Unwrapping the Nutritional Facts of Marshmallows

By

Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP

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Woman Enjoying Sweet Snacks at Work Close Up — Close up of young woman enjoying sweet snacks while working at home office, focus on hand holding marshmallow, copy space

Marshmallows and calories can add up when eating more than a single serving. Can marshmallows be consumed in moderation and still be healthy?

Table of Contents

Marshmallows

Many enjoy marshmallows with hot chocolate, sweet potatoes, and s’mores. However, their nutritional value is not the healthiest, as the ingredients typically include water, sugar, corn syrup, gelatin, and sometimes other ingredients for flavor and color. The key ingredient is whipped air, giving marshmallows their signature texture.

Nutrition

A serving weighs about 28 grams, around four large marshmallows or a half-cup of mini marshmallows. If consumed in their original form, they contain about 80 calories. (United States Department of Agriculture, 2018)

Carbohydrates

Marshmallows are made of different types of sugar (sucrose and corn syrup), and most of their calories come from carbohydrates. One marshmallow contains a little under 6 grams of carbohydrates, and a single serving provides about 23 grams of carbohydrates, primarily sugar. The glycemic index is estimated to be 62, making it a high-glycemic food. The estimated glycemic load of one marshmallow is 15, which is low. However, the glycemic load takes serving size into account. Because the serving size is small, the glycemic load is lower than expected.

Fats

Very little fat, less than 1 gram, is in a single serving.

Protein

Marshmallows are not a recommended source of protein.
There is less than 1 gram of protein in a single serving.

Micronutrients

There is no significant vitamin or mineral intake by consuming marshmallows.
A single serving does contain a small amount of phosphorus, around 2.2 milligrams, and potassium, around 1.4 milligrams.
It also increases sodium intake by 22.4 mg, providing little selenium 0.5 micrograms.

Health Benefits

Marshmallows are processed and provide little to no health benefits, but there are ways to include them in a balanced, healthy diet. They are a low-calorie, nearly fat-free food, so for those watching their weight, eating a marshmallow is a quick and easy way to satisfy a sweet tooth. Also, adding marshmallows to certain foods might help increase the intake of healthy vegetables, such as adding marshmallows to sweet potatoes, which are almost always gluten-free. For gluten-intolerant individuals, marshmallows are probably safe to consume. Some brands have also developed vegan marshmallows that use tapioca starch or agar instead of gelatin.

Storage

Marshmallows have a long shelf life. A bag can last up to six or eight months if not opened. They can last four months or less if the bag is open. Some can be purchased in an airtight tin and stored that way. However, they are most often in a plastic bag. Therefore, they should be placed in an airtight plastic container or sealed tightly after opening. Marshmallows do not need refrigeration, but many cooks freeze them to make them last longer. An unopened bag can be frozen, forming cubes that may stick together. To prevent sticking, dust with powdered sugar and place in an airtight container. When they are thawed, they regain their fluffy texture.

Allergies

Allergies are rare. However, those allergic to gelatin may want to avoid marshmallows since gelatin is a primary ingredient in almost all prepared and homemade versions.(Caglayan-Sozmen S. et al., 2019)

Injury Medical Chiropractic and Functional Medicine Clinic

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

Balancing Body and Metabolism

References

United States Department of Agriculture. FoodData Central. (2018). Candies, marshmallows. Retrieved from https://fdc.nal.usda.gov/fdc-app.html#/food-details/167995/nutrients

Caglayan-Sozmen, S., Santoro, A., Cipriani, F., Mastrorilli, C., Ricci, G., & Caffarelli, C. (2019). Hazardous Medications in Children with Egg, Red Meat, Gelatin, Fish, and Cow’s Milk Allergy. Medicina (Kaunas, Lithuania), 55(8), 501. https://doi.org/10.3390/medicina55080501

Navigating the Healing Stages: Neck and Back Injuries Explained

By

Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP

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Experienced physical therapist conducting spinal palpation in patient — Qualified physiotherapist palpating paraspinal muscles of adult Caucasian man in standing position

Can knowing the characteristics of each stage of healing help expedite recovery for individuals who are healing after neck and back injuries?

Table of Contents

Back or Neck Injury Healing Stages

At each stage, different things happen at the injury site. This means recommended exercises and activity levels will vary depending on how long it’s been since the injury. The stages to know about when healing from a neck or back injury. (Brumitt J., and Cuddeford T. 2015)

Inflammation or Acute Stage

Also known as the inflammatory stage, the acute stage occurs during the injury and can continue for 72 hours. The body releases repair chemicals in response to tissue damage, causing inflammation and pain. Symptoms of inflammation, including redness, swelling, pain at rest, and diminished function, are expected. Inflammation and pain during the inflammation stage are caused by the body’s repair chemicals released in response to tissue damage. (Wu, Y. S. and Chen S. N. 2014) The biological reaction decreases mobility so the injured area can rest and heal, but the substances that promote healing also cause pain and swelling. (Shah A. and Amini-Nik S. 2017) Scar tissue also begins to form during the inflammatory stage. (Wilgus T. A. 2020) Initial treatment focuses on reducing pain, swelling, and muscle spasms. Individuals are encouraged to use ice packs, compression, and over-the-counter anti-inflammatory medications like ibuprofen or naproxen. (Duchesne E., Dufresne S. S., and Dumont N. A. 2017)

