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Unhealthy Posture: What Causes It and How to Counteract It

By
Dr. Alex Jimenez
-
Shot of a young businesswoman experiencing back pain while working at her desk in a modern office.

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

Unhealthy Posture: What Causes It and How to Counteract It

Unhealthy Posture Causes

Numerous factors can cause individuals to practice unhealthy postures regularly.

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

Injury and Muscle Guarding

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

Muscle Tension and Weakness

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

Daily Habits

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

Use of Technology

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

Mental Attitude and Stress

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

Footwear Choice and They Are Worn

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

Heredity and Genetics

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

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

The Path To Healing

References

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

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

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

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

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

Discover How Friction Massage Can Help Improve Scar Tissue

By
Dr. Alex Jimenez
-
Shoulder pain, physical therapy and chiropractor with patient, injury and healthcare with help and .

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

Discover How Friction Massage Can Help Improve Scar Tissue

Friction Massage

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

Scar Tissue and Adhesions

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

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

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

Massage Objectives

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

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

Massage Technique

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

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

Contraindications

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

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

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

Diagnoses Treated

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

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

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

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

Chiropractic Care After Accidents and Injuries

References

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

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

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

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

Nonsurgical Tips & Tricks To Reduce Low Back Pain

By
Dr. Alex Jimenez
-

Can individuals with low back pain find nonsurgical solutions to restore lumbar mobility and stability to the lower limbs?

Introduction

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

 

What Causes Back Pain?

 

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

 

Diabetic Back Pain Explained- Video

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

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

Nonsurgical Tips & Tricks To Reduce Low Back Pain

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

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

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

References

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

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

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

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

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

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

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

Disclaimer

Common Mistakes That Can Hinder Muscle Growth

By
Dr. Alex Jimenez
-
Health smoothie, couple and fitness nutritionist with fruit, healthy food and smile at home. Nutrit.

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

Common Mistakes That Can Hinder Muscle Growth

Muscle Growth Nutritional Mistakes

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

  • Nutrition
  • Genetics
  • Training

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

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

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

Factors

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

Genetics

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

Nutrition

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

Training

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

Muscle Strength for Healthy Aging

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

Nutritional Mistakes

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

Not Enough Protein

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

Not Enough Calories

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

Not Enough Carbs

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

Not Hydrating Enough

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

Water Intake Recommendations

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

Not Enough Healthy Fats

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

Forgetting Post-Workout Nutrition

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

Training Mistakes

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

Military Training and Chiropractic Care

References

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

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

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

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

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

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

Learn Everything About Lumbar Disc Degeneration Pathology

By
Dr. Alex Jimenez
-

Can healthcare providers help many individuals with lumbar disc degeneration find relief through spinal decompression treatments?

Introduction

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

 

The Anatomy Of The Lumbar Disc

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

 

How Disc Degeneration Affects The Lumbar Spine

 

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

 

An Overview Of Spinal Decompression- Video

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

Spinal Decompression Can Reduce Lumbar Disc Degeneration

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

 

References

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

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

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

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

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

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

 

Disclaimer

Managing Chronic Sciatica Symptoms: A Multidisciplinary Plan

By
Dr. Alex Jimenez
-
Experienced doctor examines the back of a gray-haired patient, a modern ultrasound machine indoors

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

Managing Chronic Sciatica Symptoms: A Multidisciplinary Plan

Chronic Sciatica

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

Advanced Sciatica Symptoms

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

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

Disabling Sciatica Treatment Options

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

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

Discectomy

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

Laminectomy

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

Foraminotomy

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

Spinal Fusion

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

Daily Relief Management for Advanced Sciatica

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

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

Healing Chronic Sciatica

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

Pain Specialist Treatment Plan Development

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

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

Sciatica Causes and Treatments

References

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

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

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

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

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

Hospital for Special Surgery. (2023). Sciatica.

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

Pain Management Specialists: The Multidisciplinary Approach

By
Dr. Alex Jimenez
-
Caucasian woman in neck brace looking at x-ray image on digital device held by bearded therapist in lab coat. Medical specialist explaining test results to patient with walking cane in exam room.

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

Pain Management Specialists: The Multidisciplinary Approach

Pain Management Specialists

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

Specialists

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

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

Other Medical Specialties

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

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

  • Anesthesiology
  • Physical rehabilitation
  • Psychiatry
  • Neurology

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

Management Goals

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

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

A pain management clinic will go through the following:

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

Individuals who do well with a pain management program

Individuals who have:

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

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

Chiropractic Care for Leg Instability

References

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

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

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

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

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

What You Need to Know about Nutrition in Turkey

By
Dr. Alex Jimenez
-
Roasted turkey breast sliced on a board with Thanksgiving sides

“For individuals watching their food intake during the Thanksgiving holiday, can knowing the nutritional value of turkey help maintain diet health?”

What You Need to Know about Nutrition in Turkey

Nutrition and Benefits

Minimally processed turkey can be a beneficial source of protein, vitamins, and minerals. However, processed turkey can be high in sugar, unhealthy fats, and sodium.

Nutrition

Nutrition information for a roasted turkey leg with the skin – 3 ounces – 85g. (U.S. Department of Agriculture. 2018)

  • Calories – 177
  • Fat – 8.4
  • Sodium – 65.4mg
  • Carbohydrates – 0g
  • Fiber – 0g
  • Sugars – 0g
  • Protein – 23.7g

Carbohydrates

  • Turkey does not contain any carbohydrates.
  • Certain deli lunch meats contain carbs as the turkey is breaded, marinated, or coated in a sauce containing sugar or added during processing.
  • Choosing fresh can make a big difference in sugar content.

Fats

  • Most of the fat comes from the skin.
  • Turkey generally has equal parts of saturated, monounsaturated, and polyunsaturated fat.
  • Removing the skin and cooking without added fat significantly reduces total fat content.

Protein

  • Turkey is an excellent source of complete protein, with around 24 grams in a 3-ounce serving.
  • Leaner cuts, like skinless turkey breast, have more protein.

Vitamins and Minerals

  • Provides vitamin B12, calcium, folate, iron, magnesium, phosphorus, potassium, and selenium.
  • Dark meat is higher in iron than the white meat.

