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Take Your Fitness to the Next Level with Sprint Exercise Training

By
Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP
-
Active young brunette in sport clothes standing on yoga mat and making criss cross crunches exercise. Multiracial healthy woman training abs during domestic workout.

For individuals who don’t have time for a full workout, could incorporating sprint exercise training be an option to improve their cardiovascular and overall health?

Take Your Fitness to the Next Level with Sprint Exercise Training

Sprint Exercise Training

Most think of running when they hear the word sprinting. However, sprinting can be performed in any aerobic activity, whether swimming, cycling, rollerblading, or exercising on an elliptical machine. Sprint exercise training means varying the intensity levels of the activity. It is also known as sprint interval training or speed drills. It targets cardiovascular endurance and is suitable for all fitness levels, from beginners to advanced. This type of training is demanding and requires high motivation, but it can lead to significant improvements and help achieve fitness goals faster.

Sprint workouts are a time saver. Many exercise guidelines recommend up to 60 minutes of moderate exercise 3 times a week; however, many people don’t have the time. Studies have shown that short, high-intensity sprint exercise training improves aerobic capacity and endurance in half the time of traditional endurance exercise. Sprint exercise training burns calories, improves cardiovascular health, builds muscle, and increases speed and power. Sprint workouts are great for individuals who lack time for traditional steady endurance exercise but want to improve cardiovascular health. (Vollaard, N. B. J., and Metcalfe, R. S. 2017) Adding them to a workout routine can take training to a new level.

Training

The key to sprint training is performing an activity at a certain percentage of all-out effort to increase heart rate. Sprint exercise training is recommended three times a week, with at least one to two days of rest or other easy exercises between sprint workouts. How to do.

Warm-up

  • Warm up with easy exercise for five to 10 minutes.
  • Slowly perform the exercise that will be done for the sprints to prepare the body for the intense sprint.

Do the First Sprint

  • Perform the first sprint at around 60% intensity.
  • Slow down and continue warming up if there is muscle tightness or joint pain.

Rest

  • Recover for four minutes by slowing to a comfortable pace, but continue moving.

Do the Second Sprint

  • Perform the next sprint at 80% max intensity.

Rest

  • Rest for four minutes.

Do the Third Sprint

  • Perform the remainder of the sprints at 100% intensity or all-out efforts for 30 seconds.
  • Push to the maximum for each exercise.

Rest

  • Recover for four minutes after each sprint to slow down breathing and heart rate, and can hold a conversation without gasping.

Repeat

  • Repeat the sprint/recovery routine four to eight times, depending on fitness level and ability.
  • For the first workout, stop at four sprints.
  • Gradually build up to eight.

Benefits

Sprint exercise training enhances endurance performance and can be effectively used by athletes, fitness enthusiasts, and individuals who want to improve their fitness and health. (Litleskare, S. et al., 2020) In one study, participants who completed eight weeks of sprint training saw improvements in maximal oxygen uptake or VO2 max. The test is one way to measure cardiovascular fitness. (Litleskare, S. et al., 2020) These short bursts of intense exercise improve muscle health and performance comparable to several weeks of traditional training. (Gunnarsson, T. P. et al., 2013) Other studies have found that short, high-intensity exercise burns more calories than the same amount of moderate-level cardiovascular exercise. (Vollaard, N. B. J., and Metcalfe, R. S. 2017)

Variations

There are different ways to structure a sprinting routine, and different fitness goals will determine the intensity, duration, and number of sprints that should be performed.

Beginners

Those new to sprinting should start slow, as overdoing it can lead to injury. Work on building up a base level of fitness before introducing sprinting into an exercise routine. Start with one set of four sprint/rest cycles when trying sprints. As fitness goals are achieved, add more sprints to each set or different sprints.

Intermediate

Once a sprinting exercise routine is begun, it may only be a few weeks before one is ready to advance to an intermediate level. Try increasing the number of sprints at different intensity levels. However, avoid sprint exercises too often weekly as the body needs adequate rest.

Advanced

Advanced athletes can intensify the routine by increasing intensity and adding reps. One way is by adding resistance. For example, for those running or cycling, try sprinting hills, or if rollerblading, try wearing wrist and ankle weights to increase the load. Swimmers can use strength-building techniques to focus on specific body areas or add resistance. The intensity of any sprinting activity can be intensified by wearing a weighted vest.

Beginner Errors

A few common starting mistakes include going too hard, advancing too quickly, and doing too many for too long. Sprints are not meant to replace moderate-intensity exercise. The goal is to modulate the intensity of aerobic activities. A study showed that not getting enough rest between sprints led to an inability to perform as well during sprinting. (Selmi, M. A. et al., 2016)

Safety

Sprint workouts can be done with running, swimming, cycling, or other aerobic cardiovascular exercises. The following precautions should be considered before adding sprint training to a workout schedule:

Safety

  • Because sprinting is a high-intensity exercise, it is recommended that individuals consult with a healthcare professional and review the physical activity readiness questionnaire (PAR-Q) before beginning a sprint training workout.

Base Fitness

  • A strong fitness base in the sprint activity is also important.
  • To build a fitness base, follow the 10% rule and gradually increase training volume.

Frequency

  • Because of the intensity, sprint workouts should not be done more than three times a week.

Muscle Soreness

  • Launching into a sprint program can cause delayed-onset muscle soreness.
  • Experts recommend having about three to four weeks of base fitness before beginning.
  • Injuries are more likely if the body isn’t properly prepared.

The goal is to do a sprint workout six times in two weeks, then only perform 2 times a week for maintenance for six to eight weeks before changing the workout. On the days following a sprint workout, aim for 20–30 minutes of the same aerobic activity at an easier pace to help recover but maintain results. If pleased with the results, continue with the routine longer, but it is recommended to vary the workouts every few months and throughout the year. Modify the routine to find what works best.

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References

Vollaard, N. B. J., & Metcalfe, R. S. (2017). Research into the Health Benefits of Sprint Interval Training Should Focus on Protocols with Fewer and Shorter Sprints. Sports medicine (Auckland, N.Z.), 47(12), 2443–2451. https://doi.org/10.1007/s40279-017-0727-x

Litleskare, S., Enoksen, E., Sandvei, M., Støen, L., Stensrud, T., Johansen, E., & Jensen, J. (2020). Sprint Interval Running and Continuous Running Produce Training Specific Adaptations, Despite a Similar Improvement of Aerobic Endurance Capacity-A Randomized Trial of Healthy Adults. International journal of environmental research and public health, 17(11), 3865. https://doi.org/10.3390/ijerph17113865

Gunnarsson, T. P., Christensen, P. M., Thomassen, M., Nielsen, L. R., & Bangsbo, J. (2013). Effect of intensified training on muscle ion kinetics, fatigue development, and repeated short-term performance in endurance-trained cyclists. American journal of physiology. Regulatory, integrative and comparative physiology, 305(7), R811–R821. https://doi.org/10.1152/ajpregu.00467.2012

Selmi, M. A., Haj, S. R., Haj, Y. M., Moalla, W., & Elloumi, M. (2016). Effect of between-set recovery durations on repeated sprint ability in young soccer players. Biology of sport, 33(2), 165–172. https://doi.org/10.5604/20831862.1198636

The Clinical Approach and the Role of Nursing in Healthcare

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

How do healthcare professionals provide a clinical approach in the role of nursing to reducing pain in individuals?

Introduction

The practice of Registered Nurses (RN), Advanced Practice Registered Nurses (APRN), and Licensed Practical Nurses (L.P.N.) is governed by the Nurse Practice Act. Nurses working in the specializations above must keep up their practice skills and knowledge, which includes familiarity with the rules and regulations that pertain to their profession. Practicing practical nursing is authorized for Licensed Practical Nurses (L.P.N.s). Today’s article looks at the role of nursing. We discuss with certified associated medical providers who consolidate our patients’ information to assess any pain or discomfort they are experiencing. We also inform and guide patients while asking their associated medical provider intricate questions to integrate into their personalized treatment plan to manage the pain. Dr. Jimenez, DC, includes this information as an academic service. Disclaimer.

