Exploring the Benefits of Acupuncture for Insomnia

Sitting and talking. Young woman have a visit with female doctor in modern clinic.

“Can acupuncture treatment help individuals dealing with or experiencing insomnia and sleep issues and/or disorders?”

Table of Contents

Acupuncture For Insomnia

Acupuncture is a type of holistic medicine that involves inserting sterile, disposable, thin needles at specific points known as acupoints on the body. Each needle is inserted into a different area to stimulate symptom relief of various conditions, like chronic pain and nausea. (Johns Hopkins Medicine. 2024) Recent research has looked into acupuncture for insomnia and found that it may be an effective alternative. (Mingming Zhang et al., 2019)

Insomnia

Insomnia causes individuals to have trouble falling or staying asleep. Individuals who have insomnia tend to wake up earlier than they intend to and find it difficult to impossible to get back to sleep once they are awake. The sleep disorder is quite common, with around 10% of individuals experiencing it at some point. (Andrew D. Krystal et al., 2019) There are three categories, all characterized by the duration of the disorder. They include: (Andrew D. Krystal et al., 2019)

Acute/Short-Term

Lasting less than three months.

Episodic

Happens once in a while for less than three months.

Chronic

Lasting more than three months.

Health Issues

Insomnia can cause various health issues, and individuals can develop mood changes, irritability, fatigue, and problems with memory, impulse control, and concentration. (Andrew D. Krystal et al., 2019)
Insomnia has also been shown to increase the risk of heart failure, heart attack, and other chronic health conditions. (Mingming Zhang et al., 2019)

Benefits

Studies on the use of acupuncture for insomnia have found that it may improve sleep because of its influence on certain neurotransmitters. One review noted that specific neurotransmitters involved in the sleep-wake cycle are positively affected by acupuncture. (Kaicun Zhao 2013) The neurotransmitters include:

Norepinephrine

Helps with waking up and staying alert.

Melatonin

A hormone that helps the body calm down and prepare for sleep.

Gamma-aminobutyric acid – GABA

Helps the body fall asleep and stay asleep.

However, more research is needed to confirm the benefits of acupuncture for insomnia further.

Conditions

Certain conditions can contribute to insomnia, including:

Mood disorders
Chronic pain
Other sleep disorders

Acupuncture can help lower the effects of these disorders.

Pain

Because of the way acupuncture affects certain chemicals, it is a proven complementary treatment for pain.

The needles enhance chemicals like endorphins, dynorphins, and encephalins.
Acupuncture also releases corticosteroids, which are stress hormones.
Each of these chemicals has a role in pain symptoms.
Adjusting their levels helps reduce pain. (Shilpadevi Patil et al., 2016)

Anxiety

Studies have found that individuals with anxiety can also benefit from acupuncture to help reduce symptoms. (Meixuan Li et al., 2019)

Sleep Apnea

Sleep apnea is a sleep-breathing disorder that causes an individual to stop breathing during the night temporarily.
The muscles in the nasal cavity, nose, mouth, or throat become overly relaxed.
Acupuncture can help stimulate the muscles and prevent over-relaxation, preventing apneas.
Data suggests that acupuncture may affect the apnea-hypopnea index, the number of times an individual stops and starts breathing during sleep. (Liaoyao Wang et al., 2020)

Session

Individuals should not feel pain and just a small amount of pressure in the needles’ insertion area.
If pain is present, it could be because the needles are not inserted in the right spot.
It’s essential to tell the acupuncturist so they can reset and re-insert them correctly. (Malcolm W. C. Chan et al., 2017)

Side Effects

Side effects are rare but can occur. These include: (G. Ernst, H. Strzyz, H. Hagmeister 2003)

Dizziness
Bleeding or bruising where the needle was inserted.
Nausea
Fainting
Pins and needles sensation
Feeling more pain treatment

Prior to getting acupuncture, individuals are recommended to speak to their healthcare provider. They can advise on how it can help and any side effects that may occur due to the individual’s health, underlying conditions, and medical history. Once cleared, they can recommend a licensed acupuncturist.

Tension Headaches

References

Johns Hopkins Medicine. (2024). Acupuncture (Health, Issue. www.hopkinsmedicine.org/health/wellness-and-prevention/acupuncture

Zhang, M., Zhao, J., Li, X., Chen, X., Xie, J., Meng, L., & Gao, X. (2019). Effectiveness and safety of acupuncture for insomnia: Protocol for a systematic review. Medicine, 98(45), e17842. doi.org/10.1097/MD.0000000000017842

Krystal, A. D., Prather, A. A., & Ashbrook, L. H. (2019). The assessment and management of insomnia: an update. World psychiatry: official journal of the World Psychiatric Association (WPA), 18(3), 337–352. doi.org/10.1002/wps.20674

Zhao K. (2013). Acupuncture for the treatment of insomnia. International review of neurobiology, 111, 217–234. doi.org/10.1016/B978-0-12-411545-3.00011-0

Patil, S., Sen, S., Bral, M., Reddy, S., Bradley, K. K., Cornett, E. M., Fox, C. J., & Kaye, A. D. (2016). The Role of Acupuncture in Pain Management. Current pain and headache reports, 20(4), 22. doi.org/10.1007/s11916-016-0552-1

Li, M., Xing, X., Yao, L., Li, X., He, W., Wang, M., Li, H., Wang, X., Xun, Y., Yan, P., Lu, Z., Zhou, B., Yang, X., & Yang, K. (2019). Acupuncture for treatment of anxiety, an overview of systematic reviews. Complementary therapies in medicine, 43, 247–252. doi.org/10.1016/j.ctim.2019.02.013

Wang, L., Xu, J., Zhan, Y., & Pei, J. (2020). Acupuncture for Obstructive Sleep Apnea (OSA) in Adults: A Systematic Review and Meta-Analysis. BioMed research international, 2020, 6972327. doi.org/10.1155/2020/6972327

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

Ernst, G., Strzyz, H., & Hagmeister, H. (2003). Incidence of adverse effects during acupuncture therapy-a multicentre survey. Complementary therapies in medicine, 11(2), 93–97. doi.org/10.1016/s0965-2299(03)00004-9

Unlocking the Potential of Green Powder Supplements

Dr. Alex Jimenez

Blend of vegetable Superfoods for making smoothies. Healthy fresh green vegetables.

“For individuals that have difficulty getting plenty of fruits and vegetables, can incorporating green powder supplements increase nutritional levels for a balanced diet?”

Table of Contents

Green Powder Supplements

Meeting daily nutrient needs through whole, unprocessed foods can’t always be met when access is limited or for other reasons. A green powder supplement is a great way to fill in the gaps. Green powder supplements are a daily supplement that helps increase vitamin, mineral, and fiber intake and enhances overall health. Green powders are easy to mix in water with a favorite beverage or smoothie or bake into a recipe. They can help:

Increase energy
Nourish the immune system
Improve digestion
Promote mental clarity
Contribute to healthy blood sugar levels
Reduce the risk of chronic disease
Promote optimal liver and kidney function

What Are They?

Green powder supplements are forms of vitamins, minerals, fiber, antioxidants, phytochemicals, and other bioactive compounds.
They are derived from fruits, vegetables, herbs, and algae to combine ingredients into a convenient supplement. (Giulia Lorenzoni et al., 2019)

Nutrients

Because most green powders comprise a combination of ingredients, the nutrient density is high. Green powder supplements can be considered a vitamin and mineral product. They typically contain:

Vitamins A, C, and K
Iron
Magnesium
Calcium
Antioxidants

The recommended daily intake of vitamins and minerals can be helpful for individuals with limited access to produce or who want to supplement their diet with additional nutrients.

Energy

The phytochemicals found in fruits and vegetables have been shown to improve energy levels. Studies on their effects on physical performance and endurance have resulted in positive outcomes. Researchers found that phytonutrients like those in green powders helped to increase energy, improve agility, reduce fatigue perception, improve memory, and decrease recovery time. (Nicolas Monjotin et al., 2022)

Digestive Health

Green powders are rich in soluble and insoluble fiber, which contribute to feeling full and satisfied after a meal and are important for healthy digestion and regular bowel movements. Eating fiber-rich foods is associated with optimal blood sugar control and improved gut microbiota diversity. These factors are important for maintaining a healthy body weight and decreasing the risk of chronic disease, for example, type 2 diabetes. (Thomas M. Barber et al., 2020) Phytochemicals, including flavonoids, have been shown to have therapeutic effects on gas, bloating, constipation, and diarrhea associated with IBS. Other phytonutrients have been shown to reduce certain symptoms of ulcerative colitis. (Nicolas Monjotin et al., 2022)

Immune System Function

Supplemental green powder supplements have shown the ability to maintain a healthy immune system and reduce inflammation by their antioxidant content. Green powders containing seaweed or algae are rich in phytochemical and poly-unsaturated fatty acids that have antioxidant properties to reduce inflammation and prevent oxidative damage to cells. (Agnieszka Jaworowska, Aliza Murtaza 2022) A randomized trial found that a fruit, berry, and vegetable powder concentrate blend decreased oxidation and reduced inflammation, attributed to the phytochemicals found in fruits and vegetables.(Manfred Lamprecht et al., 2013)

Detoxification

The liver and kidneys are the main organs of natural detoxification. The liver helps the body absorb nutrients from consumed foods and removes waste and toxins through the kidneys. (National Library of Medicine. 2016) Plants are packed with antioxidants and phytochemicals that protect the liver and kidneys from free radical damage and oxidative stress. (Yong-Song Guan et al., 2015) The green powder supplements are made from these plants. When drinking green powders, fluid intake naturally increases as a standard serving of green powder is mixed with 8 to 12 ounces of water.

Whether mixed, blended, or made into a shake, powdered greens are a convenient and efficient way to get the daily dose of antioxidants, vitamins, minerals, and other nutrients.

The Healing Diet: Combat Inflammation, Embrace Wellness

References

Lorenzoni, G., Minto, C., Vecchio, M. G., Zec, S., Paolin, I., Lamprecht, M., Mestroni, L., & Gregori, D. (2019). Fruit and Vegetable Concentrate Supplementation and Cardiovascular Health: A Systematic Review from a Public Health Perspective. Journal of clinical medicine, 8(11), 1914. doi.org/10.3390/jcm8111914

Monjotin, N., Amiot, M. J., Fleurentin, J., Morel, J. M., & Raynal, S. (2022). Clinical Evidence of the Benefits of Phytonutrients in Human Healthcare. Nutrients, 14(9), 1712. doi.org/10.3390/nu14091712

Barber, T. M., Kabisch, S., Pfeiffer, A. F. H., & Weickert, M. O. (2020). The Health Benefits of Dietary Fibre. Nutrients, 12(10), 3209. doi.org/10.3390/nu12103209

Jaworowska, A., & Murtaza, A. (2022). Seaweed Derived Lipids Are a Potential Anti-Inflammatory Agent: A Review. International journal of environmental research and public health, 20(1), 730. doi.org/10.3390/ijerph20010730

Lamprecht, M., Obermayer, G., Steinbauer, K., Cvirn, G., Hofmann, L., Ledinski, G., Greilberger, J. F., & Hallstroem, S. (2013). Supplementation with a juice powder concentrate and exercise decrease oxidation and inflammation, and improve the microcirculation in obese women: randomised controlled trial data. The British journal of nutrition, 110(9), 1685–1695. doi.org/10.1017/S0007114513001001

InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. How does the liver work? 2009 Sep 17 [Updated 2016 Aug 22]. Available from: www.ncbi.nlm.nih.gov/books/NBK279393/

Guan, Y. S., He, Q., & Ahmad Al-Shatouri, M. (2015). Complementary and Alternative Therapies for Liver Diseases 2014. Evidence-based complementary and alternative medicine : eCAM, 2015, 476431. doi.org/10.1155/2015/476431

Training for Long Distance: Building Endurance Effectively

Dr. Alex Jimenez

Fit african american woman wearing backpack nordic walking on coast. healthy lifestyle, exercising in nature.

“For individuals training for long-distance walking marathons and/or events, can focusing on building a walking foundation and then increasing mileage progressively help condition the body for overall readiness?”

Table of Contents

Long Distance Walking Training

Training helps individuals be comfortable and safe for long-distance walking and events.
Training should focus on building a walking pace and increasing mileage gradually.
Individuals need endurance, not speed, and want to build mental stamina for walking for hours at a steady pace.
To reduce the risk of training injuries, increasing the total mileage per week/the distance of the longest walk per week to no more than 10% is recommended.
Individuals should also train to wear the gear worn during long-distance walks.
Training could last a few months.
Being methodical allows the body time to repair and build new muscle, blood supplies, and endurance.