Health Benefits

Supports Muscle Retention

  • Sarcopenia, or muscle wasting, commonly leads to frailty in elderly individuals.
  • Getting enough protein at every meal is essential for older adults to maintain muscle mass and physical mobility.
  • Turkey can help meet guidelines suggesting lean meat consumption 4-5 times a week to maintain muscle health with aging. (Anna Maria Martone, et al., 2017)

Reduces Diverticulitis Flare-Ups

Diverticulitis is inflammation of the colon. Dietary factors that influence the risk of diverticulitis include:

  • Fiber intake – lowers risk.
  • Processed red meat intake – raises risk.
  • Intake of red meat with higher total fat – raises risk.
  1. Researchers studied 253 men with diverticulitis and determined that replacing one serving of red meat with a serving of poultry or fish reduces the risk of diverticulitis by 20%. (Yin Cao et al., 2018)
  2. The study’s limitations are that the meat intake was recorded in men only, the intake was self-reported, and the amount consumed at each eating episode was not recorded.
  3. It may be a helpful substitution for anyone at risk for diverticulitis.

Prevents Anemia

  • Turkey offers nutrients required by blood cells.
  • It provides heme iron, easily absorbed during digestion, to prevent iron deficiency anemia. (National Institutes of Health. 2023)
  • Turkey also contains folate and vitamin B12, which are needed in the formation and proper function of red blood cells.
  • Regular turkey consumption can help maintain healthy blood cells.

Supports Heart Health

  • Turkey is a lean alternative to other low-sodium meats, especially if the skin is removed and cooked fresh.
  • Turkey is also high in the amino acid arginine.
  • Arginine can help keep arteries open and relaxed as a precursor to nitric oxide. (Patrick J. Skerrett, 2012)

Allergies

Meat allergies can happen at any age. A turkey allergy is possible and may be associated with allergies to other types of poultry and red meat.  Symptoms can include: (American College of Allergy, Asthma & Immunology. 2019)

  • Vomiting
  • Diarrhea
  • Wheezing
  • Shortness of breath
  • Repetitive cough
  • Swelling
  • Anaphylaxis

Storage and Safety

Preparation

  • The USDA recommends 1 pound for each person.
  • That means a family of five needs a 5-pound turkey, a group of 12 a 12-pound. (U.S. Department of Agriculture. 2015)
  • Keep fresh meat in the refrigerator until ready to cook.
  • Frozen pre-stuffed turkeys labeled with the USDA or state mark of inspection have been prepared under safe, controlled conditions.
  • Cook frozen pre-stuffed turkeys directly from the frozen state rather than thawing first. (U.S. Department of Agriculture. 2015)
  1. Safe ways to thaw a frozen turkey: in the refrigerator, in cold water, or microwave oven.
  2. They should be thawed for a specified amount of time using guidelines based on weight.
  3. It needs to be cooked to an internal temperature of 165 degrees Fahrenheit.
  4. Cooked turkey needs to be refrigerated within 1–2 hours after cooking and used within 3–4 days.
  5. Turkey leftovers stored in the freezer should be eaten within 2–6 months.

Eating Right to Feel Better

References

U.S. Department of Agriculture. FoodData central. (2018). Turkey, all classes, leg, meat and skin, cooked, roasted.

Martone, A. M., Marzetti, E., Calvani, R., Picca, A., Tosato, M., Santoro, L., Di Giorgio, A., Nesci, A., Sisto, A., Santoliquido, A., & Landi, F. (2017). Exercise and Protein Intake: A Synergistic Approach against Sarcopenia. BioMed research international, 2017, 2672435. doi.org/10.1155/2017/2672435

Cao, Y., Strate, L. L., Keeley, B. R., Tam, I., Wu, K., Giovannucci, E. L., & Chan, A. T. (2018). Meat intake and risk of diverticulitis among men. Gut, 67(3), 466–472. doi.org/10.1136/gutjnl-2016-313082

National Institutes of Health, Office of Dietary Supplements. (2023). Iron: Fact Sheet for Health Professionals.

Skerrett PJ. Harvard Health Publishing, Harvard Medical School. (2012). Turkey: A Healthy Base of Holiday Meals.

American College of Allergy, Asthma & Immunology. (2019). Meat Allergy.

U.S. Department of Agriculture. (2015). Let’s Talk Turkey — A Consumer Guide to Safely Roasting a Turkey.

Non-Surgical Solutions for Back Pain: The Ultimate Guide

By
Dr. Alex Jimenez
-

For individuals with back pain, how can health practitioners incorporate non-surgical solutions to reduce spinal pain?

Introduction

The spine is one of the most important structures in the human body, providing host mobility and stability when vertical pressure is pressing on the spinal structure. The spine is surrounded by various muscles, ligaments, and tissues that help support the upper and lower body portions and extremities. When normal factors like heaving lifting, improper stances, obesity, or pre-existing conditions start to affect the body, it can cause the spinal structure to potentially cause unwanted issues that lead to back, neck, and shoulder pain. When experiencing these three common body pains often correlate with other associated symptoms that can affect the other extremities. When this happens, many individuals begin to miss out on work or daily activities that can cause them to be miserable, and they even try to look for various solutions to reduce the pain they are experiencing. Today’s article looks at one of the common body pains like back pain and how it can cause numerous issues that affect a person’s ability to function, and how non-surgical solutions can not only reduce the pain-like effects but also provide the necessary relief that many people deserve in their health and wellness journey. We speak with certified medical providers who incorporate our patients’ information to provide numerous treatment plans to ease the pain-like symptoms associated with spinal issues causing back pain. We also inform our patients that there are non-surgical options to reduce these pain-like issues and restore spinal mobility to the body. We encourage our patients to ask intricated and educational questions to our associated medical providers about the pain-like symptoms they are experiencing correlating with the lower back. Dr. Alex Jimenez, D.C., utilizes this information as an academic service. Disclaimer.

 

Back Pain Affecting The Spine

Do you often experience radiating pain in your lower back that causes symptoms of numbness or tingling sensations down to your legs and feet? Do you feel muscle stiffness in the morning while getting up, only to slowly disappear throughout the day? Or do you feel symptoms of muscle aches and pain when carrying a heavy object from one location to another? Many individuals, more often than not, have dealt with back pain associated with various factors. With back pain being in the top three common problems in the workforce, many individuals have dealt with the common problem in multiple ways. From improper heavy lifting to excessive sitting at a desk, back pain can cause musculoskeletal issues that many are trying to find relief. Low back pain can either be acute or chronic, depending on the severity. It can lead to mobility impairment within the thoracic, lumbar, and sacroiliac spinal regions, causing referred pain to the lower extremities. It can lead to a life of impairment without any symptoms or signs of serious medical or psychological conditions associated with environmental factors. (Delitto et al., 2012) Back pain is also associated with spinal conditions like inflammation, asymmetric loading, and muscle strain, which can cause the spinal structures to be compressed, thus causing disc herniations. (Zemková & Zapletalová, 2021) 

 

 

Additionally, back pain is a multifactorial musculoskeletal condition that causes many individuals to be in a socio-economic situation that can decrease their quality of life. Many examples of back pain are correlated with altered motor control within the spinal erector muscles that causes impaired proprioception in the spine. (Fagundes Loss et al., 2020) When this happens to many individuals, they often experience a hindrance of lumbar stability, body balance, posture, and postural control. At the same time, when many working individuals are having severe back pain associated with everyday factors, the amount of pain they are in can change the threshold of the mechanoreceptors that are transmitting the pain signals through the spinal cord. To this point, back pain can affect the neuromuscular response and affect normal musculoskeletal functionality. Fortunately, numerous treatments can help reduce back pain and provide relief to spinal pain that is affecting many individuals.