Subacute Stage

Inflammation decreases, and new connective tissue and capillaries grow to help repair damaged structures. The subacute phase generates new connective tissue and capillary growth and reduced inflammation. (Brumitt J., and Cuddeford T. 2015) Scar tissue continues to grow during this time, as well. The tissues are still fragile at this stage, stressing the injured area should be limited to when the therapist or doctor is examining or working with the patient. Most physical therapists recommend beginning with gentle movement during the subacute phase and gradually building up the intensity of exercise. Mild isometric and low-intensity exercises are often used. Because activity is restricted, the muscles may seem weak. Depending on the severity of the injury and the type of tissue that was injured (i.e., tendons have less blood circulation and tend to heal more slowly, it can take a few days to several weeks. (Brumitt J., and Cuddeford T. 2015)

The Chronic Stage or Maturation

The inflammation disappears entirely during the chronic or maturation stage of neck or back injury healing. The new collagen fibers build strength, and the wound shrinks. (Brumitt J., and Cuddeford T. 2015) During this stage, pain associated with the injury tends to be limited to the end joint’s range of motion. The first ten weeks of the chronic stage are essential for engaging in exercises that enhance healing and help remodel the fibers so they will function as close as possible to the way they did before the injury. (Azevedo P. S. et al., 2016) Exercises during the ten weeks are important because otherwise, individuals can permanently lose some of their ability to move and function.

After around ten weeks, the scar tissue can permanently change, so re-acquiring strength and flexibility may necessitate surgery or manual release treatment from a physical therapist or chiropractor. During this time, the scar tissue can be remodeled with exercise, meaning that the activities and motions performed on the injured area will affect the formation of new tissue fibers. The chronic stage of healing begins after 21 days and doesn’t end after the 10-week prime time (Brumitt J., and Cuddeford T. 2015). It can continue for quite some time.

Treatment

Treatment focuses on engaging the injured muscles in light isometric contractions to help align new collagen fibers. Physical therapy helps rebuild mobility, strength, balance, and flexibility and can also help learn about injury and how to recover. A treatment that may also help during these phases is massage therapy. Extended bed rest or immobility can prolong symptoms and delay recovery. Tips to manage pain and recovery:

When sitting for long periods, get up and move around frequently.
Wear comfortable shoes.
When driving long distances, stop frequently to stand up and walk around.
Sleep on the side with a small pillow between the knees.
Limit how much weight is carried.
Add exercises gradually.

Most symptoms of back strain or sprain improve in about two weeks. Individuals may need additional treatment if symptoms continue for longer than two weeks. Maintaining exercises will continue to make the body stronger, more flexible, more functional, and pain-free.

Chiropractic Care for Healing After Trauma

References

Brumitt, J., & Cuddeford, T. (2015). CURRENT CONCEPTS OF MUSCLE AND TENDON ADAPTATION TO STRENGTH AND CONDITIONING. International journal of sports physical therapy, 10(6), 748–759.

Wu, Y. S., & Chen, S. N. (2014). Apoptotic cell: linkage of inflammation and wound healing. Frontiers in pharmacology, 5, 1. https://doi.org/10.3389/fphar.2014.00001

Shah, A., & Amini-Nik, S. (2017). The Role of Phytochemicals in the Inflammatory Phase of Wound Healing. International journal of molecular sciences, 18(5), 1068. https://doi.org/10.3390/ijms18051068

Wilgus T. A. (2020). Inflammation as an orchestrator of cutaneous scar formation: a review of the literature. Plastic and aesthetic research, 7, 54. https://doi.org/10.20517/2347-9264.2020.150

Duchesne, E., Dufresne, S. S., & Dumont, N. A. (2017). Impact of Inflammation and Anti-inflammatory Modalities on Skeletal Muscle Healing: From Fundamental Research to the Clinic. Physical therapy, 97(8), 807–817. https://doi.org/10.1093/ptj/pzx056

Azevedo, P. S., Polegato, B. F., Minicucci, M. F., Paiva, S. A., & Zornoff, L. A. (2016). Cardiac Remodeling: Concepts, Clinical Impact, Pathophysiological Mechanisms and Pharmacologic Treatment. Arquivos brasileiros de cardiologia, 106(1), 62–69. https://doi.org/10.5935/abc.20160005

Gym or Home: Factors to Consider for Your Fitness Routine

By

Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP

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Blue home gym with black and yellow fitness equipment — Blue home gym with punching boxer,cyle and other fitness equipment - 3d rendering

Individuals getting into fitness may wonder whether they should join a gym or exercise at home. Is there an advantage to one versus the other?