Example Training Plans

Following a marathon training plan for mileage building and determining the proper hydration, nutrition, and gear for multi-day walks and treks is recommended. However, individuals must build back-to-back long days into their training sessions to assess any issues or problems resulting from walking long distances on back-to-back days.

Example Walking Training Plans

Multi-Day Walks/Treks Training Schedule

13 miles per day/21 kilometers
Use this plan for marathons or other multi-day walks with hills and natural surfaces requiring a backpack.

Training to Walk a Marathon

26.2 miles/42 kilometers
This will condition the body to go longer distances.
When training for distances of 31 to 100 miles/50 to 161 kilometers, the longest distance to train should not need to exceed 20 to 25 miles,
These should be performed at least twice two months before the marathon or event.
Taper down the month before the event to a 12.4-mile/20-kilometer distance.

Gear

All clothing, shoes, sunscreen, backpacks, etc., must be tested on the longer training days before the event.

Given the climate and terrain, plan for what will be needed and removed.
Try things out, as individuals don’t want to be surprised with something unfamiliar at the event. From head to toe, test the gear, including:
Shoes/boots, socks, underwear, bra, shirt, pants, hat, jacket, and rain gear.
Choose shoes or walking boots and wear them on long training days to break them in and ensure they perform.
Backpacks should be tested on longer training days to ensure they can be carried comfortably over long distances and have the necessary capacity.
Choose wicking fabrics that allow the skin to breathe and cool, especially under layers. (Justin De Sousa et al., 2014)
Individuals will want to wear gear similar to marathon walkers if the walk will mostly be on pavement or asphalt.
Individuals can modify their gear if the route is off-road or during different seasons. Find out what other long-distance walkers have worn on the same route or event.

Individuals can connect with fellow walkers via social media or find answers to frequently asked questions on the event’s or destination’s website.
Individuals can also contact the event director via the website or social media.

Nutrition

Proper sports nutrition will prepare the body for endurance activity.

For example, individuals are recommended to follow a diet comprising 70% carbohydrates, 20% protein, and 10% fat.
Avoid high-protein diets, as they can cause hydration problems and strain your kidneys under endurance walking conditions. (Marta Cuenca-Sánchez et al., 2015)
Train with the water, sports drinks, food, and snacks taken to the event, and do not deviate from them during the event.
Water is needed for 20 kilometers and under events, but an electrolyte replacement sports drink may be better for longer walks.
Diluting or leaving out some sugar can be easier on the stomach.

Have snacks pre-packaged and labeled for the times to be eaten.
Individuals need to eat fat and protein for ultramarathon distances – this can come from trail mix, peanut butter sandwiches, and chocolate bars with nuts.
Carbohydrates can be provided by sports gels or energy bars.

It is recommended to avoid products made for short distances and power sports as they can cause digestive problems when walking longer distances.

Planning a Walk

Planning begins by setting goals. Considerations include:

Time of year
Distance
Transportation to the event
Event pace requirements
Altitude and hill profile
Climate

Individuals are recommended to:

Prepare by researching routes and trails.
Study the course maps to know what services are provided along the way and what individuals must bring.
Walk a long distance without a supporting event.
Contact individuals who have walked the course.
Know the terrain and areas of total sun, hills, pavement, natural trails, and shade.
If possible, drive the course to become familiar with it.
Individuals may be able to find apps designed for their route.

Taking Breaks and Resting

Regular breaks should be short – using the bathroom, eating a snack, rehydrating, tying shoes, or bandaging blisters.
The body can stiffen up quickly during breaks and take several minutes to regain walking pace after a long break.
Recommendations could be taking a walking break instead, which means continuing to walk but at a very slow pace.

Foot Care

Individuals will have found what works for them concerning shoes, boots, socks, etc., on the long training days to prevent blisters and injuries. It is recommended to try different strategies, which include:

Sports tape
Blister block pads
Sprays
Lubricants
Wicking and/or double-layered socks
Moleskin
Stop at the first sign of irritation along the walk and doctor the foot with tape, blister bandages, or whatever method works best.

The body was built for walking. Planning and training properly before taking a long-distance or multi-day walk will ensure a safe and enjoyable marathon.

Move Better, Live Better

References

De Sousa, J., Cheatham, C., & Wittbrodt, M. (2014). The effects of a moisture-wicking fabric shirt on the physiological and perceptual responses during acute exercise in the heat. Applied ergonomics, 45(6), 1447–1453. doi.org/10.1016/j.apergo.2014.04.006

Cuenca-Sánchez, M., Navas-Carrillo, D., & Orenes-Piñero, E. (2015). Controversies surrounding high-protein diet intake: satiating effect and kidney and bone health. Advances in nutrition (Bethesda, Md.), 6(3), 260–266. doi.org/10.3945/an.114.007716

The Effectiveness of Acupuncture for Knee Pain Relief

Dr. Alex Jimenez

Acupuncture has done wonders for my knee. Shot of a acupuncturist treating a client

“For individuals dealing with knee pain symptoms from injury and/or arthritis, can incorporating an acupuncture and/or electroacupuncture treatment plan help in pain relief and management?”

Table of Contents

Acupuncture For Knee Pain

Acupuncture involves inserting very thin needles into the skin at specific acupoints on the body. It is based on the premise that the needles restore the flow of the body’s energy to activate and promote healing, relieve pain, and help the body relax.

Acupuncture can help address various health conditions, including knee pain caused by arthritis or injury.
Depending on the type and severity of pain, treatments can help reduce the pain for days or weeks.
Acupuncture is often used as a complementary therapy – treatment in addition to other treatment or therapy strategies like massage and chiropractic.

Acupuncture Benefits

Knee pain caused by osteoarthritis or injury can reduce flexibility, mobility, and quality of life. Acupuncture can help provide relief.

When the acupuncture needles are placed on the body, a signal is sent along the spinal cord to the brain, which triggers a release of endorphins/pain hormones. Medical researchers believe this helps reduce pain. (Qian-Qian Li et al., 2013) Acupuncture also helps decrease the production of cortisol, a hormone that helps control inflammation. (Qian-Qian Li et al., 2013) With reduced pain sensations and less inflammation after acupuncture treatments, knee function and mobility can be improved.

Various factors play a role in the pain relief experienced from acupuncture. Some evidence suggests that an individual’s expectations may impact the results of acupuncture treatment. (Stephanie L. Prady et al., 2015)
Researchers are currently assessing whether the expectation that acupuncture is beneficial contributes to a better outcome after treatment. (Zuoqin Yang et al., 2021)
In 2019, acupuncture was recommended in treating knee osteoarthritis in the American College of Rheumatology/Arthritis Foundation guidelines for hand, hip, and knee osteoarthritis pain management. (Sharon L. Kolasinski et al., 2020)

Research

Different clinical studies support acupuncture’s ability to help in knee pain relief and management.
One study found that acupuncture helps manage various conditions that cause chronic pain. (Andrew J. Vickers et al., 2012)
A scientific review analyzed previous studies on pain management interventions after knee surgery and found supporting evidence that the treatments delayed and reduced the use of medications for pain relief post-surgery. (Dario Tedesco et al., 2017)

Osteoarthritis

A systematic review analyzed randomized control studies to determine whether or not acupuncture reduced pain and improved joint function in individuals with chronic osteoarthritis knee pain. (Xianfeng Lin et al., 2016)
Individuals received six to twenty-three weekly acupuncture sessions for three to 36 weeks.
The analysis determined that acupuncture can improve short and long-term physical function and mobility and provide up to 13 weeks of pain relief in individuals with chronic knee pain caused by osteoarthritis.

Rheumatoid Arthritis

Rheumatoid arthritis is a chronic disease that affects joints, including the knee joint, causing pain and stiffness.
Acupuncture is beneficial in treating rheumatoid arthritis/RA.
A review found that acupuncture alone and in combination with other treatment modalities benefits individuals with RA. (Pei-Chi, Chou Heng-Yi Chu 2018)
Acupuncture is believed to have anti-inflammatory and antioxidant effects to help regulate immune system function.

Chronic Knee Pain

Various conditions and injuries can cause chronic knee pain, making mobility difficult.
Individuals with joint pain often turn to complementary therapies for pain relief management, with acupuncture being one of the popular modalities. (Michael Frass et al., 2012)
A study showed modest improvements in pain relief at 12 weeks. (Rana S. Hinman et al., 2014)
Acupuncture resulted in modest improvements in mobility and function at 12 weeks.

Safety

Acupuncture is considered safe when administered by a trained, licensed professional.
Few complications have been reported from the use of acupuncture. (National Center for Complementary and Integrative Health. 2022)

Side Effects

Side effects can include soreness, bruising, or bleeding at the site of needle insertion and dizziness.
Less common side effects include fainting, increased pain, and nausea. (Harvard Medical School. 2023)
Working with a licensed, professional acupuncture practitioner can reduce the risk of unwanted side effects and complications.

Types

Other acupuncture options that may be offered include:

Electroacupuncture

A modified form of acupuncture where a mild electrical current passes through the needles, providing additional stimulation to the acupoints.
In one research study, individuals with knee osteoarthritis reported significant improvements in their pain, stiffness, and physical function after electroacupuncture treatment. (Ziyong Ju et al., 2015)

Auricular

Auricular or ear acupuncture works on acupoints in the ear corresponding to the body’s different parts.
A research review analyzed several studies on auricular acupuncture for pain relief and found that it can provide relief within 48 hours of pain onset. (M. Murakami et al., 2017)

Battlefield Acupuncture

The military and veteran healthcare facilities use a unique form of auricular acupuncture for pain management.
Studies show that it is effective at providing immediate pain relief, but more research is necessary to determine long-term pain relief effectiveness. (Anna Denee Montgomery, Ronovan Ottenbacher 2020)

Before trying acupuncture, consult a healthcare professional for guidance, as it may be integrated with other therapies and lifestyle adjustments.

Overcoming an ACL Injury

References

Li, Q. Q., Shi, G. X., Xu, Q., Wang, J., Liu, C. Z., & Wang, L. P. (2013). Acupuncture effect and central autonomic regulation. Evidence-based complementary and alternative medicine : eCAM, 2013, 267959. doi.org/10.1155/2013/267959

Prady, S. L., Burch, J., Vanderbloemen, L., Crouch, S., & MacPherson, H. (2015). Measuring expectations of benefit from treatment in acupuncture trials: a systematic review. Complementary therapies in medicine, 23(2), 185–199. doi.org/10.1016/j.ctim.2015.01.007

Yang, Z., Li, Y., Zou, Z., Zhao, Y., Zhang, W., Jiang, H., Hou, Y., Li, Y., & Zheng, Q. (2021). Does patient’s expectation benefit acupuncture treatment?: A protocol for systematic review and meta-analysis. Medicine, 100(1), e24178. doi.org/10.1097/MD.0000000000024178

Kolasinski, S. L., Neogi, T., Hochberg, M. C., Oatis, C., Guyatt, G., Block, J., Callahan, L., Copenhaver, C., Dodge, C., Felson, D., Gellar, K., Harvey, W. F., Hawker, G., Herzig, E., Kwoh, C. K., Nelson, A. E., Samuels, J., Scanzello, C., White, D., Wise, B., … Reston, J. (2020). 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis care & research, 72(2), 149–162. doi.org/10.1002/acr.24131

Vickers, A. J., Cronin, A. M., Maschino, A. C., Lewith, G., MacPherson, H., Foster, N. E., Sherman, K. J., Witt, C. M., Linde, K., & Acupuncture Trialists’ Collaboration (2012). Acupuncture for chronic pain: individual patient data meta-analysis. Archives of internal medicine, 172(19), 1444–1453. doi.org/10.1001/archinternmed.2012.3654

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

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

Chou, P. C., & Chu, H. Y. (2018). Clinical Efficacy of Acupuncture on Rheumatoid Arthritis and Associated Mechanisms: A Systemic Review. Evidence-based complementary and alternative medicine : eCAM, 2018, 8596918. doi.org/10.1155/2018/8596918

Frass, M., Strassl, R. P., Friehs, H., Müllner, M., Kundi, M., & Kaye, A. D. (2012). Use and acceptance of complementary and alternative medicine among the general population and medical personnel: a systematic review. Ochsner journal, 12(1), 45–56.

