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Unlocking Wellness: The Benefits of Recreation Therapy

high angle view of smiling senior woman and caregiver shaking hands above table football

Individuals who have been injured or ill or have a chronic disability may be having difficulty performing everyday activities. Can recreation therapy help rehabilitate injuries and manage chronic conditions?

Unlocking Wellness: The Benefits of Recreation Therapy

Recreation Therapy

Living with a chronic disability or functional limitation due to an illness or injury can significantly impact an individual’s quality of life. Working with a team of rehabilitation professionals can help improve mobility and the ability to complete everyday tasks comfortably. A recreational therapist is one professional who helps regain emotional and functional well-being. A recreational therapist is a healthcare professional who helps individuals maximize physical and emotional health through recreational activities. Also known as therapeutic recreation, the therapist will use activities to help move and feel better. A physical or occupational therapist uses exercises to improve functional mobility, and a recreational therapist uses recreational activities to help regain mobility and improve well-being. Activities can include:

  • Playing games
  • Outdoor activities
  • Hiking
  • Puzzles
  • Horseback riding
  • Cooking

Therapy

A healthcare specialist uses activity-based interventions to help individuals move and feel better after injury or illness or if they have a chronic disability. The interventions and therapies are based on recreational activities the individual likes and are designed to help recover physical, functional, and emotional health. Recreational therapists are trained to evaluate an individual’s condition and intervene in ways that help maximize social, mental, and physical health. The main goal is to reduce depression and anxiety and to help individuals socialize comfortably. (American Therapeutic Recreation Association, 2024)

Activities

Therapeutic recreation involves engaging in specific activities to help individuals regain their confidence and independence. Examples of activities can include: (American Therapeutic Recreation Association, 2024)

  • Painting or drawing
  • Dancing
  • Sports programs
  • Cooking
  • Community outings
  • Group exercise classes

The key to a positive experience is that the activity should be specific to the individual’s emotional and physical needs and capabilities and something the individual would want to do as an activity.

Other Types of Therapy

Individuals may be familiar with other types of therapists, like physical and occupational therapists. These professionals help individuals regain pain-free functional mobility after injury or illness. For individuals who cannot move their upper extremities after falling, the physical therapist can measure their shoulder range of motion and strength and develop a personalized treatment program. Recreation therapists are similar; they meet with patients regularly to help them recover from injuries or positively socialize with their community. During the initial meeting, they will evaluate the individual’s condition and learn how their emotional and physical needs prevent them from achieving maximal potential. (American Therapeutic Recreation Association, 2024) The patient and therapist will engage in activities to help move and feel better during therapy. During the activity, the therapist may suggest adjustments or ideas that improve movement and ability to interact with the environment.

Who Can Benefit?

Individuals of all ages and abilities with physical and psychological conditions can benefit from working with a recreational therapist. Children, teenagers, adults, and older individuals who have a disability, either temporary or permanent, can engage in recreation therapy as part of a rehabilitation and recovery program. (American Therapeutic Recreation Association, 2024)

Benefits

Whenever engaging in any healthcare activity or treatment, ask if that treatment can help your specific condition. A review of the use of recreational dance in children and young people ages 5 to 21 found evidence of the benefits of the therapy, which included: (Burkhardt J, Brennan C. 2012)

  • Decreased anxiety
  • Improve self-image
  • Improved cardiovascular fitness
  • Decreased obesity
  • Improved bone health

Another study examined health improvements in individuals injured in military service after a week-long recreational therapy wellness retreat. The participating service members’ results showed significant improvement in outcome measures for post-traumatic stress disorder, stress, anxiety, and depression. The health improvements remained three and six months after completing the recreation therapy. This shows that therapeutic recreation may offer significant emotional and psychological benefits to injured military service members’ long-term health and an effective treatment to improve the well-being of injured or disabled individuals with limited negative side effects. (Townsend J, Hawkins BL, Bennett JL, et al., 2018)

Professional Background

Most therapists have a bachelor’s degree in recreational or leisure studies, focusing on art, psychology, and music classes. Upon graduation, students can take a national exam and become Certified Therapeutic Recreation Specialists/CTRS. (Hoss M.A.K, 2019) Once certified, therapists must regularly take continuing education classes and undergo a recertification process every five years.

Receiving Therapy Services

To start working with a recreational therapist, visit your healthcare provider and request a referral. They can ensure the treatment is appropriate for the specific injury and/or condition and should be able to help find a therapist. (American Therapeutic Recreation Association, 2024) Individuals in an inpatient hospital will likely spend time with a recreational therapist at some point. Just like working with a physical or occupational therapist to help individuals move better, working with a recreation therapist while in rehabilitation may be an everyday occurrence to help reintegrate into the community after discharge.

Insurance Coverage

One question regarding recreational therapy is, will my insurance cover the services of a recreational therapist?

  • For individuals with Medicare insurance, recreational therapy is a covered service for individuals with certain diagnoses and settings.
  • Therapeutic recreation is a covered rehabilitation service for individuals in an inpatient rehabilitation facility.
  • Individuals who receive outpatient recreational therapy should ensure they have a prescription and letter of medical necessity from a physician to qualify for Medicare reimbursement. (American Therapeutic Recreation Association, 2024)
  • Individuals with private insurance should call their insurance provider and inquire about coverage for recreation therapy.
  • Individuals who do not have insurance can expect to pay $100-$150 per session.
  • Each session lasts around one to two hours. (De Vries D. 2014)

Injury Medical Chiropractic and Functional Medicine Clinic

Working in therapeutic recreation may help decrease anxiety and depression, improve the sense of well-being, and improve function in daily tasks. (Townsend J, Hawkins BL, Bennett JL, et al., 2018) Always consult your healthcare provider before beginning new treatment methods. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.


Integrative Healthcare


References

American Therapeutic Recreation Association. Association, A. T. R. (2024). What is Recreational Therapy? www.atra-online.com/about-rt

American Therapeutic Recreation Association. Association, A. T. R. (2024). Who We Are. www.atra-online.com/who-we-are

Burkhardt, J., & Brennan, C. (2012). The effects of recreational dance interventions on the health and well-being of children and young people: A systematic review. Arts & Health, 4(2), 148–161. doi.org/10.1080/17533015.2012.665810

Townsend, J., Hawkins, B. L., Bennett, J. L., Hoffman, J., Martin, T., Sotherden, E., … Duregger, C. (2018). Preliminary long-term health outcomes associated with recreation-based health and wellness programs for injured service members. Cogent Psychology, 5(1). doi.org/10.1080/23311908.2018.1444330

Hoss, PhD, CTRS, FACHE, FDRT, M. A. K. (2019). Recreational therapy workforce: An update. American Journal of Recreation Therapy, 18(3), 9–15. doi.org/10.5055/ajrt.2019.0191

De Vries, DHA, MPA, CTRS, D. (2014). Regulatory requirements for recreational therapy in nursing homes. American Journal of Recreation Therapy, 13(1), 25–30. doi.org/10.5055/ajrt.2014.0063

Ways to Increase Vitamin C Levels and Boost Your Immune System

Can individuals incorporate ways to increase their vitamin C levels to boost their immune system against cold and flu season?

Introduction

When it comes to the cold and flu season, the weather gets colder, and the immune system will flare up as numerous pathogens enter the body. Many individuals will begin to notice their bodies aching and deal with congestion and upper respiratory symptoms. This is due to viral infections that compromise the immune system and cause individuals to be sick. However, numerous ways exist to combat cold and flu season while boosting their immune system by increasing their vitamin C levels. Today’s article looks at how the immune system and pain correlate, how healthy nutrition relates to the immune system, and how people can naturally increase their vitamin C levels to fight cold and flu season. We talk with certified associated medical providers who inform our patients about how the immune system can be impacted by various pathogens that cause overlapping risk profiles associated with pain.  While asking their associated medical provider intricate questions, we advise patients to incorporate ways to increase their vitamin C intake to boost the immune system and prevent cold and flu season from impacting the body. Dr. Alex Jimenez, D.C., includes this information as an academic service. Disclaimer.

 

The Immune System & Pain

How often do you feel so congested that your head is filled with cotton? Do you feel general aches and pains in your muscles that cause you to feel discomfort? Or have you noticed that your energy is lower than usual and is stressing you out? More often than not, many people who have dealt with these situations have often correlated with their immune systems. The immune system has a large network in the body that helps protect the individual from germs, heal the body from any infections and injuries, and develop antibodies to fight off pathogens. Sometimes, when the immune system becomes weak, it can lead to the development of autoimmune. This is because when pathogens compromise the immune system, they can adapt their response to modulate oxidative stress and trigger inflammation by enhancing the protein secretion towards the intra- and extra-cellular pathogens to enhance infections. (Iddir et al., 2020)

 

Additionally, when the immune system is compromised, it can cause the immune system to overproduce inflammatory cytokines and attack healthy cellular activities, leading to the development of autoimmune conditions and symptoms of musculoskeletal pain. When individuals with weak immune systems are dealing with musculoskeletal pain, some of the biomarkers that can contribute to its development include environmental factors (smoking, physical inactivity, obesity, etc.), chronic inflammation, and vitamin deficiency that can cause individuals to be in constant pain and discomfort. (Djade et al., 2022) Hence, boosting vitamin levels can benefit the immune system and body.