 

The Roles In Nursing

The Nurse Practice Act describes practical nursing as “the performance of selected various actions, including the administration of numerous treatments and medications, in the care of the ill, injured, and providing the promotion of wellness, health maintenance and prevention of illnesses while following under the direction of a registered nurse, a licensed physician, osteopathic physician, podiatric physician, or a licensed dentist.” It was revised in 2014 and now teaches broad health and wellness concepts to non-nursing students and the public. The main goal for an RN is to complement the access to health care for individuals in pain or who are dealing with chronic issues. (Cassiani & Silva, 2019)

 

Many individuals are under the supervision of a registered nurse, doctor, or dentist, individuals who have completed a prelicensure practical nursing education program approved by the Board, a professional nursing education program, and graduate practical nursing students qualifying as professional nursing students; however, licensed practical nurses who have not completed the specified course under Rule 64 B9-12.005, FAC, may perform a limited scope of intravenous therapy. This range consists of:

Intravenous Therapy Within the Scope of the Practical Nurse:

  • Calculate and adjust the flow rate of IV therapy.
  • Observe and report both subjective and objective signs of various reactions to IV administration to the patient.
  • Must inspect the insertion site, change the dressing, and remove the intravenous needle or catheter from the peripheral veins
  • Hanging bags or bottles of hydrating fluid.

Intravenous Therapy Outside the Scope of the Practical Nurse:

  • Initiation of blood and blood products
  • Initiation or administration of cancer chemotherapy
  • Initiation of plasma expanders
  • Initiation of administration of investigational drugs
  • Making IV solution
  • IV pushes, except for heparin flushes and saline flushes

It is appropriate for licensed practical nurses to provide treatment for patients undergoing such therapy, even though this rule restricts the practice of licensed practical nurses. 64B-12.005 Requirements for Competency and Knowledge required for the LPN to be qualified to give IV therapy. If the IV Therapy Course Guidelines published by the National Federation of Licensed Practical Nurses Education Department are completed, an LPN may be certified to administer IV therapy. The LPN can take part in further training to provide IV therapy via central lines while supervised by an RN. “The Central Lines. The Board acknowledges that a Licensed Practical Nurse, as defined in subsection 64B9-12.002, FAC, may provide intravenous therapy via central lines under a registered professional nurse’s supervision with the necessary education and training. Four hours of instruction is the minimum required for appropriate education and training. The thirty hours of education for intravenous therapy needed for this rule’s subsection may include four hours of training. At the very least, didactic and clinical practicum instruction in the following areas must be included in the education and training mandated by this subsection:

  • Central venous anatomy and physiology
  • CVL site assessment
  • CVL dressing and cap changes
  • CVL flushing
  • CVL medication and fluid administration
  • CVL blood drawing
  • CVL complications and remedial measures

The Licensed Practical Nurse will be evaluated on clinical practice, competency, and theoretical knowledge and practice after completing the intravenous therapy course via central lines. A Registered Nurse must witness the clinical practice assessment and file a proficiency statement on a Licensed Practical Nurse. The Licensed Practical Nurse will be evaluated on clinical practice, competence, and theoretical knowledge and practice. A Registered Nurse who oversees the clinical practice assessment must sign a proficiency statement attesting to the Licensed Practical Nurse’s competence in administering intravenous treatment through central lines. The applicant’s Licensed Practical Nurse personnel file must contain the proficiency statement. 64B9-12.005 code.

 

Professional nursing is practiced by registered nurses (RNs). The Nurse Practice Act defines this as “the performance of those numerous acts requiring substantial specialized knowledge, judgment, and nursing skill based upon the applied principles of psychological, biological, physical, and social sciences.” Professional nursing goes beyond hands-on care to include nursing diagnosis, planning, supervision, and training other staff members in the theory and execution of any tasks mentioned above. Additionally, nurses must use numerous experiences to assist patients with an understanding of empathy to make them feel comfortable and safe. (Torres-Vigil et al., 2021)

 

Delegations & Certificates For Nursing

The delegation of responsibilities to another healthcare provider or a competent unlicensed individual is permitted by the Florida Nurse Practice Act. When assigning a task or activity, the registered nurse (RN) or licensed practical nurse (L.P.N.) must consider appropriateness. They had to consider the possibility of patient injury, the difficulty of the work, the outcome’s predictability or unpredictability, and the resources—including staff and equipment—available in the patient environment. The RN and the LPN may assign tasks outside the supervising or delegating nurse’s scope of practice. These tasks include determining the nursing diagnosis or interpreting nursing assessments, developing the plan of care, establishing the goals of nursing care, and assessing the progress of the care plan. The role of nursing is to promote advocacy and create a direct relationship with patients. (Ventura et al., 2020)

464.0205 Retired Volunteer Nurse Certificate

A retired practical or registered nurse may apply for a retired volunteer certificate from the Board of Nursing to work with underprivileged, impoverished, or critically ill populations. They are directly supervised by a physician, advanced practice registered nurse, registered nurse, director of a county health department, and:

  • Provides services under the certificate only in sponsored settings that the Board has approved
  • The scope of practice for a certified volunteer is limited to primary and preventive health care by the Board.

A retired volunteer nurse shall not:

  • Administer controlled substances
  • Supervise other nurses
  • Receive monetary compensation

464.012 Advanced Practice Registered Nurse (APRN)

“The Barbara Lumpkin Prescribing Act” was proposed towards the end of 2018. This Act helps many practitioners convert a certificate to a license, and it takes effect on October 1, 2018. This Act established a transition timeline and process for practitioners certified as advanced registered nurse practitioners or clinical nurse specialists as of September 30, 2018, to practice as advanced practice registered nurses (APRNs). Until the department and Board complete the transition from certification to licensure, established under this Act, an advanced registered nurse practitioner who is holding a certificate to practice on September 30, 2018, may continue to practice with all the rights, authorizations, and responsibilities under this licensure section as an advanced practice registered nurse. They may also use the applicable title under s.464.015 after this Act’s effective date.

The Board of Nursing requires the following to establish an APRN license:

  • A nurse who wants to become an advanced practice registered nurse must apply to the APRN department, provide documentation that they meet the requirements set out by the Board, and have a valid license to practice professional nursing or an active multistate license to practice professional nursing by s. 464.0095.
  • Accreditation by a relevant specialty board. To become a certified nurse in any nursing department and to renew your current state license, you must first obtain this certification. For a duration deemed suitable for preparing for and passing the national certification examination, the Board may, by rule, grant certified registered nurse anesthetists, clinical nurse specialists, certified nurse practitioners, psychiatric nurses, and certified nurse midwives provisional state licensure.
  • Completing a master’s program in a clinical nursing specialty field and training in particular practitioner skills. For candidates who will graduate on or after October 1, 1998, paragraph (4)(a) requires completion of a master’s degree program to be eligible for initial certification as a certified nurse practitioner.

The Board of Nursing defines APRN’s role/duties:

  • Prescribe, dispense, administer, or order any medication; however, an advanced practice registered nurse is only permitted to prescribe or dispense the controlled substance as specified in s.893.03 if they have completed a master’s or doctoral program that provides training in specialized practitioner skills and leads to a master’s or doctoral degree in clinical nursing.
  • Initiate appropriate therapies for certain conditions.
  • Performed additional functions as may be determined by rule under s.464.003.
  • Order diagnostic tests and physical and occupational therapy.
  • Order any medication for administration to a patient in a facility.

Beyond the general duties mentioned in subsection (3), an APRN is qualified to carry out the following tasks within their area of expertise:

  • Within the confines of established protocol, the certified nurse practitioner may carry out any or all of the following actions:
  • Manage selected medical problems.
  • Order physical and occupational therapy.
  • Initiate, monitor, or alter therapies for certain acute illnesses.
  • To monitor and manage patients with stable chronic diseases.
  • Established behavioral problems and diagnoses and made treatment recommendations.

The Stature goes on to define the functions of anesthetists and nurse midwives. Refer to the Statue for more details.