Hinman, R. S., McCrory, P., Pirotta, M., Relf, I., Forbes, A., Crossley, K. M., Williamson, E., Kyriakides, M., Novy, K., Metcalf, B. R., Harris, A., Reddy, P., Conaghan, P. G., & Bennell, K. L. (2014). Acupuncture for chronic knee pain: a randomized clinical trial. JAMA, 312(13), 1313–1322. doi.org/10.1001/jama.2014.12660

National Center for Complementary and Integrative Health. (2022). Acupuncture in depth. National Center for Complementary and Integrative Health. www.nccih.nih.gov/health/acupuncture-what-you-need-to-know

Harvard Medical School. (2023). Acupuncture: what is it? Harvard Health Publishing Harvard Medical School Blog. www.health.harvard.edu/a_to_z/acupuncture-a-to-z#:~:text=The%20most%20common%20side%20effects,injury%20to%20an%20internal%20organ.

Ju, Z., Guo, X., Jiang, X., Wang, X., Liu, S., He, J., Cui, H., & Wang, K. (2015). Electroacupuncture with different current intensities to treat knee osteoarthritis: a single-blinded controlled study. International journal of clinical and experimental medicine, 8(10), 18981–18989.

Murakami, M., Fox, L., & Dijkers, M. P. (2017). Ear Acupuncture for Immediate Pain Relief-A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Pain medicine (Malden, Mass.), 18(3), 551–564. doi.org/10.1093/pm/pnw215

Montgomery, A. D., & Ottenbacher, R. (2020). Battlefield Acupuncture for Chronic Pain Management in Patients on Long-Term Opioid Therapy. Medical acupuncture, 32(1), 38–44. doi.org/10.1089/acu.2019.1382

The Health Benefits of Pita Bread: A Nutritious Choice

Dr. Alex Jimenez

Pita stuffed with chicken, tomato and lettuce on wooden background. Middle Eastern cuisine.

“Could pita bread be a possible option for individuals trying to eat healthier?”

Table of Contents

Pita Bread

Pita bread is a yeast-leavened, round flatbread made with wheat flour. When baked, the dough turns into two layers. These layers create a pocket that can be filled with vegetables, meats, or vegetarian proteins. Pita bread offers health benefits because of its low carbohydrate count, the amount of nutrients in one serving, and the use of wheat flour.

Nutrition

Nutrition information for one serving of pita bread is 39 grams. (U.S. Department of Agriculture 2021)

Carbohydrates – 17 grams
Fat – 0.998 grams
Protein – 4.02 grams
Fiber – 1.99 grams
Sodium – 120 milligrams
Sugars – 0 grams
Calories – 90.1

Carbohydrates

The carbohydrate count for pita bread is 17 grams per serving or a little more than one carb count – 15 grams, used in meal planning for individuals with diabetes.
Non-keto bread is around 20 grams of carbohydrates per serving or slice.
Pita bread has a lower carbohydrate count than most breads.

Fats

Pita breads are relatively low in fat content.
The total lipid fat is under 2 grams, only 2% of the recommended daily amount or RDA.
The bread contains no fatty acids or trans or saturated fat.

Protein

Four grams of protein are in one serving of pita bread.
The protein content is found in the wheat flour.

Vitamins and Minerals

Other minerals in pita bread include:

Calcium, with 60.1 milligrams per serving.
Iron with 1.08 milligrams per serving – helps the body create hemoglobin, a protein in red blood cells that carries oxygen from the lungs. (National Institute of Health, 2023)
Sodium with 120 milligrams.
According to the Federal Drug Administration, this is a low amount of sodium. However, individuals should stay aware of sodium intake and limit it to no more than 2,300 milligrams per day.
The average adult consumes about 3,400 milligrams of sodium a day. (Food and Drug Administration, 2022)

Calories

One serving of pita bread contains 90 calories.
Pita bread for a sandwich contains fewer calories than two slices of regular bread.

Benefits

Potential health benefits include the following:

Glucose Levels Lowered

Whole wheat can be beneficial to glucose levels.
The American Diabetes Association suggests that choosing bread with whole wheat grains, like pita bread, instead of white bread, can work to keep blood sugar levels from spiking. (American Diabetes Association 2024)

Digestion Support

Whole-grain pita bread fiber content can benefit the digestive system by regulating bowel movements.
Complex carbohydrates are digested slower than simple carbohydrates, keeping the body fuller for longer and assisting in weight management. (Harvard Health 2022)

Protein Source

Pita bread provides a healthy amount of protein.
A serving contains around 8% of protein.
Consuming the proper amount of protein helps in muscle repair. (Harvard Health 2024)

Allergies

Major allergies or intolerances can cause individuals to pass on the bread. What individuals need to know.

Celiac Disease

Celiac disease is a heredity autoimmune disease that occurs in genetically predisposed individuals.
Individuals with the disease cannot ingest gluten – a protein found in wheat – which can lead to small intestinal damage.
Individuals who experience gastrointestinal distress when eating wheat should consult a healthcare professional to get tested. (Celiac Disease Foundation 2023)

Wheat Allergy

A wheat allergy may mimic celiac disease symptoms, but they are different allergies.
The allergy occurs when the body produces antibodies to wheat proteins.
Symptoms include anaphylaxis, swelling and itching of the mouth, nasal congestion, headache, cramps, nausea, vomiting, and breathing difficulties. (American College of Allergy, Asthma, and Immunology 2024)
Individuals who suspect a wheat allergy should consult a healthcare provider about an allergy test.

Gluten Intolerance

Gluten intolerance can cause similar symptoms to celiac disease when eating products containing gluten.
Symptoms include bloating, abdominal pain, constipation, joint pain, fatigue, brain fog, and depression. (Celiac Disease Foundation 2023)

Preparation

Pita bread preparation options.

Dunk the bread in sauces or dips.
Use the bread for pita-pocket sandwiches and fill it with meats and/or vegetables.
Cut the bread and bake for pita chips.
Cut the bread into small cubes and toast as an alternative to croutons for salads and soups.
Grill the pita bread.

Diabetes and Back Pain

References

USDA. Pita Bread. (2021). Pita Bread. Retrieved from fdc.nal.usda.gov/fdc-app.html#/food-details/2134834/nutrients

National Institute of Health, Office of Dietary Supplements. (2023). Iron. Retrieved from ods.od.nih.gov/factsheets/Iron-HealthProfessional/

Food and Drug Administration. (2022). Sodium in your diet. Retrieved from www.fda.gov/food/nutrition-education-resources-materials/sodium-your-diet

American Diabetes Association. (2024). Types of carbohydrates (Food and Nutrition, Issue. diabetes.org/food-nutrition/understanding-carbs/types-carbohydrates

Harvard Health. (2022). Fiber (The Nutrition Source, Issue. www.hsph.harvard.edu/nutritionsource/carbohydrates/fiber/

Harvard Health. (2024). Protein (The Nutrition Source, Issue. www.hsph.harvard.edu/nutritionsource/what-should-you-eat/protein/

Celiac Disease Foundation. (2023). What is celiac disease? (About Celiac Disease, Issue. celiac.org/about-celiac-disease/what-is-celiac-disease/

American College of Allergy, Asthma, and Immunology. (2024). Wheat (Allergic Conditions, Issue. acaai.org/allergies/allergic-conditions/food/wheat-gluten/

How Acupuncture Can Help Reduce Joint Pain in Lupus

Dr. Alex Jimenez

Can individuals dealing with joint pain incorporate acupuncture therapy to manage lupus symptoms and restore body mobility?

Table of Contents

Introduction

The immune system is highly important to the body as its main job is to protect vital structures from foreign invaders that can cause pain-like issues and discomfort. The immune system has a healthy relationship with the different body systems, including the musculoskeletal system, as the inflammatory cytokines help heal muscle and tissue damage when the body is injured. Over time, however, when normal environmental and genetic factors start to develop in the body, the immune system will begin to send out these cytokines to healthy, normal cells. To that point, the body starts at risk of developing autoimmune diseases. Now, autoimmune diseases in the body can cause havoc over time when they are not managed, leading to chronic disorders that can cause overlapping symptoms in the musculoskeletal system. One of the most common autoimmune diseases is systemic lupus erythematosus or lupus, and it can cause a person to be in consistent pain and discomfort while correlating with muscle and joint pain. Today’s article looks at the factors and effects of lupus, the burden of joint pain in lupus, and how holistic approaches like acupuncture can help manage lupus while restoring body mobility. We talk with certified medical providers who consolidate our patients’ information to assess how to minimize the pain effects caused by lupus on the joints. We also inform and guide patients on how acupuncture can help manage lupus and combine other therapies to reduce its pain-like symptoms affecting the musculoskeletal system. We encourage our patients to ask their associated medical providers intricate and important questions about incorporating acupuncture therapy to relieve the inflammatory effects of lupus while finding natural ways to restore mobility. Dr. Jimenez, D.C., includes this information as an academic service. Disclaimer.

The Factors & Effects Of Lupus

Have you been experiencing joint pain in your upper or lower extremities, making it difficult to function throughout the day? Have you been feeling the constant effects of fatigue? Many individuals experiencing these pain-like issues could risk developing systemic lupus erythematosus. In this autoimmune disease, the body’s own immune system mistakenly starts to attack its tissues, thus leading to inflammation and a range of pain-like symptoms. Lupis is tricky to diagnose because of its complex immune dysregulation that can lead to an overproduction of cytokines that can affect the body. (Lazar & Kahlenberg, 2023) At the same time, lupus can affect a diverse population, with symptoms and severity varying depending on how mild or severe the factors affect the body. Lupus can impact various body parts, including the joints, skin, kidneys, blood cells, and other vital body parts and organs, as environmental and hormonal factors can influence its development. (Tsang & Bultink, 2021) Additionally, lupus can be closely associated with other comorbidities that are causing overlapping risk profiles with inflammation that can affect the joints in the musculoskeletal system.

The Burden of Joint Pain In Lupus

Lupus is tricky to diagnose since it often mimics other ailments; the most common pain symptom that lupus affects is the joints. Individuals with lupus experience joint pain, which can cause inflammatory effects and structural damage to the joints, tendons, muscles, and bones, causing pathological abnormalities. (Di Matteo et al., 2021) Since lupus causes inflammatory effects in the joints, many individuals will think that they are experiencing inflammatory arthritis, and it can cause overlapping risk profiles as it is accompanied by lupus, thus causing localized pain in the joints regardless of its origin. (Senthelal et al., 2024) Joint pain in lupus individuals can significantly hinder daily activities, reducing mobility and overall quality of life as they are trying to find relief.

Unlocking The Secrets of Inflammation-Video

Unlocking the Secrets of Inflammation: Integrative Medicine Approach | El Paso, Tx (2023)

A Holistic Approach to Managing Lupus

While standard treatments for lupus involve medication and immunosuppressants to reduce the inflammation caused by lupus, many people want to seek out holistic approaches to manage lupus and reduce the inflammatory effects from affecting their joints by making small changes in their lives. Many people incorporate anti-inflammatory foods rich in antioxidants to dampen the inflammatory effects. Various supplements, like vitamin D, calcium, zinc, etc., can help reduce inflammation caused by lupus and strengthen bone health. Additionally, non-surgical treatments can even improve cardiorespiratory capacity and decrease fatigue while improving psychological function, which can help improve a person’s quality of life by managing the symptoms caused by lupus. (Fangtham et al., 2019)

How Acupuncture Could Help Lupus & Restore Mobility

One of the oldest forms of non-surgical and holistic approaches to reducing inflammation and managing lupus is acupuncture. Acupuncture involves solid, thin needles used by highly trained professionals to be inserted into specific body points to balance the body’s qi (energy) by stimulating the nervous system and releasing beneficial chemicals into the affected muscles, spinal cord, and brain. Additionally, acupuncture, with its minimal side effects and holistic approach, can help manage lupus. This is because when acupuncture needles are placed at the acupoints of the body, it can disrupt the pain signals that are causing pain in the affected area and regulate the inflammatory cytokines from lupus to provide relief. (Wang et al., 2023) This is due to its philosophy of addressing not only the physical pain but also the emotional and psychological symptoms of living with a chronic condition like lupus.

Additionally, acupuncture can help restore joint mobility while managing lupus through consecutive treatments, as many people notice that their joint mobility is improved and their pain is diminished. This is because the insertion and manipulation of the needles in the body’s acupoints cause alterations in afferent sensory input to the central nervous system, which increases alpha motoneuron excitability and reduces inflammation. (Kim et al., 2020) When individuals are dealing with lupus and are trying to find alternative holistic methods to relieve inflammation and joint pain caused by lupus, acupuncture, and non-surgical treatments can offer a ray of hope in managing the daily challenges of lupus.