 


Optimizing Your Wellness- Video

Optimizing Your Wellness | El Paso, Tx (2023)

Nutrition & The Immune System Connection

When boosting the immune system, many individuals can start slowly by changing their nutritional intake. As one of the strongest and adjustable environmental factors, having a proper dietary mindset can help many people reduce the burdens of chronic issues from reappearing. (Kiani et al., 2022) This is due to people who want to make small changes in their daily routine, who can start by eating nutritional foods that can help boost their immune system and bodies. This is because a bidirectional relationship between the duet and the immune system can be utilized in multiple approaches. (Venter et al., 2020) One of the best ways many individuals can improve their immune system during cold and flu season is by increasing and boosting their vitamin C levels.

BestFoodSourcesofVitaminC ElPasoChiropractor

 

How Vitamin C Can Help With Cold/Flu

Boosting vitamin C levels is an excellent way to help jumpstart the immune system. Vitamin C is hugely important in normal immune system functioning and has been used to prevent or treat viral infections. (Cerullo et al., 2020) This is because people can’t produce vitamin C naturally, so it has to be consumed for the body to maintain healthy vitamin levels. Additionally, vitamin C is a plant-based ingredient that promotes healing and provides immune-boosting properties that augment the chemotaxis and phagocytosis in the body while generating free radicals in the immune cells. (Gasmi et al., 2023) Another great thing about vitamin C is that it can be combined with vitamin D to reduce the load of the cytokine storm in the body and the viral load of the cold and flu. (Ish et al., 2020)

 

Ways To Increase Vitamin C Levels

There are ways to increase vitamin C levels in the body, which can benefit people who want to reduce the chances of cold and flu season impacting their routine.

  • Reduce sugar intake: Reduce excessive sugar intake by following a nutritional plan from a healthcare professional, which is customizable to the individual.
  • Incorporating Vitamin C: Many people can load up on high-quality Vitamin C containing bioflavonoids that can help decrease pro-inflammatory cytokines in the body. (Ramon et al., 2023)
  • Vitamin C-rich foods: Adding whole foods of Vitamin C like bell peppers, broccoli, citrus, and green leafy veggies can help boost vitamin C levels
  • Intermittent Fasting: Combining Vitamin C-infused lemon water with intermittent fasting can help the body boost immunity and improve blood sugar regulation.
  • Glutathione Boost: Incorporating vitamin C with glutathione can help recycle vitamin C into the body, boosting vitamin and supplement levels.

Incorporating these ways to boost vitamin C levels in the immune system can provide beneficial results during the cold and flu season while improving a person’s health and wellness journey.


References

Cerullo, G., Negro, M., Parimbelli, M., Pecoraro, M., Perna, S., Liguori, G., Rondanelli, M., Cena, H., & D’Antona, G. (2020). The Long History of Vitamin C: From Prevention of the Common Cold to Potential Aid in the Treatment of COVID-19. Front Immunol, 11, 574029. doi.org/10.3389/fimmu.2020.574029

Djade, C. D., Diorio, C., Laurin, D., & Dionne, C. E. (2022). An exploratory identification of biological markers of chronic musculoskeletal pain in the low back, neck, and shoulders. PLOS ONE, 17(4), e0266999. doi.org/10.1371/journal.pone.0266999

Gasmi, A., Shanaida, M., Oleshchuk, O., Semenova, Y., Mujawdiya, P. K., Ivankiv, Y., Pokryshko, O., Noor, S., Piscopo, S., Adamiv, S., & Bjorklund, G. (2023). Natural Ingredients to Improve Immunity. Pharmaceuticals (Basel), 16(4). doi.org/10.3390/ph16040528

Iddir, M., Brito, A., Dingeo, G., Fernandez Del Campo, S. S., Samouda, H., La Frano, M. R., & Bohn, T. (2020). Strengthening the Immune System and Reducing Inflammation and Oxidative Stress through Diet and Nutrition: Considerations during the COVID-19 Crisis. Nutrients, 12(6). doi.org/10.3390/nu12061562

Ish, P., Agrawal, S., & Gupta, N. (2020). Vitamin C (ovi) D; An unexplored option! Infez Med, 28(suppl 1), 122-125. www.ncbi.nlm.nih.gov/pubmed/32532949

Kiani, A. K., Dhuli, K., Donato, K., Aquilanti, B., Velluti, V., Matera, G., Iaconelli, A., Connelly, S. T., Bellinato, F., Gisondi, P., & Bertelli, M. (2022). Main nutritional deficiencies. J Prev Med Hyg, 63(2 Suppl 3), E93-E101. doi.org/10.15167/2421-4248/jpmh2022.63.2S3.2752

Ramon, R., Holguin, E., Chiriboga, J. D., Rubio, N., Ballesteros, C., & Ezechieli, M. (2023). Anti-Inflammatory Effect of Vitamin C during the Postoperative Period in Patients Subjected to Total Knee Arthroplasty: A Randomized Controlled Trial. J Pers Med, 13(9). doi.org/10.3390/jpm13091299

Venter, C., Eyerich, S., Sarin, T., & Klatt, K. C. (2020). Nutrition and the Immune System: A Complicated Tango. Nutrients, 12(3). doi.org/10.3390/nu12030818

 

Disclaimer

Can You Enjoy Pasta on a Cholesterol-Friendly Diet?

healthy pasta salad with zucchini sweet corn tomato and basil, vegetarian lunch

Can healthy noodle alternatives and heart-healthy ingredients help make cholesterol-friendly pasta dishes for individuals trying to lower and manage cholesterol levels?

Can You Enjoy Pasta on a Cholesterol-Friendly Diet?

Pasta and Cholesterol

Pasta, like other refined carbohydrates such as white bread and rice, can increase cholesterol levels. Although pasta does not contain cholesterol, it is high in carbohydrates, which can increase the amount of calories and fat in one’s diet and contribute to high cholesterol levels. Since some types of carbohydrates can affect cholesterol levels, the goal is to eat the right pasta and healthier sauces and sides. Even for those following a cholesterol-lowering diet, there’s no reason you can’t enjoy meals containing pasta occasionally.

The Pasta and Cholesterol Link

Pasta made from white flour is considered a refined carbohydrate because it is high in carbs and low in fiber. Research has shown that a diet high in refined carbohydrates is associated with increased levels of triglycerides and LDL (unhealthy) cholesterol in the blood. (Yu, D. et al., 2013) (Bhardwaj B., O’Keefe E. L., and O’Keefe J. H. 2016) High levels of blood fats increase the risk of developing heart disease. Examples of refined carbohydrates include:

  • White rice
  • Breakfast cereals
  • Potato Chips
  • White bread
  • Pastries
  • Pizza

One cup of dry pasta has 0 milligrams of cholesterol but is high in carbohydrates, with around 43 grams per serving (U.S. Department of Agriculture, 2018). Eating foods high in saturated fats and refined carbohydrates can raise cholesterol levels.

Choosing Healthy Alternatives

Choosing healthier options that are cholesterol-friendly can make pasta healthy. Pasta labeled whole wheat or whole grain is darker than white flour pasta, which contains more fiber and can lower cholesterol levels and reduce the risk of heart disease. (American Heart Association, 2024) The label will show the carbohydrate and fiber content per serving.

Alternatives

Alternatives that are lower in carbohydrates and/or higher in protein and fiber include:

  • Spaghetti squash
  • Spiralized vegetables like zucchini, carrots, and butternut squash.
  • Shirataki noodles are made from the konjac plant.
  • Chickpea pasta
  • Black bean pasta
  • Red lentil pasta
  • Edamame pasta

Vegetables

Vegetables are heart-healthy and are a great addition to pasta dishes. Vegetables that pair well with pasta include:

  • Peppers
  • Onion
  • Zucchini
  • Spinach
  • Broccoli
  • Asparagus

Add a few olives, which contain healthy monounsaturated fats. (Rocha J., Borges N., and Pinho O. 2020) Mix vegetables and pasta in equal amounts to create a lower-carb, fiber-dense dish that will keep cholesterol levels low and maintain a healthy heart.

