Pelvic Floor Physical Therapy: A Treatment & Prevention Guide

By

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High-qualified man orthopedist adjusting kneecap to female patient who complained for pain during walking, trauma and quick recovery, rehabilitation centre

“For individuals experiencing pelvis pain symptoms and associated problems, can integrating pelvic floor physical therapy exercises help with treatment and prevention?”

Table of Contents

Pelvic Floor Physical Therapy

The pelvic floor muscles are located at the base of the pelvis and protect the pelvic organs like the vagina, cervix, uterus, bladder, urethra, and rectum. (U.S. Food and Drug Administration. 2019)
They provide posture support, aid in orgasm function, facilitate sphincter function, and help pump lymphatic blood. (Dulcegleika Vilas Boas Sartori, et al., 2021) (Varuna Raizada, Ravinder K. Mittal. 2008)

When the muscles fail to function correctly, individuals can experience symptoms like:

Painful intercourse
Prolapse – when an organ or tissue drops or shifts out of place.
Urinary incontinence
Constipation problems
These conditions are common in pregnant individuals or older women.

These symptoms can be treated with pelvic floor physical therapy to alleviate discomfort. Pelvic floor physical therapy can help women and individuals with vaginas:

Alleviate issues like painful sex, urinary leakage, and prolapse.
In physical therapy, individuals work on breathing, relaxation, and lengthening and strengthening techniques to train their muscles to function optimally.

Causes of Pelvic Floor Issues

Pelvic floor dysfunction tends to happen with age, during pregnancy, or in combination with events like the postpartum period and menopause, which can lower hormone levels.

Individuals who are pregnant are especially prone to pelvic floor issues but might not know they have a problem.
The pregnancy weight of a uterus can pressure and strain the muscles.
Vaginal childbirth can also stretch or weaken the muscles. (Ilaria Soave, et al., 2019)

Symptoms

Symptoms can include: (Columbia Surgery. 2022)

Pain in the pelvis region
Back pain
Painful urination
Constipation
Urinary leakage or incontinence
Stool leakage or incontinence
Painful intercourse
If left untreated, these symptoms can worsen over time.

Pelvic Floor Physical Therapy

An individual will meet with a specialist to discuss symptoms and undergo a physical examination that includes:

Pelvic floor exam.
Evaluation of posture, mobility, and core strength.
Once the initial exams and evaluation are complete, the practitioner will go over pelvic floor exercises and provide a treatment plan.
Recommended exercises vary based on symptoms but focus on relaxing, stretching, and/or strengthening muscles.

Muscle Relaxation

To relax the muscles, a therapist may recommend breathing exercises.
For pregnant individuals, this means timing breaths with contractions.
For individuals experiencing constipation, breathing exercises can help the body relax and reduce strain.

Stretching Muscles

Stretching can help relieve muscle tightness and stiffness.
A therapist may help stretch the pelvic floor through various therapy modalities.
This type of physical therapy can help loosen tight muscles or help gently reset dislocated organs back into place.

Strengthening Muscles

After the pelvic floor is loose and relaxed, the focus typically switches to strengthening the muscles.
Strength work may target abdominal muscles or the pelvic floor muscles themselves.

With time, commitment, and targeted treatment, individuals can use pelvic floor physical therapy to loosen tissues, strengthen muscles, and restore function.

Spinal Decompression In Depth

References

U.S. Food and Drug Administration. (2019). Pelvic organ prolapse (pop).

Sartori, D. V. B., Kawano, P. R., Yamamoto, H. A., Guerra, R., Pajolli, P. R., & Amaro, J. L. (2021). Pelvic floor muscle strength is correlated with sexual function. Investigative and clinical urology, 62(1), 79–84. doi.org/10.4111/icu.20190248

Raizada, V., & Mittal, R. K. (2008). Pelvic floor anatomy and applied physiology. Gastroenterology clinics of North America, 37(3), 493–vii. doi.org/10.1016/j.gtc.2008.06.003

Soave, I., Scarani, S., Mallozzi, M., Nobili, F., Marci, R., & Caserta, D. (2019). Pelvic floor muscle training for prevention and treatment of urinary incontinence during pregnancy and after childbirth and its effect on urinary system and supportive structures assessed by objective measurement techniques. Archives of gynecology and obstetrics, 299(3), 609–623. doi.org/10.1007/s00404-018-5036-6

Columbia Surgery. (2022). Pelvic floor disorders: frequently asked questions.

FITT for Beginners: Frequency, Intensity & Exercise Type

By

Dr. Alex Jimenez

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Strength training makes your joints stronger.

“For individuals trying to get into a regular fitness regimen, could using the FITT Principle help structure exercise, track progress, and achieve fitness goals?”

Table of Contents

FITT Principle

The FITT principle is a set of guidelines for adjusting, revising, and improving exercise workouts. FITT is an acronym for:

Frequency
Intensity
Time
Type of exercise
Individuals take these elements to create and adjust workouts that fit their goals and fitness levels.

For example, this could be a workout of 3 to 5 days combined with low, medium, and high-intensity exercises for 30 to 60 minutes each session that incorporates cardio and strength training. Focusing on these details and progressing over time helps create an effective program.

Frequency

Workout frequency and how often the individual is going to exercise is the first thing to look at.

Frequency depends on various factors, including the type of workout being done, how hard the workout is, fitness levels, and exercise goals.
General exercise guidelines developed by the American College of Sports Medicine offer recommendations. (Carol Ewing Garber, et al., 2011)

Cardiovascular Workouts

Cardio workouts are usually scheduled more often.
Depending on goals, guidelines recommend moderate cardio exercise five or more days a week or intense cardio three days a week to improve health.
Individuals can adjust the exercise intensity level easily on a treadmill to provide excellent and convenient cardiovascular workouts.
Individuals who want to lose weight may want to work up to more workouts gradually.
However, more is not always better, and recovery time is essential. (Pete McCall. 2018)

Strength Training

The recommended frequency for strength training is two to three non-consecutive days a week. (National Strength and Conditioning Association. 2017)
Individuals should have at least one to two days of rest and recovery between sessions.
Workout frequency will often depend on the type of training sessions being performed as well as health goals.
For example, individuals want to work on each muscle group at least two times a week if their goal is to build muscle. (Brad J. Schoenfeld, Dan Ogborn, James W. Krieger. 2016)
For individuals following a split routine, like upper body one day and lower body the next, workouts can be more frequent than total body workouts.

Intensity

Workout intensity involves how hard the individual is pushing themselves during exercise. How it is increased or decreased depends on the type of workout. (Carol Ewing Garber, et al., 2011)

Cardiovascular Workouts

For cardio, individuals will monitor workout intensity by:

Heart rate
Perceived exertion
Talk test
Heart rate monitor
A combination of these measures.

The general recommendation is to work at a moderate intensity for steady workouts.
Interval training is done at a higher intensity for a shorter period.
It’s recommended to mix up low, medium, and high-intensity cardio exercises to stimulate different energy systems and prevent overtraining. (Nathan Cardoos. 2015)

Strength Training

Individual intensity comprises the amount of weight being lifted and the number of reps and sets done.
The intensity can change based on health goals.

Beginners looking to build stability, endurance, and muscle are recommended to use a lighter weight and do fewer sets with high repetitions – for example, two or three sets of 12 to 20 reps.
Individuals wanting to grow muscle are recommended to do more sets with a moderate amount of reps – for example, four sets of 10 to 12 reps each.
Individuals who want to build strength are recommended to use heavy weights and do more sets with fewer reps – for example, five sets of three reps each.
Building muscle can be done with a wide range of repetitions and weights. (Brad J. Schoenfeld, Dan Ogborn, James W. Krieger. 2016)

Time

The next element of the plan is how long the exercise will be during each session. Exercise length depends on individual fitness level and the type of workout being done.

Cardiovascular Workouts

The exercise guidelines suggest 30 to 60 minutes of cardio, but workout duration will depend on fitness level and type of exercise. ((Carol Ewing Garber, et al., 2011)

Beginners are recommended to start with a 15- to 20-minute workout.
Individuals with some workout experience and are doing steady-state cardio, like jogging or using a cardio machine, might exercise for 30 to 60 minutes.
For individuals doing interval training and working at very high intensity, the workout will be shorter, around 10 to 15 minutes of high-intensity interval training.
Having a variety of workouts of different intensities and durations will provide a solid, balanced cardiovascular program.

Strength Training

How long an individual strength trains will depend on the type of workout and schedule.
A total body workout can take over an hour.
A split routine can take less time by working fewer muscle groups in one session.

Type

The type of exercise you do is the last part of the FIIT principle.
It is easy to manipulate to avoid overuse injuries or weight loss plateaus.

Cardiovascular Workouts

Cardio is easy to adjust and change because any activity that increases heart rate counts.

Walking, dancing, running, cycling, swimming, and using an elliptical trainer are a few activities that can be incorporated.
Having multiple cardio activities is recommended to reduce burnout and keep workouts fresh.

Strength Training

Strength training workouts can also be varied.
They include any exercise where some type of resistance – bands, dumbbells, machines, etc. are used to work the muscles.
Bodyweight exercises can also be considered a form of strength training.
Strength workouts can be changed from total body training to adding, for example, supersets or pyramid training.
Incorporating new exercises for each body area is another way to vary the type of workouts.
Spending a few weeks working on functional strength movements, then switching to hypertrophy or strength-based training.
Each modality includes various alternative types of strength-based exercises.

Using FITT

The FITT principle outlines how to adjust workout programs to achieve better results. It also helps figure out how to change workouts to avoid burnout, overuse injuries, and plateaus.

For example, walking three times a week for 30 minutes at a moderate pace is recommended for a beginner to start out with. After a few weeks, the body adapts to the workout. This results in burning fewer calories, burnout, or weight management efforts, and goals are put on hold. This is where the FITT principles come in. For example, a change-up could include:

Changing frequency by adding another day of walking or jogging.
Changing intensity by walking faster, adding more challenging terrain like a hill, or jogging at certain intervals.
Walking for a longer time each workout day.
Changing the type of workout by swapping one or more of the walk sessions for cycling or aerobics.

Even just changing one element can make a big difference in the workout and how the body responds to exercise.
It’s important to change things up regularly to keep the body healthy and mind engaged.