References

Di Matteo, A., Smerilli, G., Cipolletta, E., Salaffi, F., De Angelis, R., Di Carlo, M., Filippucci, E., & Grassi, W. (2021). Imaging of Joint and Soft Tissue Involvement in Systemic Lupus Erythematosus. Curr Rheumatol Rep, 23(9), 73. doi.org/10.1007/s11926-021-01040-8

Fangtham, M., Kasturi, S., Bannuru, R. R., Nash, J. L., & Wang, C. (2019). Non-pharmacologic therapies for systemic lupus erythematosus. Lupus, 28(6), 703-712. doi.org/10.1177/0961203319841435

Kim, D., Jang, S., & Park, J. (2020). Electroacupuncture and Manual Acupuncture Increase Joint Flexibility but Reduce Muscle Strength. Healthcare (Basel), 8(4). doi.org/10.3390/healthcare8040414

Lazar, S., & Kahlenberg, J. M. (2023). Systemic Lupus Erythematosus: New Diagnostic and Therapeutic Approaches. Annu Rev Med, 74, 339-352. doi.org/10.1146/annurev-med-043021-032611

Senthelal, S., Li, J., Ardeshirzadeh, S., & Thomas, M. A. (2024). Arthritis. In StatPearls. www.ncbi.nlm.nih.gov/pubmed/30085534

Tsang, A. S. M. W. P., & Bultink, I. E. M. (2021). New developments in systemic lupus erythematosus. Rheumatology (Oxford), 60(Suppl 6), vi21-vi28. doi.org/10.1093/rheumatology/keab498

Wang, H., Wang, B., Huang, J., Yang, Z., Song, Z., Zhu, Q., Xie, Z., Sun, Q., & Zhao, T. (2023). Efficacy and safety of acupuncture therapy combined with conventional pharmacotherapy in the treatment of systemic lupus erythematosus: A systematic review and meta-analysis. Medicine (Baltimore), 102(40), e35418. doi.org/10.1097/MD.0000000000035418

Disclaimer

Acupuncture for Sciatica: A Natural and Effective Pain Relief

Dr. Alex Jimenez

doctor senior patient woman medical hospital health care man medicine office clinic healthcare elderly back pain — Portrait of a female doctor and senior patient with back pain at her doctor's office in clinic

“For individuals considering acupuncture for sciatica relief and management, can knowing how it works and what to expect during a session help in making the decision?”

Table of Contents

Acupuncture Sciatica Treatment Session

Acupuncture for sciatica is a safe and effective medical treatment to relieve and manage pain symptoms. Studies suggest it is as effective as other treatment strategies and causes fewer side effects. (Zhihui Zhang et al., 2023) The frequency of acupuncture to relieve sciatica pain depends on the severity of the condition and injury, but many report improvement within two to three weeks. (Fang-Ting Yu et al., 2022)

Needle Placement

Circulation problems can cause the body’s energy to stagnate in one or more meridians/channels, leading to pain in and around the surrounding area. (Wei-Bo Zhang et al., 2018)
The objective of acupuncture is to restore optimal circulation by stimulating specific points in the body called acupoints.
Thin, sterile needles stimulate the acupoints to activate the body’s natural healing abilities and relieve pain. (Heming Zhu 2014)
Some practitioners use electroacupuncture – a gentle, mild electrical current is applied to the needles and passes through the tissues to activate the nervous system. (Ruixin Zhang et al., 2014)

Acupoints

Acupuncture sciatica treatment involves specific acupoints along the bladder and gallbladder meridians.

Bladder Meridian – BL

The bladder meridian/BL runs down the back along the spine, hips, and legs. The acupoints within the meridian for sciatica include: (Fang-Ting Yu et al., 2022)

BL 23 -Shenshu – Location on the lower back, near the kidney.
BL 25 – Dachangshu – Location on the lower back.
BL 36 – Chengfu – Location on the back of the thigh, just below the buttocks.
BL 40 – Weizhong – Location behind the knee.

Gallbladder Meridian – GB

The gallbladder meridian/GB runs along the sides from the corner of the eyes to the pinky toe. (Thomas Perreault et al., 2021) The acupoints for sciatica within this meridian include: (Zhihui Zhang et al., 2023)

GB 30 – Huantiao – Location on the back, where the buttocks meet the hips.
GB 34 – Yanglingquan – Location on the outside of the leg, below the knee.
GB 33 – Xiyangguan – Location lateral to the knee, on the side.

Stimulating acupoints in these meridians increases blood flow to the area, reduces inflammation, and releases endorphins and other pain-relieving neurochemicals to relieve symptoms. (Ningcen Li et al., 2021) The specific acupoints vary depending on symptoms and the root cause. (Tiaw-Kee Lim et al., 2018)

Example Patient

An example of acupuncture sciatica treatment session: A patient with persistent shooting pain extending down the back and side of the leg. A standard treatment consists of the following:

The acupuncturist thoroughly goes over the patient’s medical history and symptoms and has the patient point to where the pain is located.
Then, they palpate on and around the area to find where the pain worsens and lessens, communicating with the patient as they go along.
Depending on the site and severity, they may start placing needles at the lower back, focusing on the site of the injury.
Sometimes, the sacrum is involved, so the acupuncturist will place needles on those acupoints.
They then move to the back of the leg and insert needles.
The needles are retained for 20-30 minutes.
The acupuncturist leaves the room or treatment area but regularly checks in.
The patient may feel a warmth, tingling, or mild heaviness, which is a normal response. This is where patients report a calming effect. (Shilpadevi Patil et al., 2016)
The needles are carefully removed.
The patient may feel deeply relaxed and will be advised to get up slowly to avoid dizziness.
There may be soreness, redness, or bruising at the needle insertion site, which is normal and should resolve quickly.
The patient will be given recommendations as to avoiding strenuous activity, properly hydrating, and performing gentle stretches.

Acupuncture Benefits

Acupuncture has been shown to be a complementary therapy for pain relief and management. The benefits of acupuncture:

Improves Circulation

Acupuncture stimulates blood circulation, which nourishes damaged or irritated nerves and promotes healing.
This helps relieve sciatica symptoms, like numbness, tingling, and pain. (Song-Yi Kim et al., 2016)

Releases Endorphins

Acupuncture triggers the release of endorphins and other natural pain-relieving chemicals, which help relieve pain. (Shilpadevi Patil et al., 2016)

Regulates the Nervous System

Acupuncture rebalances the sympathetic and parasympathetic responses, which reduces stress, tension, and pain. (Xin Ma et al., 2022)

Relaxes the Muscles

Nerve pain often accompanies muscle tension and spasms.
Acupuncture relaxes tight muscles, reducing pressure and providing relief. (Zhihui Zhang et al., 2023)

From Symptoms to Solutions

References

Zhang, Z., Hu, T., Huang, P., Yang, M., Huang, Z., Xia, Y., Zhang, X., Zhang, X., & Ni, G. (2023). The efficacy and safety of acupuncture therapy for sciatica: A systematic review and meta-analysis of randomized controlled trails. Frontiers in neuroscience, 17, 1097830. doi.org/10.3389/fnins.2023.1097830

Yu, F. T., Liu, C. Z., Ni, G. X., Cai, G. W., Liu, Z. S., Zhou, X. Q., Ma, C. Y., Meng, X. L., Tu, J. F., Li, H. W., Yang, J. W., Yan, S. Y., Fu, H. Y., Xu, W. T., Li, J., Xiang, H. C., Sun, T. H., Zhang, B., Li, M. H., Wan, W. J., … Wang, L. Q. (2022). Acupuncture for chronic sciatica: protocol for a multicenter randomised controlled trial. BMJ open, 12(5), e054566. doi.org/10.1136/bmjopen-2021-054566

Zhang, W. B., Jia, D. X., Li, H. Y., Wei, Y. L., Yan, H., Zhao, P. N., Gu, F. F., Wang, G. J., & Wang, Y. P. (2018). Understanding Qi Running in the Meridians as Interstitial Fluid Flowing via Interstitial Space of Low Hydraulic Resistance. Chinese journal of integrative medicine, 24(4), 304–307. doi.org/10.1007/s11655-017-2791-3

Zhu H. (2014). Acupoints Initiate the Healing Process. Medical acupuncture, 26(5), 264–270. doi.org/10.1089/acu.2014.1057

Zhang, R., Lao, L., Ren, K., & Berman, B. M. (2014). Mechanisms of acupuncture-electroacupuncture on persistent pain. Anesthesiology, 120(2), 482–503. doi.org/10.1097/ALN.0000000000000101

Perreault, T., Fernández-de-Las-Peñas, C., Cummings, M., & Gendron, B. C. (2021). Needling Interventions for Sciatica: Choosing Methods Based on Neuropathic Pain Mechanisms-A Scoping Review. Journal of clinical medicine, 10(10), 2189. doi.org/10.3390/jcm10102189

Li, N., Guo, Y., Gong, Y., Zhang, Y., Fan, W., Yao, K., Chen, Z., Dou, B., Lin, X., Chen, B., Chen, Z., Xu, Z., & Lyu, Z. (2021). The Anti-Inflammatory Actions and Mechanisms of Acupuncture from Acupoint to Target Organs via Neuro-Immune Regulation. Journal of inflammation research, 14, 7191–7224. doi.org/10.2147/JIR.S341581

Lim, T. K., Ma, Y., Berger, F., & Litscher, G. (2018). Acupuncture and Neural Mechanism in the Management of Low Back Pain-An Update. Medicines (Basel, Switzerland), 5(3), 63. doi.org/10.3390/medicines5030063

Kim, S. Y., Min, S., Lee, H., Cheon, S., Zhang, X., Park, J. Y., Song, T. J., & Park, H. J. (2016). Changes of Local Blood Flow in Response to Acupuncture Stimulation: A Systematic Review. Evidence-based complementary and alternative medicine : eCAM, 2016, 9874207. doi.org/10.1155/2016/9874207

Ma, X., Chen, W., Yang, N. N., Wang, L., Hao, X. W., Tan, C. X., Li, H. P., & Liu, C. Z. (2022). Potential mechanisms of acupuncture for neuropathic pain based on somatosensory system. Frontiers in neuroscience, 16, 940343. doi.org/10.3389/fnins.2022.940343

Electroacupuncture: The Key to Relieving Thoracic Outlet Syndrome

Dr. Alex Jimenez

Can individuals with thoracic outlet syndrome incorporate electroacupuncture to reduce neck pain and restore proper posture?

Table of Contents

Introduction

More times throughout the world, many individuals have experienced pain around their necks, which can lead to pain and discomfort. Many environmental factors, like being in a hunched position while looking at the computer or phone, traumatic injuries, poor posture, or spinal issues, can cause pain-like symptoms and complications to the body. Since neck pain is a common complaint many people suffer, symptoms like tingling, numbness, or muscle weakness in the upper extremities can lead to comorbidities. When this happens, it can lead to the development of a complex condition known as thoracic outlet syndrome or TOS. Today’s article looks at the link between thoracic outlet syndrome and neck pain, how to manage TOS while alleviating neck pain, and how electroacupuncture can help with TOS. We talk with certified medical providers who consolidate our patients’ information to assess how to minimize the effects of TOS while reducing neck pain. We also inform and guide patients on how electroacupuncture can help manage TOS. We encourage our patients to ask their associated medical providers intricate and important questions about incorporating electroacupuncture to alleviate TOS associated with the neck. Dr. Jimenez, D.C., includes this information as an academic service. Disclaimer.

The Link Between Thoracic Outlet Syndrome & Neck Pain

Have you been noticing how you are hunched over more than usual? Do you experience symptoms of tingling or numbness down from your arms to your hands? Or do you feel muscle tension in your neck? Thoracic outlet syndrome, or TOS, is a challenging condition resulting in the compression of neurovascular structures between the clavicle and the first rib. (Masocatto et al., 2019) These neurovascular structures are near the neck and shoulders. When environmental structures affect the upper extremities, it can lead to referred neck pain, which can cause overlapping risk profiles. Some of the factors that TOS can contribute to neck pain include:

Atomical variations
Poor posture
Repetitive motions
Traumatic injuries

At the same time, people with neck pain can develop TOS, as neck pain is a multifactorial musculoskeletal condition that can be associated with overlapping risk profiles that contribute to TOS. (Kazeminasab et al., 2022) As stated earlier, factors like poor posture can overstretch the neck muscles and the neurovascular structures, leading to neuropathic pain symptoms that can cause deep aching referred pain to the neck and muscle weakness. (Childress & Stuek, 2020) When this happens, many people will begin to feel miserable and start to seek treatment to not only reduce TOS but also alleviate neck pain.