Gym or Home

Exercising, whether at the gym or at home, depends on individual preference and budget. The first step is committing to a fitness health plan. Where to work out depends on the individual and their characteristics. For those who are self-motivated and will exercise no matter what, a home workout may be the best option. (Essery R. et al., 2017) Going to a gym may be a better choice for those who find too many distractions at home and other things to do besides the workout, like laundry, checking the phone, cleaning, etc. Working out at home is convenient; it takes driving out of the equation, changing into gym clothes, and going at the right time. However, the gym provides fewer distractions, community access, equipment like weights and cardiovascular machines, and group fitness classes. Each has pros and cons.

Pros and Cons – The Gym

Pros

Gym features and resources
Motivation
Focus
Classes
Community

Cons

Membership fees
Inconvenience
Too many people

Pros of a Gym

Features and Resources

Exercise can be so much easier when there are plenty of options.
There are various machines, such as treadmills, ellipticals, stair climbers, stationary bikes, and rowing machines.
Weights and machines, free weights, cable machines, bands, and more.

Motivation

Paying for a membership can be a motivating factor to regularly working out.
There is a friendly, competitive vibe with the other members who can help motivate each other.

Focus

Exercising at the gym can help maintain focus on fitness goals.
No chores, kids, or distractions to break off from the workouts.

Classes

Working out in a class can increase motivation and make working out fun.
There are online classes for working out at home, but it’s not the same as going to the gym and being around people.
Other features like a swimming pool, hot tub, tennis courts, etc may be available.

Community

Working out with others can give a sense of community.
People draw energy from others, pushing us to work harder.

Cons of a Gym

Gym membership drawbacks.

Cost

Membership fees can cause stress.
Some high-end gyms charge more than $100 monthly, while smaller gyms may charge only $10.

Inconvenience

Going to the gym includes packing a bag, driving there, parking, and waiting for the machines, weights, etc.
Total time will be longer because of the drive time.

Too Many People

At times, the gym can be packed with people.
Sometimes, individuals talk too loudly on their phones, leave sweat on the machines, and do not put weights away.
These could be the days or nights to work out at the house.

At Home Workouts

Pros

Cost
Convenience
Mix workouts

Cons

Space
Excuses
Boredom

Pros at Home

For some, home workouts could be the better option, and the benefits include:

Cost

There’s no membership fee.
Individuals can do bodyweight workouts that require no equipment.
Develop a house gym with inexpensive resistance bands, a few weights, and an exercise ball.

Convenience

Individuals do not have to get their gym bag, drive, and arrange for child care.
Individuals can work out in pajamas or underwear.
Individuals can also work out whenever they like if they need to split their workouts or work out at a specific time.

Mix Workouts

Although gyms also mix things up, individuals can do it at home at their convenience.
Combining weights and cardio and finishing up with yoga.
Individuals can go outside, watch exercise videos, stream live classes, use fitness mirrors, play exercise games, or download workout apps.
There is also versatile home gym equipment.

Cons at Home

These can cause individuals to lose home workout motivation.

Space

Although not much space is needed to work out, wanting to use a treadmill or other large equipment might not be practical, which could lead to boredom.

Excuses

There can be endless excuses to skip a workout.
Individuals who are not self-motivated might avoid workouts with chores or other important home tasks.

Boredom

At a gym, there is energy potential that motivates individuals to move.
If there is not enough exercise variety at home, boredom can set in.

Injury Medical Chiropractic and Functional Medicine Clinic

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

The Right Way To Implement an Exercise Prescription

References

Essery, R., Geraghty, A. W., Kirby, S., & Yardley, L. (2017). Predictors of adherence to home-based physical therapies: a systematic review. Disability and rehabilitation, 39(6), 519–534. https://doi.org/10.3109/09638288.2016.1153160

When to Replace Walking Shoes: Maintaining Optimal Support

By

Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP

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Close-up portrait of young woman in sportswear, jogging in the park by the sea, holding a smartphone — Close-up portrait of a young woman in sportswear, jogging in the park by the sea, holding a smartphone, talking on the phone. The concept of sports and communications. Cyberspace. Sunbeam of light.

For individuals who enjoy walking for exercise and health, can knowing when to replace walking shoes help protect their feet and prevent musculoskeletal injuries?

Replacing Walking Shoes

The best walking shoes must be replaced to ensure musculoskeletal health and prevent injuries. Wearing worn-out shoes during prolonged standing, distance walking or running, and high-impact workouts can exacerbate lower back stiffness, soreness, and pain. Comfortable walking shoes offer substantial support and superior cushioning, working to alleviate discomfort and prevent injury. However, they break down cushioning and support with each step. When an individual walks or runs 500 miles, most athletic shoes are ready for replacement and should be recycled or saved for non-exercise purposes.