 

The Role Of Chiropractic Care- Video

The Role of Chiropractic Care on improving your Health | El Paso, Tx (2023)

 How many times a day do you experience back pain associated with stiffness, general aches, or pains that are affecting your ability to work? Do you notice you hunching more when moving from one location to another? Or do you feel aches and pain in your back after stretching in the morning? Many individuals dealing with these common environmental factors are closely associated with back pain. Back pain is in the top three most common problems many individuals have experienced at some point in their lives. More often than not, many people have dealt with back pain by using home remedies to reduce the pain-like effects. However, research studies reveal that when many individuals start to ignore the pain, it can lead them to a life of disability and cause numerous amounts of distress if not treated right away. (Parker et al., 2015) Hence, non-surgical treatments can not only reduce the pain associated with back pain but also help restore spinal mobility. Non-surgical treatments like chiropractic care incorporate spinal manipulation, which can positively affect the spine. (Koes et al., 1996) What chiropractic care does is that it includes mechanical and manual manipulation techniques to stretch out tight muscles and reduce trigger points from reforming. The video above shows how chiropractic care can positively affect the individual while being part of a health and wellness journey to reducing back pain.

Non-Surgical Spinal Decompression For Back Pain

Just like chiropractic care, spinal decompression is another non-surgical treatment that uses traction to gently pull and stretch the spine to alleviate compressed spinal discs associated with back pain and help stretch out tight muscles. When many people start to incorporate spinal decompression as part of their routine, they will notice that spinal decompression can reduce intradiscal pressure within the negative range. (Ramos, 2004) What this does is that when the spinal discs are being pulled by gentle traction, all the fluids and nutrients that were not hydrating the disc flow back and help kickstart the body’s natural healing process. When many people begin to utilize spinal decompression for their back pain, they will notice a huge reduction in their pain after a few consecutive sessions. (Crisp et al., 1955) When many people start to combine other various non-surgical therapies with spinal decompression, they will be able to regain their spinal mobility while being more mindful of what environmental factors are affecting their spine and not repeat the issue to allow back pain to return.

References

Crisp, E. J., Cyriax, J. H., & Christie, B. G. (1955). Discussion on the treatment of backache by traction. Proc R Soc Med, 48(10), 805-814. www.ncbi.nlm.nih.gov/pubmed/13266831

www.ncbi.nlm.nih.gov/pmc/articles/PMC1919242/pdf/procrsmed00390-0081.pdf

Delitto, A., George, S. Z., Van Dillen, L., Whitman, J. M., Sowa, G., Shekelle, P., Denninger, T. R., & Godges, J. J. (2012). Low Back Pain. Journal of Orthopaedic & Sports Physical Therapy, 42(4), A1-A57. doi.org/10.2519/jospt.2012.42.4.a1

Fagundes Loss, J., de Souza da Silva, L., Ferreira Miranda, I., Groisman, S., Santiago Wagner Neto, E., Souza, C., & Tarrago Candotti, C. (2020). Immediate effects of a lumbar spine manipulation on pain sensitivity and postural control in individuals with nonspecific low back pain: a randomized controlled trial. Chiropr Man Therap, 28(1), 25. doi.org/10.1186/s12998-020-00316-7

Koes, B. W., Assendelft, W. J., van der Heijden, G. J., & Bouter, L. M. (1996). Spinal manipulation for low back pain. An updated systematic review of randomized clinical trials. Spine (Phila Pa 1976), 21(24), 2860-2871; discussion 2872-2863. doi.org/10.1097/00007632-199612150-00013

Parker, S. L., Mendenhall, S. K., Godil, S. S., Sivasubramanian, P., Cahill, K., Ziewacz, J., & McGirt, M. J. (2015). Incidence of Low Back Pain After Lumbar Discectomy for Herniated Disc and Its Effect on Patient-reported Outcomes. Clin Orthop Relat Res, 473(6), 1988-1999. doi.org/10.1007/s11999-015-4193-1

Ramos, G. (2004). Efficacy of vertebral axial decompression on chronic low back pain: study of dosage regimen. Neurol Res, 26(3), 320-324. doi.org/10.1179/016164104225014030

Zemková, E., & Zapletalová, L. (2021). Back Problems: Pros and Cons of Core Strengthening Exercises as a Part of Athlete Training. International Journal of Environmental Research and Public Health, 18(10), 5400. doi.org/10.3390/ijerph18105400

Disclaimer

Rib Cage and Pelvis: Connecting the Core for Healthy Posture

By
Dr. Alex Jimenez
-
Exercises for posture, smooth straight back, spine. Slim woman training with yoga coach. Private lessons with personal trainer, fitness instructor. Workout, exercises in fitness gym.

“For older individuals experiencing posture problems, slumping, slouching, and upper back pain, could adding rib cage exercises help bring relief and prevent the condition from worsening?”

Rib Cage and Pelvis: Connecting the Core for Healthy Posture

Improved Posture

It’s common to associate a collapsed upper back posture with age, but other factors can also contribute to the problems. (Justyna Drzał-Grabiec, et al., 2013) The rib cage and the pelvis are important to body structure and comprise much of the core. If these bone structures become misaligned due to unhealthy posture, the muscles that attach to them become tight, weak, or both, and the surrounding muscles have to compensate, causing a worsening of the condition and further injury.

  • Unhealthy postures can be caused by a rib cage that compresses down onto the pelvic bone.
  • As the upper back slumps or compresses, height can begin to decrease.
  • Posture awareness exercises can help lift the rib cage off the pelvic bone.

Rib Cage Exercises

This exercise can be done sitting or standing. A daily routine can help improve posture and relieve back problems and pain.

  • The sitting version helps keep the focus on doing the exercise right.
  • The standing version challenges body awareness, allowing the individual to feel how the rib cage and upper back movements affect pelvic and lower back posture.
  • To begin, it is recommended to start in a sitting position.
  • Once the basics are learned, then certainly progress to standing.