What Is Thoracic Outlet Syndrome- Video

What is Thoracic Outlet Syndrome? | El Paso, Tx (2023)

Managing TOS & Alleviating Neck Pain

When it comes to treating TOS, especially when neck pain is a significant component, many individuals will try to seek out non-surgical treatments to reduce the symptoms. Many individuals may try physical therapy to stretch and strengthen their shoulder, chest, and neck muscles to relieve compression. Others might try a manual treatment that is joint-oriented for the neck while neural-tissue-oriented for TOS to improve mobilization on the upper extremities and even improve poor posture. (Kuligowski et al., 2021) Additionally, non-surgical treatments can be combined with other therapies to reduce the chances of TOS from returning as they can further increase sensory-motor function back to the neck and upper extremities. (Borrella-Andres et al., 2021)

How Electroacupuncture Can Help With TOS

Electroacupuncture is a modern form of traditional acupuncture that is part of the non-surgical treatments that can help manage TOS while alleviating neck pain. Electroacupuncture is a modification of inserting needles into the body’s acupoints while incorporating electric stimulation to deliver a pulsed electrical current to the affected area gently. (Zhang et al., 2022) Some of the beneficial properties that electrostimulation can provide for TOS include:

Pain reduction by stimulating the release of endorphins to decrease inflammation.
Help relax the affected muscles in the chest and neck to alleviate the pressure on the nerves of the thoracic outlet.
Help enhance the blood flow to reduce vascular compression of TOS.
Help stimulate the nerve pathway to promote healthy nerve function and reduce pain-like symptoms.

By incorporating electroacupuncture and non-surgical treatments to reduce TOS, many individuals can make modifications to their lifestyle habits and prevent issues from affecting their upper body extremities. By utilizing these treatments, many people can listen to their bodies and focus on their health and well-being by addressing the pain-like symptoms they are experiencing from TOS correlating with neck pain. At the same time, they have a positive relationship with their primary doctors to develop a personalized treatment plan that can manage their TOS symptoms to the best outcomes.

References

Borrella-Andres, S., Marques-Garcia, I., Lucha-Lopez, M. O., Fanlo-Mazas, P., Hernandez-Secorun, M., Perez-Bellmunt, A., Tricas-Moreno, J. M., & Hidalgo-Garcia, C. (2021). Manual Therapy as a Management of Cervical Radiculopathy: A Systematic Review. Biomed Res Int, 2021, 9936981. doi.org/10.1155/2021/9936981

Childress, M. A., & Stuek, S. J. (2020). Neck Pain: Initial Evaluation and Management. American Family Physician, 102(3), 150-156. www.ncbi.nlm.nih.gov/pubmed/32735440

www.aafp.org/dam/brand/aafp/pubs/afp/issues/2020/0801/p150.pdf

Kazeminasab, S., Nejadghaderi, S. A., Amiri, P., Pourfathi, H., Araj-Khodaei, M., Sullman, M. J. M., Kolahi, A. A., & Safiri, S. (2022). Neck pain: global epidemiology, trends and risk factors. BMC Musculoskelet Disord, 23(1), 26. doi.org/10.1186/s12891-021-04957-4

Kuligowski, T., Skrzek, A., & Cieslik, B. (2021). Manual Therapy in Cervical and Lumbar Radiculopathy: A Systematic Review of the Literature. Int J Environ Res Public Health, 18(11). doi.org/10.3390/ijerph18116176

Masocatto, N. O., Da-Matta, T., Prozzo, T. G., Couto, W. J., & Porfirio, G. (2019). Thoracic outlet syndrome: a narrative review. Rev Col Bras Cir, 46(5), e20192243. doi.org/10.1590/0100-6991e-20192243 (Sindrome do desfiladeiro toracico: uma revisao narrativa.)

Zhang, B., Shi, H., Cao, S., Xie, L., Ren, P., Wang, J., & Shi, B. (2022). Revealing the magic of acupuncture based on biological mechanisms: A literature review. Biosci Trends, 16(1), 73-90. doi.org/10.5582/bst.2022.01039

Disclaimer

Reduce Hip Pain and Plantar Fasciitis with Nonsurgical Treatments

Dr. Alex Jimenez

Can plantar fasciitis patients incorporate non-surgical treatments to reduce hip pain and restore mobility?

Table of Contents

Introduction

Everyone is on their feet constantly as it helps people stay mobile and allows them to go from one location to another. Many people are constantly on their feet from childhood to adulthood. This is because the feet are part of the lower musculoskeletal extremities that stabilize the hips and allow sensory-motor function to the legs, thighs, and calves. The feet also have various muscles, tendons, and ligaments surrounding the skeletal structure to prevent pain and discomfort. However, when repetitive motions or injuries start to affect the feet, it can lead to plantar fasciitis and, over time, cause overlapping risk profiles that lead to hip pain. When people are experiencing these pain-like conditions, it can significantly affect their daily activities and overall quality of life. When this happens, many people seek various treatments to reduce the pain-like symptoms caused by plantar fasciitis and restore hip mobility. Today’s article looks at how plantar fasciitis correlates with hip pain, the connection between the feet and the hips, and how there are non-surgical solutions to reduce plantar fasciitis. We talk with certified medical providers who consolidate our patients’ information to assess how to mitigate plantar fasciitis and restore hip mobility. We also inform and guide patients on how numerous non-surgical treatments can help strengthen weak muscles associated with plantar fasciitis and help with restoring stabilization from hip pain. We encourage our patients to ask their associated medical providers intricate and important questions about incorporating small changes to reduce the pain-like effects caused by plantar fasciitis. Dr. Jimenez, D.C., includes this information as an academic service. Disclaimer.

How Plantar Fasciitis Correlates With Hip Pain

Do you experience pain in your heels constantly after a long walk? Do you feel stiffness in your hips when stretching? Or do you feel your shoes are causing tension and pain in your feet and calves? Often, many of these pain-like scenarios are due to people dealing with plantar fasciitis, characterized by heel pain due to inflammation or degenerative irritation of the plantar fascia, a band of thick tissues is running across the bottom of the foot and connecting to the heel bone to the toes in the lower extremities. This band of tissues plays an essential role in the body, providing normal biomechanics to the foot while supporting the arch and helping with shock absorption. (Buchanan et al., 2024) Plantar fasciitis can affect the stability of the lower extremities since the pain affects the feet and causes hip pain.

So, how would plantar fasciitis correlate with hip pain? With plantar fasciitis, many people are experiencing pain in their feet. It can lead to abnormal foot posture, lower extremity muscle weakness, and muscle stress that can reduce the stability of the legs and hip muscles. (Lee et al., 2022) With hip pain, many people can experience a gait dysfunction that causes muscle weakness in the lower extremities and causes the accessory muscles to perform the primary muscles’ jobs. To that point, this forces people to scrap the ground when walking. (Ahuja et al., 2020) This is because normal conditions like natural aging, muscle overuse, or trauma can cause pain-like symptoms to the hips, including discomfort on the thighs, groin, and buttock region, joint stiffness, and reduced range of motion. Hip pain can cause overlapping risk profiles that may include repetitive strain on the feet, thus leading to symptoms of sharp to dull aches on the heel.

The Connection Between The Feet and The Hips

It is important to understand that foot problems like plantar fasciitis can affect the hips and vice versa, as both body regions have a beautiful relationship within the musculoskeletal system. Plantar fasciitis on their feet can alter their gait function, potentially leading to hip pain over time. This is due to many environmental factors that can affect the hips and feet over time, leading to plantar fasciitis correlating with hip pain. From excessive weight-bearing activities to microtrauma in the hips or the plantar fascia, many people will often seek treatment to reduce the effects of plantar fasciitis correlated with hip pain by addressing how their range of motion is affecting the plantarflexion and their load on the force-absorbing plantar surface structures could be good starting points in the prevention and treatment of plantar fasciitis correlated with hip pain. (Hamstra-Wright et al., 2021)

What Is Plantar Fasciitis?-Video

What is Plantar Fasciitis? | El Paso, Tx (2023)

Non-Surgical Solutions To Reduce Plantar Fasciitis

When it comes to reducing plantar fasciitis in the body, many individuals will seek non-surgical treatments that can alleviate the pain from plantar fascia. Non-surgical treatments are cost-effective and can reduce the pain from plantar fasciitis and its associated symptoms, like hip pain. Some of the benefits of non-surgical treatments are promising, as they have a low risk of complications, good accessibility, and even a high capacity to relieve the mechanical load on the plantar fascia when doing regular activities. (Schuitema et al., 2020) Some of the non-surgical treatments that many people can incorporate include:

Stretching exercises
Orthotic devices
Chiropractic care
Massage therapy
Acupuncture/electroacupuncture
Spinal decompression

These non-surgical treatments not only help reduce plantar fasciitis but also help alleviate hip pain. For example, spinal decompression can help restore hip mobility by stretching the lumbar spine and relieving the lower extremities from numbness while strengthening tight muscles. (Takagi et al., 2023). Electroacupuncture can stimulate the body’s acupoints to release endorphins from the lower extremities to reduce inflammation of the plantar fascia. (Wang et al., 2019) When people begin to make small changes in their routine, like wearing proper footwear and not carrying or lifting heavy weighted objects, it can go a long way to prevent plantar fasciitis and hip pain from reoccurring can go a long way. Having a personalized treatment plan can ensure many individuals seeking non-surgical treatments have a better outcome on their health and mobility while preventing long-term complications.

References

Ahuja, V., Thapa, D., Patial, S., Chander, A., & Ahuja, A. (2020). Chronic hip pain in adults: Current knowledge and future prospective. J Anaesthesiol Clin Pharmacol, 36(4), 450-457. doi.org/10.4103/joacp.JOACP_170_19

Buchanan, B. K., Sina, R. E., & Kushner, D. (2024). Plantar Fasciitis. In StatPearls. www.ncbi.nlm.nih.gov/pubmed/28613727

Hamstra-Wright, K. L., Huxel Bliven, K. C., Bay, R. C., & Aydemir, B. (2021). Risk Factors for Plantar Fasciitis in Physically Active Individuals: A Systematic Review and Meta-analysis. Sports Health, 13(3), 296-303. doi.org/10.1177/1941738120970976

Lee, J. H., Shin, K. H., Jung, T. S., & Jang, W. Y. (2022). Lower Extremity Muscle Performance and Foot Pressure in Patients Who Have Plantar Fasciitis with and without Flat Foot Posture. Int J Environ Res Public Health, 20(1). doi.org/10.3390/ijerph20010087

Schuitema, D., Greve, C., Postema, K., Dekker, R., & Hijmans, J. M. (2020). Effectiveness of Mechanical Treatment for Plantar Fasciitis: A Systematic Review. J Sport Rehabil, 29(5), 657-674. doi.org/10.1123/jsr.2019-0036

Takagi, Y., Yamada, H., Ebara, H., Hayashi, H., Inatani, H., Toyooka, K., Mori, A., Kitano, Y., Nakanami, A., Kagechika, K., Yahata, T., & Tsuchiya, H. (2023). Decompression for lumbar spinal stenosis at the intrathecal catheter insertion site during intrathecal baclofen therapy: a case report. J Med Case Rep, 17(1), 239. doi.org/10.1186/s13256-023-03959-1

Wang, W., Liu, Y., Zhao, J., Jiao, R., & Liu, Z. (2019). Electroacupuncture versus manual acupuncture in the treatment of plantar heel pain syndrome: study protocol for an upcoming randomised controlled trial. BMJ Open, 9(4), e026147. doi.org/10.1136/bmjopen-2018-026147

Disclaimer

Exploring the Role of Intervertebral Foramen in Nerve Connectivity

Dr. Alex Jimenez

Lumbar spine displaced herniated disc fragment, spinal nerve and bone. Model for treatment medical in the orthopedic department.

“For individuals looking to improve their spinal health, can understanding the anatomy of the intervertebral foramen help in injury rehabilitation and prevention?”