Injury Prevention

One of the best things about using FITT is that it allows individuals to monitor the length and intensity of their workouts. When individuals work out too frequently or don’t get enough rest, they run the risk of overuse injuries, burnout, and muscle strains. The FITT principle encourages adding variety to workouts. When following this practice, it allows the body to rest and recover properly. Because individuals are not working the same muscle groups over and over again, better results are achieved.

Fighting Inflammation Naturally

References

Garber, C. E., Blissmer, B., Deschenes, M. R., Franklin, B. A., Lamonte, M. J., Lee, I. M., Nieman, D. C., Swain, D. P., & American College of Sports Medicine (2011). American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Medicine and science in sports and exercise, 43(7), 1334–1359. doi.org/10.1249/MSS.0b013e318213fefb

McCall Pete. 8 reasons to take a rest day. (2018) American Council on Exercise.

National Strength and Conditioning Association. (2017) Determination of resistance training frequency.

Schoenfeld, B. J., Ogborn, D., & Krieger, J. W. (2016). Effects of Resistance Training Frequency on Measures of Muscle Hypertrophy: A Systematic Review and Meta-Analysis. Sports medicine (Auckland, N.Z.), 46(11), 1689–1697. doi.org/10.1007/s40279-016-0543-8

Cardoos, Nathan MD. Overtraining Syndrome. (May/June 2015). Current Sports Medicine Reports 14(3):p 157-158. DOI: 10.1249/JSR.0000000000000145

The Benefits of Posture Awareness Training

By

Dr. Alex Jimenez

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Woman doing exercises at home using chair. Urdhva hastasana asana. — Beautiful young girl doing exercises at home using chair. Urdhva hastasana asana.

“For individuals trying to achieve a healthy posture, could using posture awareness training be effective in treatment and prevention?”

Table of Contents

Posture Awareness

Spinal curves help support the body’s weight, movement, and balance. Five areas include the neck, upper back, lower back, sacrum, and coccyx. The bottom of the spine or sacrum rests between the two hip bones that comprise the pelvis. Because of this location, the movements made with the pelvis significantly affect the spine. (Ibrahim Alkatout, et al., 2021) When the pelvis moves, the spine moves.

Posture-related back pain and associated symptoms are often caused by a weakened strength and flexibility ratio between the opposing muscle groups that hold the body upright.
Achieving healthy posture requires technique and consistent practice for maintaining a healthy pelvis and low back curve. (DeokJu Kim, et al., 2015)
Finding the low back curve and exploring how it responds when moving the pelvis is important to effective posture awareness training.

Lower Back Curve Awareness Exercise

One important thing to do to increase postural awareness is to become aware of the low back curve. (Arkadiusz Łukaz Żurawski, et al., 2020)

Sit On a Firm Chair or Stool

So that the weight is planted into the seat in a balanced way.

Hold Onto the Arms of the Chair

If the chair doesn’t have arms, hold onto the edge of a desk/workstation or the sides of the chair seat.
This will support the back when moving the pelvis.
Maintaining core abdominal strength is key to preventing back injury. (Erika Zemková, Ludmila Zapletalová. 2021)

Movement

Tilt the pelvis forward.
In this position, notice the slightly exaggerated arch in the lower back and the increase in lower back muscle tension.
A moderate amount of this increase and exaggeration is normal.

Relax Back to the Start Position

Sitting upright with the hip bones/top of the pelvis directly above the bottom.

Next, tilt the pelvis back.
The abs may have to work hard to support this position
Use your hands against the chair for support.
Check the lumbar curve area, noticing if it has flattened out.
Notice the tension in the back muscles.
Is it a little looser? This is normal.

Relax Back to the Start Position

Sitting upright.
Repeat the sequence again.
This time, when in the forward position, pause briefly and slide a hand between the lower back and the back of the chair or the wall.
When in the backward position, there will be little to no space between the lower back and the seatback or wall.

Problems

If there are problems moving the pelvis back and forth, imagine a basket or bowl of fruit.
The pelvis has a round shape and is open at the top, like a bowl or basket.
Imagine the fruit is placed toward the front of the bowl, and the weight brings the bowl/pelvis forward.
To go back, imagine the fruits are placed toward the back.
The weight causes the bowl to roll backward.
This may help to get the rhythm of the movement.

This posture awareness exercise can be used as a posture muscle builder by doing it with the back against the wall.

A more challenging position for this exercise is standing against a wall.
Keep the heels against the baseboard to really work the abs.
Start with sitting and gradually to standing.

Foot Motion and Posture

References

Kim, D., Cho, M., Park, Y., & Yang, Y. (2015). Effect of an exercise program for posture correction on musculoskeletal pain. Journal of physical therapy science, 27(6), 1791–1794. doi.org/10.1589/jpts.27.1791

Alkatout, I., Wedel, T., Pape, J., Possover, M., & Dhanawat, J. (2021). Review: Pelvic nerves - from anatomy and physiology to clinical applications. Translational neuroscience, 12(1), 362–378. doi.org/10.1515/tnsci-2020-0184

Żurawski, A. Ł., Kiebzak, W. P., Kowalski, I. M., Śliwiński, G., & Śliwiński, Z. (2020). Evaluation of the association between postural control and sagittal curvature of the spine. PloS one, 15(10), e0241228. doi.org/10.1371/journal.pone.0241228

Zemková, E., & Zapletalová, L. (2021). Back Problems: Pros and Cons of Core Strengthening Exercises as a Part of Athlete Training. International journal of environmental research and public health, 18(10), 5400. doi.org/10.3390/ijerph18105400

Comprehensive Guide to Women’s Lower Back and Pelvic Pain

By

Dr. Alex Jimenez

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Gynecologist showing bones of female pelvis and giving consultation to woman — Gynecologist doctor shows bones of female pelvis and giving consultation to woman in modern medical clinic

“For women experiencing lower back and pelvic pain, could understanding symptoms help in the diagnostic process, treatment options, and prevention?”

Low Back and Pelvic Pain In Women

In women, lower back and hip pain that radiates to the front pelvis area can have a variety of causes. The pain can feel dull, sharp, or burning. The main causes of lower back and pelvic pain in women fall into two categories. (William S. Richardson, et al., 2009)

Musculoskeletal and nervous system

Related causes of pain affect how your muscles, nerves, ligaments, joints, and bones move.
Examples include sciatica, arthritis, and injury.

Other organ system-based

Causes may stem from the following:

Acute/chronic conditions or infections
Kidneys – stones, infection, and other ailments or conditions.
Reproductive system – such as the ovaries.
Gastrointestinal system – inguinal hernias or appendix.

Musculoskeletal and Nervous System Causes

Musculoskeletal and nervous system-related causes can be from injuries like a fall or practicing unhealthy posture.

Overuse Injuries and Trauma

Frequent use and repetitive movements can lead to overuse injuries to the muscles, ligaments, and joints. :

Exercises, sports, and physical activities that require repetitive twisting and bending.
Lifting, carrying, and placing objects that require movements that are repeated regularly.
Trauma from vehicle collisions, accidents, falls, or sports accidents can inflict acute and chronic bodily injuries, like strained muscles or broken bones.
Depending on the type of trauma, healing and recovery time and treatment vary.
Both types of injuries can lead to numbness, tingling, pain, stiffness, popping sensations, and/or weakness in the legs.

Mobility Problems

Over time, a decreased range of motion and mobility in muscles and joints can cause discomfort and pain. Causes include:

Long periods of time spent in the same position.
Sitting for extended periods.
The pain often feels dull, achy, and stiff.
It can also lead to muscle spasms characterized by quick episodes of sharp and intense pain.

Posture

Posture while sitting, standing, and walking affects the body’s range of motion.
It can affect the nerves and blood circulation to the back and pelvic region.
Prolonged unhealthy postures can contribute to lower back pain and muscle strain.
Posture-related symptoms can feel achy and stiff and lead to quick episodes of severe or intense pain, depending on the position.

Sciatica and Nerve Compression

A bulging or herniating vertebral disc most commonly causes sciatica and pinched or compressed nerves.
The sensations can be sharp, burning, electrical, and/or radiating pain along the nerve pathway.

Arthritis

Arthritis inflammation causes swelling, stiffness, pain, and the breakdown of cartilage that cushions the joints.
Hip arthritis causes groin pain that can radiate to the back and becomes more intense when standing or walking.
Thoracic and lumbar spine arthritis, or degenerative disc disease, are other common causes of back pain.

Sacroiliac Joint Dysfunction

The sacroiliac joints connect the lower spine and pelvis.
When these joints move too much or too little, it can cause sacroiliac joint pain, leading to a burning sensation in the lower back and pelvic area. (Daisuke Kurosawa, Eiichi Murakami, Toshimi Aizawa. 2017)

Renal and Urinary Causes

Kidney Stones

Kidney stones are the build-up of minerals and salts, which form into hard stones in the kidneys.
When the kidney stone begins to move to the bladder, pain symptoms will present.
It can trigger severe back and side pain that radiates to the pelvic region.
Other symptoms include – a change in urine color, pain when urinating, nausea, and vomiting.

Kidney Infection and Urinary Tract Infections

Urinary tract and kidney infections are also causes of lower back and pelvic pain in women.
They cause fever, continued urge to urinate, and painful urination.

Gynecological Causes

Pelvic Inflammatory Disease

Infections, known as pelvic inflammatory disease, occur when sexually transmitted bacteria spread through the vagina, womb, fallopian tubes, or ovaries. Symptoms include:

Pain during intercourse.
Bleeding between periods.
Vaginal discharge.
Pain in the lower abdomen or groin.
Fever.

Ovarian Cysts

The cyst can be a solid or fluid-filled sac on the surface or within an ovary.
Small ovarian cysts are unlikely to cause pain.
Large cysts or those that rupture can cause mild to severe pain.
The pain can occur during menstruation or intercourse and present acutely in the back, pelvis, or lower abdomen.

During Pregnancy

Back pain and discomfort in the pelvis area are common.
As the body adjusts, the bones and round ligaments in the pelvis move and stretch, which can cause discomfort.
Symptoms are usually normal but should be discussed with a healthcare provider during check-ups.
Pain in the lower back and groin can be a sign of miscarriage or labor – including preterm labor.

Sexually Transmitted Infection

Sexually transmitted infections, like chlamydia or gonorrhea, can cause lower back and groin pain.
Other symptoms can include – painful urination, vaginal discharge, intercourse pain, and bleeding between periods.

