a gentle warm-up, advance to more physical poses, and end with a short meditation.

Breathing

Most Hatha classes start with a period of focus on breathing.
As you perform the poses, the instructor will continue to remind everyone to focus on breathing and may suggest different breathing exercises.

Poses

Yoga poses, also called postures or asanas, are a series of movements that help improve balance, flexibility, and strength.
Poses range in difficulty from laying flat on the floor to physically challenging positions.
If, during a class, a pose is too difficult, the instructor can provide a modified posture.

Meditation

Most classes end with a short period of meditation.

If you go into a Hatha class and it feels too slow or inactive, there are faster-paced, more athletic yoga classes, including flow, vinyasa, or power yoga classes. See if it’s more your speed.

Injury Medical Chiropractic Clinic

At Injury Medical Chiropractic and Functional Medicine Clinic, we focus on what works for you and strive to create fitness and better the body through research methods and total wellness programs. These programs use the body’s ability to achieve health and fitness goals, and athletes can condition themselves to excel in their sport through proper fitness and nutrition. Our providers use an integrated approach to create personalized programs, often including Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine principles.

Home Exercises for Pain Relief

References

National Center for Complementary and Integrative Health. (2023). Yoga: What you need to know. Retrieved from www.nccih.nih.gov/health/yoga-what-you-need-to-know#hed11

Qaseem, A., Wilt, T. J., McLean, R. M., Forciea, M. A., Clinical Guidelines Committee of the American College of Physicians, Denberg, T. D., Barry, M. J., Boyd, C., Chow, R. D., Fitterman, N., Harris, R. P., Humphrey, L. L., & Vijan, S. (2017). Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Annals of internal medicine, 166(7), 514–530. doi.org/10.7326/M16-2367

Skelly, A. C., Chou, R., Dettori, J. R., Turner, J. A., Friedly, J. L., Rundell, S. D., Fu, R., Brodt, E. D., Wasson, N., Kantner, S., & Ferguson, A. J. R. (2020). Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review Update. Agency for Healthcare Research and Quality (US).

Watts, A. W., Rydell, S. A., Eisenberg, M. E., Laska, M. N., & Neumark-Sztainer, D. (2018). Yoga’s potential for promoting healthy eating and physical activity behaviors among young adults: a mixed-methods study. The international journal of behavioral nutrition and physical activity, 15(1), 42. doi.org/10.1186/s12966-018-0674-4

Li, Y., Li, S., Jiang, J., & Yuan, S. (2019). Effects of yoga on patients with chronic nonspecific neck pain: A PRISMA systematic review and meta-analysis. Medicine, 98(8), e14649. doi.org/10.1097/MD.0000000000014649

Managing Extensor Tendonitis: Tips and Remedies

Dr. Alex Jimenez

Woman exercising with dumbbells during rehabilitation — Young woman exercising with dumbbells together with therapist during rehabilitation

Individuals with inflammation, pain, and swelling on the tops of their feet or hands could be experiencing extensor tendonitis. What treatment options are available?

Table of Contents

Extensor Tendonitis

These tendons attach to muscles that straighten the fingers and lift the toes and the top of the foot. Extensor tendonitis is characterized by inflammation of the tendons on the tops of the hands and feet. It often results from overuse of the muscles and from wearing tight shoes. Symptoms tend to worsen with activity and improve with rest. The condition does not usually require surgery; treatments include medications, home remedies/activity modification, and physical therapy.

Types

Tendonitis can develop in any tendon of the extensor muscles. These tendons are long, thin bands of tissue that can be felt on the tops of the hands and feet. The structures attach to muscles on one end and bones of the fingers and toes on the other. The extensor tendons in the hands include: (American Society for Surgery of the Hand, 2024)

The extensor digitorum communis straightens the index, middle, ring, and small fingers.
The extensor digiti minimi straightens the small finger.
The extensor indicis proprius straightens the index finger.
The extensor pollicis longus and extensor pollicis brevis muscles move the thumb into the thumb-up position.

Extensor tendons on the top of the foot attach to: (American Society for Surgery of the Hand, 2024)

The extensor digitorum longus and extensor digitorum brevis muscles lift the second, third, fourth, and fifth toes.
The extensor hallucis longus lifts the big toe.

Tendonitis vs Tendinopathy

Chronic tendon pain can lead to a condition known as tendinopathy.
Tendonitis results from inflammation.
Tendinopathy is the degeneration/micro-tearing of a tendon that occurs with long-term overuse.
Knowing which condition you are dealing with is important because it requires different treatments.