Table of Contents

Intervertebral Foramen

The intervertebral foramen, aka neural foramen, is the opening between the vertebrae through which spinal nerve roots connect and exit to other body areas. If the foramina narrows, it can place added pressure on the nerve roots near and around them, causing pain symptoms and sensations. This is known as neuroforaminal stenosis. (Sumihisa Orita et al., 2016)

Anatomy

The vertebrae comprise the spinal column.
They protect and support the spinal cord and most of the weight placed on the spine.
Foramen is the singular form, and foramina is the plural form.

Structure

The body is the large, round part of the bone that makes up each vertebra.
The body of each vertebra is attached to a bony ring.
As the vertebrae are stacked on each other, the ring creates a tube through which the spinal cord passes. (American Academy of Orthopaedic Surgeons 2020)

The intervertebral foramen opening is between every two vertebrae, where the nerve roots exit the spine.
Two neural foramina exist between each pair of vertebrae, with one on each side.
The nerve roots move through the foramen to the rest of the body.

Function

The intervertebral foramina are exits from which the nerve roots leave the spine and branch out to the rest of the body.
Without the foramen, nerve signals cannot transmit to and from the brain to the body.
Without nerve signals, the body is unable to function correctly.

Conditions

A common condition that can affect the neuroforamina is spinal stenosis. Stenosis means narrowing.

Spinal stenosis is (not always) usually an age-related disorder associated with arthritis. (American Academy of Orthopaedic Surgeons, 2021)
Stenosis can occur in the spinal canal, known as central canal stenosis, and the foramina.
Pain brought on by neuroforaminal spinal stenosis and arthritis-related bone growth/bone spurs/osteophytes that are present in one or more foramen rub against the nerve root that passes through the space, causing radicular pain.
Pain accompanied by other sensations, like tingling or numbness, is known as radiculopathy. (Young Kook Choi, 2019)

The main symptom is pain.
Numbness and/or tingling can present depending on the injury.
Neurogenic claudication occurs as a result of ischemia or a lack of blood circulation to the nerves and typically presents with a heaviness in the legs.
It is typically associated with central stenosis rather than foraminal stenosis.
Most individuals with spinal stenosis feel better when flexing or bending forward and worse when arching their backs.
Other symptoms include weakness and/or difficulty walking. (Seung Yeop Lee et al., 2015)

Treatment

Stenosis treatment aims to relieve pain and prevent nerve symptoms from occurring or worsening. Conservative treatments are recommended and can be highly effective.
These include:

Physical therapy
Acupuncture and Electroacupuncture
Chiropractic
Non-surgical decompression
Therapeutic massage
Nonsteroidal anti-inflammatory drugs/NSAIDs
Targeted exercises and stretches
Cortisone injections. (American Academy of Orthopaedic Surgeons, 2021)
Surgery is usually not necessary.

However, a doctor may recommend surgery for an individual who is experiencing:

Radiculopathy – pain, pins and needles, electrical sensations, and/or weakness going down one arm or leg (Jon Lurie, Christy Tomkins-Lane, 2016)
Neurogenic claudication in the lower back (Jon Lurie, Christy Tomkins-Lane, 2016)
Myelopathy in the neck and/or upper or mid-back (myelopathy symptoms are spinal cord related and occur in central canal stenosis) (Cleveland Clinic. 2021)
Intense incapacitating pain

Different surgical techniques include:

Decompression laminectomy – entails removing the buildup of bone in the spinal canal.
Spinal fusion – when there is instability of the spine or severe foraminal stenosis.
However, most cases don’t require fusion. (American Academy of Orthopaedic Surgeons, 2021)

Root Causes Spinal Stenosis

References

Orita, S., Inage, K., Eguchi, Y., Kubota, G., Aoki, Y., Nakamura, J., Matsuura, Y., Furuya, T., Koda, M., & Ohtori, S. (2016). Lumbar foraminal stenosis, the hidden stenosis including at L5/S1. European journal of orthopaedic surgery & traumatology : orthopedie traumatologie, 26(7), 685–693. doi.org/10.1007/s00590-016-1806-7

American Academy of Orthopaedic Surgeons. (2020). Spine Basics (OrthoInfo, Issue. orthoinfo.aaos.org/en/diseases–conditions/spine-basics/

American Academy of Orthopaedic Surgeons. (2021). Lumbar spinal stenosis (OrthoInfo, Issue. orthoinfo.aaos.org/en/diseases–conditions/lumbar-spinal-stenosis/

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

Lee, S. Y., Kim, T. H., Oh, J. K., Lee, S. J., & Park, M. S. (2015). Lumbar Stenosis: A Recent Update by Review of Literature. Asian spine journal, 9(5), 818–828. doi.org/10.4184/asj.2015.9.5.818

Lurie, J., & Tomkins-Lane, C. (2016). Management of lumbar spinal stenosis. BMJ (Clinical research ed.), 352, h6234. doi.org/10.1136/bmj.h6234

Cleveland Clinic. (2021). Myelopathy (Health Library, Issue. my.clevelandclinic.org/health/diseases/21966-myelopathy

How Spinal Decompression Can Reduce Cervical Spinal Pain

Dr. Alex Jimenez

Can individuals with cervical spinal pain incorporate spinal decompression therapy to reduce neck pain and headaches?

Table of Contents

Introduction

Many individuals deal with neck pain at some point, leading to many issues that can impact their daily lives. See, the neck is part of the cervical region of the musculoskeletal system. It is surrounded by muscles, soft tissues, and ligaments that protect the spinal cord while allowing the head to be mobile. Like back pain, neck pain is a common issue that causes pain and discomfort from associated environmental factors and traumatic injuries. When a person is dealing with neck pain, they are also coping with comorbidities that cause overlapping risk profiles like headaches and migraines. However, treatments like spinal decompression can help reduce cervical spinal pain affecting the neck and reduce the painful effects of headaches and migraines. Today’s article looks at the impact of cervical pain and headaches, how spinal decompression can reduce cervical spinal pain, and how it benefits from reducing headaches. We talk with certified medical providers who consolidate our patients’ information to assess how to mitigate cervical spinal pain from the neck. We also inform and guide patients on how spinal decompression can help reduce headaches caused by cervical spinal pain. We encourage our patients to ask their associated medical providers intricate and important questions about incorporating spinal decompression therapy as part of their routine to reduce headaches and migraines associated with the neck. Dr. Jimenez, D.C., includes this information as an academic service. Disclaimer.

The Effects Of Cervical Pain & Headaches

Do you feel stiffness on both sides of your neck that causes you limited mobility when you turn your neck? Have you experienced constant throbbing pain in your temples? Or do you feel muscle aches on your neck and shoulders from being hunched on the computer for an extended period? Many individuals dealing with these pain-like issues could be coping with cervical spinal pain. Various causes that can lead to the development of cervical spinal pain include herniated discs, pinched nerves, spinal stenosis, and muscle strain that originates from the neck region. This is because cervical spinal pain can be associated with environmental factors that can cause pain and discomfort, disability, and impaired quality of life as the surrounding neck muscles are overstretched and tight. (Ben Ayed et al., 2019) When people are dealing with cervical spinal pain, one of the symptoms it is associated with is headaches. This is because the intricated nerve pathways are connected to the neck and head. When cervical spinal pain is causing these issues, it can significantly impact a person’s daily body function as the pain is traveling upwards.

At the same time, neck pain is a multifactorial disease that can become a major issue worldwide. Like back pain, numerous risk factors can contribute to its development. (Kazeminasab et al., 2022) Some risk factors, like excessive phone usage, cause prolonged neck flexion to the neck and shoulders, causing static muscular loading with a lack of support to the upper extremities. (Al-Hadidi et al., 2019) To this point, environmental risk factors like excessive phone usage can make individuals develop a hunched position in their necks that can compress the spinal disc in the cervical region and aggravate the nerve roots to produce headaches and pain. However, many individuals have found ways to reduce cervical spinal pain and find pain relief from their headaches.

Home Exercises for Pain Relief-Video

Home Exercises for Pain Relief | El Paso, Tx (2023)

How Spinal Decompression Reduces Cervical Spinal Pain

When it comes to reducing cervical spinal pain, many individuals have experienced that spinal decompression can help mitigate the effects of cervical pain. Spinal decompression has increasingly been recognized as an effective non-surgical treatment when it comes to alleviating cervical spinal pain. What spinal decompression does is that it allows negative pressure on the cervical spine to relieve any herniated disc of the aggravated nerve roots and help improve neurological symptoms. (Kang et al., 2016) This is due to a person being strapped comfortably on a traction machine that gently stretches and decompresses the spinal vertebrae. Additionally, some of the benefits of spinal decompression for cervical spinal pain include:

Improved spinal alignment to reduce muscle strain on the neck muscles and joints.
Enhanced the body’s natural healing by increasing blood flow and nutrient exchange.
Increased neck mobility by decreasing muscle stiffness.
Reducing pain levels that are causing intense headaches.

The Benefits of Spinal Decompression For Headaches

Additionally, spinal decompression can help reduce headaches associated with cervical spinal pain as spinal decompression can be combined with other therapies like acupuncture and physical therapy to relieve the protruding spinal dice and stabilize within the annulus by spinal elongation. (Van Der Heijden et al., 1995) This is due to gentle traction on the neck that is causing the prolapsed disc to reposition itself while restoring disc height to minimize the pressure on the nerves. (Amjad et al., 2022) When a person is doing spinal decompression therapy consecutively, the pain-like effects of cervical spinal pain and the associated headaches begin to reduce over time, and many people will start to notice how their habits are in correlation with their pain. By incorporating spinal decompression therapy as part of their treatment, many people can make small changes in their routine and be more mindful of their bodies to prevent the progression of cervical spinal pain from returning.

References

Al-Hadidi, F., Bsisu, I., AlRyalat, S. A., Al-Zu’bi, B., Bsisu, R., Hamdan, M., Kanaan, T., Yasin, M., & Samarah, O. (2019). Association between mobile phone use and neck pain in university students: A cross-sectional study using numeric rating scale for evaluation of neck pain. PLOS ONE, 14(5), e0217231. doi.org/10.1371/journal.pone.0217231

Amjad, F., Mohseni-Bandpei, M. A., Gilani, S. A., Ahmad, A., & Hanif, A. (2022). Effects of non-surgical decompression therapy in addition to routine physical therapy on pain, range of motion, endurance, functional disability and quality of life versus routine physical therapy alone in patients with lumbar radiculopathy; a randomized controlled trial. BMC Musculoskelet Disord, 23(1), 255. doi.org/10.1186/s12891-022-05196-x

Ben Ayed, H., Yaich, S., Trigui, M., Ben Hmida, M., Ben Jemaa, M., Ammar, A., Jedidi, J., Karray, R., Feki, H., Mejdoub, Y., Kassis, M., & Damak, J. (2019). Prevalence, Risk Factors and Outcomes of Neck, Shoulders and Low-Back Pain in Secondary-School Children. J Res Health Sci, 19(1), e00440. www.ncbi.nlm.nih.gov/pubmed/31133629

www.ncbi.nlm.nih.gov/pmc/articles/PMC6941626/pdf/jrhs-19-e00440.pdf

Kang, J.-I., Jeong, D.-K., & Choi, H. (2016). Effect of spinal decompression on the lumbar muscle activity and disk height in patients with herniated intervertebral disk. Journal of Physical Therapy Science, 28(11), 3125-3130. doi.org/10.1589/jpts.28.3125

Van Der Heijden, G. J., Beurskens, A. J., Koes, B. W., Assendelft, W. J., De Vet, H. C., & Bouter, L. M. (1995). The Efficacy of Traction for Back and Neck Pain: A Systematic, Blinded Review of Randomized Clinical Trial Methods. Physical Therapy, 75(2), 93-104. doi.org/10.1093/ptj/75.2.93

Disclaimer

Acupuncture-Electroacupuncture: A Holistic Approach to Healing

Dr. Alex Jimenez

For individuals dealing with musculoskeletal pain, can incorporating acupuncture and electroacupuncture therapy provide beneficial results?