500-Miles

Most athletic shoes are built to last 350 to 500 miles. (Cook, S. D., Kester, M. A., and Brunet, M. E. 1985) Walkers’ feet don’t impact their feet as hard as runners’, but individuals are unlikely to feel support and cushioning past 500 miles. Weight is also a factor; the more an individual weighs, the faster their shoes wear down.

It is recommended that individuals who walk 30 minutes daily or an average of three to four hours a week replace their shoes every six months.
Individuals who walk 60 minutes daily or seven hours weekly replace their shoes every three months.
Replace walking shoes every three to six months or every 500 miles.

Shoe Wear

When athletic shoes are glued together, they start to wear from the factory to the stores as the adhesive dries out. The air pockets in the cushioning slowly begin to dissipate. Walking shoes are often on sale when old models are discontinued and may already be over a year old. To get the longest life, buy the current model and ask staff how long they have been on the shelf.

Shoe Care

Shoes can last longer by following a few guidelines:

Use walking Shoes only for Walking Exercise

It is recommended not to wear them for daily use.
Use them only for walking.
Wearing them all day exposes them to foot moisture and bacteria, breaking them down faster.

Air Out Shoes Between Uses

Store walking shoes where they are exposed to air so they can dry out completely between uses.
Keeping them in a gym bag won’t allow them to breathe.

Wash Shoes and Air Dry

When washing walking shoes, use gentle soap and cold water to prevent the glue from breaking down.
Always air dry rather than placing them in a dryer.
Avoid heat, as this will contribute to faster glue breakdown.

Replace the Insoles

Individuals who prefer custom insoles should replace them each time shoes are replaced.
However, changing the insole is not a substitute for replacing the shoe.
Cushioning insoles do not provide the same support.
A new insole will not fix a broken-down walking shoe.

Rotate Walking Shoes

Alternate walking shoes every one to two months. The feet sense the difference when the older pair begins to break down. For individuals who walk one or more times daily, alternating shoes allow each pair to dry out fully between uses. Having two pairs of walking shoes to alternate will keep you from replacing them more frequently.

Signs It’s Time

Many wait until their shoes look worn out, with holes and torn laces, before considering replacing them. Here are a few guidelines for when to replace walking shoes:

Worn Tread

Many of today’s walking shoes change color through the sole to alert the individual.
If green turns to pink or some other combination, it’s time to replace the shoes.

Overpronation or Supination

This can lead to the heel of the shoe being worn down on one side more than the other.
This can affect your gait, making it important to replace your walking shoe.

Wrinkles On The Side or Bottom Of The Sole

The breakdown of support and cushioning can cause this.

Weak Ankle Support

This is usually from the uppers being broken down around the ankle.

Wear Patterns

Where and how the soles and heels of walking shoes are worn can tell a foot and shoe professional which shoes the individual should wear. It is recommended that used shoes be taken to the shoe store. They can indicate overpronation, a neutral gait, or supination.

Risks

The risks of wearing worn-out walking shoes include:

Lack of cushioning and support can lead to foot, knee, or leg pain.
Injuries include plantar fasciitis and iliotibial band syndrome. (Rethnam, U., and Makwana, N. 2011)
Individuals who notice new soreness and aches may indicate that the shoes need replacing.

Recycling

Keeping one or two pairs of used walking shoes is great for household chores. They can also be recycled or donated. Recycled walking shoes are used to make playground and track surfaces. Look for a shoe bin at a community recycling center or athletic shoe store. Shoes in decent condition can be donated to charity clothing centers.

Injury Medical Chiropractic and Functional Medicine Clinic

At Injury Medical Chiropractic and Functional Medicine Clinic, our areas of practice include Wellness & Nutrition, Chronic Pain, Personal Injury, Auto Accident Care, Work Injuries, Back Injury, Low Back Pain, Neck Pain, Migraine Headaches, Sports Injuries, Severe Sciatica, Scoliosis, Complex Herniated Discs, Fibromyalgia, Chronic Pain, Complex Injuries, Stress Management, Functional Medicine Treatments, and in-scope care protocols. We focus on what works for you to achieve improvement goals and create an improved body through research methods and total wellness programs. If other treatment is needed, individuals will be referred to a clinic or physician best suited to their injury, condition, and/or ailment.

Custom Foot Orthotics Benefits

References

Cook, S. D., Kester, M. A., & Brunet, M. E. (1985). Shock absorption characteristics of running shoes. The American journal of sports medicine, 13(4), 248–253. https://doi.org/10.1177/036354658501300406

Rethnam, U., & Makwana, N. (2011). Are old running shoes detrimental to your feet? A pedobarographic study. BMC research notes, 4, 307. https://doi.org/10.1186/1756-0500-4-307

Level Up Your Everyday Routine with Daily Massage Gun Self Care

By

Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP

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Girl at home holding a therapeutic percussion vibrating massage gun in her hand and massaging her back muscles Sports recovery concept after a workout. . High quality photo

Therapeutic massage guns are great for athletes and fitness enthusiasts. Can daily massage gun use be incorporated into a daily routine?