Exercise

  1. Position the pelvis so it is in a slight forward tilt.
  2. This forward tilt will exaggerate the low back curve slightly while tightening the lower back muscles in a good way.
  3. Establishing and maintaining this curve in the sitting position should feel natural.
  4. Inhale and exaggerate the upward lift of the rib cage.
  5. Inhaling causes the spine and ribs to extend slightly.
  6. Exhale and allow the rib cage and upper back to return to their natural position.
  7. Repeat up to 10 times once or twice a day.
  • For this exercise, use breathing to develop the rib cage’s lift and carriage incrementally.
  • Don’t max out on the spinal extension.
  • Instead, focus on how breathing/inhaling supports the movement of the ribs and upper back and develops the muscles from there.
  • Try to lift the rib cage equally on both sides as the body allows.

With practice, individuals will realize the healthy posture changes and increased distance between the ribs and pelvis.

Guidance and Variation

  • Perform the exercise with the back against a wall for upper back guidance.
  • Another variation of the pelvis and rib cage posture training exercise is to raise the arms.
  • This will create a different posture awareness training perspective.
  • Focus on rib cage movement when the arms are raised.
  • Does lifting the arms make the exercise easier, harder, or different?
  • To enhance posture improvement, stretch the pectoral muscles.

Yoga

Individuals looking for more ways to strengthen healthy posture should consider yoga.

A study published in the International Journal of Yoga suggests that a great way to activate the core may be to include a variety of yoga postures into the routine. (Mrithunjay Rathore et al., 2017) The ab muscles attach to various places on the rib cage and play a role in posture, alignment, and balance. The researchers identified two muscles, the external obliques, and the transverse abdominal, as key to a healthily aligned posture.

Core Strength

References

Drzał-Grabiec, J., Snela, S., Rykała, J., Podgórska, J., & Banaś, A. (2013). Changes in the body posture of women occurring with age. BMC geriatrics, 13, 108. doi.org/10.1186/1471-2318-13-108

Rathore, M., Trivedi, S., Abraham, J., & Sinha, M. B. (2017). Anatomical Correlation of Core Muscle Activation in Different Yogic Postures. International journal of yoga, 10(2), 59–66. doi.org/10.4103/0973-6131.205515

Papegaaij, S., Taube, W., Baudry, S., Otten, E., & Hortobágyi, T. (2014). Aging causes a reorganization of cortical and spinal control of posture. Frontiers in aging neuroscience, 6, 28. doi.org/10.3389/fnagi.2014.00028

What Causes Facet Hypertrophy? Causes & Symptoms

By
Dr. Alex Jimenez
-
young female athlete feeling pain in the body after sport exercise, sport injury

“Facet hypertrophy is an incurable, chronic disease that affects the facet joints in the spine. Can recognizing symptoms, help in diagnosis, and treatment?”

What Causes Facet Hypertrophy? Causes & Symptoms

Facet Hypertrophy

Facet hypertrophy causes the facet joints in the spine to enlarge. They are found where the vertebrae come into contact on the back of the vertebrae that form the backbone. These joints stabilize the spine when twisting and bending. Hypertrophy results when damage wears down the cartilage that cushions the bones that meet in the joint. This can include:

  • Aging
  • Wear and tear
  • Arthritis
  • Other joint diseases can damage facet joints.

Swelling, new bone growth, and bone spurs can occur as the joint tries to repair the damaged cartilage. The swelling and new bone growth can narrow the spinal canal and compress surrounding nerves, causing pain and other sensation symptoms. This ailment does not have a cure and worsens over time. The objective of treatment is to manage the pain symptoms and slow down the disease’s progress.

Types

Facet hypertrophy can be described as unilateral or bilateral.

  • Unilateral – the pain is felt on one side.
  • Bilateral – the pain is felt on both sides

On the following areas: (Romain Perolat et al., 2018)

  • Buttocks
  • Sides of the groin
  • Thighs

Symptoms

Symptoms can have a wide range of intensity, from a dull ache to chronic, disabling pain. The location of symptoms depends on the affected joint and the nerves involved, Pain manifests when the enlarged joints and new bone growth compresses the nearby nerves. The result leads to nerve damage and the following symptoms: (Weill Cornell Medicine Brain & Spine Center. 2023) (Cedars Sinai. 2022)

  • Stiffness, especially when standing up or getting out of a chair.
  • Inability to stand straight when walking.
  • Inability to look up to the left or right without turning the whole body.
  • Reduced range of motion and mobility.
  • Numbness or a tingling sensation of pins and needles.
  • Muscle spasms
  • Muscle weakness
  • Burning pain

The following symptoms are specific to the location of the affected joint (Weill Cornell Medicine Brain & Spine Center. 2023) (Cedars Sinai. 2022)

  • Radiating pain from the affected joint into the buttocks, hips, and upper thigh when the affected joint/s are in the lower back.
  • Radiating pain from the affected joint into the shoulder, neck, and back of the head when the affected joint/s are in the upper back.
  • Headaches when the affected joint is in the neck.

Causes

A common cause is the age-related degeneration of the joints, called spondylosis. Research indicates that more than 80% of individuals who are 40 or older have radiologic evidence of spondylosis, even though they may not have symptoms. (The University of Toledo Medical Center. N.D.) The following conditions can also increase the risk of facet hypertrophy (Weill Cornell Medicine Brain & Spine Center. 2023)

  • Unhealthy posture
  • Being overweight or obese
  • Sedentary lifestyle
  • Injury or trauma to the spine
  • Inflammatory conditions like rheumatoid arthritis or ankylosing spondylitis
  • Osteoarthritis
  • Genetic predisposition to the condition

Diagnosis

Diagnosis can be challenging when neck or back pain is the main complaint, as symptoms can mimic conditions such as sciatica from a herniated disc or hip arthritis. (Weill Cornell Medicine Brain & Spine Center. 2023)

  1. CT scans with or without myelogram – the use of contrast dye in the space around the spinal cord.
  2. MRI
  3. X-rays with or without a myelogram

A diagnosis is confirmed by injecting a diagnostic block that involves administering an anesthetic injection, sometimes with an anti-inflammatory like cortisone, into the joint or nerves near the affected joint. Two injections are given at different times to confirm the effect. (Romain Perolat et al., 2018)

  • If immediate relief improves after each injection, the facet joint is confirmed as the source of the pain symptoms.
  • If the block does not decrease the pain, the facet joint is probably not the source of the pain symptoms. (Brigham and Women’s Hospital. 2023)

Treatment

There is no cure for facet hypertrophy.
The goal of treatment is to make the pain more manageable.
Conservative treatment is usually successful in making a difference.