Yeast Infection

A yeast infection – overgrowth of the fungus candidiasis.
A common vaginal infection with symptoms including – itching, swelling, irritation, and pelvic pain.

Other Causes

Appendicitis

When the appendix becomes blocked, infected, and inflamed.
In most cases, a major symptom is pain that starts near or around the belly button.
In other cases, it can start in the lower back and radiate to the right side of the pelvic area. (Johns Hopkins Medicine. 2023)
Associated pain can worsen over time or when coughing, moving, or taking deep breaths.

Other symptoms include:

Upset stomach
Nausea
Vomiting
Loss of appetite
Fever
Chills
Abnormal bowel movements – constipation and/or diarrhea. (Johns Hopkins Medicine. 2023)

Inguinal Hernia

A groin hernia is referred to an inguinal hernia.
It involves soft tissue and part of the intestine, pushing through weak groin muscles.
Pain presents in the abdomen, lower back, or pelvis, especially when bending or lifting objects.

Pancreatitis

Inflammation in the pancreas.
Infection, bile stones, or alcohol can cause it.
One symptom is abdominal pain that radiates to the back.
The pain becomes worse during and after eating.
Other symptoms include nausea, vomiting, and fever.

Enlarged Lymph Nodes

Lymph nodes lie in the internal and external regions of the iliac artery in the pelvis.
These can become enlarged by infection, injury, and, in rare cases, cancer.
Symptoms include pain, swelling, redness, skin irritation, and fever.

Enlarged Spleen

The spleen is located behind the left side of the rib cage.
It filters the blood and supports new blood cell creation.
Infections and diseases can cause the spleen to become enlarged.

An enlarged spleen – a condition known as splenomegaly – causes pain in the upper left part of the belly and sometimes the left shoulder and upper back.
However, some individuals with an enlarged spleen experience abdominal symptoms – not being able to eat without discomfort. (Mount Sinai. 2023)

Diagnosis

Depending on the cause of your pain, a healthcare provider may be able to diagnose it with a physical exam and by asking questions about your condition.
Other tests may be needed to find the cause, particularly blood work and imaging (X-ray or magnetic resonance imaging).

Treatment

Treatment of symptoms depends on the cause.
Once a diagnosis is made, an effective treatment plan will be developed and contain a combination of therapies:

Lifestyle Adjustments

For injuries caused by muscle strains, joint sprains, overuse, and smaller traumas, pain can be resolved with:
Rest
Ice therapy
Over-the-counter pain relievers – acetaminophen or ibuprofen.
Braces or compression wraps can help support the body and alleviate symptoms during healing and recovery.

Exercises to improve posture
Paying attention to form when lifting objects
Stretching can help ease the pain.

Medication

Medications can be used in a variety of ways to help in the treatment of lower back and pelvic pain. If an infection is the cause, medications will be prescribed to remove the infection and resolve the symptoms, which can include:

Antibiotics
Antifungals
Antivirals

Medications may also be prescribed to help manage pain symptoms and may include:

Medication to relieve nerve pain
Muscle relaxants
Steroids

Physical Therapy

A physical therapist can help to correct problems with:

Posture
Decreased mobility
Walking gait
Strengthening

A physical therapist will provide exercises to help increase and maintain strength, range of motion, and flexibility.

Pelvic Floor Therapy

This is physical therapy that focuses on the muscles, ligaments, and connective tissues in the pelvis.
It helps with pain, weakness, and dysfunction in the pelvic area.
A treatment plan will be developed to help with strength and range of motion in the pelvic muscles.

Chiropractic Care

Chiropractors offer spinal and hip adjustments to realign the joints of the spine.
Adjustments have been shown to help reduce back and hip pain. (Valter Santilli, Ettore Beghi, Stefano Finucci. 2006)

Surgery

Some more severe conditions could require surgery.
Ovarian cysts, hernias, and other infections sometimes require surgery to remove infected or unhealthy tissue – ruptured ovarian cysts or appendicitis.

Recommended surgeries can include:

A hernia repair.
Hip replacement.
Gallbladder removal to prevent recurring pancreatitis.

Prevention

Not all conditions and diseases cause lower back and pelvic pain. Symptoms can be prevented and reduced by adopting lifestyle changes. Prevention recommendations can include:

Staying hydrated.
Using proper bending and lifting techniques.
Eating healthy foods.
Regularly engaging in some form of physical activity – walking, swimming, yoga, cycling, or strength training.
Maintaining a healthy weight.

Pregnancy and Sciatica

References

Richardson, W. S., Jones, D. G., Winters, J. C., & McQueen, M. A. (2009). The treatment of inguinal pain. Ochsner journal, 9(1), 11–13.

Kurosawa, D., Murakami, E., & Aizawa, T. (2017). Groin pain associated with sacroiliac joint dysfunction and lumbar disorders. Clinical neurology and neurosurgery, 161, 104–109. doi.org/10.1016/j.clineuro.2017.08.018

Johns Hopkins Medicine. Appendicitis.

Mount Sinai. Splenomegaly.

Santilli, V., Beghi, E., & Finucci, S. (2006). Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized double-blind clinical trial of active and simulated spinal manipulations. The spine journal : official journal of the North American Spine Society, 6(2), 131–137. doi.org/10.1016/j.spinee.2005.08.001

Acupuncture Treatment for Stress and Inflammatory Conditions

By

Dr. Alex Jimenez

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Portrait of acupuncturist at the acupuncture session — Female lying on massage table, doctor holding acupuncture needle near her skin and performing procedure to relax back muscles

“For individuals dealing with pain, inflammatory conditions, and stress issues, could adding acupuncture to a treatment plan help bring relief and healing?”

Table of Contents

Acupuncture Treatment

Acupuncture treatment is a traditional Chinese medicine based on circulating the body’s life energy, or qi, with the idea that a blockage or disturbance in the energy flow can cause health issues. Acupuncturists insert thin needles into specific points throughout the body to rebalance the body’s energy, stimulate healing, and promote relaxation. (Johns Hopkins Medicine. 2023) Researchers are not exactly sure how the treatment works; however, theories suggest that it can help release endorphins, as well as influence the autonomic nervous system.

How Does It Work?

Researchers have not been able to understand how acupuncture works fully, but some theories include:

The needles stimulate the release of endorphins – the body’s natural pain-relieving chemicals.
They can influence the autonomic nervous system, and specific needle placement impacts breathing, blood pressure, and heart rate. (Tony Y. Chon, Mark C. Lee. 2013)

Conditions

Acupuncture has been useful for a variety of conditions, including (Tony Y. Chon, Mark C. Lee. 2013)

Chronic pain
Migraines and associated symptoms
Sinus congestion or nasal stuffiness
Insomnia and sleep-related difficulties
Stress
Anxiety
Arthritis joint inflammation
Nausea
Infertility – difficulty getting pregnant
Depression
Skin appearance (Younghee Yun et al., 2013)

Benefits

The health benefits can vary depending on the individual. It may take several sessions before benefits are noticed. (Tony Y. Chon, Mark C. Lee. 2013) Research is still limited; however, there are some studies that found acupuncture to be helpful for certain conditions.

Low Back Pain

A study on non-pharmacological options for lower back pain showed that acupuncture treatment relieved intense pain and promoted better back functioning.
However, in terms of long-term benefits, it was not clear how helpful the treatment was. (Roger Chou, et al., 2017)

Migraines

Research done over a six-month period showed that:

Acupuncture was able to reduce the frequency of migraine symptoms by half in 41% of individuals compared to those not receiving acupuncture.
Treatment was noted as being helpful as preventative migraine medications. (Klaus Linde, et al., 2016)

Tension Headaches

According to research, having at least six acupuncture sessions may be helpful for individuals with frequent head pain or pressure/tension headaches.
This study also noted that acupuncture, combined with pain medication, significantly reduced headache frequency compared to those only given medication. (Klaus Linde, et al., 2016)

Knee Pain

Multiple studies found that acupuncture treatment may be able to improve knee function short and long-term in individuals who have knee osteoarthritis.
This condition causes the connective tissue in the knee to break down.
The study also found that treatment was able to help with osteoarthritis and decrease knee pain but was only helpful for the short term. (Xianfeng Lin, et al., 2016)
Another review looked at multiple studies that found that treatment delayed and reduced the use of pain medication in individuals who had knee replacement surgery. (Dario Tedesco, et al., 2017)

Facial Elasticity

Cosmetic or facial acupuncture is used to improve the appearance of the skin on the head, face, and neck.
In a study, individuals had five acupuncture sessions in three weeks, and a little over half of the participants showed skin elasticity improvement. (Younghee Yun et al., 2013)

The Process

Before getting acupuncture treatment, the acupuncturist will ask the individual about their medical history and may perform a physical examination.

Thin needles are placed in specific areas to address your concern or condition.
The acupuncturist may gently twist the needles to emphasize stimulation.
The needles are left in for 20 to 30 minutes, with the total session lasting anywhere from 30 minutes to an hour. (Tony Y. Chon, Mark C. Lee. 2013)

The acupuncturist may use additional techniques that can include: (Tony Y. Chon, Mark C. Lee. 2013)

Moxibustion

This is the burning of dried herbs near the acupuncture needles to warm and stimulate the points and enhance healing.

Electroacupuncture

An electrical device is connected to the needles, providing a gentle electrical current that stimulates the muscles.

Cupping

Glass or silicone cups are placed on the area, creating a vacuum/suction effect, which helps stimulate blood circulation and rebalance the energy. (Johns Hopkins Medicine. 2023)
After the treatment, some individuals may feel relaxed, while others may feel energized.

Is It Painful?

Individuals may feel a slight ache, sting, or pinch as the needle is inserted. Some acupuncturists adjust the needle after it has been inserted, which can cause additional pressure.

Once the needle is properly placed, individuals may feel a tingling or heavy feeling, referred to as de qi. (National Institutes of Health. (N.D.)
Let the acupuncturist know if there is discomfort or increased pain at any point during the session.
Intense pain may mean the needle has not been inserted or placed correctly. (Johns Hopkins Medicine. 2023)

Side Effects

As with any treatment, side effects can present in individuals that include:

Pain and bleeding from the needle insertion
Bruising around the area, the needles were placed
Nausea
Allergic reaction
Skin rash
Infections
Dizziness (Malcolm W. C. Chan et al., 2017)

In order to reduce the risks, the treatment should always be done by a licensed trained healthcare provider using clean, disposable needles. It is recommended to consult with a primary care physician before getting acupuncture, as the treatment may not be right for individuals with certain health conditions.