 

Obtaining & Maintaining Nursing License

A license may be acquired through testing, endorsement, or the Nurse Licensure Compact’s enactment. Upon application and a non-refundable payment fee determined by the Board, the department will grant the necessary license by endorsement to engage in professional or practical nursing to the applicant who can provide proof to the Board that they:

  • Possesses a valid license to practice professional or practical nursing in another state or territory in the United States, provided that the requirements for licensure in that state were either more stringent or substantially equivalent to those in Florida when the applicant obtained their original license.
  • Fulfills the requirements outlined in s.464.008 for licensing and has passed a state, regional, or national exam that is at least as difficult as the one administered by the department.
  • Has spent two of the previous three years actively practicing nursing in a different state, territory, or jurisdiction within the United States without having any action taken against their license by any jurisdiction’s licensing body. Under this paragraph, applicants who obtain a permit must finish a board-approved Florida laws and rules course within six months of receiving their license. After reviewing the findings of the national criminal background check, the applicant will be granted the relevant license by endorsement as soon as the department determines that the applicant has no criminal history.

It will be assumed that any exams and requirements from other US states and territories are roughly the same or more demanding than those from this state. This assumption will materialize on January 1, 1980. The Board may, however, establish rules designating some states and territories, the qualifications and exams for which shall not be deemed to be substantially similar to those of this state.

 

When an individual submission of the appropriate application and fees, as well as the successful completion of the criminal background check that is required under subsection (4), an applicant for licensure by endorsement who is relocating to this state due to the official military orders of their spouse with a military connection and who is a member of the Nurse Licensure Compact in another state will have all the requirements satisfied.

 

The applicant must submit a set of fingerprints to the department on a form and per departmental rules. The applicant must also pay the department a sum equal to the expenses the Department of Health paid for the applicant’s criminal background check. For a statewide criminal history check, the Department of Health will send the applicant’s fingerprints to the Florida Department of Law Enforcement, and the Florida Department of Law Enforcement will forward the fingerprints to the FBI for a nationwide criminal history check. When an applicant satisfies all other requirements for licensure and has no criminal record, the Department of Health will review the results of the criminal history check, issue a license, and refer all other applicants who have a criminal history back to the Board for a decision on whether or not to issue a permit and under what circumstances.

 

Until the investigation is finished, at which point the requirements of s.464.018 will take effect, the department will not grant an endorsement license to any applicant who is being investigated in another state, jurisdiction, or territory of the United States for an act that would violate this part or chapter 456. After completing all necessary data collection and verification, the department will issue a license within 30 days. It will also develop an electronic applicant notification process and provide electronic notifications upon application receipt and completion of background checks. Suppose the applicant must appear before the Board because of information on their application or because of screening, data gathering, and verification procedures. In that case, the 30-day license issuance time will be extended. The qualifications for licensure by endorsement in this section do not apply to an individual with an active multistate license in another state under s. 464.0095.

 

Licensure By Examination

Anyone who wants to take the licensing exam to become a registered nurse must apply to the department. The department will assess each candidate who:

  • The applicant has fulfilled the requirements by filling out the application form and paying the $150 fee set by the Board. Additionally, they have paid the $75 examination fee set by the Board and the actual cost per applicant to the department for purchasing the exam from the NCSBN (National Council of State Boards of Nursing) or a comparable national organization.
  • Possesses enough information as of October 1, 1989, or later, which the department needs to provide to conduct a statewide criminal records correspondence check with the Department of Law Enforcement.
  • Possesses a high school diploma or its equivalent, is in good mental and physical health, and has fulfilled the prerequisites for:
  • Graduation from an approved program
  • Graduation from a pre-licensure nursing education program equivalent to an approved program determined by the Board.
  • Graduated on or after July 1, 2009, from an accredited program
  • Graduation before July 1, 2009, from a pre-licensure nursing education program whose graduates were eligible for examination.

Completing courses in a professional nursing education program may satisfy the educational criteria for licensing as a licensed practical nurse. Possesses the ability to communicate in English, as assessed by a department exam. Unless rejected by s.464.018, any applicant who passes the exam and has completed the educational requirements listed in subsection (1) is eligible to become a licensed practical nurse or registered professional nurse, as the case may be.

 

Regardless of the jurisdiction in which the examination is administered, any applicant who fails the test three times in a row will need to finish a remedial course approved by the Board to be eligible for reexamination. The candidate may be permitted to attempt the test up to three times after completing the remedial course before being forced to undertake remediation. After the remedial process, the applicant has six months to petition for a reexamination. By regulation, the Board will set requirements for remedial education.

 

An applicant who completes an approved program must be enrolled in and complete a board-approved licensure examination preparing course if they choose not to take the license examination within six months of graduation. The applicant cannot use federal or state financial aid to cover any course-related expenses; they are solely responsible for covering them. The Board will set rules for the preparatory courses for licensing exams. Section 464.0095 exempts an individual from the licensure requirements if they currently have an active multistate license in another state (2).

 

Licensure Upon Enactment of the Nurse Licensure Compact

Florida passed the Nurse Licensure Compact into law. This allows nurses to participate in 26 states’ licensing compacts. The call to remove the burdensome and redundant system of duplicate licensure and to advance public safety and health advantages led to the enactment of this law. The official statement is as follows:

  • “This agreement becomes operative and legally binding on December 31, 2018, whichever comes sooner, or on the day it is enacted into law by at least 26 states. Within six months following the implementation date of this compact, any member states that were also parties to the previous Nurse Licensure Compact (“prior compact”) that this compact replaced are considered to have withdrawn from the previous compact.”

Until a party state is withdrawn from the prior compact, each party state to this one shall respect a nurse’s multistate licensure privilege to practice in that party state granted under the preceding compact. Any party state may opt out of the compact by passing a law canceling it. A party state’s departure becomes effective six months after the repealing Act is passed. Any cooperative arrangement, including nurse licensure agreements, between a party state and a nonparty state that complies with the other conditions of this compact remains valid and unaffected by this compact. The party states may alter this contract. Only when it is incorporated into the laws of every party, state a modification to this compact is binding on the party states and becomes effective. Before all party states adopt this compact, representatives of nonparty states to the agreement will be invited to engage in commission activities without being able to vote.

 

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Continuing Nursing Education Requirement

Licenses need to be renewed every biennium or every two years. One contact hour must be completed for each calendar month of the licensure cycle in a given year. The hours stipulated in subsection (1) at the designated times must include the following continuing education courses as a necessary component:

  • A 2-hour course in prevention of medical errors must be completed each biennium.
  • A 1-hour course in HIV/AIDS in the first biennium only
  • A 2-hour course in Florida laws and rules in each biennium
  • Effective August 1, 2017, a 2-hour course in recognizing impairment in clinical approach and every other biennium after that.
  • On or after January 1, 2019, a 2-hour course on human trafficking and each biennium after that.
  • A 2-hour course in domestic violence is required every third biennium.

In addition, the Florida Board of Nursing requires general hours of continuing education to fulfill the requirement of one contact hour for each calendar month of the licensure cycle. These hour requirements are updated on their website. In addition to the courses mentioned above, they currently demand 16 hours of continuing education in general nursing.

 

Nurse Licensee With Two Licenses & CE Requirements

A licensee with an RN and an LPN license may fulfill CE requirements by completing the necessary RN-specific continuing education. Visit the Board of Nursing website for further information regarding the rules, as mentioned earlier, and the exceptions.

 

Standards For Continuing Education

Learner Objectives: The objectives should outline the anticipated behavioral outcomes of the learners and be measurable, reachable, and pertinent to the state of nursing practice today. The goals will dictate the curriculum, mode of instruction, and assessment strategy.

 

Subject Matter: The content must be specifically created to satisfy the participants’ learning needs, levels, and objectives. The information will be arranged logically and incorporate advice from subject-matter experts. Appropriate subject matter for continuing education offerings should include information from one or more of the following. It should represent the learner’s professional educational needs to address the consumer’s health care demands:

  • Nursing areas and special health care problems.
  • Biological, physical, behavioral, and social sciences.
  • Legal aspects of healthcare
  • Management/administration of health care personnel and patient care
  • Teaching/ learning process of health care personnel and patients

Evaluation: It must be demonstrated in a way that satisfies the Board that participants are given the chance to assess the educational opportunities, delivery strategies, facilities, and resources utilized in the offering. At the end of the learning process, self-directed learning activities—such as computer programs, web-based courses, internet research, and home study—must be used to assess student knowledge. There must be ten questions or more in the assessment. For the learner to be eligible for the contact hours, they must receive an evaluation score of at least 70%. The provider is required to grade the assessment.