Table of Contents

Daily Massage Gun Use

Athletes or individuals participating in recreational sports and exercise may want to consider adding a massage gun to their daily routine. Massage guns create short, repeated bursts of pressure on certain areas of the body. Most massage guns have multiple settings to allow for different preferences and levels of intensity. They can help by warming up the muscles and during recovery. While the benefits are still being researched, daily massage gun therapy can improve the quality of physical activity, exercise, and life.

Benefits

Because massage guns work by softly and repeatedly stimulating or massaging the muscles, they are gentle enough to use daily as long as they are used correctly. They offer several benefits, including increasing physical ability and reducing recovery time. One study found that consistently using a massage gun increased the quality of life in fibromyalgia patients, indicating potential beyond exercise and sports. (Kraft, K., Kanter, S., and Janik, H. 2013) Some of the benefits include:

Decrease Muscle Soreness

Delayed-onset muscle Soreness/DOMS is a feeling of soreness experienced after a workout or intense manual labor. An example is waking up and feeling sore from work or exercising the previous day (National Academy of Sports Medicine, 2024). A study compared the effectiveness of vibration and massage therapy on DOMS. Both were found to be equally effective in preventing delayed onset muscle soreness. (Imtiyaz, S., Veqar, Z., and Shareef, M. Y. 2014)

Help Prevent Muscle Fatigue

Muscle fatigue occurs when the muscles are overworked and cannot function. Reduced muscle performance can lead to shorter workouts and injuries. A study on non-athletic males found that massage therapy helped prevent or reduce muscle fatigue. Researchers also found that different massage gun settings prevented or prolonged the onset of muscle fatigue. (Otadi, K. et al., 2019)

Increase Range of Motion

Range of motion/ROM describes the flexibility of a muscle or joint in the body. When engaging in physical activity or exercise, it is vital to know and consider the range of motion of the joints to ensure proper form and decrease the risk of injury. One study found that massage therapy can improve joint performance by increasing an individual’s range of motion. (Lyu, B. J. et al., 2020) The performance of the joints depends in part on the muscles that expand and contract to move it. Another research study found that a five-minute massage on certain muscle groups improved muscle performance and range of motion. (Konrad, A. et al., 2020)

Increase Muscle Strength and Endurance

Muscle strength and endurance are key components of a healthy musculoskeletal system and are essential to avoid straining or overworking muscles. Muscle strength describes the immediate performance of a muscle or muscle group, and muscle endurance describes how long performance can be sustained. (Lyu, B. J. et al., 2020) Massage therapy has been shown to improve muscle strength and endurance by helping increase immediate performance and the number of repetitions an individual can endure. (García-Sillero, M. et al., 2021)

Improve Agility

Agility is the ability to accelerate, decelerate, stabilize, and quickly change directions while maintaining proper posture. (National Academy of Sports Medicine, 2024) It is a skill that needs to be developed. One study found that engaging in massage therapy before a workout could improve agility. (Lyu, B. J. et al., 2020)

Daily Use

A massage gun is safe to use daily as long as it is used properly. Using a massage device correctly will improve effectiveness and prevent discomfort or injury. Recommended daily usage of a massage gun includes:

Set the massage gun to the lowest setting.
Use a light touch.
Adjust the speed to comfort level, ensuring there is no pain.
Focus the massage gun on an area for 10 to 30 seconds.
Hover it across the muscle or tendon to allow the vibrations to do their job.
Do this over the desired areas as part of a warm-up and cool-down.

Safety

While massage guns are useful for warmups and workout recovery, they should be used cautiously. Individuals should use massage guns over muscles and not on bony or sensitive areas. Individuals should avoid massaging around vital organs and/or inflamed body areas as these areas could cause a jarring or uncomfortable sensation and lead to injury. If the massage gun is causing bruising, sensitivity, or discomfort, stop using it and allow the body to recover before trying again. If pain persists, talk to a healthcare provider or a physical therapist. They can determine what is causing issues, whether a massage gun is being used correctly, and whether it is an appropriate self-care treatment for the individual. There are situations where using a massage gun is not advised. Individuals should talk to a healthcare provider before using the device if they have any of the following:

Have a musculoskeletal condition like osteoporosis or arthritis.
Take blood thinners.
Have anemia.
Have other blood-related conditions.
Are older than 65.
Take several medications.
Have a broken bone or a fracture.
Have varicose veins or a history of deep vein thrombosis.

Using a massage gun can help improve performance and reduce recovery time and can be incorporated into a daily routine.

Injury Medical Chiropractic and Functional Medicine Clinic

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

Enhance Your Lifestyle With Chiropractic!