Heel Spurs

References

Johns Hopkins Medicine. (2023) Acupuncture.

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

Yun, Y., Kim, S., Kim, M., Kim, K., Park, J. S., & Choi, I. (2013). Effect of facial cosmetic acupuncture on facial elasticity: an open-label, single-arm pilot study. Evidence-based complementary and alternative medicine : eCAM, 2013, 424313. doi.org/10.1155/2013/424313

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

Linde, K., Allais, G., Brinkhaus, B., Fei, Y., Mehring, M., Vertosick, E. A., Vickers, A., & White, A. R. (2016). Acupuncture for the prevention of episodic migraine. The Cochrane database of systematic reviews, 2016(6), CD001218. doi.org/10.1002/14651858.CD001218.pub3

Linde, K., Allais, G., Brinkhaus, B., Fei, Y., Mehring, M., Shin, B. C., Vickers, A., & White, A. R. (2016). Acupuncture for the prevention of tension-type headache. The Cochrane database of systematic reviews, 4(4), CD007587. doi.org/10.1002/14651858.CD007587.pub2

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

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

National Institutes of Health. (N.D.) De qi sensation.

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

How to Choose the Best Protein Bar for Your Diet

By

Dr. Alex Jimenez

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“For individuals trying to make healthy lifestyle adjustments, can adding protein bars into their diet help achieve health goals?”

Table of Contents

Protein Bar

Protein bars provide a quick energy boost between meals that can help curb appetite and avoid filling up on high-fat, sodium-packed snacks for individuals trying to lose weight. They can also increase calorie intake for individuals like athletes trying to increase muscle mass. Protein bars can vary in terms of factors like additives, calories, fat, sugars, and other ingredients. Labels need to be read carefully; otherwise, the bar can be more of a candy bar than a healthy, nutritious mini-meal or snack. It’s important to have a sense of how much protein is really needed each day, and the amount varies depending on individual factors.

How Much Protein Is Needed

Protein is vital to many body functions, but the body can’t produce this macronutrient, and it has to come from food. Dietary protein is broken down during digestion, and compounds known as amino acids are formed:

These are the building blocks the body uses to build and maintain muscles and organs.
It is vital to the production of blood, connective tissue, antibodies, enzymes, and hair. (Marta Lonnie, et al., 2018)
As protein is necessary for building muscle, athletes or individuals with physically demanding jobs are recommended to eat more.
The same is true of women who are pregnant or breastfeeding. (Trina V. Stephens, et al., 2015)
Bodybuilders eat even more protein than the average person to support muscle growth.

Protein Calculator

A calculator from the U.S. Department of Agriculture can help figure out daily protein requirements and recommended amounts of other nutrients based on sex, age, activity level, and other factors.
The ideal protein intake considers how much is eaten at individual sittings. The average individual is recommended to consume between 25 and 35 grams of protein at every meal. (Emily Arentson-Lantz, et al., 2015)

Sources

The richest sources of dietary protein include:

Meats
Poultry
Fish and shellfish
Eggs
Milk and other dairy products

Plant sources include:

Beans
Legumes
Nuts
Seeds
Whole grains

These are foods that are easy to include in a balanced diet, so eating a variety in ample quantities daily will equal the recommended amount of protein. Recommendations are to stick with those low in saturated fat and processed carbs and rich in nutrients. However, eating too much protein can cause kidney problems. Therefore, individuals who are predisposed to kidney disease are recommended to be careful over-protein intake. (Kamyar Kalantar-Zadeh, Holly M. Kramer, Denis Fouque. 2020)

What To Look For

Incorporating protein bars into a diet, either as a between-meal snack, as a grab-and-go option when there is no time for a full meal, or as a part of a weight-loss or weight-gain strategy, individuals need to read and understand the ingredients on the different types of bars to choosing the healthiest options. Some general guidelines to consider:

Protein Content

For a between-meal or pre-post-workout snack, look for a bar with at least 20 grams of protein.
Meal replacement bars should have at least 30 grams of protein.
A less is more approach to these guidelines is recommended, as the body can digest only between 20 and 40 grams of protein in one sitting. (Brad Jon Schoenfeld, Alan Albert Aragon. 2018)

Protein Type

The protein usually comes from dairy or plant sources.
The most common include eggs, milk, rice, whey, soy, peas, and hemp.
Individuals with allergies or sensitivities need to choose a bar that is comprised of a type of protein that is safe to eat.

Calories

For a bar to eat between meals, recommendations are those with around 220 to 250 calories.
A protein bar that substitutes for a full meal can have 300 to 400 calories.

Fat

Ten to 15 grams of total fat and no more than two grams of saturated fat is ideal.
Steer clear of unhealthy trans fats found in partially hydrogenated oils.

Fiber

Fiber is filling, so the more fiber, the more likely it is to keep hunger satisfied until the next snack or meal.
It is recommended to choose those that contain more than three to five grams of fiber.

Sugar

Some protein bars have just as much sugar content as candy bars.
Some have as much as 30 grams of added sugar.
The ideal amount is around five grams or less.
Artificial sweeteners like erythritol, sorbitol, and maltitol are not better options as they can cause bloating and gas.

It is recommended to work with a nutritionist to figure out the most effective type so that they can be incorporated into an individual’s diet to achieve and maintain health goals.

Nutrition Fundamentals

References

Lonnie, M., Hooker, E., Brunstrom, J. M., Corfe, B. M., Green, M. A., Watson, A. W., Williams, E. A., Stevenson, E. J., Penson, S., & Johnstone, A. M. (2018). Protein for Life: Review of Optimal Protein Intake, Sustainable Dietary Sources and the Effect on Appetite in Ageing Adults. Nutrients, 10(3), 360. doi.org/10.3390/nu10030360

Stephens, T. V., Payne, M., Ball, R. O., Pencharz, P. B., & Elango, R. (2015). Protein requirements of healthy pregnant women during early and late gestation are higher than current recommendations. The Journal of nutrition, 145(1), 73–78. doi.org/10.3945/jn.114.198622

Arentson-Lantz, E., Clairmont, S., Paddon-Jones, D., Tremblay, A., & Elango, R. (2015). Protein: A nutrient in focus. Applied physiology, nutrition, and metabolism = Physiologie appliquee, nutrition et metabolisme, 40(8), 755–761. doi.org/10.1139/apnm-2014-0530

Kalantar-Zadeh, K., Kramer, H. M., & Fouque, D. (2020). High-protein diet is bad for kidney health: unleashing the taboo. Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association – European Renal Association, 35(1), 1–4. doi.org/10.1093/ndt/gfz216

Schoenfeld, B. J., & Aragon, A. A. (2018). How much protein can the body use in a single meal for muscle-building? Implications for daily protein distribution. Journal of the International Society of Sports Nutrition, 15, 10. doi.org/10.1186/s12970-018-0215-1

Essential Guide To Rehabilitation Exercise Program

By

Dr. Alex Jimenez

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Senior woman with trainer doing rehab using pilates ball in the rehabilitation center

“Individuals who have gone through recent low back surgery, like a lumbar laminectomy and discectomy, could they benefit from physical therapy for full recovery? (Johns Hopkins Medicine. 2008)”

Table of Contents

Rehabilitation Exercise Program

A lumbar laminectomy and discectomy is a surgical procedure performed by an orthopedic or neurologic surgeon to help decrease pain, relieve associated symptoms and sensations, and improve flexibility and mobility. The procedure involves cutting away disc and bone material that presses against, irritates, and damages the spinal nerves. (Johns Hopkins Medicine. 2023)

Post-Surgery

The therapist will work with the individual to develop a rehabilitation exercise program. The objective of a rehabilitation exercise program is to help the individual:

Relax their muscles to prevent muscle tensing and becoming over-cautious
Regain full range of motion
Strengthen their spine
Prevent injuries

A guide on what to expect in physical therapy.

Postural Retraining

After back surgery, individuals have to work to maintain proper posture when sitting and standing. (Johns Hopkins Medicine. 2008)
Postural control is important to learn as it maintains the lower back in the optimal position to protect and expedite the healing of lumbar discs and muscles.
A physical therapist will teach the individual how to sit with proper posture and use lumbar support.
Attaining and maintaining proper posture is one of the most important things to help protect the back and prevent future back problems.

Walking Exercise

Walking is one of the best exercises after lumbar surgery. (Johns Hopkins Medicine. 2008)

Walking helps to improve cardiovascular health and blood circulation throughout the body.
This helps to provide added oxygen and nutrients to the spinal muscles and tissues as they heal.
It is an upright exercise that puts the spine in a natural position, which helps to protect the discs.
The therapist will help set up a program tailored to the individual’s condition.

Prone Press Up

One of the exercises to protect the back and lumbar discs is prone press-ups. (Johns Hopkins Medicine. 2008) This exercise helps keep the spinal discs situated in the proper position. It also helps to improve the ability to bend back into lumbar extension.

To perform the exercise:

Lie facing down on a yoga/exercise mat and place both hands flat on the floor under the shoulders.
Keep the back and hips relaxed.
Use the arms to press the upper part of the body up while allowing the lower back to remain against the floor.
There should be a slight pressure in the lower back while pressing up.
Hold the press-up position for 2 seconds.
Slowly lower back down to the starting position.
Repeat for 10 to 15 repetitions.

Sciatic Nerve Gliding

Individuals who had leg pain coming from the back prior to surgery may have been diagnosed with sciatica or an irritation of the sciatic nerve. Post-surgery, individuals may notice their leg feels tight whenever straightening it out all the way. This could be a sign of an adhered/trapped sciatic nerve root, a common problem with sciatica.

After lumbar laminectomy and discectomy surgery, a physical therapist will prescribe targeted exercises called sciatic nerve glides to stretch and improve how the nerve moves. (Richard F. Ellis, Wayne A. Hing, Peter J. McNair. 2012)
Nerve glides can help free the stuck nerve root and allow for normal motion.

To perform the exercise:

Lie on the back and bend one knee up.
Grab underneath the knee with the hands.
Straighten the knee while supporting it with the hands.
Once the knee is fully straightened, flex and extend the ankle about 5 times.
Return to the starting position.
Repeat the sciatic nerve glide 10 times.
The exercise can be performed several times to help improve how the nerve moves and glides in the lower back and leg.