Table of Contents

Introduction

The upper and lower body quadrants are surrounded by muscles, soft tissues, and ligaments that allow the body to be mobile with feelings of pain or discomfort. Each muscle group has an important job providing sensory-motor functions like grasping objects, moving extremities, supporting the body in a correct posture, and stabilizing vertical axial weight. However, many people have adopted various habits from environmental factors or have been through traumatic injuries that can cause referred muscle pain in the upper and lower body quadrants. When this happens, it can lead to a life of disability, pain, and discomfort over time if it is not treated right away. To that point, musculoskeletal pain can also cause overlapping risk profiles with other comorbidities that can be pre-existing in the body. Fortunately, numerous treatments can help reduce musculoskeletal pain and benefit the body. Today’s article looks at two different non-surgical therapies, how each is beneficial to reducing musculoskeletal pain, and how effective they can help many people with musculoskeletal pain. We talk with certified medical providers who consolidate our patients’ information to assess how to reduce the pain-like effects of musculoskeletal pain with non-surgical treatments. We also guide patients on how these non-surgical treatments can help lessen the referred pain caused by various environmental factors affecting their musculoskeletal system. We encourage our patients to ask their associated medical providers intricate and important questions about incorporating non-surgical treatments into their health and wellness treatments. Dr. Jimenez, D.C., includes this information as an academic service. Disclaimer.

The Traditional Touch Of Acupuncture

After a long workday, do you feel soreness in your arms, legs, or feet? Have you experienced any symptoms of numbness or stiffness in the upper or lower portions of your body? Or do you feel muscle aches and pains after waking up in the morning? Around the world, many individuals have dealt with musculoskeletal pain at some point, which causes many people to miss out on numerous activities. Musculoskeletal pain is a multifactorial condition that any individual can develop over time. Some biological mechanisms contributing to the development of musculoskeletal pain can be heterogeneous, cardiometabolic, and systemic inflammation that can affect the body. (Dzakpasu et al., 2021) When many people are doing repetitive motions or have dealt with injuries, it can cause the various muscles to be overstretched, tightened, or weak, which can cause individuals to feel miserable and seek treatment. When people go to get treatment for their musculoskeletal pain, many people will tell their doctors about their pain experience and how it impacts their daily social well-being. By gaining information about how musculoskeletal pain negatively affects their lives, a multidisciplinary approach to pain management that emphasizes rehabilitation and non-surgical treatments can be the first step in effectively managing musculoskeletal pain. (Welsh et al., 2020)

Now, non-surgical treatments vary depending on the severity of musculoskeletal pain the person is experiencing. Since musculoskeletal pain is a multifactorial condition, many people could experience comorbidities that cause overlapping risk profiles that correlate with musculoskeletal pain, hence why many people incorporate non-surgical treatments since it is affordable and can be combined with other treatments. One of the oldest therapies that is still practiced today is acupuncture. Now, acupuncture involves the insertion of thin, solid needles into the body’s acupoints to restore the normal flow of energy through the body’s pathways. Highly trained professionals do acupuncture, and it is safe and effective for the person dealing with musculoskeletal pain. Additionally, acupuncture can positively affect the body as it can help change the pain perception of the affected muscle. (Kelly & Willis, 2019)

How Acupuncture Benefits Muscle Pain

Acupuncture can also provide beneficial results to individuals by emphasizing the mobilization of self-healing mechanisms to restore the body’s homeostasis to normal. (Wang et al., 2023) Some of the beneficial properties that people can experience with acupuncture include:

Provides natural pain relief by stimulating the release of endorphins in the affected muscle.
Reducing muscle inflammation in the affected muscle group area.
Improving blood flow circulation to decrease muscle stiffness and soreness.
Reducing stress and muscle tension in the affected area.

At the same time, acupuncture therapy for muscle pain can help reduce the inhibitory effects and modulate the feeling of pain, which then modifies central sensitization. (Zhu et al., 2021)

The Modern Twist Of Electroacupuncture

Now, electroacupuncture is a different form of acupuncture that uses the application of acupuncture needles and electric stimulation on the affected muscle. At the same time, when people are getting treated with electroacupuncture, their somatosensory afferent nerves provide pain relief. They are blocked to stop the pain signals from reaching the central nervous system. (Chen et al., 2021) This is because adding electric stimulation can enhance the therapeutic effects of the acupuncture points in the body.

How Electroacupuncture Benefits Muscle Pain

Regarding reducing muscle pain, electroacupuncture is more effective as acupuncturists can help adjust the intensity of the electric currents on the affected muscle to ensure comfort. Some of the benefits that electroacupuncture provides include:

Enhanced pain relief as the electric current can stimulate endorphin release.
Muscle relaxation from spasms in the affected muscle group.
Increased the healing rate by stimulating deeper muscles.
Help enhance muscle strength and flexibility to improve functionality.

Electroacupuncture can relieve pain and even adjust the biomechanical properties of the extensor-flexor muscles to improve abnormal joint loading caused by musculoskeletal pain. (Shi et al., 2020)

How These Two Treatments Help With Musculoskeletal Pain?

When it comes to acupuncture and electroacupuncture, it all depends on the severity of musculoskeletal pain affecting the body. Many people prefer traditional acupuncture for acute musculoskeletal pain in a more holistic approach. In comparison, others might prefer electroacupuncture to reduce the chronic pain effects of musculoskeletal pain. However, both of these treatments are non-surgical. They can be combined with other therapies like physical therapy or chiropractic care to help stimulate the body’s natural healing factor and relieve musculoskeletal pain. When these two treatments are combined with other therapies, the affected muscles are strengthened and provide mobility function back into the extremities. When people start thinking about their well-being, they can utilize these treatments to reduce the comorbidities associated with musculoskeletal pain that is affecting them. Thus allowing them to make small, healthy changes to their routine and live pain-free lives.

Beyond Adjustments: Chiropractic and Integrative Healthcare- Video

Beyond Adjustments: Chiropractic and Integrative Healthcare | El Paso, Tx (2024)

References

Chen, L., Wang, X., Zhang, X., Wan, H., Su, Y., He, W., Xie, Y., & Jing, X. (2021). Electroacupuncture and Moxibustion-Like Stimulation Relieves Inflammatory Muscle Pain by Activating Local Distinct Layer Somatosensory Afferent Fibers. Front Neurosci, 15, 695152. doi.org/10.3389/fnins.2021.695152

Dzakpasu, F. Q. S., Carver, A., Brakenridge, C. J., Cicuttini, F., Urquhart, D. M., Owen, N., & Dunstan, D. W. (2021). Musculoskeletal pain and sedentary behaviour in occupational and non-occupational settings: a systematic review with meta-analysis. Int J Behav Nutr Phys Act, 18(1), 159. doi.org/10.1186/s12966-021-01191-y

Kelly, R. B., & Willis, J. (2019). Acupuncture for Pain. American Family Physician, 100(2), 89-96. www.ncbi.nlm.nih.gov/pubmed/31305037

www.aafp.org/pubs/afp/issues/2019/0715/p89.pdf

Shi, X., Yu, W., Wang, T., Battulga, O., Wang, C., Shu, Q., Yang, X., Liu, C., & Guo, C. (2020). Electroacupuncture alleviates cartilage degradation: Improvement in cartilage biomechanics via pain relief and potentiation of muscle function in a rabbit model of knee osteoarthritis. Biomed Pharmacother, 123, 109724. doi.org/10.1016/j.biopha.2019.109724

Wang, M., Liu, W., Ge, J., & Liu, S. (2023). The immunomodulatory mechanisms for acupuncture practice. Front Immunol, 14, 1147718. doi.org/10.3389/fimmu.2023.1147718

Welsh, T. P., Yang, A. E., & Makris, U. E. (2020). Musculoskeletal Pain in Older Adults: A Clinical Review. Med Clin North Am, 104(5), 855-872. doi.org/10.1016/j.mcna.2020.05.002

Zhu, J., Li, J., Yang, L., & Liu, S. (2021). Acupuncture, from the ancient to the current. Anat Rec (Hoboken), 304(11), 2365-2371. doi.org/10.1002/ar.24625

Disclaimer

Biomechanics on Movement, Performance, and Therapy

Dr. Alex Jimenez

Fit female testing the stepper with electrodes on it and the doctor watching the evolution of the test on the screen. Modern sports laboratory

“For individuals experiencing musculoskeletal issues and pain symptoms, can learning about biomechanics and how it applies to movement, physical training, and performance help in injury treatment and prevention?”

Table of Contents

Biomechanics

Biomechanics studies all life forms and their mechanical workings. Many think of biomechanics in sports and athletic performance, but biomechanics helps create and improve technologies, equipment, and injury rehabilitation techniques. (Tung-Wu Lu, Chu-Fen Chang 2012) Scientists, sports medicine doctors, physiotherapists, chiropractors, and conditioning specialists utilize biomechanics to help develop training protocols and techniques to improve therapy outcomes.

Body Movement

Biomechanics studies the movement of the body, including how muscles, bones, tendons, and ligaments work together, especially when movement is not optimal or correct. It is part of the larger field of kinesiology, specifically focusing on motion mechanics and analysis of how all the individual parts of the body work together to make up athletic and normal movements. (José M Vilar et al., 2013) Biomechanics includes:

Structure of bones and muscles.
Movement ability.
Mechanics of blood circulation, renal function, and other functions.
The study of forces and the effects of these forces on the tissues, fluid, or materials used for diagnosis, treatment, or research. (Jose I. Priego-Quesada 2021)

Sports

Sports biomechanics studies motion in exercising, training, and sports, which incorporates physics and the laws of mechanics. For example, the biomechanics of a specific exercise looks at:

Body position.
Movement of the feet, hips, knees, back, shoulders, and arms.

Knowing the correct movement patterns helps make the most of the exercise while preventing injuries, correcting form mistakes, informing training protocols, and increasing positive results. Understanding how the body moves and why it moves the way it does helps medical professionals prevent and treat injuries, alleviate pain symptoms, and improve performance.

Equipment

Biomechanics is used in the development of physical and sports equipment to improve performance. For example, a shoe can be designed for optimal performance for a skateboarder, long-distance runner, or soccer player. Playing surfaces are also studied for this purpose, such as how the surface stiffness of artificial turf affects athletic performance. (Jose I. Priego-Quesada 2021)

Individuals

Biomechanics can analyze an individual’s movements for more effective movement during training and games.
For example, an individual’s running gait or swing can be filmed with recommendations on what to change to improve.

Injuries

The science studies the causes, treatment, and prevention of neuromusculoskeletal injuries.
The research can analyze the forces that cause injuries and provide information for medical professionals on how to reduce the risk of injury.

Training

Biomechanics studies sports techniques and training systems to develop ways to improve efficiency.
This can include research on positioning, release, follow-through, etc.
It can analyze and help design new training techniques based on the mechanical demands of the sport, aimed at resulting in better performance.
For example, muscle activation is measured in cycling using electromyography and kinematics, which helps researchers analyze factors like posture, components, or exercise intensity that affect activation. (Jose I. Priego-Quesada 2021)

Motions

In biomechanics, the body’s motions are referred to from anatomical positioning:

Standing upright, with the gaze straight ahead
Arms at the sides
Palms facing forward
Feet spaced slightly apart, toes forward.

The three anatomical planes include:

Sagittal – median – Dividing the body into right and left halves is the sagittal/median plane. Flexion and extension occur in the sagittal plane.
Frontal – The frontal plane divides the body into front and back sides but also includes abduction, or moving a limb away from the center, and adduction, or moving a limb towards the center in the frontal plane.
Transverse – horizontal. – The upper and lower parts of the body are divided by the transverse/horizontal plane. Rotating movements occur here. (American Council on Exercise 2017)
Moving the body in all three planes occurs with daily activity. This is why performing exercises in each plane of motion to build strength, function, and stability is recommended.

Tools

Various tools are used to study biomechanics. Studies are usually performed using a device known as electromyography or EMG sensors. Sensors are placed on the skin and measure the amount and degree of muscle fiber activation in certain muscles during test exercises. EMGs can help:

Researchers understand which exercises are more effective than others.
Therapists know whether patients’ muscles are properly operating and functioning.