Conservative Treatment

First-line treatment involves utilizing conservative therapies (Romain Perolat et al., 2018)

  • Massage therapy
  • Physical therapy to strengthen the core muscles and spine.
  • Targeted exercises to help maintain flexibility.
  • Chiropractic adjustments to realign the spine.
  • Healthy posture retraining.
  • Non-surgical mechanical decompression.
  • Bracing to stabilize the spine
  • Acupuncture
  • Nonsteroidal anti-inflammatory – aspirin, ibuprofen, and naproxen.
  • Muscle relaxers – cyclobenzaprine or metaxalone.
  • Steroid injection into the facet joints.
  • Injection of platelet-rich plasma/PRP into the joints.

Medial Branch or Facet Block

  • A medial branch block injects local anesthetic near the medial nerves that connect to an inflamed joint.
  • Medial nerves are small nerves outside the joint space near the nerve that transmit signals and other impulses to the brain.
  • A facet block injects the medication outside the joint space near the nerve that supplies the joint called the medial branch.

Neurolysis

Neurolysis, also known as rhizotomy or neurotomy, is a procedure that destroys affected nerve fibers to relieve pain, reduce disability, and reduce the need for analgesics. This treatment can relieve pain for six to 12 months until the nerve regenerates, where further treatments may be necessary. (Matthew Smuck et al., 2012) Neurolysis can be performed using one of the following techniques (Romain Perolat et al., 2018)

  • Radiofrequency ablation RFA – the application of heat through radiofrequency.
  • Cryoneurolysis – the application of cold temperatures to the targeted nerve.
  • Chemical neurolysis – applying chemical agents, like a combination of phenol and alcohol.
  • Severing the nerves with surgical instrumentation.

Surgery

When one or more facet joints are severely damaged, they can become nonfunctional and painful. Surgery may be recommended when symptoms are not relieved by other therapies. (Ali Fahir Ozer, et al., 2015)

Prognosis

Facet hypertrophy is a chronic condition that progresses with age and does not affect life expectancy. (Weill Cornell Medicine Brain & Spine Center. 2023) The disorder is incurable, but symptoms can be managed with conservative therapies

  • A healthcare provider can help develop a treatment plan based on the extent and location of the joint affected.
  • Early diagnosis and treatment can help individuals achieve the best results.

Maintaining an active lifestyle and healthy weight can help prevent further joint stress. Individuals may be recommended to do regular stretching and strengthening exercises to lower inflammation, reduce stress, and improve overall health.

Facet Syndrome Treatment

References

Perolat, R., Kastler, A., Nicot, B., Pellat, J. M., Tahon, F., Attye, A., Heck, O., Boubagra, K., Grand, S., & Krainik, A. (2018). Facet joint syndrome: from diagnosis to interventional management. Insights into imaging, 9(5), 773–789. doi.org/10.1007/s13244-018-0638-x

Weill Cornell Medicine Brain & Spine Center. (2023). Symptoms of facet syndrome.

Cedars Sinai. (2022). Facet joint syndrome.

The University of Toledo Medical Center. (N.D.). Spondylosis.

Weill Cornell Medicine Brain & Spine Center. (2023). Facet syndrome.

Weill Cornell Medicine Brain & Spine Center. (2023). Diagnosing and treating facet syndrome.

Brigham and Women’s Hospital. (2023). Facet and medial branch blocks.

Smuck, M., Crisostomo, R. A., Trivedi, K., & Agrawal, D. (2012). Success of initial and repeated medial branch neurotomy for zygapophysial joint pain: a systematic review. PM & R : the journal of injury, function, and rehabilitation, 4(9), 686–692. doi.org/10.1016/j.pmrj.2012.06.007

Ozer, A. F., Suzer, T., Sasani, M., Oktenoglu, T., Cezayirli, P., Marandi, H. J., & Erbulut, D. U. (2015). Simple facet joint repair with dynamic pedicular system: Technical note and case series. Journal of craniovertebral junction & spine, 6(2), 65–68. doi.org/10.4103/0974-8237.156049

What to Know About Groin Strain Injury Treatment

By
Dr. Alex Jimenez
-
Osteopath performing a sacroiliac myofascial massage on a young woman manipulating the muscles of her sacrum, pelvis ans spine with his hands in a healthcare concept

“When a groin strain injury happens, can knowing the symptoms help in the diagnosis, treatment, and recovery times?”

What to Know About Groin Strain Injury Treatment

Groin Strain Injury

A groin strain is an injury to an inner thigh muscle. A groin pull is a type of muscle strain affecting the adductor muscle group (the muscles help pull the legs apart). (Parisa Sedaghati, et al., 2013) The injury is caused when the muscle is stretched beyond its normal range of motion, creating superficial tears. Severe strains can tear the muscle in two. (Parisa Sedaghati, et al., 2013)

  • A groin muscle pull causes pain and tenderness that worsens when squeezing the legs together.
  • There may also be swelling or bruising in the groin or inner thigh.
  • An uncomplicated groin pull takes four to six weeks to heal with proper treatment. (Andreas Serner, et al., 2020)

Symptoms

A groin pull can be painful, interfering with walking, navigating stairs, and/or driving a car. In addition to pain, other symptoms around the injured area include: (Parisa Sedaghati et al., 2013)

  • A popping sound or snapping sensation when the injury occurs.
  • Increased pain when pulling the legs together.
  • Redness
  • Swelling
  • Bruising of the groin or inner thigh.

Groin pulls are graded by severity and how much they impact mobility:

Grade 1

  • Mild discomfort but not enough to limit activities.

Grade 2

  • Moderate discomfort with swelling or bruising that limits running and/or jumping.

Grade 3

  • Severe injury with significant swelling and bruising can cause pain while walking and muscle spasms.

Signs of a severe groin strain

  • Difficulty walking
  • Groin pain while sitting or resting
  • Groin pain at night
  • A healthcare provider should see severe groin pulls because the muscle may have ruptured or be on the verge of rupturing.
  • In severe cases, surgery is necessary to reattach the torn ends.

Groin pulls are sometimes accompanied by a stress fracture of the pubis/forward-facing pelvic bones, which can significantly extend healing and recovery time. (Parisa Sedaghati et al., 2013)

Causes

Groin pulls are often experienced by athletes and individuals who play sports where they must stop and change directions quickly, placing excessive strain on the adductor muscles. (Parisa Sedaghati et al., 2013) The risk is increased in individuals who: (T. Sean Lynch et al., 2017)

  • Have weak hip abductor muscles.
  • Are not in adequate physical condition.
  • Have a previous groin or hip injury.
  • Pulls can also occur from falls or extreme activities without the proper conditioning.