Supine Lumbar Flexion

After surgery, gentle back flexion exercises can help safely stretch the low-back muscles and gently stretch the scar tissue from the surgical incision. Supine lumbar flexion is one of the simplest exercises to improve lumbar flexion range of motion.

To perform the exercise:

Lie on the back with the knees bent.
Slowly lift the bent knees towards the chest and grasp the knees with both hands.
Gently pull the knees toward the chest.
Hold the position for 1 or 2 seconds.
Slowly lower the knees back to the starting position.
Perform for 10 repetitions.
Stop the exercise if experiencing an increase in pain in the lower back, buttocks, or legs.

Hip and Core Strengthening

Once cleared, individuals can progress to an abdominal and core strengthening program. This involves performing specific motions for the hips and legs while maintaining a pelvic neutral position. Advanced hip strengthening exercises help generate strength and stability in the muscles that surround the pelvic area and lower back. A physical therapist can help decide which exercises are recommended for the specific condition.

Return-to-Work and Physical Activities

Once individuals have gained an improved lumbar range of motion, hip, and core strength, their doctor and therapist may recommend working on specific activities to help them return to their previous level of work and recreation. Depending on job occupation, individuals may need to:

Work on proper lifting techniques.
Require an ergonomic evaluation if they spend time sitting at a desk or workstation.
Some surgeons may have restrictions on how much an individual can bend, lift, and twist from two to six weeks after surgery.

Low-back surgery can be difficult to rehab properly. Working with a healthcare provider and physical therapist, individuals can be sure to improve their range of motion, strength, and functional mobility to return to their previous level of function quickly and safely.

Sciatica, Causes, Symptoms and Tips

References

Johns Hopkins Medicine. (2008). The road to recovery after lumbar spine surgery.

Johns Hopkins Medicine. (2023). Minimally Invasive Lumbar Discectomy.

Ellis, R. F., Hing, W. A., & McNair, P. J. (2012). Comparison of longitudinal sciatic nerve movement with different mobilization exercises: an in vivo study utilizing ultrasound imaging. The Journal of orthopaedic and sports physical therapy, 42(8), 667–675. doi.org/10.2519/jospt.2012.3854

Headache on Top of the Head: Common Causes & Solutions

By

Dr. Alex Jimenez

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Headache and migraine in woman alone at home, Hispanic woman sick has severe headache sitting alone tired on couch in living room.

“Individuals experiencing headaches on top of the head could be caused by different factors. Can recognizing what triggers pain or pressure help prevent this type of headache, and healthcare providers develop effective treatment plans?”

Table of Contents

Headache On Top of The Head

Various factors could cause a headache on top of the head; common causes include:

Stress
Sleep problems
Eye strain
Caffeine withdrawal
Dental problems
Hormonal changes
Alcohol consumption

Causes

Many causes have to do with underlying issues happening in other parts of the body.

Stress

Stress is a common cause of headaches, including one on top of the head.
Researchers don’t know exactly how stress causes headaches, but they think it causes tightening of the muscles in the back of the head or neck, which
pulls the tissues down, resulting in pain or pressure in the scalp and/or forehead area.
These are also called tension headaches.
Headaches caused by stress generally feel like dull pressure rather than throbbing pain.

Sleep Problems

Not getting enough sleep can induce a headache on top of the head.
When the mind and body do not get proper sleep, it can interfere with body functions like temperature, hunger, and sleep-wake cycles, which can lead to headaches.
It is common to feel more stressed when sleep-deprived, which can cause or compound a headache and other symptoms.

Eye Strain

You may develop a headache on the top of your head after you’ve been reading, watching, or otherwise focusing on something for a while.
Over time, your eye muscles tire and have to work harder, causing them to contract.
These spasms can lead to headaches. Squinting can make the muscle contractions even worse.

Caffeine Withdrawl

Individuals may feel pain on the top of their heads if they skip their regular coffee.
Regular caffeine consumption can lead to dependency and withdrawal symptoms, which include headaches when intake is reduced or stopped.
This type of headache can be moderate to severe and can feel worse with activity.
Most individuals start to feel better from caffeine withdrawal after a week. (World Health Organization. 2016)

Dental Problems

Teeth issues like cracks, cavities, or impaction can irritate the trigeminal nerve, setting off head pain.
Teeth grinding can also lead to headaches.

Hormonal Changes

Individuals who have a low level of thyroid hormone may experience headaches.
This could be from having too little thyroid or a symptom of the condition.
Like stress-induced headaches, this type is generally dull and not throbbing.
Some women may feel pain on the top of their heads before menstruation triggered by estrogen levels dropping.

Alcohol

Some individuals develop a headache on the top of their head or elsewhere within a few hours after drinking alcohol.
This is known as a cocktail headache.
Alcohol-induced headaches usually resolve within 72 hours.
The mechanism behind this headache is not fully researched, but it’s been thought that the widening of blood vessels in the brain/vasodilation when consuming alcohol may trigger head pain.
This type of headache is different than a hangover headache that comes from overconsumption and is based on dehydration and the toxic effects of alcohol. (J G Wiese, M. G. Shlipak, W. S. Browner. 2000)

Rare Causes

Top-of-the-head pain can also result from more serious and rare causes:

Brain Tumor

Headaches are one of the most common symptoms of brain tumors.
A headache on the top of the head depends on the location and size of the tumor. (MedlinePlus. 2021)

Brain Aneurysm

This is a weak or thin area in a brain artery that bulges and fills with blood, which can cause a life-threatening rupture.
Headaches are the most common symptom. (Brigham and Women’s Hospital. 2023)

Brain Bleed

Also known as a brain hemorrhage, this condition can cause intensely painful and quick headaches.
Brain bleeds can be caused by head trauma, high blood pressure, an aneurysm, a bleeding disorder, or liver disease. (New York-Presbyterian. 2023)

Treatment

Treatment for reducing a headache on top of the head includes:

Putting an ice bag over the area to reduce inflammation.
Getting an eye examination.
Making healthy lifestyle adjustments like drinking more water throughout the day.
Less caffeine intake.
Changing sleep patterns for a healthier, rested mind and body.
Taking a therapeutic bath to relax the body.
Gentle exercises like walking, pilates, or yoga.
Practicing deep breathing.
Mindfulness exercises like meditation.
Taking non-steroidal anti-inflammatory medication or NSAIDs like aspirin, Advil/ibuprofen), or Aleve/naproxen.

Depending on the cause and symptoms, a doctor may suggest specialist treatment options like:

Physical therapy
Cognitive behavioral therapy
Chiropractic therapy
Acupuncture
Prescription medication

A medical professional will be able to help identify the type of headache being experienced, offer treatment options, and advise on how to manage triggers.

Neck Injuries, El Paso, Texas

References

World Health Organization. (2016) Headache disorders.

Wiese, J. G., Shlipak, M. G., & Browner, W. S. (2000). The alcohol hangover. Annals of internal medicine, 132(11), 897–902. doi.org/10.7326/0003-4819-132-11-200006060-00008

MedlinePlus. (2021) Brain tumor.

Brigham and Women’s Hospital. (2023) Brain aneurysm.

New York-Presbyterian. (2023) Brain hemorrhage.

Exploring Pomegranates: A Guide to Their Benefits

By

Dr. Alex Jimenez

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Fruit salad with grapefruit and orange, pomegranate seeds, honey and lemon, decorated with mint

“For individuals looking to increase their antioxidant, fiber, and vitamin intake, can adding pomegranates to their diet help?”

Table of Contents

Pomegranates

Pomegranates can amplify various dishes, from breakfasts to sides to dinners, with their balanced blend of mild sweetness, tartness, and crunch from their seeds.

Health Benefits

The fruit has been found to be a healthy source of vitamins, fiber, and antioxidants. A medium-sized fruit contains:

High amounts of vitamin C, vitamin K, copper, and other micronutrients (FoodData Central. U.S. Department of Agriculture. 2019)
About 18% of the recommended daily value of vitamin C.
28% of the recommended value of vitamin K based on a 2,000-calorie-per-day diet. (FoodData Central. U.S. Department of Agriculture. 2019)
6 grams of fiber (FoodData Central. U.S. Department of Agriculture. 2019)
High in antioxidants (Aida Zarfeshany et al., 2014)

Ways to use a pomegranate include:

Guacamole

Stir in some pomegranate arils before serving. They will provide an unexpected crunch that contrasts deliciously with guacamole’s smoothness.

Mash 2 ripe avocados
Mix in 1/4 cup diced red onion
1/4 tsp. salt
1 Tbsp. lemon juice
2 cloves garlic – minced
1/2 cup chopped fresh cilantro
Stir in 1/4 cup pomegranate arils
Serves 6

Nutrition per serving:

144 calories
13.2 grams fat
2.8 grams of saturated fat
103 milligrams sodium
7.3 grams carbs
4.8 grams fiber
1.5 grams protein

Smoothie

Smoothies provide extra nutrition and a healthy snack.

In a blender, mix 1/2 cup pomegranate arils
1 frozen banana
1/4 cup low-fat Greek yogurt
2 tsp. honey
Splash of orange juice
Pour into a glass and enjoy!

Nutrition per serving:

287 calories
2.1 grams fat
0.6 grams of saturated fat
37 milligrams sodium
67.5 grams carbs
6.1 grams fiber
4.9 grams protein

Oatmeal

Enhance oatmeal as pomegranates bounce off other fruits, sweeteners, and butter nicely.

Prepare 1/2 cup oats
Stir in 1/2 of a medium banana, sliced
1 Tbsp. brown sugar
2 Tbsp. pomegranate arils
1/2 tsp. ground cinnamon

Nutrition per serving:

254 calories
3 grams fat
0.5 grams of saturated fat
6 milligrams sodium
52.9 grams carbohydrates
6.7 grams fiber
6.2 grams protein

Brown Rice

Another way to use pomegranates is on rice.

Cook 1 cup brown rice.
Toss with 1/4 cup pomegranate arils
1 Tbsp. olive oil
1/4 cup chopped, toasted hazelnuts
1 Tbsp. fresh thyme leaves
Salt and pepper to taste
Makes 4 servings

Nutrition per serving:

253 calories
9.3 grams fat
1.1 grams of saturated fat
2 milligrams sodium
38.8 grams carbohydrates
2.8 grams fiber
4.8 grams protein

Cranberry Sauce

Make a tangy and crunchy cranberry sauce.