 

References

Cassiani, S. H. B., & Silva, F. (2019). Expanding the role of nurses in primary health care: the case of Brazil. Rev Lat Am Enfermagem, 27, e3245. https://doi.org/10.1590/1518-8345.0000.3245

Licensure/Certification – Florida Nurses Association. (2022). www.floridanurse.org. https://www.floridanurse.org/page/Licensure

Resources – Florida Nurses Association. (2022). www.floridanurse.org. https://www.floridanurse.org/resources/documents/HistoryofFloridaNursesAssociation.doc

Selecting a Nursing Program – Florida Nurses Association. (2022). www.floridanurse.org. https://www.floridanurse.org/page/SelectingaNursingProgram

Torres-Vigil, I., Cohen, M. Z., Million, R. M., & Bruera, E. (2021). The role of empathic nursing telephone interventions with advanced cancer patients: A qualitative study. Eur J Oncol Nurs, 50, 101863. https://doi.org/10.1016/j.ejon.2020.101863

Ventura, C. A. A., Fumincelli, L., Miwa, M. J., Souza, M. C., Wright, M., & Mendes, I. A. C. (2020). Health advocacy and primary health care: evidence for nursing. Rev Bras Enferm, 73(3), e20180987. https://doi.org/10.1590/0034-7167-2018-0987

 

Disclaimer

Sleeping in Record-Breaking Heat: Tips to Stay Cool and Rested

By
Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP
-
The woman sleeping near the man in the bed. night time

High temperatures can disrupt the body’s sleep cycles, leading to health problems. Can knowing strategies and remedies help manage sleep quality?

hot weather Sleeping in Record-Breaking Heat: Tips to Stay Cool and Rested

Hot Weather Sleep

Sleep is important for refreshing the mind and body and being productive in school, work, relationships, and overall health. With record-breaking temperatures becoming the norm, consistently sleeping healthy is becoming difficult as forecasters predict another scorching summer with above-average temperatures. 2023 was the hottest year ever recorded. (National Oceanic and Atmospheric Administration. 2024) Studies show that high temperatures make it hard to fall asleep and stay asleep, which can negatively affect the immune system, cardiovascular system, cognitive performance, and mood. (Zheng, G., Li, K., and Wang, Y. 2019) (Obradovich, N. et al., 2017) Throughout the night, the body cycles through different sleep stages. (National Heart, Lung, and Blood Institute, 2022)

Because the body’s temperature regulation is less effective during certain stages, a hot environment can cause waking so the body can thermoregulate. The right temperature is imperative for a healthy night’s sleep. For optimal sleep, it is recommended that the bedroom temperature be between 65 and 69 degrees Fahrenheit. However, this isn’t always possible without air conditioning, which increases electricity bills. Here are other strategies to help keep the body cool for better sleep in hot weather.

Cooler Sleeping Environment

Thinking creatively about sleeping arrangements can help. Try to find the place that is the coolest and has the most airflow. Shutters or curtains during the day can help keep the room dark and cooler, and opening the windows can increase airflow. (Fergus Nicol, 2019) Using a fan can help improve air circulation, and putting ice behind the fan can blow cooler air for improved sleep.

Cooling Pillows and Breathable Pajamas

Pajamas and bedding made from breathable fabrics can help keep the body cool, and cooling mattress toppers or pillows can also help. Cooling pillows have gel overlays that absorb body heat and cool the head and neck. Keep an ice pack on the bedside table and a towel and ice to keep the body cool.

Take a Slightly Warm Shower

Taking a cold shower can cool the body down quickly, but studies have shown that showering in warm water before bed can make it easier to fall asleep. (Tai, Y. et al., 2021) The warm shower signals the body into cooling mode, which can help promote sleep as the body temperature falls at night. However, the water shouldn’t be too warm, which could exacerbate sweating.

Sleep Hygiene

It can be difficult to create the perfect sleep environment in hot weather. A healthy going-to-bed routine is essential in the summer, as stress and anxiety can significantly affect sleep quality. Avoid eating close to bedtime, avoid alcohol, and add some time to relax and unwind before going to bed. Sleep experts suggest general sleep hygiene habits like keeping a consistent bedtime and turning off screens an hour before bed can help improve sleep, even in hot weather. (Baranwal, N., Yu, P. K., and Siegel, N. S. 2023)

Chiropractic Treatment

Chiropractic care, massage, and decompression therapy can help improve sleep. Treatment retrains the body to relax; stretching and pulling the muscles increases blood circulation and advanced and improved brain signals telling the body to relax. A chiropractor will evaluate the individual’s sleeping patterns and recommend various strategies. Benefits include:

  • Muscle tension relief.
  • Stimulates nerve and blood circulation.
  • Relaxes the whole body.
  • Enhances central nervous system function.
  • Relieves pain and discomfort.
  • A chiropractor will also provide:
  • Sleeping position recommendations.
  • Postural stretches and exercises.
  • Recommendations on supportive mattresses.
  • Ergonomics for work, home, and bed.

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution through an integrated approach to treating injuries and chronic pain syndromes, improving flexibility, mobility, and agility programs to relieve pain and help individuals return to normal. Our providers create personalized plans for each patient. If other treatments are needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments.

Beyond Adjustments: Chiropractic and Integrative Healthcare

References

National Oceanic and Atmospheric Administration. (2024). April 2024 was Earth’s warmest on record. Retrieved from https://www.noaa.gov/news/april-2024-was-earths-warmest-on-record

Zheng, G., Li, K., & Wang, Y. (2019). The Effects of High-Temperature Weather on Human Sleep Quality and Appetite. International journal of environmental research and public health, 16(2), 270. https://doi.org/10.3390/ijerph16020270

Obradovich, N., Migliorini, R., Mednick, S. C., & Fowler, J. H. (2017). Nighttime temperature and human sleep loss in a changing climate. Science advances, 3(5), e1601555. https://doi.org/10.1126/sciadv.1601555

National Heart, Lung, and Blood Institute. (2022). Sleep phases and stages. Retrieved from https://www.nhlbi.nih.gov/health/sleep/stages-of-sleep

Nicol F. (2019). Temperature and sleep. Energy and Buildings, 204. https://doi.org/https://doi.org/10.1016/j.enbuild.2019.109516.

Tai, Y., Obayashi, K., Yamagami, Y., Yoshimoto, K., Kurumatani, N., Nishio, K., & Saeki, K. (2021). Hot-water bathing before bedtime and shorter sleep onset latency are accompanied by a higher distal-proximal skin temperature gradient in older adults. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 17(6), 1257–1266. https://doi.org/10.5664/jcsm.9180

Baranwal, N., Yu, P. K., & Siegel, N. S. (2023). Sleep physiology, pathophysiology, and sleep hygiene. Progress in cardiovascular diseases, 77, 59–69. https://doi.org/10.1016/j.pcad.2023.02.005

How to Manage a Nervous Stomach: Tips and Treatments

By
Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP
-
Patient suffering from stomach ache while consulting doctor in clinic

Emotional challenges like anxiety and depression or digestive disorders can cause individuals to experience a nervous stomach. Can knowing common symptoms, what causes them, and when to see a healthcare provider help manage the disorder?

How to Manage a Nervous Stomach: Tips and Treatments

Nervous Stomach

A nervous stomach is usually nothing to worry about, but it can happen occasionally as a reaction to a new environment, groups of people, foods, stress, and anxiety. Symptoms include indigestion, fluttering stomach/butterflies, or a gut-wrenching feeling. (Anxiety and Depression Association of America. 2023) Causes include underlying psychological and physical health conditions, certain medications, and lifestyle factors. Individuals experiencing chronic or ongoing symptoms should speak with a healthcare provider about their full range of symptoms. Treatments include medication, therapy, and lifestyle changes.