Cheese and Low-Fat Cheese

It is common to incorporate cheese. While cheese contains calcium and adds flavor and texture, it also adds saturated fat. The American Heart Association recommends that saturated fats make up less than 6% of daily calories because of their role in heart health and high cholesterol risks. (American Heart Association, 2024) Instead, use a small amount of cheese, such as Romano or cheddar, and add a small amount of low-fat cheese that includes:

  • Parmesan cheese
  • Part-skim mozzarella cheese
  • Low-fat ricotta
  • Low-fat cottage cheese

Lean Meats

Sausage and ground beef are common additions but are also a source of saturated fat that could raise cholesterol levels. (American Heart Association, 2024) So, when possible, limit red meat and sausage or use a low-fat sausage alternative that is chicken or turkey-based, and add heart-healthy options, which include:

  • Beans
  • Shrimp
  • Turkey
  • Chicken
  • Salmon

Make It Herbaceous and Spicy

Spices can enhance the taste of a dish. Many herbs and spices commonly used in pasta dishes, such as parsley, oregano, garlic, and basil, contain healthy nutrients and don’t add any fat or calories. Spice up a pasta dish to taste with a little heart-healthy olive oil and spices to create a light coating on the noodles. (Rocha J., Borges N., and Pinho O. 2020) One tablespoon of olive oil contains nearly 120 calories and 14 grams of fat. (U.S. Department of Agriculture, 2019)

Healthy Sauces

Sauces are important, but an unhealthy one can introduce extra sugar and fat. Plenty of healthy sauces are at the store, but check the label as some contain extra salt, sugar, and fat, which are not heart-healthy. (U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015) Try to limit the use of creamy sauces, such as cheese and alfredo sauces, as they are a source of added fat and are high in saturated fat. An alternative is to dress the pasta with sautéd olive oil and sliced cherry tomatoes. Sauteing helps soften the tomatoes and release extra flavor into the oil.

Injury Medical Chiropractic and Functional Medicine Clinic

So, experiment with healthy pasta, various vegetables, lean meat, and healthy sauces to add flavor and make your next pasta dish delicious and cholesterol-friendly. Injury Medical Chiropractic and Functional Medicine Clinic focuses on and treats injuries and chronic pain syndromes through personalized care plans that improve ability through flexibility, mobility, and agility programs to relieve pain. Our providers use an integrated approach to create customized care plans for each patient and restore health and function to the body through nutrition and wellness, functional medicine, acupuncture, Electroacupuncture, and sports medicine protocols. If the individual needs other treatment, they will be referred to a clinic or physician best suited for them. Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, nutritionists, and health coaches to provide the most effective clinical treatments.


Chiropractic, Fitness, and Nutrition


References

Yu, D., Shu, X. O., Li, H., Xiang, Y. B., Yang, G., Gao, Y. T., Zheng, W., & Zhang, X. (2013). Dietary carbohydrates, refined grains, glycemic load, and risk of coronary heart disease in Chinese adults. American journal of epidemiology, 178(10), 1542–1549. doi.org/10.1093/aje/kwt178

Bhardwaj, B., O’Keefe, E. L., & O’Keefe, J. H. (2016). Death by Carbs: Added Sugars and Refined Carbohydrates Cause Diabetes and Cardiovascular Disease in Asian Indians. Missouri medicine, 113(5), 395–400.

U.S. Department of Agriculture. FoodData Central. (2018). Pasta, dry, enriched. Retrieved from fdc.nal.usda.gov/fdc-app.html#/food-details/169736/nutrients

American Heart Association. (2024). Whole grains, refined grains, and dietary fiber. www.heart.org/en/healthy-living/healthy-eating/eat-smart/nutrition-basics/whole-grains-refined-grains-and-dietary-fiber

Rocha, J., Borges, N., & Pinho, O. (2020). Table olives and health: a review. Journal of nutritional science, 9, e57. doi.org/10.1017/jns.2020.50

American Heart Association. (2024). Saturated fat. www.heart.org/en/healthy-living/healthy-eating/eat-smart/fats/saturated-fats

U.S. Department of Agriculture. FoodData Central. (2019). Oil, olive, extra virgin. Retrieved from fdc.nal.usda.gov/fdc-app.html#/food-details/748608/nutrients

U.S. Department of Health and Human Services and U.S. Department of Agriculture. (2015). Dietary Guidelines for Americans. 8th Edition. Retrieved from odphp.health.gov/our-work/nutrition-physical-activity/dietary-guidelines/previous-dietary-guidelines/2015

The Science Behind Herniated Bulging Discs and MRI

Concentrated male physician sits at a computer monitor in a room for a describing MRI images and monitoring patient's condition

How are MRIs used to help diagnose bulging and herniated discs and help healthcare providers develop effective treatment programs for individuals experiencing back pain symptoms?

The Science Behind Herniated Bulging Discs and MRI

Herniated Bulging Disc MRI

A herniated bulging disc is often identified during magnetic resonance imaging (MRI); however, it’s usually an incidental finding that was done for other reasons where spinal problems and/or injuries are found. A bulging disc is relatively common, even in individuals who experience no symptoms. A herniated or bulging disc in the back can be identified with an MRI test, typically recommended when someone experiences back pain symptoms for at least six weeks. (American Academy of Neurological Surgeons, 2024) Normal wear and tear and age cause changes in the spinal disc/s cushion to bulge and become misaligned with the spine. (Brinjikji W. et al., 2015) And with a herniated disc, it can press against the spinal cord and nerves. Repeated heavy lifting, practicing unhealthy postures, a history of back injuries, or underlying health conditions are common causes.

Bulging Disc

Bulging discs are common even in healthy individuals but can be difficult to interpret independently on an MRI, so other symptoms and findings are as important in diagnosis.

Causes

A bulging disc is usually considered age-related degenerative changes that cause the disc to bulge downward with gravity. (Penn Medicine, 2018)

Symptoms

Many with a bulging disc won’t have symptoms initially. (Wu P. H., Kim H. S., & Jang I. T. 2020) MRI findings are helpful but need to be evaluated alongside other symptoms (American Academy of Neurological Surgeons, 2024) (Penn Medicine, 2018)

  • Back pain
  • Pain in the legs and/or buttocks
  • Changes in gait and/or difficulty walking
  • Symptoms that affect just one side

A significant bulge is expected to cause leg pain due to irritation to the nerves going down the legs. (Amin R. M., Andrade N. S., & Neuman B. J. 2017) As the condition progresses, more than one disc can be affected, leading to other spinal conditions, including spinal stenosis.

A Bulging Disc On MRI

A disc bulge will measure over 25% of the total disc circumference. Its displacement is usually 3 millimeters or less from the normal shape and position of the disc. (Radiopaedia, 2024)

Herniated Disc

A herniated disc shifts out of its correct position and compresses nearby spinal nerves, causing pain and mobility issues.

Causes

Herniated disc causes include: (American Academy of Orthopaedic Surgeons, 2022)

  • Automobile accident injuries
  • Work or sports repetitive motion injuries
  • Heavy lifting and/or Incorrect lifting practices
  • Being overweight
  • Sedentary jobs and/or lifestyles that place pressure on the spine when sitting.
  • Smoking can speed up degenerative damage to the spine.

Symptoms

Symptoms include back and leg pain as well as: (American Academy of Orthopaedic Surgeons, 2022)

  • Tingling sensations
  • Numbness
  • Burning sensations
  • Muscle spasms
  • Muscle weakness

Herniated Disc on MRI

Herniated discs will measure less than 25% of the total disc circumference. However, herniation is based on the type and can include: (Wei B., & Wu H. 2023)

  • Disc Protrusion – the displacement is limited, and the ligaments are intact.
  • Disc Extrusion – part of the disc remains connected but has slipped through the annulus or outer covering of the disc.
  • Disc Sequestration – a free fragment has separated and broken off from the main disc.

Candidates For Spinal MRI

The MRI is generally safe for most, including those with implanted cardiac devices like newer-model pacemakers. (Bhuva A. N. et al., 2020) However, it’s important to ensure that the healthcare team is aware of cochlear implants or other devices so that necessary precautions can be taken. It is recommended for all individuals that symptoms be present for six weeks before an MRI. A specialist may want to see MRI results sooner, especially if symptoms include: (American Academy of Neurological Surgeons, 2024)

  • A specific injury, like a fall that caused the pain
  • Recent or current infection or fever with spinal symptoms
  • Significant weakness in arms or legs
  • Loss of pelvic sensation.
  • A history of metastatic cancer.
  • Loss of bladder or bowel control

An MRI may be needed if symptoms are rapidly worsening. However, many with a disc bulge don’t have symptoms at all. In most cases, an MRI is an outpatient procedure that can be completed in an hour or less but can take longer if contrast dye is used. The healthcare provider will provide specific instructions about MRI preparation.

Treatment

Treatment for a herniated or bulging disc depends on the cause and severity of symptoms.

Bulging Disc

Many disc bulges don’t require treatment; however, bulging disc pain treatment can include: (American Academy of Orthopaedic Surgeons, 2022) (American Academy of Neurological Surgeons, 2024)

  • Rest
  • No heavy lifting
  • Limited walking
  • Over-the-counter pain relief, including nonsteroidal anti-inflammatory drugs (NSAIDs).
  • Physical therapy
  • In rare cases that have not resolved with conservative treatment, surgery may be recommended.