Dynamometers are another tool that helps measure muscle strength.
They measure the force output generated during muscle contractions to see if the muscles are sufficiently strong.
They are used to measure grip strength, which can be an indicator of overall strength, health, and longevity. (Li Huang et al., 2022)

Beyond Adjustments: Chiropractic and Integrative Healthcare

References

Lu, T. W., & Chang, C. F. (2012). Biomechanics of human movement and its clinical applications. The Kaohsiung journal of medical sciences, 28(2 Suppl), S13–S25. doi.org/10.1016/j.kjms.2011.08.004

Vilar, J. M., Miró, F., Rivero, M. A., & Spinella, G. (2013). Biomechanics. BioMed research international, 2013, 271543. doi.org/10.1155/2013/271543

Priego-Quesada J. I. (2021). Exercise Biomechanics and Physiology. Life (Basel, Switzerland), 11(2), 159. doi.org/10.3390/life11020159

American Council on Exercise. Makeba Edwards. (2017). Planes of Motion Explained (Exercise Science, Issue. www.acefitness.org/fitness-certifications/ace-answers/exam-preparation-blog/2863/the-planes-of-motion-explained/

Huang, L., Liu, Y., Lin, T., Hou, L., Song, Q., Ge, N., & Yue, J. (2022). Reliability and validity of two hand dynamometers when used by community-dwelling adults aged over 50 years. BMC geriatrics, 22(1), 580. doi.org/10.1186/s12877-022-03270-6

The Connection Between Low Back Sciatica and Electroacupuncture

Dr. Alex Jimenez

Can the effects of electroacupuncture reduce sciatica in individuals dealing with low back pain to restore their mobility?

Table of Contents

Introduction

When many people start to overuse their muscles in the lower quadrants, it can lead to numerous issues that cause pain and discomfort. One of the most common pain issues in the lower quadrants of the musculoskeletal system is sciatica, which is associated with low back pain. This pain duo can affect a person’s daily routine and lead them to pain and discomfort. This musculoskeletal condition is common, and when it affects one of the legs and lower back, many people state that it’s a radiating shooting pain that doesn’t go away for a while. Luckily, there are treatments like electroacupuncture to reduce sciatica associated with low back pain. Today’s article looks at the sciatica-low-back connection, how electroacupuncture reduces this pain connection, and how electroacupuncture can restore mobility to the individual. We talk with certified medical providers who consolidate our patients’ information to assess how to reduce the sciatica-low-back connection with electroacupuncture. We also inform and guide patients on how electroacupuncture therapy can be combined with other therapies to restore mobility to the body. We encourage our patients to ask their associated medical providers intricate and important questions about incorporating electroacupuncture therapy as part of their routine to reduce sciatica associated with low back pain. Dr. Jimenez, D.C., includes this information as an academic service. Disclaimer.

The Sciatica & Low Back Connection

Do you feel muscle aches or pain in your lower back or your legs? Do you experience radiating, throbbing pain in your legs that affects your walking ability? Or have you noticed that your legs and lower back ache more when carrying a heavy object? Many of these scenarios are associated with sciatica, which correlates with lower back pain. Now, sciatica is often characterized by aggravating pain traveling along the sciatic nerve from the lower back region, impairing a person’s quality of life. In the musculoskeletal system, the sciatic nerve plays an important role by providing motor function to the legs. (Davis et al., 2024) Now, when the sciatic nerve, the lumbar region also has a pivotal role. The lumbar region in the musculoskeletal region also has a crucial role in providing support, strength, and flexibility to the body. However, both the sciatic nerve and lumbar spinal region are more prone to stress and injuries from traumatic injuries and environmental factors that can impact the lumbar spinal discs and the sciatic nerve.

Repetitive motions, obesity, improper lifting, degenerative spinal issues, and musculoskeletal conditions are a few causes and risk factors contributing to the development of sciatica associated with the lower back. What eventually happens is that the water content and the progressive loss of the proteoglycans of the spinal discs break down between the vertebrae and protrude out to press on the sciatic nerve, which then can become irritated and cause referred radiating pain in the legs and lower back. (Zhou et al., 2021) The combination of sciatica and lower back pain can become a socio-economic issue depending on the severity of the pain that the sciatic nerve is causing and can make individuals miss out on any activities they are participating in. (Siddiq et al., 2020) While sciatica pain-like symptoms often correlate with the lumbar region, many individuals can find the relief they are looking for through various treatments.

Sciatica Causes- Video

Sciatica, Causes, Symptoms and tips| El Paso, Tx (2023)

Electroacupuncture Reducing The Sciatica-Low Back Connection

When it comes to reducing the sciatic-low-back connection, many individuals seek out treatment that is affordable and effective in decreasing pain-like issues. Non-surgical treatments like electroacupuncture can be beneficial to many individuals who are experiencing sciatica pain correlated with the lower back. Electroacupuncture is another form of traditional acupuncture therapy that originates in China. Highly trained acupuncturists follow the same acupuncture principles by placing solid thin needles at different acupoints in the body to restore qui or chi (energy flow). Electroacupuncture combines needles and electrostimulation to reduce the central pain-regulatory mechanisms causing low back pain and sciatica by blocking the pain signals and providing pain relief. (Kong, 2020) At the same time, electroacupuncture offers analgesic properties to stimulate endorphins and reduce pain medication for low back pain safely. (Sung et al., 2021)

Electroacupuncture Restoring Mobility

When the lower extremities are experiencing limited mobility due to sciatica associated with low back pain, electroacupuncture can help relax the muscles that are aggravating the sciatic nerve and even help improve blood flow to the lumbar muscles. That is because electroacupuncture can stimulate specific body regions to reduce the somato-vagal-adrenal reflexes to relieve and restore mobility to the lower extremities. (Liu et al., 2021) Additionally, electroacupuncture can be combined with other non-surgical therapies to help strengthen the core and lower back muscles, allowing people to be more mindful of what factors are causing sciatica and lower back pain. By doing this, many people struggling with sciatica associated with low back pain can incorporate electroacupuncture as part of their treatment program combined with holistic approaches to improving their quality of life and providing a pathway to improving their mobility.

References

Davis, D., Maini, K., Taqi, M., & Vasudevan, A. (2024). Sciatica. In StatPearls. www.ncbi.nlm.nih.gov/pubmed/29939685

Kong, J. T. (2020). Electroacupuncture for Treating Chronic Low-Back Pain: Preliminary Research Results. Med Acupunct, 32(6), 396-397. doi.org/10.1089/acu.2020.1495

Liu, S., Wang, Z., Su, Y., Qi, L., Yang, W., Fu, M., Jing, X., Wang, Y., & Ma, Q. (2021). A neuroanatomical basis for electroacupuncture to drive the vagal-adrenal axis. Nature, 598(7882), 641-645. doi.org/10.1038/s41586-021-04001-4

Siddiq, M. A. B., Clegg, D., Hasan, S. A., & Rasker, J. J. (2020). Extra-spinal sciatica and sciatica mimics: a scoping review. Korean J Pain, 33(4), 305-317. doi.org/10.3344/kjp.2020.33.4.305

Sung, W. S., Park, J. R., Park, K., Youn, I., Yeum, H. W., Kim, S., Choi, J., Cho, Y., Hong, Y., Park, Y., Kim, E. J., & Nam, D. (2021). The effectiveness and safety of electroacupuncture for nonspecific chronic low back pain: A protocol for systematic review and/or meta-analysis. Medicine (Baltimore), 100(4), e24281. doi.org/10.1097/MD.0000000000024281

Zhou, J., Mi, J., Peng, Y., Han, H., & Liu, Z. (2021). Causal Associations of Obesity With the Intervertebral Degeneration, Low Back Pain, and Sciatica: A Two-Sample Mendelian Randomization Study. Front Endocrinol (Lausanne), 12, 740200. doi.org/10.3389/fendo.2021.740200

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Prevent Weightlifting Knee Injuries: Learn Proper Form

Dr. Alex Jimenez

Young sport woman holding knee with hands in pain after suffering injury gym workout. Fitness woman sit on bench with knee injury and pain.

“Knee injuries can present in physically active individuals that lift weights. Can understanding the types of weightlifting knee injuries help in prevention?”

Table of Contents

Weightlifting Knee Injuries

Weight training is very safe for the knees as regular weight training can improve knee strength and prevent injury as long as the correct form is followed. For Individuals with knee injuries from other activities, incorrect weight-training exercises could worsen the injury. (Ulrika Aasa et al., 2017) As well as, sudden twisting movements, poor alignment, and pre-existing injuries can increase the risk of worsening or creating further injuries. (Hagen Hartmann et al, 2013) The body and the knees are designed to support vertical forces on the joints.

Common Injuries

Weightlifting knee injuries occur as the knee joints endure a wide range of stresses and strains. In weight training, the ligaments that attach to the complex bone system of the knee joint can be damaged by incorrect movements, overloading the weight, and increasing the weight too soon. These injuries can result in pain, swelling, and immobility that can range from minor to severe, from a sprain or a slight tear to a complete tear in serious cases.

Anterior Cruciate Ligament – ACL – Injury

This ligament attaches the thigh’s femur bone to the lower leg’s shin bone/tibia and controls excessive rotation or extension of the knee joint. (American Academy of Family Physicians. 2024)

Anterior means front.
ACL injuries are seen mostly in athletes but can happen to anybody.
Severe damage to the ACL usually means surgical reconstruction and up to 12 months of rehabilitation.
When weightlifting, try to avoid twisting knee movements, intentionally or accidentally, under excessive load.

Posterior Cruciate Ligament – PCL – Injury

The PCL connects the femur and tibia at different points to the ACL.
It controls any backward motion of the tibia at the joint.
Injuries occur most with high-impact forces as a result of accidents and sometimes in activities where forceful trauma to the knee occurs.

Medial Collateral Ligament – MCL – Injury

This ligament maintains the knee from bending too far to the inside/medially.
Injuries mostly occur from impact to the outside of the knee or from accidental bodyweight force on the leg that bends at an unusual angle.

Lateral Collateral Ligament – LCL – Injury

This ligament connects the smaller bone of the lower leg/fibula to the femur.
It is opposite to the MCL.
It maintains excessive outward movement.
LCL injuries occur when a force pushes the knee out.

Cartilage Injury

Cartilage prevents bones from rubbing together and cushions impact forces.
Knee menisci are cartilage that cushions the knee joints inside and outside.
Other types of cartilage protect the thigh and shin bones.
When cartilage gets torn or damaged, surgery may be required.

Tendonitis

Aggravated and overused knee tendons can lead to weightlifting knee injuries.
A related injury known as iliotibial band syndrome/ITB causes pain to the outside of the knee, usually in runners, but it can occur from overuse.
Rest, stretching, physical therapy, and anti-inflammatory medication are a common treatment plan.
Individuals should consult a physical therapist for pain lasting longer than two weeks. (Simeon Mellinger, Grace Anne Neurohr 2019)

Osteoarthritis

As the body ages, normal wear and tear can cause the development of osteoarthritis of the knee joints. (Jeffrey B. Driban et al., 2017)
The condition causes the cartilage to deteriorate and bones to rub together, resulting in pain and stiffness.

Prevention

Individuals can minimize their risk of weightlifting knee injuries and pain by following their doctor’s and personal trainers’ recommendations.
Individuals with an existing knee injury should follow their doctor’s or physical therapist’s recommendations.
A knee sleeve can keep the muscles and joints secure, providing protection and support.
Stretching the leg and knee muscles can maintain joint flexibility.
Avoid sudden lateral movements.
Possible recommendations can include:

Avoiding Certain Exercises

Isolation exercises like leg curls, standing, or on a bench, as well as using the leg extension machine, can stress the knee.

Deep Squat Training

Research shows that the deep squat can protect against lower leg injury if the knee is healthy. However, this is when done with proper technique, under expert supervision, and with a gradual progressive load. (Hagen Hartmann et al, 2013)

Individuals should talk to their doctor before beginning a new exercise routine. A personal trainer can provide training in learning the proper technique and weightlifting form.

How I Tore my ACL Part 2

References

Aasa, U., Svartholm, I., Andersson, F., & Berglund, L. (2017). Injuries among weightlifters and powerlifters: a systematic review. British journal of sports medicine, 51(4), 211–219. doi.org/10.1136/bjsports-2016-096037

Hartmann, H., Wirth, K., & Klusemann, M. (2013). Analysis of the load on the knee joint and vertebral column with changes in squatting depth and weight load. Sports medicine (Auckland, N.Z.), 43(10), 993–1008. doi.org/10.1007/s40279-013-0073-6

American Academy of Family Physicians. ACL injury. (2024). ACL injury (Diseases and Conditions, Issue. familydoctor.org/condition/acl-injuries/

Mellinger, S., & Neurohr, G. A. (2019). Evidence based treatment options for common knee injuries in runners. Annals of translational medicine, 7(Suppl 7), S249. doi.org/10.21037/atm.2019.04.08

Driban, J. B., Hootman, J. M., Sitler, M. R., Harris, K. P., & Cattano, N. M. (2017). Is Participation in Certain Sports Associated With Knee Osteoarthritis? A Systematic Review. Journal of athletic training, 52(6), 497–506. doi.org/10.4085/1062-6050-50.2.08