Symptoms

The primary symptom is pain in the affected tendon/s. Individuals may also experience swelling, and the skin can become red or warm to the touch. Extensor tendonitis can cause pain when using the affected muscles, moving the hand or foot in the opposite direction, and stretching the tendons. Usually, the pain worsens when using the affected muscles and improves with rest.

Causes

Extensor tendonitis in the hands usually results from overuse, which causes inflammation. However, it can also result from trauma, such as falling on the hand or an injury during physical or sports activities. Common activities include: (Hanson Z. C., and Lourie G. M. 2022)

Manual labor work
Typing
Computer mouse use
Weightlifting
Gymnastics
Playing a musical instrument

Extensor tendonitis in the foot can also result from overuse activities like running, especially uphill. However, it can also occur from wearing overly tight or tightly laced shoes for physical activities like running or dancing. Less common causes include: (Arthritis Foundation, N.D.)

Medical conditions like diabetes or arthritis
Medication side effects
Infection
Joint deformities

Treatment

Extensor tendonitis usually improves with conservative treatment, which includes self-care, activity modification, physical therapy, and medication.

Medications

Individuals can treat inflammation with non-steroidal anti-inflammatory drugs NSAIDs like:

Ibuprofen
Naproxen
Aspirin
Acetaminophen can help reduce pain.
In some cases, individuals may need prescription anti-inflammatory medications like corticosteroids or pain relievers for short-term use.

Self-Care and Activity Adjustments

Self-care includes:

Rest and avoid any activities that increase pain symptoms. If you can’t avoid them completely, take frequent breaks to allow the muscles to relax.
Apply ice to the hand or foot several times daily for up to 20 minutes.
Compression wraps should be applied on the foot or hand using an elastic bandage or soft splint to help support the injured tendons and reduce swelling.
Elevate the hand or foot if swollen above the heart level when resting.

Activity Adjustments

Modifying activities can help address the underlying cause/s.
Hand extensor tendonitis can develop from poor positioning.
Setting up an ergonomic workstation can help.
Consult a coach or trainer if the tendonitis is related to sports or exercise.
Individuals might need to adjust their technique or training schedule to decrease pressure on the tendons.

Physical Therapy

Physical therapy is an effective treatment. A therapy team can help determine the condition’s underlying cause and provide a personalized treatment program. Interventions can include:

Pain-reducing treatments like ultrasound, electrical stimulation, electroacupuncture, and laser therapy.
Manual therapy
Massage therapies
Targeted exercise programs
Prescription of orthotics like a hand splint or shoe inserts.

Surgery

Surgery is not necessary unless the tendon is torn. (Bronner S., Ojofeitimi S., and Rose D. 2008) (American Society for Surgery of the Hand, 2014) Recovery after surgical repair requires physical therapy treatment following specific protocols based on the patient’s case.

Prognosis

Extensor tendonitis can take weeks or even months to fully heal. Early diagnosis and determining the condition’s underlying cause rather than just treating symptoms are recommended for a faster and optimal recovery. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop personalized treatment programs through an integrated approach to treating injuries and chronic pain syndromes, improving flexibility, mobility, and agility, relieving pain, and helping individuals return to normal activities. Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers if other treatments are needed.

Move Better, Live Better, with Chiropractic

References

American Society for Surgery of the Hand. (2024). Tendons. www.assh.org/handcare/safety/tendons#Finger%20Extensor

Hanson, Z. C., & Lourie, G. M. (2022). Middorsal Wrist Pain in the High-Level Athlete: Causes, Treatment, and Early Return to Play. Orthopaedic journal of sports medicine, 10(4), 23259671221088610. doi.org/10.1177/23259671221088610

Arthritis Foundation. Foundation, A. (N.D.). Tendinitis. www.arthritis.org/diseases/tendinitis

Bronner, S., Ojofeitimi, S., & Rose, D. (2008). Repair and rehabilitation of extensor hallucis longus and brevis tendon lacerations in a professional dancer. The Journal of orthopaedic and sports physical therapy, 38(6), 362–370. doi.org/10.2519/jospt.2008.2749

American Society for Surgery of the Hand. (2014). Extensor tendon injury. www.assh.org/handcare/condition/extensor-tendon-injury#:~:text=The%20tendon%20may%20take%20eight%20to%20twelve%20weeks,may%20include%20stitches%20%28for%20cuts%20in%20the%20tendon%29.