Remember that the MRI findings may not identify or rule out all conditions, including muscle strains or ligament injuries, which may require different treatments, such as targeted stretches and exercises. (Brinjikji W. et al., 2015) (Fujii K. et al., 2019)

Herniated Disc

Treatment depends on the cause and severity of symptoms, if any. It can include stand-alone or a combination of physical therapy, medication, and steroid injections. Cases usually resolve in six to 12 weeks (Penn Medicine, 2018). Electrical nerve stimulation may be performed through specialized devices and/or acupuncture to help with nerve compression. (National Institute of Neurological Disorders and Stroke, 2020) Surgery may be recommended if conservative treatments fail to achieve significant pain relief and healing. (Wang S. et al., 2023)

Injury Medical Chiropractic and Functional Medicine Clinic

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


Root Causes of Spinal Stenosis


References

American Academy of Neurological Surgeons. (2024). Herniated disc. www.aans.org/patients/conditions-treatments/herniated-disc/

Brinjikji, W., Diehn, F. E., Jarvik, J. G., Carr, C. M., Kallmes, D. F., Murad, M. H., & Luetmer, P. H. (2015). MRI Findings of Disc Degeneration are More Prevalent in Adults with Low Back Pain than in Asymptomatic Controls: A Systematic Review and Meta-Analysis. AJNR. American journal of neuroradiology, 36(12), 2394–2399. doi.org/10.3174/ajnr.A4498

Penn Medicine. (2018). Bulging Disc vs. Herniated Disc: What’s The Difference? Penn Musculoskeletal and Rheumatology Blog. www.pennmedicine.org/updates/blogs/musculoskeletal-and-rheumatology/2018/november/bulging-disc-vs-herniated-disc

Wu, P. H., Kim, H. S., & Jang, I. T. (2020). Intervertebral Disc Diseases PART 2: A Review of the Current Diagnostic and Treatment Strategies for Intervertebral Disc Disease. International journal of molecular sciences, 21(6), 2135. doi.org/10.3390/ijms21062135

Amin, R. M., Andrade, N. S., & Neuman, B. J. (2017). Lumbar Disc Herniation. Current reviews in musculoskeletal medicine, 10(4), 507–516. doi.org/10.1007/s12178-017-9441-4

Radiopaedia. (2024). Disc herniation. radiopaedia.org/articles/disc-herniation

American Academy of Orthopaedic Surgeons. (2022). Herniated disk in the lower back. orthoinfo.aaos.org/en/diseases–conditions/herniated-disk-in-the-lower-back/

Wei, B., & Wu, H. (2023). Study of the Distribution of Lumbar Modic Changes in Patients with Low Back Pain and Correlation with Lumbar Degeneration Diseases. Journal of pain research, 16, 3725–3733. doi.org/10.2147/JPR.S430792

Bhuva, A. N., Moralee, R., Moon, J. C., & Manisty, C. H. (2020). Making MRI available for patients with cardiac implantable electronic devices: growing need and barriers to change. European radiology, 30(3), 1378–1384. doi.org/10.1007/s00330-019-06449-5

Brinjikji, W., Luetmer, P. H., Comstock, B., Bresnahan, B. W., Chen, L. E., Deyo, R. A., Halabi, S., Turner, J. A., Avins, A. L., James, K., Wald, J. T., Kallmes, D. F., & Jarvik, J. G. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR. American journal of neuroradiology, 36(4), 811–816. doi.org/10.3174/ajnr.A4173

Fujii, K., Yamazaki, M., Kang, J. D., Risbud, M. V., Cho, S. K., Qureshi, S. A., Hecht, A. C., & Iatridis, J. C. (2019). Discogenic Back Pain: Literature Review of Definition, Diagnosis, and Treatment. JBMR plus, 3(5), e10180. doi.org/10.1002/jbm4.10180

Wang, S., Zhao, T., Han, D., Zhou, X., Wang, Y., Zhao, F., Shi, J., & Shi, G. (2023). Classification of cervical disc herniation myelopathy or radiculopathy: a magnetic resonance imaging-based analysis. Quantitative imaging in medicine and surgery, 13(8), 4984–4994. doi.org/10.21037/qims-22-1387

National Institute of Neurological Disorders and Stroke. (2020). Low back pain fact sheet. Retrieved from www.ninds.nih.gov/sites/default/files/migrate-documents/low_back_pain_20-ns-5161_march_2020_508c.pdf

Uncovering the Secrets of Eucalyptus Tea

A cup of herbal tea with lemon and eucalyptus leaves in a small ceramic mortar

How is eucalyptus tea made, and what are its health benefits?

Uncovering the Secrets of Eucalyptus Tea

Eucalyptus Tea

Eucalyptus tea is an herbal tea made from the leaves of the Australian eucalyptus tree. It is drunk as a hot tea and is commonly used to treat cold and flu symptoms. It can also be combined with other teas as a tonic. Researchers have been studying its benefits.

Eucalyptus Tree

There are different varieties of eucalyptus trees. The blue gum or Australian fever tree is a fast-growing tree that produces long grey-greenish leaves whose glands contain essential oil to prepare eucalyptus tea and oil. Eucalyptus tea is made from crushed leaves of the tree, not from the oil. The hot drink is sometimes called eucalyptus leaves tea to avoid confusion. The tea has a pale green color and a strong scent that can be described as woody or piney and clean or fresh. The smell is familiar to many because many lip balms and skin creams are made with eucalyptus.

Making The Tea

Eucalyptus or loose-leaf tea bags can be purchased in grocery stores, health markets, and online. Follow the instructions provided on the box. Eucalyptus leaves can be prepared for tea at home, but it must be prepared with leaves and not with eucalyptus oil, as using the oil can produce harmful side effects.

Home Preparation

  • To make the tea, use one dried eucalyptus leaf (around a teaspoon).
  • Add the crushed leaf to the bottom of an eight-ounce teacup.
  • Heat water to 194-205 Fahrenheit if using a temperature-controlled teapot.
  • Or bring water to a boil and let it sit for a minute to reduce the temperature.
  • Pour six ounces of water over the tea leaves.
  • Let the leaves steep for as long as desired, up to 10 minutes.
  • Breathe in the vapors while the tea is steeping.
  • Strain loose leaves from the cup before drinking.

Adding honey to the tea will increase sugar, sweetness, and calories. However, if you drink the tea to soothe a sore throat, the honey can also help ease symptoms. (Allan G. M. and Arroll B. 2014) The tea can also be blended with peppermint and chamomile (manzanilla) to increase its soothing properties.

Caffeine

Eucalyptus tea is not a traditional tea and is not made from Camellia sinensis plant leaves, like black or green tea. It is brewed from just the leaves of the eucalyptus tree, which do not contain any caffeine, making the tea completely caffeine-free. However, the vapors can be described as bright and refreshing.

Health Benefits

Most scientific research on eucalyptus’s health benefits uses the oil rather than the tea. The oil is much more concentrated, so drinking the tea is unlikely to provide the same benefits. However, according to a study, the leaves contain flavonoids and tannins that provide antioxidant and anti-inflammatory properties. (Panche A. N., Diwan A. D., and Chandra S. R. 2016)

Eucalyptus tea is commonly used as an inhalant to relieve cold or flu symptoms. Its vapors are often described as healing because inhaling them helps open up congested airways. However, there isn’t enough evidence to recommend using eucalyptus for cold. (American Lung Association, 2024) In addition to treatment for the common cold, eucalyptus has gained a variety of other health benefits, including (Dhakad A. K. et al., 2018)

  • Headache relief
  • Asthma treatment
  • Bronchitis treatment
  • Diabetes treatment
  • Reduce dental plaque and bad breath
  • Help treat liver and gallbladder problems
  • Prevent insect bites
  • Eliminate head lice

Toothpaste, mouthwash, bath products, and body creams made with eucalyptus are commonly found in stores.

Side Effects

Eucalyptus leaves are generally safe when consumed in the small amounts found in foods. However, there isn’t enough information to determine whether supplements containing larger amounts of eucalyptus leaf are safe when taken by mouth. Consulting with a healthcare provider before using this or any other herbal treatment is always recommended.