References

Kraft, K., Kanter, S., & Janik, H. (2013). Safety and effectiveness of vibration massage by deep oscillations: a prospective observational study. Evidence-based complementary and alternative medicine : eCAM, 2013, 679248. https://doi.org/10.1155/2013/679248

National Academy of Sports Medicine. Kaminski, J. (2024). Muscle soreness & DOMS. NASM. https://blog.nasm.org/doms-muscle-sorenes

Imtiyaz, S., Veqar, Z., & Shareef, M. Y. (2014). To Compare the Effect of Vibration Therapy and Massage in Prevention of Delayed Onset Muscle Soreness (DOMS). Journal of clinical and diagnostic research : JCDR, 8(1), 133–136. https://doi.org/10.7860/JCDR/2014/7294.3971

Otadi, K., Ghasemi, M., Jalaie, S., Bagheri, H., Azizian, M., Emamdoost, S., Sarafraz, H., & Sepahvand, M. (2019). A prophylactic effect of local vibration on quadriceps muscle fatigue in non-athletic males: a randomized controlled trial study. Journal of physical therapy science, 31(3), 223–226. https://doi.org/10.1589/jpts.31.223

Lyu, B. J., Lee, C. L., Chang, W. D., & Chang, N. J. (2020). Effects of Vibration Rolling with and without Dynamic Muscle Contraction on Ankle Range of Motion, Proprioception, Muscle Strength and Agility in Young Adults: A Crossover Study. International journal of environmental research and public health, 17(1), 354. https://doi.org/10.3390/ijerph17010354

Konrad, A., Glashüttner, C., Reiner, M. M., Bernsteiner, D., & Tilp, M. (2020). The Acute Effects of a Percussive Massage Treatment with a Hypervolt Device on Plantar Flexor Muscles’ Range of Motion and Performance. Journal of sports science & medicine, 19(4), 690–694.

García-Sillero, M., Jurado-Castro, J. M., Benítez-Porres, J., & Vargas-Molina, S. (2021). Acute Effects of a Percussive Massage Treatment on Movement Velocity during Resistance Training. International journal of environmental research and public health, 18(15), 7726. https://doi.org/10.3390/ijerph18157726

National Academy of Sports Medicine. Miller, K. (2024). Speed, agility, and quickess: SAQ. NASM. https://blog.nasm.org/sports-performance/speed-agility-quickness-saq

The Distinct Nutritional Makeup of Honey and Maple Syrup

By

Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP

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A stack of plain mini pancakes served with honey, maple syrup and jam over a white background.

For individuals who like sweet foods but want to maintain health, how do honey and maple syrup compare nutritionally?

Table of Contents

Honey and Maple Syrup

Reducing sugar intake is recommended for overall health, but that does not mean eliminating sweeteners completely for most. Honey and maple syrup can flavor various dishes, baked goods, beverages, and more. Because of their natural origins, honey and maple syrup can seem interchangeable as they are brown, thick, and sweet. Maple syrup and honey can be part of a healthy diet in moderation, sweetening everything from breakfast to dinnertime dishes. Depending on individual dietary goals or taste preferences, individuals may have a personal favorite, but neither is better than the other. The nutritional makeup of these two sweeteners is distinct, and there are recommended practices for when to include each in cooking and baking.

Nutrition

Honey is slightly higher in calories, carbohydrates, and sugar than maple syrup and somewhat lower in fat. Maple syrup comprises more micronutrients, such as calcium and manganese, but it also has more sodium than honey. Nutrition information for

One tablespoon of maple syrup (20 grams) (U.S. Department of Agriculture, 2018)
Honey (21 grams) (U.S. Department of Agriculture, 2018).

For food-labeling purposes, honey and maple syrup have different serving sizes:

One tablespoon of honey
1/4 cup of maple syrup

Nutritional Comparison

Honey 1 tbsp. Maple syrup 1 tbsp.

Calories: 64 – 52
Fat: 0g – >1g
Sodium: >1mg – 2.4mg
Carbohydrates: 17.3g – 13.4g
Fiber: >1g – 0g
Sugars: 17.2g – 12.1g
Protein: >1g – >1g
Calcium: 1.26mg – 20.4mg
Manganese: 0.17mg – 0.582mg
Zinc: 0.046mg – 0.294mg
Riboflavin: 0.008mg – 0.254mg

Similarities

Honey and maple syrup are similar liquid sweeteners nutritionally. Both contain no substantial amount of fat or protein, with carbohydrates from sugar supplying all their calories. Both also contain some micronutrients and antioxidants. Research has revealed promising levels of antioxidants in honey (Schramm, D. D. et al., 2003) and maple syrup (Li, L., and Seeram, N. P. 2011) that could contribute to reducing oxidative stress, a key component in preventing some chronic diseases.