In a medium saucepan, combine 12 oz. fresh cranberries
2 cups pomegranate juice
1/2 cup granulated sugar
Cook over medium heat – adjust if the mixture gets too hot
Stir frequently for about 20 minutes or until most of the cranberries have popped and released their juice.
Stir in 1 cup pomegranate arils
Serves 8

Nutrition per serving:

97 calories
0.1 grams fat
0 grams of saturated fat
2 milligrams sodium
22.5 grams carbohydrates
1.9 grams fiber
0.3 grams protein

Infused Water

A fruit-infused water can help reach proper hydration.

Place 1 cup pomegranate arils
1/4 cup fresh mint leaves in the insert of a 1-quart infuser water bottle
Mix lightly
Fill with filtered water
Refrigerate for at least 4 hours to let flavors steep
Serves 4

Each serving will offer only trace amounts of nutrients, which depend on how much pomegranate juice infuses into the water.

For any questions about more specific nutrition goals or how to achieve them, consult the Injury Medical Chiropractic and Functional Medicine Clinic Health Coach and/or Nutritionist.

Healthy Diet and Chiropractic

References

FoodData Central. U.S. Department of Agriculture. (2019) Pomegranates, raw.

Zarfeshany, A., Asgary, S., & Javanmard, S. H. (2014). Potent health effects of pomegranate. Advanced biomedical research, 3, 100. doi.org/10.4103/2277-9175.129371

What You Need to Know About Dormant Butt Syndrome

By

Dr. Alex Jimenez

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Young athletic woman doing exercises on legs and buttocks in gym. Sport, fitness, bodybuilding, training, healthy lifestyle concept.

“Individuals dealing with chronic knee discomfort, hip tightness, and lower back pain could be experiencing dormant gluteal-butt syndrome. Can recognizing the symptoms and signs and incorporating lower body and core fitness help prevent and treat the condition?”

Table of Contents

Dormant Gluteal Butt Syndrome

Knee, hip, and lower back problems could be traced back to weakened buttocks. Some scientists call the condition “dormant butt syndrome” (Ohio State University, .2023). However, researchers are learning about the important role the gluteal muscles provide in maintaining the lower body strong and healthy. (Hal David Martin, Manoj Reddy, Juan Gómez-Hoyos. 2015)

What Is It?

The syndrome is defined as weak buttock muscles and tight hip flexors. Experts from the Ohio State Wexner Medical Center have worked with individuals dealing with knee, hip, or back injuries and believe many of these issues are linked to weakened gluteal muscles. (Ohio State University.2023) The glutes are the muscles of the hips and buttocks. Weakened muscles fail to absorb the shock they’re supposed to during activities, which results in overloading the surrounding muscles and joints and increases the risk of injury. (Ohio State University, .2023)

Dormant gluteal-butt syndrome can result from a sedentary lifestyle and prolonged inactivity, like sitting for long periods.
The condition also occurs in runners and other physically active individuals who forget about these muscles with targeted exercises.

Exercises

Exercises to target the gluteals and prevent dormant gluteal-butt syndrome include activities/exercises that work the hips and core.

When walking properly, the gluteals should execute hip extension naturally.
Unhealthy postures, excessive sitting, and continued dysfunctional biomechanics mean walking without achieving optimal hip extension. (Hadi Daneshmandi. 2017)
When this happens, the gluteal muscles never get to fully function work, ending up with a series of aches and pains.
Pilates exercises can be adjusted to address order, repetition, and variation to strengthen the gluteals. (Laís Campos de Oliveira, 2015)

Hamstring Curls

Lie face down on an exercise mat.
Use your hands to create a cushion for the forehead.
Bend both knees so the feet point up towards the ceiling.
Let the knees be slightly apart, but keep the heels together.
Squeeze the heels together and tighten the gluteal muscles.
Hold for 3 seconds, then release the buttocks.
Repeat 10 times and then rest.
Hamstring curls can also be done using a weight machine.

Leg Pull Ups

Sit on a mat with your legs together in front.
Place the hands just behind the backside with the fingers pointing forward if possible.
Raise the body up.
Keep your head up and look straight ahead.
Raise one leg as high as possible.
Hold for as long as possible.
Lower and raise the other leg.
Repeat for a total of 3 reps.

Lining Up With A Wall Posture Helper

Standing posture is important to proper buttock function. Lining the body up with a wall can help train the body to maintain proper posture.

Find a wall and stand against it from the heels to the back of the head.
Work the backs of the legs and spine as firmly as possible into the wall.
Work to get the back of the skull into the wall as well.
Add some abdominal work by working the waistline inward and upward.
Hold for up to one minute.
The alignment is how you want to hold your body.
As you move off the wall, learn to maintain that posture throughout the day and night.
Repeat the wall exercise several times for reinforcement.

If aching of the hip, back, or knee is part of daily struggles, working out the gluteal muscles may be the solution. Contact the Injury Medical Chiropractic and Functional Medicine Clinic for a full consultation.

Easiest Weight Loss Hack

References

The Ohio State University Wexner Medical Center. (2023) Dormant butt syndrome may be to blame for knee, hip and back pain.

Martin, H. D., Reddy, M., & Gómez-Hoyos, J. (2015). Deep gluteal syndrome. Journal of hip preservation surgery, 2(2), 99–107. doi.org/10.1093/jhps/hnv029

Daneshmandi, H., Choobineh, A., Ghaem, H., & Karimi, M. (2017). Adverse Effects of Prolonged Sitting Behavior on the General Health of Office Workers. Journal of lifestyle medicine, 7(2), 69–75. doi.org/10.15280/jlm.2017.7.2.69

Campos de Oliveira, L., Gonçalves de Oliveira, R., & Pires-Oliveira, D. A. (2015). Effects of Pilates on muscle strength, postural balance and quality of life of older adults: a randomized, controlled, clinical trial. Journal of physical therapy science, 27(3), 871–876. doi.org/10.1589/jpts.27.871

A Comprehensive Guide to Understanding the Sacrum

By

Dr. Alex Jimenez

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Female doctor with anatomical spine model in clinic

“Various problems with the sacrum make up or contribute to a significant portion of lower back problems. Can understanding the anatomy and function help prevent and treat back injuries?”

Table of Contents

The Sacrum

The sacrum is a bone shaped like an upside-down triangle located at the base of the spine that helps support the upper body when sitting or standing and provides pelvic girdle flexibility during childbirth. It comprises five vertebrae that fuse during adulthood and connect to the pelvis. This bone takes and endures all of the body’s pressure and stress from everyday activities and movements.

Formation

Humans are born with four to six sacral vertebrae. However, fusion does not take place in all sacral vertebrae simultaneously:

Fusion starts with the S1 and S2.
As the individual gets older, the overall shape of the sacrum begins to solidify, and the vertebrae fuse into a single structure.
The process usually starts in the mid-teens and finishes in the early to mid-twenties.
It is believed to start earlier in females than males.

The timing of the fusion can be used for estimating the age and sex of skeletal remains. (Laura Tobias Gruss, Daniel Schmitt. et al., 2015)

The sacrum in a female is wider and shorter and has a more curved top or the pelvic inlet.
The male sacrum is longer, narrower, and flatter.

Structure

The sacrum is an irregular bone that makes up the back/posterior third of the pelvic girdle. There is a ridge across the front/anterior portion of the S1 vertebra known as the sacral promontory. Small holes/foramen on both sides of the sacrum are left over after the vertebrae fuse together. Depending on the number of vertebrae, there can be three to five foramen on each side, though there are usually four. (E. Nastoulis, et al., 2019)

Each anterior foramen is typically wider than the posterior or dorsal/backside foramen.
Each sacral foramina/plural of foramen provides a channel for the sacral nerves and blood vessels.

Small ridges develop between each of the fused vertebrae, known as transverse ridges or lines.
The top of the sacrum is called the base and is connected to the largest and lowest of the lumbar vertebrae – L5.
The bottom is connected to the tailbone/coccyx, known as the apex.
The sacral canal is hollow, runs from the base to the apex, and serves as a channel at the end of the spinal cord.
The sides of the sacrum connect to the right and left hip/iliac bones. The attachment point is the auricular surface.
Right behind the auricular surface is the sacral tuberosity, which serves as an attachment area for the ligaments that hold the pelvic girdle together.

Location

The sacrum is at the level of the lower back, just above the intergluteal cleft or where the buttocks split. The cleft starts at around the level of the tailbone or coccyx. The sacrum is curved forward and ends at the coccyx, with the curvature being more pronounced in females than males. It connects to the L5 lumbar vertebra by way of the lumbosacral joint. The disc between these two vertebrae is a common source of low back pain.

On either side of the lumbosacral joint are wing-like structures known as the sacral ala, which connect to the iliac bones and form the top of the sacroiliac joint.
These wings provide stability and strength for walking and standing.

Anatomical Variations

The most common anatomical variation applies to the number of vertebrae. The most common is five, but anomalies have been documented, including individuals with four or six sacral vertebrae. (E. Nastoulis, et al., 2019)

Other variations involve the sacrum’s surface and curvature, where the curvature differs widely between individuals.
In some cases, the first and second vertebrae do not fuse and remain separately articulated.
Failure of the canal to completely close during formation is a condition known as spina bifida.

Function

Studies on the sacrum are ongoing, but some proven functions include:

It serves as an anchor point for the spinal column to attach to the pelvis.
It provides stability for the body’s core.
It acts as a platform for the spinal column to rest on when sitting.
It facilitates childbirth, providing pelvic girdle flexibility.
It supports upper body weight when sitting or standing.
It provides extra stability for walking, balance, and mobility.

Conditions

The sacrum can be a main source or focal point for lower back pain. It is estimated that 28% of men and 31.6% of women aged 18 years or older have experienced low back pain in the past three months. (Centers for Disease Control and Prevention. 2020) Conditions that can cause sacrum pain symptoms include.

Sacroiliitis

This is a common condition of sacroiliac/SI joint inflammation.
A doctor only makes the diagnosis when all other possible causes of pain have been ruled out, known as a diagnosis of exclusion.
Sacroiliac joint dysfunction is thought to account for between 15% and 30% of low back pain cases. (Guilherme Barros, Lynn McGrath, Mikhail Gelfenbeyn. 2019)

Chordoma

This is a type of primary bone cancer.
About half of all chordomas form in the sacrum, but the tumors can also develop elsewhere in the vertebral column or at the base of the skull. (National Library of Medicine. 2015)

Spina Bifida

Individuals can be born with conditions that affect the sacrum.
Spina bifida is a congenital condition that can arise from the malformation of the sacral canal.