Injury Medical Chiropractic and Functional Medicine Clinic

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


Assessing Patients in a Chiropractic Setting


References

Allan, G. M., & Arroll, B. (2014). Prevention and treatment of the common cold: making sense of the evidence. CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne, 186(3), 190–199. doi.org/10.1503/cmaj.121442

Panche, A. N., Diwan, A. D., & Chandra, S. R. (2016). Flavonoids: an overview. Journal of nutritional science, 5, e47. doi.org/10.1017/jns.2016.41

American Lung Association. (2024). Facts About the Common Cold. www.lung.org/lung-health-diseases/lung-disease-lookup/facts-about-the-common-cold

Dhakad, A. K., Pandey, V. V., Beg, S., Rawat, J. M., & Singh, A. (2018). Biological, medicinal and toxicological significance of Eucalyptus leaf essential oil: a review. Journal of the science of food and agriculture, 98(3), 833–848. doi.org/10.1002/jsfa.8600

Bioidentical Hormone Replacement Therapy: Part 2

Can hormone replacement therapy provide relief by replenishing lost hormones in menopausal women and in men to restore their body function?

Introduction

Hormones help regulate the body and ensure that it functions properly in all body systems. When a person is doing a normal routine, from eating food, being physically active, or reducing stress, hormones can help regulate body temperature and make sure that the various organs are properly working and the body is functioning. When environmental factors start to impact the body, it can make the individual deal with overlapping risk profiles and, over time, develop into chronic conditions, hence why many individuals seek out hormone therapy to replenish the lost hormones. In this 2-part series, we will get an in-depth look at hormone therapy and how it can help menopausal women. Part 1 explains what hormones are and how hormone therapy helps the body. We talk with certified associated medical providers who inform our patients about how hormone therapy can help reduce the pain-like effects of the body.  While asking their associated medical provider intricate questions, we advise patients to incorporate non-surgical therapies combined with hormone therapy to reduce pain and discomfort from affecting the body. Dr. Alex Jimenez, D.C., includes this information as an academic service. Disclaimer.

 

To Bleed or Not to Bleed

Celebrity books and talk shows have made bioidentical hormones a popular topic. Because of the media’s emphasis on the term, both men and women, particularly aging ones, are now familiar with it. The term “natural” can now be defined as “bioidentical,” which offers everyone a fresh perspective on hormone replacement.

 

New “experts” with “expert” opinions on how to take hormones have surfaced from this media frenzy. Unfortunately, a lot of women are nervous about one of these “expert” methods of hormone replacement. Some people are so unhappy that they completely avoid taking hormones. According to some experts, it is natural and advised to cycle or create a monthly period. It is implied that women have menstruation while they are “young” and in good health. Therefore, all menopausal women should continue to menstruate to maintain that same level of health. This “cycling” is accomplished by establishing a menstrual cycle by halting progesterone for one week per month. This advice is deemed inadequate by the majority of women as they decide to go with hormone replacement therapy if they think that taking hormones necessitates getting their period.

 

 

What is menstrual cycling? It is the decline of women’s hormones that causes menstruation. Consequently, a woman will cycle and bleed if she stops taking progesterone for a few days each month. This can happen even if a woman hasn’t had a period for years—unless they’ve had a hysterectomy, of course. Menopausal women do not necessarily need or benefit from it just because it is “natural” for younger women. Menopause is when a woman is dealing with hormonal changes that cause an irregular menstrual cycle and a major physiological change to the body. (Ko & Kim, 2020)

 

Menopausal Women Don’t Need To Menstruate

Hormone replacement treatment does not induce pregnancy. Estrogen levels may reach the hundreds throughout pregnancy. Ideal estradiol levels on estrogen replacement therapy are normally between 60 and 100 pg/dl, which is far lower than what is seen during pregnancy. A woman first undergoes menstruation to prepare the uterus for the eventual implantation of a fertilized egg. There is no physiological justification for or advantage to menstruating if one has no desire to become pregnant.

 

According to a recent review in the Obstetric/Gynecological literature, women most frequently quit taking HRT because of unexpected vaginal bleeding. One aspect of menopause that women welcomed was the end of their periods. For women to feel comfortable continuing hormone replacement therapy, the medical literature frequently discusses ways to reduce and avoid postmenopausal vaginal bleeding. To stop postmenopausal bleeding, Dr. Rouzier has always recommended raising progesterone levels. Women should not bleed when estrogen and progesterone levels are balanced properly, and they will be happier using HR consistently. Furthermore, why only take progesterone and estrogen for three weeks a month and stop them from bleeding in the fourth, given how crucial they are? For 25% of the time, a woman would no longer benefit from the protection that estrogen and progesterone provide.

 

To manage PMS, women have long been treated with birth control pills that are taken continuously rather than on a cycle. The symptoms of PMS are brought on by the decline in women’s hormones that occurs just before their periods. This has recently been recognized by the pharmaceutical industry, which is pushing a new birth control tablet that is only cycled for bleeding every four months rather than monthly. According to the researchers, although menstruation is not required, cycling enables women to experience periods every four months to feel “normal.” Even premenopausal women, let alone postmenopausal women, do not require menstruation, as we now understand.

 

Keep in mind that cycling entails suppressing hormones for one week per month. The loss of protection in the absence of progesterone is another reason to avoid menstruation. Bioidentical progesterone prevents cancer in the uterus and breasts. The uterus is not protected against cancer by the bleeding that occurs during menstruation; the direct action of progesterone protects it. If progesterone is stopped for a week, the body loses the protective effects for those days. To this point, when hormone levels begin to decline, it can lead to musculoskeletal issues associated with mechanical overload, causing many women to have more falls.  This is because when there is a drop in hormones, it can lead to bone resorption that exceeds bone formation, causing the development of bone loss. (Davis et al., 2023)

 

According to recent research, Provera (medroxyprogesterone) thickens breast tissue and raises the risk of breast cancer. It accomplishes this by directly stimulating the breast’s estrogen receptor sites after controlling them. According to one study, Provera quadrupled breast stimulation compared to baseline. According to the same survey, bioidentical progesterone—not the same as Provera—down-regulates the breast’s receptor sites; thus, it does not stimulate breast tissue. Since many people will lose 25% of their protection if they stop taking progesterone for 25% of the month, why lose this protective effect? When women start to have a depletion of sex hormones, it can have a high impact on their quality of life and lead to the development of sleep problems and depression. (Morssinkhof et al., 2020)

 

One disorder is called “endometrial hyperplasia.” The uterine lining, or endometrial stripe, thickens more in this disease, which is a sign of malignancy. To prevent the development of cancer, this condition needs to be addressed. High doses of progesterone (known as Provera by traditional doctors) shrink this tissue. The dosage of progesterone is doubled if a subsequent ultrasound does not reveal a reduction in the uterine lining. Progesterone directly stimulates the endometrial tissue, causing it to shrink. The lining’s shedding is not the reason for the protection. For cancer prevention, a steady, adequate dosage of progesterone is preferable.

 

For this reason, progesterone should never be discontinued. This is because when a person is experiencing endometrial hyperplasia, there are significant somatic genetic changes that are caused by extensive estrogen exposure that is not counterbalanced with progestin protective effects. (Nees et al., 2022)

 


Exploring Integrative Medicine- Video

Exploring Integrative Medicine | El Paso, Tx (2024)

Testosterone For Men

The male sex hormone has always been testosterone. Lately, it has been demonstrated to be associated with longer, healthier lives for both men and women. As men age, their testosterone hormone levels naturally decrease over time, which can lead to the development of health issues. Numerous health advantages can be obtained by testosterone replacement therapy. Restoring testosterone improves body composition, improves sexual responsiveness, reverses impotence, and increases muscle strength and lean body mass.

 

Additionally, testosterone has been demonstrated to prevent osteoporosis, arthritis, and degenerative joint change. It improves the gloomy mood and well-being sensation commonly observed during andropause (male menopause). Like estrogen in women, it has also been demonstrated to enhance memory. Above all, it has been shown to shield both men and women from cardiovascular disease.

 

As a result, men who get testosterone replacement therapy say they feel stronger, healthier, and more attractive. They claim it brings back memories of their best selves. This is, after all, the main goal of hormone replenishment. To feel like you did when you were at the height of your physical and mental potential, it aims to return hormones to their youthful levels. The management of testosterone deficiency seeks to reduce the overlapping symptoms and to correct them by maintaining secondary sex characteristics. (Barbonetti et al., 2020) The physical deterioration that deprives men of their vitality, strength, and desire can be slowed down by testosterone. Testosterone can increase endurance and tone muscles. Healthy sexual arousal and desire can be restored by testosterone, which enhances mood and general well-being.

 

Both men’s and women’s sex drive is regulated by testosterone. Both men’s and women’s sexual effectiveness declines with age, along with testosterone. This condition can be reversed by bringing testosterone levels back to their youthful levels. Men and women alike all too frequently presume that their sexual ability will deteriorate with age. Accepting this loss of sexuality is not necessary. For us to live our longer lives with the same zeal and passion we did when we were younger, testosterone can be extremely important in maintaining and even reviving sexual desire and function.