Differences

The nutrition differences between maple syrup and honey are more significant. Although a tablespoon of honey has only eight more calories than maple syrup, this can add up depending on the amount used. In a quarter cup, honey contains 32 more calories than maple syrup or 128 more calories in 1 cup. The carbohydrate count of maple syrup and honey is similar, but there is a difference of one teaspoon of added sugar. Honey and maple syrup are not identical in micronutrient levels. Honey contains small amounts of vitamins C and B, but individuals would have to consume a lot of honey to receive the benefits. In 100 grams, around five tablespoons of honey, individuals receive about 1% of the RDA for vitamin C. Maple syrup is a healthy source of manganese, riboflavin, and zinc.

Health Benefits

Honey Health Benefits

Honey’s antioxidants help clean cells of damaging free radicals. It can also be used as food and medicine during cold and flu season. Research has shown that a spoonful could be a more effective treatment for a cough than over-the-counter medications. (Oduwole, O. et al., 2018) Those with allergies may want to consider visiting a local beekeeper. While inconclusive, some studies (Asha’ari, Z. A. et al., 2013) have found that eating local raw honey can help improve seasonal allergy symptoms.

Maple Syrup Health Benefits

Maple syrup offers health benefits, particularly because it contains high amounts of manganese and riboflavin. Manganese is a trace mineral the body does not need very much of but does need to operate efficiently. It is essential to bone and tissue formation, blood clotting, proper immune response, and sexual function. Riboflavin helps create usable energy from food and could help prevent cancer and migraines. (National Institutes of Health Office of Dietary Supplements, 2022) Maple syrup also offers benefits for individuals with certain chronic health conditions. Its lower glycemic index makes it recommended for those with diabetes or other blood sugar conditions. Because of the type of sugar it contains, those with irritable bowel syndrome/IBS may be able to digest maple syrup better than honey. Maple syrup and honey both contain simple sugars; however, fructose in honey may not be digested as well in individuals with IBS who need a low FODMAP diet.

Preparation and Cooking

Honey and maple syrup have distinctive flavors, so the individual can choose where and when to use each. Maple syrup has a more earthy, woodsy taste, while honey has floral hints and a thicker texture. Honey does well in salad dressings and marinades, where it can cling to other foods, whereas maple syrup blends easily in baked goods. Both work well in various food preparations. Rules of thumb for using honey and maple syrup include:

Both can be used in place of sugar as long as the liquid in the recipe is adjusted.
For every cup of sugar replaced by honey or maple syrup, decrease other liquid ingredients by three to four tablespoons.
Scaling back a little is recommended if using either as a substitute for table sugar.
Both maple syrup and honey are sweeter than sugar; replacing sugar requires only three-fourths of either.

Lifestyle and Safety

Sometimes, when to use honey and maple syrup has nothing to do with nutrition or taste. Vegans, for example, often choose not to consume honey because it’s an insect by-product. A vegan lifestyle may prefer maple syrup, which is 100% plant-based. Parents of infants under one should keep honey off the menu. Honey can contain small amounts of the bacteria Clostridium botulinum, which can cause botulism poisoning in babies; for babies under 12 months old, maple syrup or other sweeteners are recommended in baked goods or cooked meals. However, while honey can be harvested almost anywhere honeybees live, maple syrup is native only to a small region of eastern North America, and obtaining the syrup may not be possible.

Injury Medical Chiropractic and Functional Medicine Clinic

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

Balancing Body and Metabolism

References

U.S. Department of Agriculture, FoodData Central. (2018). Syrups, maple. Retrieved from https://fdc.nal.usda.gov/fdc-app.html#/food-details/169661/nutrients

U.S. Department of Agriculture, FoodData Central. (2018). Honey. Retrieved from https://fdc.nal.usda.gov/fdc-app.html#/food-details/169640/nutrients

Schramm, D. D., Karim, M., Schrader, H. R., Holt, R. R., Cardetti, M., & Keen, C. L. (2003). Honey with high levels of antioxidants can provide protection to healthy human subjects. Journal of agricultural and food chemistry, 51(6), 1732–1735. https://doi.org/10.1021/jf025928k

Li, L., & Seeram, N. P. (2011). Further investigation into maple syrup yields 3 new lignans, a new phenylpropanoid, and 26 other phytochemicals. Journal of agricultural and food chemistry, 59(14), 7708–7716. https://doi.org/10.1021/jf2011613

Oduwole, O., Udoh, E. E., Oyo-Ita, A., & Meremikwu, M. M. (2018). Honey for acute cough in children. The Cochrane database of systematic reviews, 4(4), CD007094. https://doi.org/10.1002/14651858.CD007094.pub5

Asha’ari, Z. A., Ahmad, M. Z., Jihan, W. S., Che, C. M., & Leman, I. (2013). Ingestion of honey improves the symptoms of allergic rhinitis: evidence from a randomized placebo-controlled trial in the East coast of Peninsular Malaysia. Annals of Saudi medicine, 33(5), 469–475. https://doi.org/10.5144/0256-4947.2013.469

National Institutes of Health Office of Dietary Supplements. (2022). Riboflavin: Fact sheet for health professionals. Retrieved from https://ods.od.nih.gov/factsheets/Riboflavin-HealthProfessional/