Symptoms

Nervous stomach symptoms can vary. Stress and anxiety can lead to physical symptoms, and physical symptoms may also lead to stress and anxiety. This is because the brain and gut connection communicates which hormones and neurotransmitters will be released and when. Common symptoms include: (Anxiety and Depression Association of America. 2023)

  • Loss of appetite
  • Butterflies or fluttering feeling in the stomach
  • Upset stomach
  • Indigestion
  • Bloating
  • Flatulence
  • Gut-wrenching feeling
  • Cramping
  • Nausea, dry heaving
  • Increased need to urinate or have bowel movements
  • Constipation
  • Diarrhea
  • Out-of-sync hunger cues

Causes

In most cases, a nervous stomach will come and go. However, it can also be caused by disorders such as anxiety disorder, depression, or gastrointestinal and digestive disorders. Brain health contributes to gut health, and vice versa. The brain is always communicating with the digestive system, and the digestive system is always sending information back to the brain. (Foster, J. A., and McVey Neufeld, K. A. 2013) (University of Chicago Medical Center, 2024) Common causes of a nervous stomach include: (Anxiety and Depression Association of America. 2023)

Medications

Over-the-counter and prescription medications can cause a nervous stomach as a side effect. This can happen when taking a single medication or more than one simultaneously. It can also occur in those with food sensitivities or other medical conditions. (Johns Hopkins Medicine, 2024) This is why consulting and updating a healthcare provider on the current list of prescribed and over-the-counter medications is important. Some meds can irritate the stomach, while others can cause constipation or diarrhea, leading to discomfort and nervous stomach symptoms. Common medications that may cause stomach side effect symptoms include: (Johns Hopkins Medicine, 2024)

  • NSAIDs – non-steroidal anti-inflammatory drugs such as ibuprofen can weaken the stomach lining.
  • Iron, antacids, and pain meds can cause constipation.
  • Antibiotics can cause diarrhea.

Home Treatment

Treatment depends on the severity and cause/s. An infrequently nervous stomach may benefit from over-the-counter therapies to calm it and/or lifestyle changes to reduce stress. Tips for reducing stress and anxiety include (Anxiety and Depression Association of America. 2023)

  • More frequent short breaks during the day
  • Practicing slow and deep breathing
  • Listening to guided meditations for stress-relief
  • Adding exercise to the daily routine
  • Realizing that stomach problems are part of anxiety and worrying about symptoms may make them worse.

Medical Treatment

Individuals may benefit from additional support treatment options with a healthcare provider (Johns Hopkins Medicine, 2024)

  • Antidepressant treatment for nervous stomach and/or irritable bowel syndrome.
  • Cognitive behavioral therapy for stress relief and learning how to manage anxiety.
  • Medical hypnotherapy
  • If symptoms are a side effect of medication or certain foods, a healthcare provider can develop an effective treatment plan that includes using another medication that is easier on the stomach or seeing a dietician.

Complications

Left untreated, a nervous stomach can contribute to further symptoms and other health problems. One study looked at the relationship between irritable bowel syndrome and certain psychiatric disorders. (Fadgyas-Stanculete, M. et al., 2014) This does not mean that a psychiatric disorder causes a nervous stomach or that a nervous stomach causes a psychiatric disorder. It is more likely that a combination of chemicals released when stressed can hurt gut health. This creates imbalances known to be risk factors for digestive disorders and conditions. (Anxiety and Depression Association of America. 2023)

Seeing a Healthcare Provider

Most nervous stomach symptoms resolve on their own. However, certain signs and symptoms can indicate that it is time to see a healthcare provider. Discuss symptoms with a healthcare provider who will order lab tests to check for underlying causes like anemia. See a healthcare provider immediately if you notice the following (University of Chicago Medical Center, 2024)

  • Symptoms are making work and/or normal life challenging.
  • Chronic or unresolved gastrointestinal issues like heartburn.
  • Unexplained weight reduction – losing weight without exercising or diet changes.
  • Blood in stool or blackish, tarry stools.
  • Vomiting

If there is a medical history of digestive disorders or cancers such as stomach cancer or colon cancer, this will help a healthcare provider. Depending on overall symptoms and family medical history, individuals may be referred to a gastroenterologist and/or a mental healthcare provider, like a counselor or psychiatrist. At Injury Medical Chiropractic and Functional Medicine Clinic, we treat injuries and chronic pain syndromes by developing personalized treatment plans and specialized clinical services focused on injuries and the complete recovery process. We work with primary healthcare providers and specialists to develop an optimal health and wellness solution through an integrated approach to treating injuries and chronic pain syndromes, improving flexibility, mobility, and agility programs to relieve pain and help individuals return to optimal health. If other treatments are needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments.

Root Causes of Gut Dysfunction Part 3

References

Anxiety and Depression Association of America. (2023). How to calm an anxious stomach: The brain-gut connection. Anxiety and Depression Association of America.
Triumphing Through Science, Treatment, and Education. https://adaa.org/learn-from-us/from-the-experts/blog-posts/consumer/how-calm-anxious-stomach-brain-gut-connection

Foster, J. A., & McVey Neufeld, K. A. (2013). Gut-brain axis: how the microbiome influences anxiety and depression. Trends in neurosciences, 36(5), 305–312. https://doi.org/10.1016/j.tins.2013.01.005

University of Chicago Medical Center. (2024). Stress and stomach pain: When should you see a specialist? Forefront. https://www.uchicagomedicine.org/forefront/gastrointestinal-articles/2024/january/stress-stomach-pain-when-to-see-a-doctor

Fadgyas-Stanculete, M., Buga, A. M., Popa-Wagner, A., & Dumitrascu, D. L. (2014). The relationship between irritable bowel syndrome and psychiatric disorders: from molecular changes to clinical manifestations. Journal of molecular psychiatry, 2(1), 4. https://doi.org/10.1186/2049-9256-2-4

Ness-Jensen, E., & Lagergren, J. (2017). Tobacco smoking, alcohol consumption and gastro-oesophageal reflux disease. Best practice & research. Clinical gastroenterology, 31(5), 501–508. https://doi.org/10.1016/j.bpg.2017.09.004

Johns Hopkins Medicine. (2024). Medicines and the digestive system. Health. https://www.hopkinsmedicine.org/health/conditions-and-diseases/medicines-and-the-digestive-system

Comminuted Fractures: Surgical Interventions and Rehabilitation

By
Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP
-
happy orthopedist looking at x-ray in clinic

Can learning about comminuted fracture symptoms and repair help individuals and healthcare providers develop effective treatment and rehabilitation programs?

Comminuted Fractures: Surgical Interventions and Rehabilitation

Comminuted Fractures

A comminuted fracture is a severe break in which the bone splits into at least three pieces. Comminuted fractures typically happen in the long bones like those in the arms and legs. But they can also happen in other places, including the ribs. (Corinne Tarantino, 2022) They are usually caused by intense impact, like an automobile collision/accident or a severe fall. Depending on the location of the fracture, recovery from a comminuted fracture can take months and often involves:

  • Surgery – A surgeon will place screws and rods to hold the pieces of the bone in position. Sometimes, the hardware is left in permanently. (American Academy of Orthopaedic Surgeons, 2021)
  • Wearing a cast for several months.
  • Physical therapy.

Types

In these types of fractures, the bone is completely broken, not just cracked. The break is a highly comminuted fracture if the bone is broken into four or more pieces. (Corinne Tarantino, 2022)

Symptoms

The symptoms are the same as those of other broken bones, but they can be more intense because the bone is broken in multiple areas, which means there may also be more soft tissue injuries than with a simple fracture. Broken bone symptoms include: (MedlinePlus, 2024)

  • Persistent pain
  • Swelling
  • Bruising
  • Deformity – the bone looks out of place or is at an odd angle.
  • Tingling
  • Numbness
  • Difficulty moving the limb.

Causes

An intense force causes a comminuted fracture, often a car accident or a hard fall, but it can also result from sports injuries. (Corinne Tarantino, 2022)

Diagnosis

A comminuted fracture is diagnosed by X-ray, which shows where the bone has broken and how many pieces it has split into (MedlinePlus, 2024). Healthcare providers will diagnose any broken bones but also look for other injuries.

Treatment

Typically, broken bones can be treated with casts, braces, or a boot to keep them immobilized. (MedlinePlus, 2024) Because comminuted fractures are more severe, they often need other treatments, including surgery. Sometimes, the bone can be reset instead of surgery using a closed reduction technique, where the healthcare provider resets the bone manually. Surgery may be recommended if that’s not possible or doesn’t work.