 

As we become more aware that testosterone levels decrease with age and that many men experience severe physical and mental health repercussions; as a result, doctors’ interest in testosterone is skyrocketing. Menopause is the term used to describe it in women, while andropause is used in men. Low testosterone levels are the secondary cause of many of these symptoms and disease processes that we have learned to accept as part of normal aging, and they are easily remedied. Increased energy, less body fat, larger, stronger muscles, and a greater desire and stamina for activity are all outcomes of testosterone administration. At the same time, the FDA has recently approved the testosterone patch and topical gel as a result. Deficits in sex hormones can now be treated for both men and women.

 

In the past, testosterone replacement therapy has been linked to elevated cholesterol. This is a side effect of using synthetic testosterone, which causes liver damage and raises cholesterol at the same time. Similar to what has been observed in women using estrogen, studies now demonstrate that replacing it with natural testosterone lowers total cholesterol and raises HDL or good cholesterol. How many supplements improve our health and give us more energy, endurance, and happiness? What other pill can reduce fat and strengthen bones, muscles, ligaments, and the body all at once? An additional advantage is a greater motivation to work out due to feeling less tired and lethargic. It has been demonstrated that testosterone improves mood, learning and memory, and men’s health and well-being.

 

By lowering fat, increasing lean body mass, normalizing blood coagulation, and raising good HDL cholesterol, testosterone supplements also reduce the risk of diabetes and cardiovascular disease. Additionally, it is significantly more effective than estrogen in preventing Alzheimer’s disease and cognitive decline in women. A recent medical study showed that testosterone decreased blood vessel inflammation measured by C-reactive protein levels (CRP). Heart attacks and the advancement of heart disease are prevented by testosterone. Indeed, it has been shown that testosterone lengthens life. According to a new study published in the Annals of Internal Medicine, males with higher testosterone levels had longer lifespans. Men who had decreased testosterone levels lived shorter lives. This raises the question of why the majority of doctors do not advise testosterone for all men.

 

Oral supplements and injections are two ways that testosterone can be given. Since testosterone is synthetic, many physicians would rather not utilize either of these techniques. The liver metabolizes synthetic testosterone, which causes cholesterol levels to rise. Natural testosterone used topically lowers cholesterol because it is not subjected to this metabolism. There are also testosterone patches available. Due to the inability to achieve ideal blood levels, the painful sensation of the patch, and the unattractive tattoos that come from using them, we have determined that these patches are inappropriate. After experimenting with these patches, most patients would rather not use them. Natural testosterone gel used topically is the preferred technique. The dosage for receiving hormones will be customized according to the individual, while compounding pharmacies sell natural testosterone, like other natural and bioidentical hormones.  

 

However, if a person has active prostate cancer, they should avoid using testosterone to prevent overlapping risk profiles. Prostate cancer has not been linked to testosterone, according to numerous medical research. More aggressive cancers are linked to low testosterone levels. However, testosterone supplementation may hasten the tumor’s growth if prostate cancer does emerge. As a result, it is necessary to check the PSA to prevent prostate cancer routinely for men since it is the most prevalent cancer and is frequently detected by an annual PSA test.

 

Testosterone For Women

Not only is testosterone a male sex hormone, but it is also a female sex hormone. Known as total hormone replacement, women need to restore the natural balance of all hormones to the levels of peak physical and mental states. This also applies to women and testosterone. Many women do not feel like their younger selves even taking progesterone and estrogen due to the absence of testosterone. Despite being primarily recognized as a male hormone, testosterone is also a vital hormone for women because it is essential to their physical and mental well-being. The first to recognize the significance of this was the pharmaceutical industry, which has now started to sell a combination of estrogen and testosterone tablets—sadly, these are synthetic. Synthetic hormones should not be utilized since they can negatively affect the liver. Only use the natural, safe testosterone that specialty compounding pharmacies offer.

 

As an essential hormone for healthy female sexual development, testosterone is produced in the ovaries and adrenal glands of women. In addition to the decline in serum testosterone, women can also experience a decrease in libido as they age. When there is insufficient testosterone in the body, it also plays a role in menopausal symptoms, including decreased libido and sexual arousal. In women, testosterone replenishment helps to improve sexual desire, alleviate menopausal symptoms, regain vitality, and fortify bones, tendons, and joints. Older adults frequently lament the thinness of their skin, especially on their hands and arms. Most women are unaware that testosterone is the best hormone for the skin since it increases collagen and elastin while preventing wrinkles and thinning. Although testosterone is rarely suggested as a treatment, many doctors and women are still ignorant that it is far more effective than estrogen at preventing bone loss. Many women have yet to experience the amazing difference that can be achieved with just a modest dose of testosterone gel supplementation. Age, body weight, and blood levels will all affect the appropriate testosterone replacement therapy dosage.

 

In conclusion, the testes, adrenal glands, and ovaries secrete the hormone testosterone. It is a hormone that is both male and female. Since the testosterone hormone plays a huge role in maintaining hormone balance within the body. (Zitzmann, 2020)  It helps with weight loss, exercise tolerance, mood and well-being, and increased muscular mass, strength, and endurance. Higher libido and sexual performance, improved skin tone and healing ability, and higher bone density and osteoporosis prevention are all observed. Lowering cholesterol and raising HDL slows down aging-related illnesses, including cardiovascular disease, and improves quality of life. Testosterone enhances memory and prevents Alzheimer’s disease from developing. For both men and women, it is equally significant and advantageous. All of the advantages of testosterone were examined in a recent study published in JAMA, which referred to it as cutting-edge medicine. Together with estrogen and progesterone, the NEJM assessed testosterone replacement therapy for women and concluded that it was the most effective treatment for enhancing energy. Be sure to differentiate between natural testosterone and its synthetic counterparts. Use natural testosterone instead of synthetic; it will make you happy and improve your health.

 

 


References

Barbonetti, A., D’Andrea, S., & Francavilla, S. (2020). Testosterone replacement therapy. Andrology, 8(6), 1551-1566. doi.org/10.1111/andr.12774

Davis, S. R., Pinkerton, J., Santoro, N., & Simoncini, T. (2023). Menopause-Biology, consequences, supportive care, and therapeutic options. Cell, 186(19), 4038-4058. doi.org/10.1016/j.cell.2023.08.016

Ko, S. H., & Kim, H. S. (2020). Menopause-Associated Lipid Metabolic Disorders and Foods Beneficial for Postmenopausal Women. Nutrients, 12(1). doi.org/10.3390/nu12010202

Morssinkhof, M. W. L., van Wylick, D. W., Priester-Vink, S., van der Werf, Y. D., den Heijer, M., van den Heuvel, O. A., & Broekman, B. F. P. (2020). Associations between sex hormones, sleep problems and depression: A systematic review. Neurosci Biobehav Rev, 118, 669-680. doi.org/10.1016/j.neubiorev.2020.08.006

Nees, L. K., Heublein, S., Steinmacher, S., Juhasz-Boss, I., Brucker, S., Tempfer, C. B., & Wallwiener, M. (2022). Endometrial hyperplasia as a risk factor of endometrial cancer. Arch Gynecol Obstet, 306(2), 407-421. doi.org/10.1007/s00404-021-06380-5

Zitzmann, M. (2020). Testosterone, mood, behaviour and quality of life. Andrology, 8(6), 1598-1605. doi.org/10.1111/andr.12867

Disclaimer

The Impact of the Yips on Athletes: Causes and Management

Sports, pitching and fitness with man on field for throwing, workout or training for competition ma.

Yips are involuntary wrist muscle spasms that affect athletes. They are often associated with golf, baseball, and sports that involve swinging and throwing motions, such as bowling, darts, cricket, and others. Can understanding the information and causes help diagnose and find the right therapy or training?

The Impact of the Yips on Athletes: Causes and Management

Yips

Yips are involuntary wrist spasms that athletes experience. The term is also used to refer to performance anxiety without physical spasms. Researchers believe they are caused by muscle overuse that leads to dystonia (a condition that causes muscles to contract involuntarily), and combined with psychological factors like performance anxiety and overthinking, can make them worse. (Beacon Health Systems, 2024)

Types

Researchers have identified three types of yips that affect athletes (Clarke P. Sheffield D. and Akehurst S., 2020)

Type I

  • Muscle spasms
  • Freezing up/choking

Type II

  • Performance anxiety
  • Psychological symptoms

Type III

  • Muscle spasms
  • Performance anxiety

A study of over a hundred experienced athletes found that nearly 68% of archers and 40% of golfers experienced yips. (Clarke P., Sheffield D. and Akehurst S. 2020)

Symptoms

The most common symptom is muscle spasms, often in the hands and wrists. That’s why it is the most common among athletes who play sports that require precision hand and wrist movements. Yips affect fine motor skills. (Aoyama, T. et al., 2021) In addition to muscle spasms, symptoms can also include: (Beacon Health Systems, 2024)

  • Twitching
  • Tremors
  • Freezing up
  • Psychological distress

Causes

Healthcare providers, trainers, coaches, and researchers know that psychological and physical factors cause yips. Underlying physical causes include overusing wrist muscles, which leads to dystonia or involuntary muscle movements. Also known as task-specific dystonia, it can also affect individuals who engage in repetitive muscle movements, like factory and assembly line workers, store check-out clerks, musicians, etc. (Clarke P., Sheffield D., and Akehurst S. 2020). Performance anxiety and psychological stress can worsen dystonia. (Aoyama, T. et al., 2021) Athletes can become so focused on their movements that they overthink their actions and perform worse. Individuals who have anxiety, self-consciousness, or stress about a game or performance often find that their involuntary wrist spasms are worse. (Clarke P., Sheffield D. and Akehurst S. 2020)

Increased Risk

Yips are most common in athletes who use their hands and wrists for their sport and are likely to impact more experienced, competing, and older athletes. (Beacon Health Systems, 2024) They are more common in athletes focused on smaller movements or shorter distances. For example, golfers commonly experience involuntary wrist spasms when putting, and baseball players are likelier to experience them when throwing less than 20 meters. (Clarke P., Sheffield D. and Akehurst S. 2020)

Diagnosis

There is no official diagnosis for yips. However, a coach, athletic trainer, sports doctors, and others can observe the pattern of symptoms and behavior and provide an informed diagnosis.