Diagnosis

A healthcare provider will perform a thorough investigation to confirm the diagnosis and characterize the severity. This involves: (Juan C. Suarez et al., 2013)

Medical History Review

  • This includes any previous injuries and specifics about where and when the symptoms started.

Physical Examination

  • This involves palpating – lightly touching and pressing the groin region and manipulating the leg to understand better where and how extensive the injury is.

Imaging Studies

  • Ultrasound or X-rays.
  • If a muscle rupture or fracture is suspected, an MRI scan may be ordered to visualize soft tissue injuries and stress fractures better.

Differential Diagnosis

Certain conditions can mimic a groin pull and require different treatments. These include: (Juan C. Suarez, et al., 2013)

Sports Hernia

  • This type of inguinal hernia occurs with sports and work injuries.
  • It causes a portion of the intestine to pop through a weakened muscle in the groin.

Hip Labral Tear

  • This is a tear in the cartilage ring of the labrum outside the rim of the hip joint socket.

Hip Osteoarthritis

  • This is the wear-and-tear form of arthritis that can present with groin pain symptoms.

Osteitis Pubis

  • This is inflammation of the pubic joint and surrounding structures, usually caused by the overuse of the hip and leg muscles.

Referred Groin Pain

  • This nerve pain originates in the lower back, often due to a pinched nerve, but is felt in the groin.

Treatment

Beginning treatment is conservative and includes rest, ice application, physical therapy, and prescribed gentle stretching and exercises.

  • Individuals may need crutches or a walking device to reduce pain and prevent further injury if the pain is significant. (Andreas Serner, et al., 2020)
  • Physical therapy will be a part of the treatment plan.
  • Over-the-counter pain medications like Tylenol/acetaminophen or Advil/ibuprofen can help with pain relief short term.
  • If there is severe pain from a grade 3 injury, prescription medications may be used for a short period to help minimize pain. (Andreas Serner, et al., 2020)
  • Surgery is not usually necessary. (Andreas Serner, et al., 2020)

Recovery

Recovery times can vary based on the injury’s severity and physical condition before the injury.

  • Most injuries will heal within four to six weeks with rest and proper treatment.
  • Severe groin strains can take up to 12 weeks or longer if surgery is involved. (Andreas Serner, et al., 2020)

Injury Rehabilitation

References

Sedaghati, P., Alizadeh, M. H., Shirzad, E., & Ardjmand, A. (2013). Review of sport-induced groin injuries. Trauma monthly, 18(3), 107–112. doi.org/10.5812/traumamon.12666

Serner, A., Weir, A., Tol, J. L., Thorborg, K., Lanzinger, S., Otten, R., & Hölmich, P. (2020). Return to Sport After Criteria-Based Rehabilitation of Acute Adductor Injuries in Male Athletes: A Prospective Cohort Study. Orthopaedic journal of sports medicine, 8(1), 2325967119897247. doi.org/10.1177/2325967119897247

Lynch, T. S., Bedi, A., & Larson, C. M. (2017). Athletic Hip Injuries. The Journal of the American Academy of Orthopaedic Surgeons, 25(4), 269–279. doi.org/10.5435/JAAOS-D-16-00171

Suarez, J. C., Ely, E. E., Mutnal, A. B., Figueroa, N. M., Klika, A. K., Patel, P. D., & Barsoum, W. K. (2013). Comprehensive approach to the evaluation of groin pain. The Journal of the American Academy of Orthopaedic Surgeons, 21(9), 558–570. doi.org/10.5435/JAAOS-21-09-558

Recognizing the Symptoms of Osteitis Pubis Injury

By
Dr. Alex Jimenez
-
Male physiotherapist doing leg and knee treatment on a young female patient in a supine position. Athletic woman visiting her rehabilitation specialist

“Athletes and physically active individuals who participate in activities, exercises, and sports that involve kicking, pivoting, and/or shifting directions can develop pelvis overuse injury of the pubic symphysis/joint at the front of the pelvis known as osteitis pubis. Can recognizing the symptoms and causes help in treatment and prevention?”

Recognizing the Symptoms of Osteitis Pubis Injury

Osteitis Pubis Injury

Osteitis pubis is the inflammation of the joint that connects the pelvic bones, called the pelvic symphysis, and the structures around it. The pubic symphysis is a joint in front of and below the bladder. It holds the two sides of the pelvis together in the front. The pubis symphysis has very little motion, but when abnormal or continued stress is placed on the joint, groin and pelvic pain can present. An osteitis pubis injury is a common overuse injury in physically active individuals and athletes but can also occur as the result of physical trauma, pregnancy, and/or childbirth.

Symptoms

The most common symptom is pain over the front of the pelvis. The pain is most often felt in the center, but one side may be more painful than the other. The pain typically radiates/spreads outward. Other signs and symptoms include: (Patrick Gomella, Patrick Mufarrij. 2017)

  • Lower abdominal pain in the center of the pelvis
  • Limping
  • Hip and/or leg weakness
  • Difficulty climbing stairs
  • Pain when walking, running, and/or shifting directions
  • Clicking or popping sounds with movement or when shifting directions
  • Pain when lying down on the side
  • Pain when sneezing or coughing

Osteitis pubis can be confused with other injuries, including a groin strain/groin pull, a direct inguinal hernia, ilioinguinal neuralgia, or a pelvic stress fracture.

Causes

An osteitis pubis injury usually occurs when the symphysis joint is exposed to excessive, continued, directional stress and overuse of the hip and leg muscles. Causes include: (Patrick Gomella, Patrick Mufarrij. 2017)

  • Sports activities
  • Exercising
  • Pregnancy and childbirth
  • Pelvic injury like a severe fall

Diagnosis

The injury is diagnosed based on a physical examination and imaging tests. Other tests may be used to rule out other possible causes.

  • The physical exam will involve manipulation of the hip to place tension on the rectus abdominis trunk muscle and adductor thigh muscle groups.
  • Pain during the manipulation is a common sign of the condition.
  • Individuals may be asked to walk to look for irregularities in gait patterns or to see if symptoms occur with certain movements.
  1. X-rays will typically reveal joint irregularities as well as sclerosis/thickening of the pubic symphysis.
  2. Magnetic resonance imaging – MRI may reveal joint and surrounding bone inflammation.
  3. Some cases will show no signs of injury on an X-ray or MRI.