Types of Surgery

Surgery allows the healthcare provider to correctly position all the pieces of the bone to heal in a strong, stable formation. The two types commonly used to treat comminuted fractures are: (American Academy of Orthopaedic Surgeons, 2021)

External Fixation

  • This surgery uses rods and screws outside the body to stabilize the bone.
  • This external frame is placed during surgery and later removed.

Open Reduction Internal Fixation – ORIF

  • During this surgery, the bone is stabilized with metal plates, screws, rods, and/or wires placed inside your body.
  • Sometimes, these are permanent, but in other cases, they are removed later.
  • An orthopedic surgeon performs these surgeries.

Casting

After surgery, a cast is usually needed to prevent the bone from moving and allow healing. Typically, the cast is worn for six to eight weeks, but it may need to be worn longer with comminuted fractures. Some need a cast for several months (American Academy of Orthopaedic Surgeons, 2021). Sometimes, those with an external fixation must continue wearing a cast after removing the pins and rods, giving the bone more time to stabilize. The healthcare provider will inform the patient how long the cast will need to be worn and which sports activities should be avoided even after the cast comes off.

Physical Therapy

The healthcare provider may recommend physical therapy to help treat the fracture. Usually, when the cast is removed, physical therapy is activated to help rebuild strength and range of motion. (Corinne Tarantino, 2022)

Prognosis

Although these fractures are severe, they are treatable. The prognosis is good for individuals who follow their healthcare provider’s treatment plan. Most don’t have lingering pain after the initial injury and can eventually return to regular activities. (American Academy of Orthopaedic Surgeons, 2021)

Recovery

Healing a comminuted fracture can take months. During that time, it’s helpful to focus on tasks that can be accomplished, like new hobbies that don’t involve physical injury. Talk to the healthcare provider about any problems with the cast or ongoing pain and what to expect during recovery.

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution through an integrated approach to treating injuries and chronic pain syndromes, improving flexibility, mobility, and agility programs to relieve pain and help individuals return to normal. Our providers create personalized care plans for each patient. If other treatments are needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments.

The Path to Healing Personal Injury

References

Corinne Tarantino, MPH. Osmosis. (2022). Comminuted Fracture: What is it, Examples and More. https://www.osmosis.org/answers/comminuted-fracture

Throckmorton T.W. American Academy of Orthopaedic Surgeons. (2021). Fractures (broken bones). https://orthoinfo.aaos.org/en/diseases–conditions/fractures-broken-bones/

MedlinePlus. National Library of Medicine. (2024). Fractures Also called: Broken bone. Retrieved from https://medlineplus.gov/fractures.html

Exercises for Rheumatoid Arthritis: Improve Mobility and Reduce Pain

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

Can individuals with rheumatoid arthritis incorporate various exercises to reduce joint pain and inflammation in their hands and feet?

Introduction

The joints in the human help provide function, mobility, and flexibility to the upper and lower extremities. The joints are part of the musculoskeletal system and have an outstanding relationship with the muscles, ligaments, and soft tissues that give the body structure and support that lets the individual move around and protects the important organs to function normally. However, when a person is dealing with injuries or illnesses that affect the body’s musculoskeletal function, it can cause pain to the individual. One of the symptoms that often correlate in the joints is chronic inflammation, leading to the development of an autoimmune disease known as rheumatoid arthritis. Today’s article looks at how rheumatoid arthritis affects the joints in the musculoskeletal system and how various exercises can help manage and reduce the symptoms associated with rheumatoid arthritis. We discuss with certified associated medical providers who consolidate our patients’ information to assess rheumatoid arthritis and its associated pain symptoms affecting the joints. We also inform and guide patients while asking their associated medical provider intricate questions to integrate various exercises into their personalized treatment plan to manage the pain correlated with rheumatoid arthritis. Dr. Jimenez, D.C., includes this information as an academic service. Disclaimer.

 

How RA Affects The Joints

Do you feel pain and tenderness in your joints affecting your daily routine? Do you experience stiffness first thing in the morning, and it goes away throughout the day? Or do you feel fatigued throughout the day, even after a good night’s sleep? Many individuals with these symptoms could be dealing with early development of rheumatoid arthritis in their joints. Now, rheumatoid arthritis is a chronic inflammatory autoimmune disorder that affects the body’s joints but is more prominent on the hands, wrists, and feet. The symptoms of rheumatoid arthritis can develop early or slowly depending on the environmental factors contributing to the development. Since rheumatoid arthritis is categorized as a systemic autoimmune disease, genetic and environmental risk factors that can contribute to rheumatoid arthritis development can trigger overlapping risk profiles on the joints. (Jang et al., 2022) When a person is dealing with the symptoms of rheumatoid arthritis, one of the key pain symptoms that can affect the joints drastically is inflammation. Inflammation is associated with rheumatoid arthritis; it is reflected by joint pain, leading to swelling and subsequent destruction of the cartilage and bone. (Scherer et al., 2020) This causes many individuals to be in constant pain and prevents them from doing any activities.

 

 

Additionally, when a few joints are being affected by rheumatoid arthritis in the early stages, some of the symptoms include:

  • Fatigue
  • Flu-like symptoms
  • Swollen & tender joints
  • Stiffness

However, when rheumatoid arthritis reaches the later stages in the joints, the autoantigens that are specific to rheumatoid arthritis can lead to a self-perpetuating chronic inflammatory state on the joints, thus causing an expansion on the periarticular bone at the cartilage-bone junction, leading to bone erosion and cartilage degradation. (Lin et al., 2020) Luckily, there are therapeutic options to reduce the pain and inflammatory effects of rheumatoid arthritis and help manage the symptoms that are affecting the joints.

 

Arthritis Explained- Video

Arthritis Explained | El Paso, Tx (2023)

How Various Exercises Can Help With RA

When it comes to reducing the inflammatory effects of rheumatoid arthritis, many individuals can seek out therapeutic options to restore mobility, function, and flexibility. Many individuals can incorporate various physical activities to relieve stress on the inflamed tissues while slowing the progression of rheumatoid arthritis. (Radu & Bungau, 2021) When people with rheumatoid arthritis incorporate various physical activities, they can include a healthy diet and nutrition to suppress pro-inflammatory effects associated with rheumatoid arthritis, help provide symptomatic improvement, and restore bodily function to the joints. (Gioia et al., 2020)

 

When people with rheumatoid arthritis start exercising as part of their personalized treatment, it can have beneficial properties as they can help with the following:

  • Reduce joint pain & stiffness
  • Improve muscle strength around the joints
  • Enhance physical function
  • Boost mental health
  • Reduces inflammation
  • Increase energy levels

The main priority of incorporating exercises to reduce rheumatoid arthritis is choosing gentle exercises on the person’s joints while providing enough movement to keep the body flexible and strong. Below are some exercises to reduce rheumatoid arthritis.

 

Range of Motion Exercises

Range of motion exercises can help maintain normal joint function by improving flexibility and reducing stiffness for individuals with rheumatoid arthritis. Some examples include:

  • Finger Bends: Gently bend your fingers into a fist and straighten them. Repeat several times.
  • Wrist Stretch: Extend your arm with the palm facing down. Gently use your other hand to press the extended hand down and back for a stretch.
  • Shoulder Rolls: Roll the shoulders in a forward circular motion, then reverse the direction.

 

Strength Training Exercises

Strength training can help build the surrounding muscles around the joints. This allows many individuals with rheumatoid arthritis to provide better support and reduce stress on the joints. Some examples include:

  • Resistance Bands: Use resistance bands to perform bicep curls, leg extensions, and chest presses.
  • Light Weights: Incorporate light dumbbells to perform exercises like shoulder presses, tricep extensions, and squats.
  • Bodyweight Exercises: Engage in wall push-ups, seated leg lifts, and modified planks.

 

Water-Based Exercises

Water-based exercises provide resistance without impact on the joints, making it ideal for those with rheumatoid arthritis. The water helps cushion the joints by easing the stiffness, building strength, and helping relax sore muscles. Some examples of water-based exercises include:

  • Water Aerobics: Join a water aerobics class that offers structured routines in a supportive environment.
  • Aqua Jogging: Use a buoyancy belt to jog in the pool’s deep end.
  • Swimming: Perform laps or engage in gentle exercises like the backstroke or breaststroke.