Unlocking the Secrets of Inflammation

References

Gruss, L. T., & Schmitt, D. (2015). The evolution of the human pelvis: changing adaptations to bipedalism, obstetrics and thermoregulation. Philosophical transactions of the Royal Society of London. Series B, Biological sciences, 370(1663), 20140063. doi.org/10.1098/rstb.2014.0063

Nastoulis, E., Karakasi, M. V., Pavlidis, P., Thomaidis, V., & Fiska, A. (2019). Anatomy and clinical significance of sacral variations: a systematic review. Folia morphologica, 78(4), 651–667. doi.org/10.5603/FM.a2019.0040

Centers for Disease Control and Prevention. QuickStats: Percentage of adults aged 18 years or older who had lower back pain in the past 3 months, by sex and age group.

Barros, G., McGrath, L., & Gelfenbeyn, M. (2019). Sacroiliac Joint Dysfunction in Patients With Low Back Pain. Federal practitioner : for the health care professionals of the VA, DoD, and PHS, 36(8), 370–375.

National Library of Medicine, Chordoma.

Treating Finger Sprains and Dislocations: An Analysis

By

Dr. Alex Jimenez

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Closeup of x-ray filmof a fractured finger

“Finger sprains and dislocations are common hand injuries that can happen during work, physical/sports activities, or in automobile collisions and accidents. Can recognizing the symptoms help in developing an effective treatment strategy?”

Table of Contents

Finger Sprains and Dislocations

Finger sprains and dislocations are common injuries of the hand that cause pain and swelling.

A sprain happens when the finger tissue that supports a joint gets stretched beyond its limits in a way that stresses the ligaments and tendons.
The ligament tissue can be partially or completely torn. If the damage is bad enough, the joint comes apart.
This is a dislocation – A dislocation happens when the joint in the finger gets shifted out of its normal position.
Both injuries can cause pain and stiffness in the finger and hand.

Sprains

Finger sprains can happen any time the finger bends in an awkward or unusual way. This can happen from falling on the hand or getting hurt when engaged in physical activities like sports or household chores. Sprains can occur in any of the knuckle joints in the finger. However, most commonly, the joint in the middle of the finger gets sprained. It’s known as the proximal interphalangeal or PIP joint. (John Elfar, Tobias Mann. 2013) Symptoms of a finger sprain can include:

Pain when you move your finger
Swelling around the knuckle
Tenderness in the finger and around the joint
For a sprain, individuals may need to have imaging done to see if any of the bones in the hand are broken or fractured. (OrthoInfo. American Academy of Orthopaedic Surgeons. 2022)

Treatment

Individuals are encouraged not to move the injured finger while in recovery and healing. It can be hard to do, but wearing a splint can help.

Splints are supports that are usually made from foam and pliable metal.
A sprained finger can also be taped to one of the fingers next to it while in recovery, known as buddy-taping.
Splinting a sprained finger while engaged in activities can protect the hand from worsening or further injury.
However, splinting the finger when it is not needed can cause the joint to become stiff. (OrthoInfo. American Academy of Orthopaedic Surgeons. 2022)

An injury known as “gamekeeper’s thumb” is a more serious type of sprain.
Injury to the ligaments at the thumb joint can cause difficulty in pinching and gripping.
This injury must often be taped up or splinted for a significant amount of time for full recovery and could require surgery. (Chen-Yu Hung, Matthew Varacallo, Ke-Vin Chang. 2023)

Other treatments to help a sprained finger include:

Elevate the hand if swelling and inflamed.
Gentle finger exercises/movements to prevent stiffness.
Icing the injured finger.
Take an anti-inflammatory medication.

Individuals who have not broken bones or dislocated the joint will probably be able to move their finger in about a week. A doctor will set a timeline for when to start using the finger normally.

Individuals who sprain their finger that feels swollen and stiff for longer than a few weeks are recommended to consult a doctor or specialist.
They will need to check the hand to make ensure there aren’t any breaks or fractures. (OrthoInfo. American Academy of Orthopaedic Surgeons. 2022)
Thumb sprains and finger sprains in children may need to be splinted or taped for longer periods, as the ligament is not fully developed or as strong, which could lead to a tear.

Dislocations

A finger dislocation is a more severe injury involving the ligament, joint capsule, cartilage, and other tissues that causes misalignment of the finger. The ligaments and the joint capsule get torn when a joint is dislocated. The joint needs to be reset, which can be a simple process, or in severe cases, patients may need to be placed under anesthesia or undergo surgery to reset the joint properly.

In these cases, tendons or other tissues might be preventing the joint from getting into position.
Putting the finger back into the right position is known as”reduction.” Once reduced, the finger needs to be splinted.
Individuals also need an X-ray to ensure the joint is lined up correctly and that any bones were not broken or fractured when they sustained the injury. (James R. Borchers, Thomas M. Best. 2012)
Once reset, caring for a dislocated finger is basically the same as a sprained finger. Using ice on the finger, keeping the hand elevated to reduce swelling.
Individuals need to check with their doctor to find out when to start moving the finger. (James R. Borchers, Thomas M. Best. 2012)

The Chiropractic Approach To Improving Health

References

Elfar, J., & Mann, T. (2013). Fracture-dislocations of the proximal interphalangeal joint. The Journal of the American Academy of Orthopaedic Surgeons, 21(2), 88–98. doi.org/10.5435/JAAOS-21-02-88

OrthoInfo from the American Academy of Orthopaedic Surgeons. (2022) Hand fractures.

Hung, C. Y., Varacallo, M., & Chang, K. V. (2023). Gamekeeper’s Thumb. In StatPearls. StatPearls Publishing.

OrthoInfo from the American Academy of Orthopaedic Surgeons. (2022) Finger fractures.

Borchers, J. R., & Best, T. M. (2012). Common finger fractures and dislocations. American family physician, 85(8), 805–810.

Tips to Relieve Burning Feet and Heal the Underlying Condition

By

Dr. Alex Jimenez

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Close up on women feet and hand massage on injury spot. — Close up on women feet and hand massage on injury spot

“Individuals’ feet will heat up when walking or running; however, burning feet could be a symptom of medical conditions like athlete’s foot or a nerve injury or damage. Can awareness of these symptoms help identify solutions to relieve and heal the underlying condition?”

Burning Feet

Walkers and runners often experience heat in their feet. This is natural from the increased circulation, heart rate, warm or hot sidewalks, and pavement. But the feet could experience an abnormal hot or burning sensation. Usually, the overheating is caused by socks and shoes and fatigue after a long workout. The first self-care steps include trying new or specialized footwear and workout adjustments. If burning feet persist or there are signs of infection, tingling, numbness, or pain, individuals should see their healthcare provider. (Mayo Clinic. 2018)

Footwear

The shoes and how they are worn may be the cause.

First, look at the material of the shoes. They could be shoes and/or insoles that don’t circulate air. They can get hot and sweaty without proper air circulation around the feet.
When choosing running shoes, consider a mesh material that allows airflow to keep the feet cool.
Consider getting fitted for shoes that are the right size, as the feet swell when running or walking.
If the shoes are too small, air can’t circulate, creating more friction between the foot and the shoe.
Shoes that are too large can also contribute to friction as the feet move around too much.
Insoles could also contribute.
Some insoles can make the feet hot, even if the shoes are breathable.
Swap the insoles from another pair of shoes to see if they are contributing, and if so, look into new insoles.

Tips to help prevent hot feet:

Topical Ointments

Use an anti-blister/chafing topical cream to lubricate and protect the feet.
This will reduce friction and prevent blisters.

Lace Properly

Individuals may be lacing the shoes too tight, constricting circulation, or irritating the nerves at the top of the foot.
Individuals should be able to slide one finger under the knot.
Remember that the feet will swell as walking or running commences
Individuals may need to loosen their laces after warming up.
Individuals are recommended to learn lacing techniques that will ensure they are not too tight over the sensitive areas.

Cushioning

Fatigue from long workouts or long days standing/moving can result in burning feet.
Individuals may need added cushioning in the shoes.
Look for work and athletic shoes that have added cushioning.

Shoe Allergies

Individuals may have an allergic reaction or a sensitivity to the fabric, adhesives, dyes, or other chemicals. (Cleveland Clinic. 2023) The chemicals used in production vary for leather compared to fabric and are different by brand and manufacturer.

A shoe material allergy may also result in burning, itching, and swelling.
It’s recommended to note whether symptoms only happen when wearing a specific pair of shoes.
Recommendations are to try different kinds and brands of shoes.

Socks

The sock fabric could be contributing to hot or burning feet. Steps to take can include:

Avoid cotton

Cotton is a natural fiber but is not recommended for walking and running as it holds sweat that can keep the feet wet.
It is recommended to use socks made of Cool-Max and other artificial fibers that wick sweat away and cool them down.

Wool

Wool socks can also cause itching and burning sensations.
Consider athletic socks made from itch-free wool.

Mindfulness

Individuals could be sensitive to other fabrics or dyes in socks.
Take note of which socks cause hot or burning feet symptoms.
Individuals could also be sensitive to laundry products and are recommended to try a different brand or type.

Medical Conditions

In addition to shoes and socks, medical conditions could cause and contribute to symptoms.

Athlete’s Foot

Athlete’s foot is a fungal infection.
Individuals may feel a burning sensation in the affected area.
Typically, it is itchy, red, scaling, or cracking.

Rotate shoes.
The fungus grows in damp places, therefore, it is recommended to rotate shoes to allow them to dry out between workouts.
Wash and dry the feet after walking or running.
Try home and over-the-counter solutions, powders, and remedies to treat athlete’s foot.

Peripheral Neuropathy

Individuals frequently experiencing burning feet apart from when they have been exercising could be due to nerve damage known as peripheral neuropathy. (National Institute of Neurological Disorders and Stroke. 2023) Peripheral neuropathy symptoms include pins and needles, numbness, tickling, tingling, and/or burning sensations.

Examination

Diabetes is one of the most common causes of peripheral neuropathy.
Diabetes can come on at any age.
Individuals need to learn how to protect their feet, as exercise is recommended for diabetes.