Treatment

Effective treatment can take several months or longer. Because inflammation is the underlying cause of symptoms, the treatment will often involve: (Tricia Beatty. 2012)

Rest

  • Allows the acute inflammation to subside.
  • During recovery, sleeping flat on the back may be recommended to reduce pain.

Ice and Heat Applications

  • Ice packs help reduce inflammation.
  • The heat helps ease pain after the initial swelling has gone down.

Physical Therapy

Anti-inflammatory Medication

  • Over-the-counter nonsteroidal anti-inflammatory medications – NSAIDs like ibuprofen and naproxen can reduce pain and inflammation.

Assistive Walking Devices

  • If the symptoms are severe, crutches or a cane may be recommended to reduce stress on the pelvis.

Cortisone

  • There have been attempts to treat the condition with cortisone injections, but the evidence supporting its use is limited and needs further research. (Alessio Giai Via, et al., 2019)

Prognosis

Once diagnosed, the prognosis for full recovery is optimal but can take time. It can take some individuals six months or more to return to pre-injury level of function, but most return by around three months. If conservative treatment fails to provide relief after six months, surgery could be recommended. (Michael Dirkx, Christopher Vitale. 2023)

Sports Injuries Rehabilitation

References

Gomella, P., & Mufarrij, P. (2017). Osteitis pubis: A rare cause of suprapubic pain. Reviews in urology, 19(3), 156–163. doi.org/10.3909/riu0767

Beatty T. (2012). Osteitis pubis in athletes. Current sports medicine reports, 11(2), 96–98. doi.org/10.1249/JSR.0b013e318249c32b

Via, A. G., Frizziero, A., Finotti, P., Oliva, F., Randelli, F., & Maffulli, N. (2018). Management of osteitis pubis in athletes: rehabilitation and return to training – a review of the most recent literature. Open access journal of sports medicine, 10, 1–10. doi.org/10.2147/OAJSM.S155077

Dirkx M, Vitale C. Osteitis Pubis. [Updated 2022 Dec 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: www.ncbi.nlm.nih.gov/books/NBK556168/

Acupuncture as an Alternative Treatment for Allergies

By
Dr. Alex Jimenez
-
Male reflexologist conducts an acupuncture session for an expectant mother, the specialist works in protective gloves

“For individuals suffering from allergies, could using acupuncture help relieve and manage symptoms?”

Acupuncture as an Alternative Treatment for Allergies

Acupuncture Can Help With Allergies

Acupuncture is becoming a more respected alternative treatment for various medical issues, from anxiety to fibromyalgia to weight loss. There is evidence that acupuncture can help with allergies by alleviating symptoms and improving the quality of life. (Shaoyan Feng, et al., 2015) The American Academy of Otolaryngology-Head and Neck Surgery Foundation recommends doctors offer acupuncture to patients looking for nonpharmacological treatments for their allergies or refer them to an acupuncturist. (Michael D. Seidman, et al., 2015)

Acupuncture

Acupuncture is a traditional Chinese medicine/TCM practice in which extremely thin needles are inserted into the body at specific points, creating a network of energy pathways known as meridians.

  • These pathways circulate vital life energy/chi or qi.
  • Each meridian is associated with a different body system.
  • Needles are placed to target the organs associated with the condition being treated.
  1. Acupuncture can help with allergies by targeting several meridians, including the lungs, colon, stomach, and spleen. These meridians are believed to circulate defensive life energy or a type of immunity energy.
  2. A backup of defensive energy or a deficiency can cause allergy symptoms like swelling, watery eyes, runny nose, sneezing, allergic eczema, and conjunctivitis. (Bettina Hauswald, Yury M. Yarin. 2014)
  3. The objective is to stimulate the points to restore balance in the energies and relieve symptoms.

Scientific Theories

  • One theory is the needles work directly on nerve fibers, influencing messages to the brain or the autonomic nervous system and transmission of signals within the body, including the immune system. (Tony Y. Chon, Mark C. Lee. 2013)
  • Another is the needles influence certain activities of cells, particularly the transport, breakdown, and clearance of bioactive mediators.
  • The combination of these actions is thought to decrease inflammatory conditions like allergic rhinitis – hay fever, in which the inside of the nose becomes inflamed and swollen after breathing in an allergen. (Bettina Hauswald, Yury M. Yarin. 2014)

A 2015 review concluded there have been high-quality randomized controlled trials demonstrating acupuncture’s efficacy in treating seasonal and perennial allergic rhinitis. Smaller studies have shown some preliminary benefits of acupuncture when compared with antihistamines, but more research is needed. (Malcolm B. Taw, et al., 2015)

Treating Allergies

  • Some individuals who choose acupuncture are seeking alternatives to standard treatment like medications, nasal sprays, and immunotherapy.
  • Others are looking for ways to enhance the effectiveness of medications already being taken, such as antihistamines or nasal sprays, or shorten how long or how frequently they are needed.
  • Initial treatment usually involves weekly or twice-weekly appointments over several weeks or months, depending on symptom severity.
  • This may be followed by annual treatments or on an as-needed basis. (American Academy of Medical Acupuncture. 2020)
  1. Most states require a license, certification, or registration to practice acupuncture, but these vary from state to state.
  2. Recommendations are for a practitioner who is certified by the National Certification Commission for Acupuncture and Oriental Medicine.
  3. A medical doctor who offers acupuncture.
  4. The American Academy of Medical Acupuncture has a list of acupuncturists who are also medical doctors.

Improperly administered acupuncture needles can cause serious side effects that range from infections, punctured organs, collapsed lungs, and injury to the central nervous system. (National Center for Complementary and Integrative Health. 2022) Before trying acupuncture, consult your primary healthcare provider, allergist, or integrative medicine specialist to make sure it’s a safe and viable option and the best way to integrate it into overall allergy care.