 

Tips For Exercising With RA

It is important to remember that when exercising with rheumatoid arthritis, it is important to always start with a gentle warm-up and always end with a cool down to prepare the muscles and joints when beginning to exercise. Another thing to remember is to stay consistent and modify when needed. This allows many individuals to listen to their bodies and modify exercises to avoid pain and discomfort. Incorporating exercises is highly effective in reducing rheumatoid arthritis activity as it can help enhance the body’s immune function and help manage the inflammatory response associated with rheumatoid arthritis. (Li & Wang, 2022)

 

References

Gioia, C., Lucchino, B., Tarsitano, M. G., Iannuccelli, C., & Di Franco, M. (2020). Dietary Habits and Nutrition in Rheumatoid Arthritis: Can Diet Influence Disease Development and Clinical Manifestations? Nutrients, 12(5). https://doi.org/10.3390/nu12051456

Jang, S., Kwon, E. J., & Lee, J. J. (2022). Rheumatoid Arthritis: Pathogenic Roles of Diverse Immune Cells. Int J Mol Sci, 23(2). https://doi.org/10.3390/ijms23020905

Li, Z., & Wang, X. Q. (2022). Clinical effect and biological mechanism of exercise for rheumatoid arthritis: A mini review. Front Immunol, 13, 1089621. https://doi.org/10.3389/fimmu.2022.1089621

Lin, Y. J., Anzaghe, M., & Schulke, S. (2020). Update on the Pathomechanism, Diagnosis, and Treatment Options for Rheumatoid Arthritis. Cells, 9(4). https://doi.org/10.3390/cells9040880

Radu, A. F., & Bungau, S. G. (2021). Management of Rheumatoid Arthritis: An Overview. Cells, 10(11). https://doi.org/10.3390/cells10112857

Scherer, H. U., Haupl, T., & Burmester, G. R. (2020). The etiology of rheumatoid arthritis. J Autoimmun, 110, 102400. https://doi.org/10.1016/j.jaut.2019.102400

Disclaimer

Water Aerobics: Low-Impact Full-Body Workout

By
Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP
-
Trainer holding barbells while exercising with group of young people in swimming pool

For individuals living with chronic pain and various diseases like Parkinson’s, arthritis, and diabetes, can water aerobics be beneficial?

Water Aerobics: Low-Impact Full-Body Workout

Water Aerobics

Water aerobics are low-impact exercises performed commonly in swimming pools. It is a great way to exercise for a full-body, low-impact workout without overworking the body’s joints and muscles. Other names used include:

  • Aquafitness
  • Aqua aerobics
  • Aquarobics

Many types can be tailored to individual needs, injuries, and/or conditions. The exercises have various health benefits, especially for those who cannot perform higher-impact movements.

How It Works

Water aerobics involves performing certain controlled movements as a form of exercise. Different types focus on various areas of health, including (Harvard Health Publishing Harvard Medical School, 2023)

  • Strength training
  • Cardiovascular
  • Interval training

Individuals can also perform water aerobics if they know the movements involved. (Harvard Health Publishing Harvard Medical School, 2023)

Benefits of Pool Exercises

There are many benefits associated with water aerobics.

Because of the low-impact and full-body nature of the exercises, people can expect to see improvements (Pereira Neiva, H. et al., 2018) (Harvard Health Publishing Harvard Medical School, 2023)

Joint health

  • Water aerobics is gentle on the joints with minimal strain.

Cardiovascular

  • Water resistance during exercises can improve cardiovascular health without pushing it.
  • Studies have shown that it can also help control blood pressure.

Strength

  • Because of the resistance from the water, the muscles work harder.

Weight Loss

  • The water resistance exercises burn more calories than those outside the water, which could lead to more weight loss over time.

Health Conditions That Can Benefit

Some of the health conditions that can benefit from water aerobics include (Harvard Health Publishing Harvard Medical School, 2023)

  • Chronic pain
  • Arthritis
  • Obesity
  • Heart health
  • Blood pressure
  • Stress and Anxiety

Equipment

Individuals participating in water aerobics will need a bathing suit, towel, goggles, and a swim cap to protect their eyes or hair from chlorinated water. Individuals do not need other special equipment while exercising as the water acts as extra resistance. Foam dumbbells or paddles can be used to increase resistance. Other optional equipment includes: (Plunge San Diego, 2024) (Harvard Health Publishing Harvard Medical School, 2023)

  • Kickboards
  • Wrist and ankle weights
  • Water-jogging belts
  • Swim bar

Pool Exercises

There are many types of pool exercises to help reach health and fitness goals. They include:

Water Walking

  • The basic act of walking in water is a great way to get a full-body workout.
  • Start by standing in waist-deep water with the feet planted on the bottom of the pool.
  • Lengthen the spine by bringing the shoulders up and back and aligning the shoulders with the hips and knees.
  • Once in a good starting position, walk through the water, putting pressure on the heel first and then the toes, just like walking out of the water, while swinging the arms back and forth through the water.
  • This exercise can be done for five to 10 minutes.
  • The muscles that will get the most attention are the arms, core, and the lower body.

Arm Lifts

  • Stand up to the shoulders in water.
  • With the palms facing up, draw the elbows into the torso while lifting the forearms in front of the body up to the water’s surface.
  • Once at the surface, rotate the palms to face down and slowly move the forearms back down to the sides.
  • For more resistance, this exercise can also be done using foam dumbbells.
  • Repeat the action 10–15 times for one to three sets.
  • The muscles targeted are the core and the arm muscles.

Jumping Jacks

  • Water resistance makes jumping jacks in the water much more difficult than on land.
  • To perform, start by standing in chest-level water with your feet together and your arms straight down the sides.
  • Once in position, begin by simultaneously swinging the legs out to the side and arms over the head before returning to the starting position.
  • Muscles targeted include the entire body and cardiovascular system.
  • Add wrist or ankle weights for more resistance and to make the exercise more challenging.

High-Knee-Lift Extensions

  • High-knee-lift extensions are performed while standing in water that is waist deep.
  • To do the exercise, engage the core and lift one leg in a bent position until it is level with the water’s surface.
  • Hold the position for a few seconds, then extend the leg out in front and hold again.
  • After the hold period, move the leg back down through the water to the starting position while keeping it straight and flexing the foot.
  • Repeat on both legs for two to three sets of 15 reps per leg.
  • Use weights on the ankles to increase resistance.
  • The muscles targeted include the core, glutes, and lower body.

Risks

While exercising in water, individuals may not notice how much they sweat. This can make it seem like the workout is not as hard and can lead to dehydration. Individuals should always hydrate before and after a pool workout. Individuals who cannot swim well should avoid exercises that do not require a flotation device. Sometimes pools are heated, so choosing one 90 degrees F or below is recommended so the body doesn’t get overheated while exercising.

Stop Pool Exercises Immediately

Performing pool exercises can often seem easier than they are, leading to overworking. Stop exercising immediately if you feel:

  • Pain in any area of the body
  • Shortness of breath
  • Nauseated
  • Faint
  • Dizzy
  • Pressure in the upper body or chest

Other Health Conditions That Benefit

Water aerobics is recommended for most individuals, completely healthy or with a chronic disease. Those with chronic disease have been shown to benefit from the low-impact exercise. (Faíl, L. B. et al., 2022) One study looked at individuals with various health conditions, with the results showing that the following conditions saw improvements after 12 weeks of regular water exercise (Faíl, L. B. et al., 2022)

  • Diabetes
  • Arthritis
  • Fibromyalgia
  • Bone diseases
  • High blood pressure
  • Coronary artery disease
  • Stroke
  • Multiple sclerosis (MS)
  • Parkinson’s disease

While the benefits of water aerobics have been studied and proven effective, individuals should be cleared by a medical professional before starting any new exercise regimen. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution through an integrated approach to treating injuries and chronic pain syndromes, improving flexibility, mobility, and agility programs to relieve pain and help individuals return to normal. Our providers create personalized care plans for each patient. If other treatments are needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments.