Tabata Training: A Complete Guide for Quick and Intense Workouts

By

Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP

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

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

Table of Contents

Tabata Training

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

Protocol Format

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

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

Energy Systems

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

Safety Precautions

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

Workout Tips

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

Warm-Up

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

Start Slow

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

Rest Between Sets

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

Monitor Intensity Frequently

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

Take Rest Days

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

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

Injury Medical Chiropractic and Functional Medicine Clinic

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

Improving Athletic Performance Through Chiropractic

References

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

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

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

How to Make Ramen Noodles Healthier and More Nutritious

By

Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP

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

Table of Contents

Ramen Noodles

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

Nutrition

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

Healthy Ramen Makeover

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

Recipe

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

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

Try out other Recipes

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

Injury Medical Chiropractic and Functional Medicine Clinic

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

Atherosclerosis: The Joint Pain Connections

References

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

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

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

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

The Power of Osmotic Laxatives: Relieving Constipation Effectively

By

Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP

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

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

Table of Contents

Osmotic Laxative

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

How They Work

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

How Are They Different?

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

Emollient

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

Lubricant

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

Stimulant

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

Osmotic Laxatives

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

Polyethylene Glycol – PEG

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

Lactulose

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

Sorbitol

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

Magnesium Citrate

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

Magnesium Hydroxide

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

Potential Side Effects

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

Abdominal cramping
Bloating
Nausea
Diarrhea
Flatulence

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

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

Poop Testing: What? Why? and How?

References

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

Managing Gluteal Contusion: Rest and Rehabilitation

By

Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP

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

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

Table of Contents

Gluteal Contusion

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

Symptoms

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

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

Causes

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

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

Diagnosis

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

Grade I

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

Grade II

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

Grade III

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

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

Treatment

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

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

Prognosis

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

Healing Time and Recovery

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

Grade I

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

Grade II

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

Grade III

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

Injury Medical Chiropractic and Functional Medicine Clinic

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

Building a Stronger Body

References

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

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

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

Using the Oswestry Disability Index to Evaluate Lower Back Pain

By

Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP

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

Oswestry Disability Questionnaire

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

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

How The Questionnaire Works

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

Pain Intensity

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

Personal Care

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

Lifting

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

Walking

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

Sitting

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

Standing

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

Sleeping

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

Social Life

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

Traveling

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

Employment and/or Homemaking Duties

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

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

Scores

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

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

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

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

No Disability

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

Mild Disability

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

Moderate Disability

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

Severe Disability

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

Completely Disabled

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

Injury Medical Chiropractic and Functional Medicine Clinic

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

Optimizing Your Wellness

References

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

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

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

Choosing the Right Rheumatologist for Back Pain

By

Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP

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

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

Table of Contents

Rheumatologist

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

What Do They Do?

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

Inflammatory
Autoimmune
Related to painful joint disease

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

Symptoms

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

Redness
Swelling
Pain
Stiffness
Loss of joint function

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

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

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

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

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

Conditions

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

Rheumatoid arthritis (RA)

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

Ankylosing Spondylitis (AS)

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

Axial Spondylitis

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

Psoriatic Arthritis (PsA)

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

Reactive Arthritis

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

Enteropathic Arthritis

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

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

Lupus
Sjögren’s syndrome
Hashimoto’s thyroiditis

Finding a Doctor

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

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

Preparing For The Initial Visit

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

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

Injury Medical Chiropractic and Functional Medicine Clinic

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

Quick Patient Initiation Process

References

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

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

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

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

Household Tasks and Back Health: Ergonomic Tips

By

Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP

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

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

Table of Contents

Household Chores

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

Vacuuming

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

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

Dusting

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

Laundry

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

Dishes

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

Sweeping

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

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

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

Injury Chiropractic and Functional Medicine Clinic

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

Heel Spurs

References

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

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

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

Exploring Antalgic Gait: Causes and Solutions

By

Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP

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

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

Table of Contents

Antalgic Gait

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

Walking

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

Causes and Symptoms

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

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

Common Causes include:

Hip, knee, and/or Foot problems

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

Sprains, Strains, or Soft-tissue Injuries

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

Osteoarthritis

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

Lower Back Radiculopathy

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

Other causes include:

Broken bones
Tumors
Infections
Blood clots
Vascular issues

Treatment

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

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

Injury Medical Chiropractic and Functional Medicine Clinic

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

Chiropractic and Integrative Healthcare

References

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

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

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

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

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

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

White Rice: An Essential Fuel for Athletes and Bodybuilders

By

Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP

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

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

Table of Contents

Sports Nutrition White Rice

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

Bodybuilders

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

Fuel and Muscle Recovery

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

Safe Carbohydrate

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

Workouts

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

Brown Rice

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

Injury Medical Chiropractic and Functional Medicine Clinic

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

Sports Nutrition and Dietitian

References

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

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

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

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