Fighting Inflammation Naturally

References

Feng, S., Han, M., Fan, Y., Yang, G., Liao, Z., Liao, W., & Li, H. (2015). Acupuncture for the treatment of allergic rhinitis: a systematic review and meta-analysis. American journal of rhinology & allergy, 29(1), 57–62. doi.org/10.2500/ajra.2015.29.4116

Seidman, M. D., Gurgel, R. K., Lin, S. Y., Schwartz, S. R., Baroody, F. M., Bonner, J. R., Dawson, D. E., Dykewicz, M. S., Hackell, J. M., Han, J. K., Ishman, S. L., Krouse, H. J., Malekzadeh, S., Mims, J. W., Omole, F. S., Reddy, W. D., Wallace, D. V., Walsh, S. A., Warren, B. E., Wilson, M. N., … Guideline Otolaryngology Development Group. AAO-HNSF (2015). Clinical practice guideline: Allergic rhinitis. Otolaryngology–head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 152(1 Suppl), S1–S43. doi.org/10.1177/0194599814561600

Hauswald, B., & Yarin, Y. M. (2014). Acupuncture in allergic rhinitis: A Mini-Review. Allergo journal international, 23(4), 115–119. doi.org/10.1007/s40629-014-0015-3

Chon, T. Y., & Lee, M. C. (2013). Acupuncture. Mayo Clinic proceedings, 88(10), 1141–1146. doi.org/10.1016/j.mayocp.2013.06.009

Taw, M. B., Reddy, W. D., Omole, F. S., & Seidman, M. D. (2015). Acupuncture and allergic rhinitis. Current opinion in otolaryngology & head and neck surgery, 23(3), 216–220. doi.org/10.1097/MOO.0000000000000161

American Academy of Medical Acupuncture. (2020). Acupuncture and Seasonal Allergies.

National Center for Complementary and Integrative Health. (2022). Acupuncture: What You Need To Know.

Getting to Know Functional Gastrointestinal Disorders

By
Dr. Alex Jimenez
-
woman in gray t shirt health problems abdominal pain diarrhea. High quality photo

“Individuals with digestive problems that cannot be diagnosed could be experiencing functional gastrointestinal disorders. Could understanding the types help in developing effective treatment plans?”

Getting to Know Functional Gastrointestinal Disorders

Functional Gastrointestinal Disorders

Functional gastrointestinal disorders, or FGDs, are disorders of the digestive system in which the presence of structural or tissue abnormality cannot explain symptoms. Functional gastrointestinal disorders lack identifiable biomarkers and are diagnosed based on symptoms. (Christopher J. Black, et al., 2020)

Rome Criteria

FGDs used diagnoses of exclusion, meaning that they could only be diagnosed after organic/identifiable disease was ruled out. However, in 1988, a group of researchers and healthcare providers met to devise strict criteria for the diagnosis of the various types of FGDs. The criteria is known as the Rome Criteria. (Max J. Schmulson, Douglas A. Drossman. 2017)

FGDs

A comprehensive list as described by the Rome III criteria (Ami D. Sperber et al., 2021)

Functional Esophageal Disorders

  • Functional heartburn
  • Functional chest pain believed to be of esophageal origin
  • Functional dysphagia
  • Globus

Functional Gastroduodenal Disorders

  • Unspecified excessive belching
  • Functional dyspepsia – includes postprandial distress syndrome and epigastric pain syndrome.
  • Chronic idiopathic nausea
  • Aerophagia
  • Functional vomiting
  • Cyclic vomiting syndrome
  • Rumination syndrome in adults

Functional Bowel Disorders

  • Irritable bowel syndrome – IBS
  • Functional constipation
  • Functional diarrhea
  • Unspecified functional bowel disorder

Functional Abdominal Pain Syndrome

  • Functional abdominal pain – FAP

Functional Gallbladder and Sphincter of Oddi Disorders

  • Functional gallbladder disorder
  • Functional biliary Sphincter of Oddi disorder
  • Functional pancreatic Sphincter of Oddi disorder

Functional Anorectal Disorders

  • Functional fecal incontinence
  • Functional Anorectal Pain – includes chronic proctalgia, Levator ani syndrome, unspecified functional anorectal pain, and proctalgia fugax.
  • Functional Defecation Disorders – include dyssynergic defecation and inadequate defecatory propulsion.

Childhood Functional GI Disorders

Infant/Toddler (Jeffrey S. Hyams et al., 2016)

  • Infant colic
  • Functional constipation
  • Functional diarrhea
  • Cyclic vomiting syndrome
  • Infant regurgitation
  • Infant rumination syndrome
  • Infant dyschezia

Childhood Functional GI Disorders:

Child/Adolescent

  • Vomiting and Aerophagia – cyclic vomiting syndrome, adolescent rumination syndrome, and aerophagia
  • Abdominal Pain-Related Functional GI Disorders include:
  1. functional dyspepsia
  2. IBS
  3. Abdominal migraine
  4. Childhood functional abdominal pain
  5. Childhood functional abdominal pain syndrome
  • Constipation – functional constipation
  • Incontinence – nonretentive fecal incontinence

Diagnosis

Although the Rome criteria allow the diagnosis of FGDs to be symptom-based, a healthcare provider may still run standard diagnostic tests to rule out other diseases or look for structural problems resulting in symptoms.

Treatment

Although no visible signs of disease or structural problems may be identified as causing the symptoms, it does not mean that they are not treatable and manageable. For individuals who suspect they may have or have been diagnosed with a functional gastrointestinal disorder, it will be essential to work with a healthcare provider on a working treatment plan. Treatment options can include: (Asma Fikree, Peter Byrne. 2021)

  • Physical therapy
  • Nutritional and dietary adjustments
  • Stress management
  • Psychotherapy
  • Medication
  • Biofeedback

Eating Right To Feel Better

References

Black, C. J., Drossman, D. A., Talley, N. J., Ruddy, J., & Ford, A. C. (2020). Functional gastrointestinal disorders: advances in understanding and management. Lancet (London, England), 396(10263), 1664–1674. doi.org/10.1016/S0140-6736(20)32115-2

Schmulson, M. J., & Drossman, D. A. (2017). What Is New in Rome IV. Journal of neurogastroenterology and motility, 23(2), 151–163. doi.org/10.5056/jnm16214

Sperber, A. D., Bangdiwala, S. I., Drossman, D. A., Ghoshal, U. C., Simren, M., Tack, J., Whitehead, W. E., Dumitrascu, D. L., Fang, X., Fukudo, S., Kellow, J., Okeke, E., Quigley, E. M. M., Schmulson, M., Whorwell, P., Archampong, T., Adibi, P., Andresen, V., Benninga, M. A., Bonaz, B., … Palsson, O. S. (2021). Worldwide Prevalence and Burden of Functional Gastrointestinal Disorders, Results of Rome Foundation Global Study. Gastroenterology, 160(1), 99–114.e3. doi.org/10.1053/j.gastro.2020.04.014

Hyams, J. S., Di Lorenzo, C., Saps, M., Shulman, R. J., Staiano, A., & van Tilburg, M. (2016). Functional Disorders: Children and Adolescents. Gastroenterology, S0016-5085(16)00181-5. Advance online publication. doi.org/10.1053/j.gastro.2016.02.015

Fikree, A., & Byrne, P. (2021). Management of functional gastrointestinal disorders. Clinical medicine (London, England), 21(1), 44–52. doi.org/10.7861/clinmed.2020-0980

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