Treatment

Identifying triggers is important as yips can be triggered by: (Aoyama, T. et al., 2021)

  • Psychological distress – anxiety and/or fear
  • Abnormal sensations
  • Symptoms of discomfort and pain
  • Mechanical movement/motion adjustments or changes

Once trigger/s are identified, they can be addressed. Treatments that can help include: (Beacon Health Systems, 2024)

Alternate Hand Positions

  • This can provide relief from dystonia and overthinking.

Using Different Equipment or Stabilizers

  • This allows the immobilization of certain muscles and the activation of different muscles.

Mindfulness

  • Reducing anxiety and distress can help relax the body.
  • Practicing mindfulness before games or tournaments can help reduce psychological triggers.

Botox Injections

  • Botox injections can treat certain types of dystonia.

Sports Psychology

  • A sports psychologist is a healthcare provider who studies individual athletes’ sports performance and how it affects their minds and skills.
  • A sports psychologist can help individuals create a program that reduces stress or anxiety around games and performance.

Injury Medical Chiropractic and Functional Medicine Clinic

Yips are common among athletes. It is important to address the physical and psychological components to treat the condition. Talking with a coach or a sports psychologist, other athletes, and supporting staff like trainers can help you find a solution. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.


Sports Injuries


References

Beacon Health Systems. (2024). Yips. www.beaconhealthsystem.org/library/diseases-and-conditions/yips/

Clarke, P., Sheffield, D., & Akehurst, S. (2020). Personality Predictors of Yips and Choking Susceptibility. Frontiers in psychology, 10, 2784. doi.org/10.3389/fpsyg.2019.02784

Aoyama, T., Ae, K., Souma, H., Miyata, K., Kajita, K., Kawamura, T., & Iwai, K. (2021). Difference in Personality Traits and Symptom Intensity According to the Trigger-Based Classification of Throwing Yips in Baseball Players. Frontiers in sports and active living, 3, 652792. doi.org/10.3389/fspor.2021.652792

Prevent and Relieve Lower Back Pain with Walking

Side view of a backpacker traveler walking against orange wall in the city

For individuals dealing with newly formed or chronic lower back pain, can making daily walks a part of a weekly routine help relieve pain and discomfort symptoms and prevent strains and injuries?

Prevent and Relieve Lower Back Pain with Walking

Walking For Low Back Pain Relief

Walking is recommended to treat and prevent chronic or recurrent lower back pain. A study found that a personalized and progressive weekly walking program that builds up to 130 minutes of moderate intensity can significantly relieve severe lower back pain and prevent future flare-ups. (Pocovi N. C. et al., 2024) Walking is a cost-effective and easily accessible way to relieve lower back pain and prevent recurring or future injuries. It strengthens the back muscles, improves posture, and stabilizes the spine. (Suh JH, et al., 2019) Other benefits include improved overall physical health, posture, and circulation.

How Walking Helps

Walking for low back pain relief and general movement is better than not engaging in physical activities for individuals with recurrent lower back pain. Being sedentary can worsen back pain symptoms. (National Library of Medicine. 2019) Walking is second nature and is easy to incorporate into a weekly routine to help relieve back pain and improve overall health (Macquarie University, 2024)

Increases Spinal Flexibility

  • Walking and gentle movements increase the lower back’s functional range of motion, improve spinal flexibility, and reduce stiffness. (Smith J. A. et al., 2022)

Stabilizes Lumbar/Low Back Muscles

  • Walking builds muscle endurance and strength in the paraspinal muscles, increasing lumbar spinal stabilization. (Suh JH, et al., 2019)

Strengthens Core Muscles

  • Walking increases the body load and strengthens core muscles like the transversus abdominis, which lowers the risk of chronic lower back pain. (Lee J. S. and Kang S. J. 2016)

Improves Posture

Increases Blood Circulation

  • Walking increases blood circulation to the muscles, supplying essential nutrients to spinal discs. It also reduces the frequency and severity of lower back muscle spasms. (Sitthipornvorakul E. et al., 2018)

Lubricates Spinal joints

  • Low-impact walking improves synovial fluid production and circulation, lubricating the lumbar spine’s facet joints and other joints that tend to get achy, such as the knees. (Zhang S. L. et al., 2013)

Relieves Inflammation

  • Walking helps reduce the presence of pro-inflammatory cytokines, like (IL-8 and TNF-alpha) associated with chronic lower back pain. (Slouma M. et al., 2023)

Promotes Weight Loss

  • Walking and a healthy diet can help individuals lose excess fat, which puts added strain on the lower back and correlates with lumbar intervertebral disc degeneration. (Wang M. et al., 2024)

Stress Relief

  • Regular walking can reduce mental stress associated with chronic lower back pain. (Choi S. et al., 2021)

Releases Endorphins

  • Moderate to vigorous physical activity, like walking at about 3 miles per hour for a half-hour daily, stimulates the release of endorphins, the body’s natural pain relievers. (Bruehl S. et al., 2020)

Walking Correctly

To get all the benefits of walking for low back pain relief, it is recommended to practice the following (Macquarie University, 2024)

  • Start slowly.
  • Gradually build intensity.
  • Stay consistent with the walking program.
  • Track progress to maintain motivation.

Healthcare Provider Consultation

Walking is a low-risk, low-impact activity well-tolerated by most individuals with nonspecific low back pain. (Pocovi N. C. et al., 2022) Because it doesn’t involve twisting or vigorous movements, it is considered a safe exercise for individuals with back pain symptoms (Gordon R. and Bloxham S. 2016). However, individuals experiencing severe lower back pain due to a traumatic injury or medical condition should consult a healthcare provider before starting a regular walking program.

Limit High Impact Activities

High-impact activities like running on hard surfaces or playing sports can exacerbate chronic lower back pain. If there is chronic lower back pain, it is recommended to limit activities that involve: (Al-Otaibi S. T. 2015)

  • Heavy lifting
  • Repetitive bending
  • Twisting motions

Injury Medical Chiropractic and Functional Medicine Clinic

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


Movement as Medicine


References

Pocovi, N. C., Lin, C. C., French, S. D., Graham, P. L., van Dongen, J. M., Latimer, J., Merom, D., Tiedemann, A., Maher, C. G., Clavisi, O., Tong, S. Y. K., & Hancock, M. J. (2024). Effectiveness and cost-effectiveness of an individualised, progressive walking and education intervention for the prevention of low back pain recurrence in Australia (WalkBack): a randomised controlled trial. Lancet (London, England), 404(10448), 134–144. doi.org/10.1016/S0140-6736(24)00755-4

Suh, J. H., Kim, H., Jung, G. P., Ko, J. Y., & Ryu, J. S. (2019). The effect of lumbar stabilization and walking exercises on chronic low back pain: A randomized controlled trial. Medicine, 98(26), e16173. doi.org/10.1097/MD.0000000000016173

National Library of Medicine., & InformedHealth.org [Internet]. Cologne, G. I. f. Q. a. E. i. H. C. I. (2022). Low back pain: Learn More – Why movement is so important for back pain. www.ncbi.nlm.nih.gov/books/NBK284944/

Macquarie University. (2024). Macquarie University. Walking to combat back pain: world-first study shows dramatic improvement. lighthouse.mq.edu.au/article/june-2024/walking-away-from-pain-world-first-study-shows-dramatic-improvement-in-lower-back-trouble

Smith, J. A., Stabbert, H., Bagwell, J. J., Teng, H. L., Wade, V., & Lee, S. P. (2022). Do people with low back pain walk differently? A systematic review and meta-analysis. Journal of sport and health science, 11(4), 450–465. doi.org/10.1016/j.jshs.2022.02.001