Discover the Versatility of Fish Sauce and Substitutes

Dr. Alex Jimenez

Woman pouring soy sauce into small bowl — Woman pouring couple of tea spoons of soy sauce into small bowl when making dipping sauce for snack plate

Individuals who are vegan, vegetarian, or allergic to fish may want to avoid fish sauce and foods made with it. What are fish-free sauce substitutes?

Table of Contents

Fish Sauce Substitutes

Fish sauce is a liquid ingredient that adds a salty fish flavor to recipes. It is made by coating fish, like anchovies, in salt and letting them ferment in large barrels. The result is bottled fish sauce. Commonly associated with Asian cooking, fish sauce adds flavor to recipes like noodles, stir-fries, and more. The sauce is described as having an earthy, umami flavor. Because the sauce has a unique flavor that is difficult to replicate, removing it altogether is an option for those who do not consume fish products or do not have this ingredient readily available. There are fish sauce substitutes that are vegan—and vegetarian-friendly.

Options

Fish and fish products can be part of a balanced diet and a nutritious source of omega fatty acids. However, fish sauce can be substituted for those who follow a meat-free meal plan, have seafood allergies, or do not have fish sauce available. Omitting some or all animal products from one’s diet is not as easy as avoiding fish. Individuals must also check ingredient labels for animal-based ingredients and byproducts. According to the Asthma and Allergy Foundation of America, fish and shellfish are among the most common food allergies in the U.S. (Asthma and Allergy Foundation of America, 2022)

Nutrition

Nutrition information for one tablespoon or 18 grams of fish sauce. (U.S. Department of Agriculture, 2018)

Calories – 6.3
Fat – 0 grams
Sodium – 1,410 milligrams
Carbohydrates – 0.66 grams
Fiber – 0 grams
Sugars – 0.66 grams
Protein – 0.91 grams

Fish sauce is usually added in small amounts so that it is not a significant source of calories, protein, fat, or carbohydrates. However, it does contain 1,410 milligrams of sodium. Guidelines recommend 2,300 milligrams of sodium per day for adults, and the recommended serving size of sauce contains around 61%. (U.S. Department of Agriculture and U.S. Department of Health and Human Services, 2020)

Substitutes

Fish sauce substitutes typically replace the salty, savory flavors and help deepen the taste of recipes by adding salty and umami flavors. The vegan and vegetarian-friendly alternatives do not provide the fish flavor.

Soy Sauce

Soy sauce is a liquid condiment made with fermented ingredients. It replicates the salty flavor, and although it can be high in sodium, it yields a similar nutritional profile. Soy sauce can be substituted at a 1:1 ratio. Adding minced fish, such as anchovies or sardines, is optional to satisfy the fish flavor.

Tamari

Tamari is a gluten-free Japanese-style soy sauce that can naturally substitute fish sauce and be used in equal amounts.

Worcestershire Sauce

Worcestershire sauce can substitute the fish sauce flavor and saltiness. It is a condiment that deepens the flavor of dishes like steaks, stews, sauces, marinades, etc. Though it is not a traditional ingredient in Asian cooking, it can be used in recipes like noodles, dumplings, marinated meat, and salads. It is lower in sodium, so it may be preferred for a low-sodium meal plan. It can be used at a 1:1 ratio.

Hoisin Sauce

Hoisin sauce is made from fermented soybeans. It has the fermented aspect of fish sauce and the salty flavors of soy sauce, with a slightly sweet flavor. Compared to American-style barbecue sauce, it is thick and usually used as a glaze or dipping sauce. To substitute, mix hoisin sauce with soy sauce at a 1:1 ratio to offset the sweetness of hoisin sauce. Use the mixture to replace the fish sauce in equal amounts.

Oyster Sauce

Oyster sauce is a fish product with the closest flavor profile to fish sauce. It has a thicker consistency, offers a salty fish flavor, and can be used at a 1:1 ratio.

Integrative and Functional Medicine Clinic

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

Body Signals Decoded

References

Asthma and Allergy Foundation of America. (2022). Food allergies. Allergies. aafa.org/allergies/types-of-allergies/food-allergies/

U.S. Department of Agriculture, FoodData Central. (2018). Sauce, fish, ready-to-serve. Retrieved from fdc.nal.usda.gov/fdc-app.html#/food-details/174531/nutrients

U.S. Department of Agriculture and U.S. Department of Health and Human Services. (2020). Dietary Guidelines for Americans, 2020-2025. Retrieved from www.dietaryguidelines.gov/sites/default/files/2021-03/Dietary_Guidelines_for_Americans-2020-2025.pdf