Other conditions that can produce peripheral neuropathy include:

Vitamin B-12 deficiency
Alcohol abuse
Circulatory disorders
AIDS
Heavy metal poisoning

Massage and Movement

Massaging the feet also increases circulation.
Exercise such as walking is recommended for peripheral neuropathy as it improves circulation to the feet.

Other Causes

Symptoms could also be caused by other conditions including: (Cleveland Clinic. 2023)

Nerve Entrapment

Degenerative changes in the spine or back trauma can cause injury/damage to the nerves that can cause pain, tingling, and numbness in the feet.

Tarsal Tunnel Syndrome

Compression of the posterior tibial nerve in your lower leg can cause tingling and burning in your feet.

Morton’s Neuroma

Morton’s neuroma, which is caused by thickened nerve tissue, can cause pain and burning at the base of the toes.

Autoimmune Diseases

Diseases such as multiple sclerosis or Lupus can also cause burning feet.

Self-Care

Adjustments or additions to routines and habits can help.

Don’t walk or run in worn-out shoes.
Protect the feet by using the right socks, foot powder, and ointments, and cover any areas where rubbing and friction occur.
Immediately change out of shoes and socks after exercise, allowing thorough air drying.
This will help reduce the risk of the athlete’s foot fungus growth.
Soak the feet in cool water. Do not use ice, as it could damage the skin.
Soak the feet in Epsom salts to relieve pain and inflammation and dry up blisters.
Elevate the feet after exercising.
Rotate the shoes and socks between workout sessions and during the day.
Try different shoes, socks, and insoles.
Overtraining can worsen symptoms.
Try gradually building on distance while monitoring symptoms.

See a doctor or specialist healthcare provider if symptoms continue and are not associated with walking or running exercise.

Exploring Integrative Medicine

References

Mayo Clinic. (2018). Burning Feet.

National Institute of Neurological Disorders and Stroke. (2023). Peripheral Neuropathy.

Cleveland Clinic. (2023) Burning Feet Syndrome.

Iliopsoas Syndrome: Causes Behind Leg & Hip Pain

By

Dr. Alex Jimenez

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Dissatisfied fit black lady holding aching hip, has kidney inflammation, touching location of paim, wearing sport clothes, having sporty shaped body

“Individuals suffering from hip, thigh, and/or groin pain could be experiencing iliopsoas syndrome. Could knowing the symptoms and causes help in diagnosis and treatment?”

Table of Contents

Iliopsoas Syndrome

Iliopsoas syndrome encompasses several conditions that affect the inner hip muscle and can cause hip and thigh pain. The muscle helps to bend the leg toward the body.

The condition is usually caused by overuse injuries and commonly affects individuals who perform repeated hip flexion movements, like cyclists, gymnasts, dancers, runners, and soccer players. (Liran Lifshitz, et al., 2020)
The term is often used interchangeably with psoas syndrome, iliopsoas tendonitis, snapping hip syndrome, and iliopsoas bursitis. However, there are clinical differences.

Symptoms

Symptoms include: (American Association of Hip and Knee Surgeons. 2020)

Tenderness in the hip and groin area.
Hip or groin clicking or snapping that can be heard and/or felt during movement.
Pain and/or stiffness in the hip and thigh area.
Pain that worsens when bending the hip – walking, climbing stairs, squatting, sitting.
Movements that involve bringing the knee toward the chest can worsen the pain.

Causes

The iliopsoas muscles are hip muscles on the front of the hip. They are made up of the psoas major, the psoas minor, and the iliacus. Small, fluid-filled sacs/bursae are within the hip joint between bones and soft tissues. The bursae reduce friction and provide cushioning to help the tendons, muscles, and other structures move smoothly over the bony prominences.

The greater trochanteric bursa and the iliopsoas bursa can become inflamed, which can lead to the syndrome. (American Association of Hip and Knee Surgeons. 2020)

Iliopsoas bursitis happens when the bursa, which is located between the iliopsoas tendon and the inside of the hip joint, becomes inflamed and irritated.
Iliopsoas tendonitis/hip tendonitis happens when the tendon that attaches the thigh bone to the iliopsoas muscle becomes inflamed and irritated.
Iliopsoas bursitis and tendonitis are commonly caused by overuse injuries and intense activities like cycling, running, rowing, or strength training.

Diagnosis

Healthcare providers can diagnose iliopsoas syndrome based on symptom history and a hip examination.
Imaging tests – MRI and X-rays may be used to rule out other injuries or conditions like muscle tears. (Paul Walker, et al., 2021)

Treatment

Most mild cases of hip bursitis and hip tendonitis can be managed using the RICE method (American Association of Orthopedic Surgeons. 2020)

Rest

Avoid putting weight on the hip for a few days after the injury.

Ice

Apply ice immediately after the injury to bring the swelling down.
Use a cold pack for 20 minutes at a time, several times a day.
Do not apply ice directly on the skin.

Compression

Wrap the area in a soft bandage or use compression shorts to prevent further swelling.

Elevation

Rest as often as possible with the leg raised higher than the heart.

Medical Treatment

Non-steroidal anti-inflammatory drugs like ibuprofen and naproxen sodium can alleviate pain and reduce inflammation. (Paul Walker, et al., 2021)
Steroid injections can be used if symptoms continue or come back with additional injections administered as necessary. (Paul Walker, et al., 2021)
After pain and swelling subside, physical therapy may be recommended, as well as mild exercises to gradually improve hip strength and flexibility. (Paul Walker, et al., 2021)
A healthcare provider may recommend surgery in severe cases where pain persists, and conservative treatments don’t provide enough relief.
However, this is rare due to muscle weakness and nerve damage risks. (Paul Walker, et al., 2021)

Hip Labral Tear – Chiropractic Treatment

References

Lifshitz, L., Bar Sela, S., Gal, N., Martin, R., & Fleitman Klar, M. (2020). Iliopsoas the Hidden Muscle: Anatomy, Diagnosis, and Treatment. Current sports medicine reports, 19(6), 235–243. doi.org/10.1249/JSR.0000000000000723

American Association of Hip and Knee Surgeons. Iliopsoas tendonitis/bursitis.

Walker, P., Ellis, E., Scofield, J., Kongchum, T., Sherman, W. F., & Kaye, A. D. (2021). Snapping Hip Syndrome: A Comprehensive Update. Orthopedic reviews, 13(2), 25088. doi.org/10.52965/001c.25088

American Association of Orthopedic Surgeons. OrthoInfo. Hip strains.

Reducing Osteoarthritis Pain with Massage Therapy

By

Dr. Alex Jimenez

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Caucasian senior woman 60s doing physiotherapist with support from nurse. Senior elderly female sitting on sofa in living room workout exercise for patient with caregiver in nursing care..

“For individuals managing osteoarthritis, could massage therapy provide added treatment benefits?”

Table of Contents

Osteoarthritis Massage Therapy

Osteoarthritis happens when the cartilage between the joints wears away, causing stiffness and pain. Massage therapy is a treatment used to relieve various types of pain symptoms.

There are many types of massage therapy, that healthcare providers utilize to manipulate the muscles and other soft tissues to relieve symptoms, relax muscles, increase circulation, reduce inflammation, release trigger points, and restore mobility, flexibility, and function. (Ergonomic Trends. 2023)
Professional therapists can help relieve osteoarthritis joint pain by relaxing the surrounding muscles and other soft tissues to release stiffness. (Adam Perlman, et al., 2019)

Massage Objectives and Types

Massage therapists use their hands and fingers, forearms, elbows, and/or instruments to manipulate the body’s soft tissues. Soft tissues support and surround body structures and include muscle, fat, tendons, and ligaments.

The goal of osteoarthritis massage therapy is to relax muscles and soft tissues, increase blood and oxygen circulation, warm the affected area/s, relieve pain, and restore mobility and function.
Depending on the location of the muscles being massaged, individuals may be seated or lie down on a specialized table.
The amount of pressure and direction of movement depend on the body area.
Therapeutic oils and/or massage creams may be used to increase the therapy.

Types include:

Swedish

The therapist uses long strokes, kneading, and friction on the muscles.
Joints are moved to increase flexibility.

Deep Tissue

The therapist uses deep finger or instrument pressure, focusing on muscles that are tight or knotted.

Trigger Point

Trigger points represent a source of radiating pain symptoms.
The therapist focuses pressure on these myofascial tissue points using various strokes to release them.

Shiatsu

The therapist applies rhythmic pressure with their thumbs, fingers, and palms to redirect and increase energy or chi/qi.

A massage session lasts around 30–60 minutes depending on the severity of the condition and the number of sessions the patient has undergone. Chronic pain patients usually go through a series of specialized sessions that focus on specific areas and gradually build.

Risk Factors

Certain precautions must be taken before getting osteoarthritis massage therapy. Although there are a few serious risks, certain individuals are not suitable candidates and should not receive massage therapy. The conditions include: (Medical Massage Therapy Resource & Reference. 2023)

Damaged nerves.
Damaged blood vessels.
Infection and inflammation in the area to be massaged.
Open wounds.
Fever.
Taking a blood thinner.
Deep vein thrombosis – blood clots.
Bleeding disorders.
Osteoporosis – weak and brittle bones.
Recent fractures – broken bones.
Tumors.
Cancer.
Individuals who have recently undergone surgery.
Individuals with a skin condition that is contagious, like warts or herpes, or noncontagious, like psoriasis, could be aggravated by touch or pressure.
Individuals who have cancer, fragile skin, heart problems, or dermatomyositis are recommended to discuss osteoarthritis massage therapy with their healthcare provider.

Research on the effects of massage therapy on various health conditions is ongoing. Massage therapy promotes relaxation while reducing stress, which can help with chronic joint issues like osteoarthritis.

Arthritis Explained

References

Ergonomic Trends. 20 most common types of massages and their benefits explained.

Perlman, A., Fogerite, S. G., Glass, O., Bechard, E., Ali, A., Njike, V. Y., Pieper, C., Dmitrieva, N. O., Luciano, A., Rosenberger, L., Keever, T., Milak, C., Finkelstein, E. A., Mahon, G., Campanile, G., Cotter, A., & Katz, D. L. (2019). Efficacy and Safety of Massage for Osteoarthritis of the Knee: a Randomized Clinical Trial. Journal of general internal medicine, 34(3), 379–386. doi.org/10.1007/s11606-018-4763-5

Medical Massage Therapy Resource & Reference. When not to get a massage: 26 reasons you cannot get a massage.