Suh, J. H., Kim, H., Jung, G. P., Ko, J. Y., & Ryu, J. S. (2019). The effect of lumbar stabilization and walking exercises on chronic low back pain: A randomized controlled trial. Medicine, 98(26), e16173. doi.org/10.1097/MD.0000000000016173

Lee, J. S., & Kang, S. J. (2016). The effects of strength exercise and walking on lumbar function, pain level, and body composition in chronic back pain patients. Journal of exercise rehabilitation, 12(5), 463–470. doi.org/10.12965/jer.1632650.325

Henry, M., & Baudry, S. (2019). Age-related changes in leg proprioception: implications for postural control. Journal of neurophysiology, 122(2), 525–538. doi.org/10.1152/jn.00067.2019

Sitthipornvorakul, E., Klinsophon, T., Sihawong, R., & Janwantanakul, P. (2018). The effects of walking intervention in patients with chronic low back pain: A meta-analysis of randomized controlled trials. Musculoskeletal science & practice, 34, 38–46. doi.org/10.1016/j.msksp.2017.12.003

Zhang, S. L., Liu, H. Q., Xu, X. Z., Zhi, J., Geng, J. J., & Chen, J. (2013). Effects of exercise therapy on knee joint function and synovial fluid cytokine levels in patients with knee osteoarthritis. Molecular medicine reports, 7(1), 183–186. doi.org/10.3892/mmr.2012.1168

Slouma, M., Kharrat, L., Tezegdenti, A., Metoui, L., Ghazouani, E., Dhahri, R., Gharsallah, I., & Louzir, B. (2023). Pro-inflammatory cytokines in patients with low back pain: A comparative study. Reumatologia clinica, 19(5), 244–248. doi.org/10.1016/j.reumae.2022.07.002

Wang, M., Yuan, H., Lei, F., Zhang, S., Jiang, L., Yan, J., & Feng, D. (2024). Abdominal Fat is a Reliable Indicator of Lumbar Intervertebral Disc Degeneration than Body Mass Index. World neurosurgery, 182, e171–e177. doi.org/10.1016/j.wneu.2023.11.066

Choi, S., Nah, S., Jang, H. D., Moon, J. E., & Han, S. (2021). Association between chronic low back pain and degree of stress: a nationwide cross-sectional study. Scientific reports, 11(1), 14549. doi.org/10.1038/s41598-021-94001-1

Bruehl, S., Burns, J. W., Koltyn, K., Gupta, R., Buvanendran, A., Edwards, D., Chont, M., Wu, Y. H., Qu’d, D., & Stone, A. (2020). Are endogenous opioid mechanisms involved in the effects of aerobic exercise training on chronic low back pain? A randomized controlled trial. Pain, 161(12), 2887–2897. doi.org/10.1097/j.pain.0000000000001969

Pocovi, N. C., de Campos, T. F., Christine Lin, C. W., Merom, D., Tiedemann, A., & Hancock, M. J. (2022). Walking, Cycling, and Swimming for Nonspecific Low Back Pain: A Systematic Review With Meta-analysis. The Journal of orthopaedic and sports physical therapy, 52(2), 85–99. doi.org/10.2519/jospt.2022.10612

Gordon, R., & Bloxham, S. (2016). A Systematic Review of the Effects of Exercise and Physical Activity on Non-Specific Chronic Low Back Pain. Healthcare (Basel, Switzerland), 4(2), 22. doi.org/10.3390/healthcare4020022

Al-Otaibi S. T. (2015). Prevention of occupational Back Pain. Journal of family & community medicine, 22(2), 73–77. doi.org/10.4103/2230-8229.155370

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

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

Introduction

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

 

What Are Hormones?

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

Functional Medicine Doctor | El Paso, TX Chiropractor

 

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

 

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

 

What Are Biologically Identical Hormones?

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

 

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

 

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

 

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

 


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Hormone Replacement Therapy & Aging

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

 

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

 

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

 

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

 

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

 

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

 

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

 

Thyroid Hormones

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

 

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

 

Estrogen

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

 

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

 

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

 

Progesterone

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

 

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

 

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

 

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

 

Conclusion

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

 


References

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

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

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

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

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

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

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

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

Disclaimer

Maintaining a Strong Core with Chair Abdominal Exercises

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

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

Maintaining a Strong Core with Chair Abdominal Exercises

Chair Abdominal Exercises

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

Benefits

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

Chair Workout

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

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

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

Sitting Knee Lifts

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

Sitting Crunches

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

Sitting Leg Lifts

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

Sitting Scissor Kicks

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

Sitting Side Crunches

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

Sitting Bicycle Crunches

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

Progress

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

Injury Medical Chiropractic and Functional Medicine Clinic

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


Core Exercises and Back Pain


References

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

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

The Role of the Iliacus Muscle in Hip Flexion

A physical therapist performs lower limb mobilization to a patient

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

The Role of the Iliacus Muscle in Hip Flexion

The Iliacus Muscle

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

Anatomy

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

Functions

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

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

Conditions

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

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

Iliopsoas syndrome can affect anyone but is common in:

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

Iliopsoas Bursitis

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

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

Iliopsoas Tendinopathy

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

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

Rehabilitation

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

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

Injury Medical Chiropractic and Functional Medicine Clinic

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

Evaluation

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

Treatment plan

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

Rehabilitation

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

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


Hip Labral Tear and Chiropractic Care


References

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

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

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

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

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

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

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

Attentive factory worker picking up cardboard boxes in factory

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

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

Correct Manual Lifting Technique

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

Lifting Guide

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

Support Base

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

Ask For Help

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

Use Mechanical Assistant Devices

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

Squat To Lift Object

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

Check Posture

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

Lift Slowly

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

Load Positioning

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

Move and Maintain Alertness

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

Rest

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

Squat To Set Object Down

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

Planning and Tips

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

Make a Plan Before Lifting

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

Lift Close to The Body

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

Maintain Feet Shoulder-Width Apart

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

Visualize The Motions Involved and Practice The Motions Before Lifting

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

Tighten the Stomach Muscles

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

Lift With the Legs

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

Keep Eyes Up

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

Avoid Twisting or Bending

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

Back Belts

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

Injury Medical Chiropractic and Functional Medicine Clinic

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


Chiropractic Care For Injury Recovery


References

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

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

Transforming Fat into Energy: Understanding the Process

Two engineers wearing hardhats and safety waistcoats sitting on cement beam and resting during break on construction site

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

Transforming Fat into Energy: Understanding the Process

Fat Into Energy Conversion

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

What Is Fat?

Everything eaten is made up of:

Macronutrients

  • Protein
  • Carbohydrates
  • Fat

Micronutrients

  • Vitamins
  • Minerals

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

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

Types

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

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

When Fat Is Burned

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

Fat for Fuel

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

Digestion

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

Transportation

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

Conversion

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

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

Fat Loss Optimization

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

Macronutrient

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

High-Intensity Interval Training

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

Injury Medical Chiropractic and Functional Medicine Clinic

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


Integrative Medicine and Chiropractic Care


References

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

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

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

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

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

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

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

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

Physiotherapy, chiropractor and senior man with back pain or physiotherapist consulting a patient f.

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

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

Healthy Posture

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

Body Alignment

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

Posture Types

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

Proper Body Alignment

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

Development of Imbalances

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

Posture Assessment

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

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

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

Making Corrections

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

Spinal Adjustments

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

Corrective Exercises

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

Massage Therapy

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

Guidance and Training

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

Injury Medical Chiropractic and Functional Medicine Clinic

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


Upper Cross Syndrome


References

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

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

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

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

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

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

Exploring the Functions and Anatomy of the Axillary Nerve

Young woman with shoulder pain is being examined by a physiatrist

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

Exploring the Functions and Anatomy of the Axillary Nerve

Axillary Nerve

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

Anatomy

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

Anterior Division

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

Posterior Division

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

Articular Branch

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

Anatomical Variations

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

Function

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

Motor

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

Deltoid

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

Long Head of the Triceps

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

Teres Minor

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

Sensory

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

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

Injuries and Conditions

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

Dislocations

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

Fracture

  • Of the surgical neck of the humerus.

Compression

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

Direct Trauma

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

Added Pressure

  • This can be from wearing a cast or splint.

Surgical Accidental Injury

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

Quadrangular Space Syndrome

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

Nerve Root Damage

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

Systemic Neurological Disorders

  • Example – multiple sclerosis

Erb’s Palsy

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

Axillary Nerve Palsy

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

Nerve Injury Statistics

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

Tests

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

Rehabilitation

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

Surgery

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

Neurolysis

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

Neurorrhaphy

  • This procedure stitches a severed nerve back together.

Nerve Grafting

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

Neurotization or Nerve Transfer

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

Injury Medical Chiropractic and Functional Medicine Clinic

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


Shoulder Pain Chiropractic Treatment


References

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

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