Chiropractic and Integrative Healthcare

References

Harvard Health Publishing Harvard Medical School. (2023). Basic types of water-based exercises. HealthBeat. https://www.health.harvard.edu/healthbeat/basic-types-of-water-based-exercise

Pereira Neiva, H., Brandão Faíl, L., Izquierdo, M., Marques, M. C., & Marinho, D. A. (2018). The effect of 12 weeks of water-aerobics on health status and physical fitness: An ecological approach. PloS one, 13(5), e0198319. https://doi.org/10.1371/journal.pone.0198319

Harvard Health Publishing Harvard Medical School. (2024). Advantages of water-based exercise. HealthBeat. https://www.health.harvard.edu/healthbeat/advantages-of-water-based-exercise

Plunge San Diego. (2024). 5 must-have pieces of aquatic exercise equipment for water aerobics. Plunge San Diego. https://plungesandiego.com/what-equipment-needed-water-aerobics-shoes/

Faíl, L. B., Marinho, D. A., Marques, E. A., Costa, M. J., Santos, C. C., Marques, M. C., Izquierdo, M., & Neiva, H. P. (2022). Benefits of aquatic exercise in adults with and without chronic disease-A systematic review with meta-analysis. Scandinavian journal of medicine & science in sports, 32(3), 465–486. https://doi.org/10.1111/sms.14112

Neck Pain Traction Device: Restoring Neck Mobility and Function

By
Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP
-
Serene mature male patient undergoing the cervical traction procedure assisted by a qualified female physiatrist

Can using a self-care traction device help and be a cost-effective method of providing cervical relief at home for individuals who have neck pain?

Neck Pain Traction Device: Restoring Neck Mobility and Function

Neck Pain Traction Device

Neck Pain Traction Device: Individuals with neck or arm pain caused by neck/cervical radiculopathy may benefit from physical therapy to manage their condition. (Alshami, A. M., and Bamhair, D. A. 2021) Physical therapy can improve neck mobility, restore function, and decrease pain.

Traction

A physical therapist may use various treatments and modalities to treat the individual’s condition. Cervical traction is one treatment to help relieve neck pain and can help:

  • Stretch the muscles and soft tissues in the neck.
  • Separate and open up the disc and joint spaces.
  • Decrease pain in the neck and arms by relieving pressure on nerves from the cervical spine. (Madson, T. J., and Hollman, J. H. 2017)

There are different neck traction techniques. The therapist may use a mechanical traction device that requires the individual to strap their head and neck to a machine that gently pulls the neck, providing relief. (Romeo, A. et al., 2018) The physical therapist may also use manual traction with their hands to help the process. This type allows the therapist to easily adjust the amount of traction force and the direction of the pull on the neck. (Romeo, A. et al., 2018)

Home Traction Devices

Cervical traction that works for individuals at the clinic may also benefit from using a traction device at home to maintain their gains. Over-the-door cervical traction may be an effective, safe, and simple way to administer neck traction in the comfort of one’s home to help decrease pain. (Fritz, J. M. et al., 2014) Medical supply stores and pharmacies carry over-the-door traction devices, which can also be found online. If finding an over-the-door traction unit is difficult, the therapy clinic can help order one from a medical supplier.

Setting Up The Device

Before using a neck pain traction device, consult a physical therapist or doctor to ensure neck traction is safe and on usage. Over-the-door traction units may be built differently but comprise the main parts:

  • A hook-and-pulley apparatus that hangs over the door.
  • A nylon cord that’s fed through the pulley.
  • A weight that could be a water bag that hangs on the end of the cord to provide traction force.
  • A harness to wear on your head.
  1. The traction unit must be hung over a door secured to the top and closed.
  2. It is recommended that the door be a closet door so no one will open it while using the device.
  3. If a closet door is not available, be sure to lock the door so that no one can open it while attached to the device.
  4. A small hook with a pulley attached to it hangs on the door.
  5. The harness attaches to the end of the nylon cord opposite the weighted water bag.
  6. The harness goes on the head, and the chin strap should fit snugly under the chin and be secured by the hook-and-loop fasteners.
  7. The two straps on either side of your head should be hooked to the end of the nylon cord, which is fed through the pulley system.
  8. After strapping on the head harness, fill the water bag using the markings on the bag to indicate its weight and hang it on one end of the cord.
  9. Fill the bag until the water reaches the desired mark, usually 8–15 pounds.
  10. After filling the water bag, sit in a chair facing the door and hang the bag on the other end of the cord not attached to the head harness.
  11. Do not drop the bag; this could cause a sudden forceful traction motion on your neck.

How Long to Use

Individuals should generally use the traction device for about 15 to 20 minutes each session and can perform several sessions per day. (American Physical Therapy Association. 2020) While using the over-the-door traction device, there should be a gentle pulling sensation in the neck, relieving the neck pain, and if there is arm pain or tingling, it should also decrease. Traction does not replace neck exercises or postural correction in treating neck pain. Be sure to follow the therapist’s prescribed exercises. Active engagement is essential to treating and preventing neck pain from returning. If the pain increases while using the traction device, stop using it and consult a physical therapist or doctor. Ask a physical therapist or other neuromusculoskeletal medical professional if self-care traction is appropriate for specific conditions.

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution that helps individuals return to normal. Our providers create personalized care plans for each patient, including Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine principles through an integrated approach to treat injuries and chronic pain syndromes to improve ability through flexibility, mobility, and agility programs to relieve pain. If other treatment is needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments.

Neck Injuries

References

Alshami, A. M., & Bamhair, D. A. (2021). Effect of manual therapy with exercise in patients with chronic cervical radiculopathy: a randomized clinical trial. Trials, 22(1), 716. https://doi.org/10.1186/s13063-021-05690-y

Madson, T. J., & Hollman, J. H. (2017). Cervical Traction for Managing Neck Pain: A Survey of Physical Therapists in the United States. The Journal of orthopaedic and sports physical therapy, 47(3), 200–208. https://doi.org/10.2519/jospt.2017.6914

Romeo, A., Vanti, C., Boldrini, V., Ruggeri, M., Guccione, A. A., Pillastrini, P., & Bertozzi, L. (2018). Cervical Radiculopathy: Effectiveness of Adding Traction to Physical Therapy-A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Physical therapy, 98(4), 231–242. https://doi.org/10.1093/physth/pzy001

Fritz, J. M., Thackeray, A., Brennan, G. P., & Childs, J. D. (2014). Exercise only, exercise with mechanical traction, or exercise with over-door traction for patients with cervical radiculopathy, with or without consideration of status on a previously described subgrouping rule: a randomized clinical trial. The Journal of orthopaedic and sports physical therapy, 44(2), 45–57. https://doi.org/10.2519/jospt.2014.5065

American Physical Therapy Association. (2020). Physical therapy guide to cervical radiculopathy. https://www.choosept.com/guide/physical-therapy-guide-cervical-radiculopathy

Managing ACL Injuries Without Surgery: A Comprehensive Guide

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

Can athletic individuals with ACL injuries find relief through non-surgical treatments to restore knee mobility?

Introduction

The body’s lower extremities help the individuals to be mobile but also help stabilize the body’s upper weight. From the hips to the feet, many people are on their feet and using every muscle group to allow functionality. Athletic individuals use their lower extremities to do various physical activities and are susceptible to injuries. An ACL injury is one of the most common and feared injuries that can impact an athletic person’s performance. These types of injuries affect the knees of the individual and can make a person feel miserable. However, numerous surgical and non-surgical treatments can help the recovery process of an ACL injury while helping the individual restore their motion to their lower extremities. Today’s article looks at what an ACL injury is, how it affects the knees, and how non-surgical treatments can help restore knee mobility from ACL injuries. We discuss with certified associated medical providers who consolidate our patients’ information to assess ACL injuries affecting their mobility. We also inform and guide patients while asking their associated medical provider intricate questions to integrate and provide them with numerous non-surgical treatments to be incorporated into their personalized treatment plan. Dr. Jimenez, D.C., includes this information as an academic service. Disclaimer.

 

What Is An ACL Injury?

 

Do you feel aches or pains around your knees after a long exercise regime? Do you feel or hear a loud popping sensation in your knees? Or do you experience pain and swelling affecting your ability to be mobile? Many of these pain-like scenarios are correlated with ACL injuries, that is amongst the most common and feared injuries for athletic individuals and non-athletic individuals. However, we must look at the ACL itself to better understand ACL injuries. The ACL (anterior cruciate ligament) plays an important role as it helps with knee joint stabilization, prevents excessive forward movements from the tibia (shin bone), and limits rotational knee movements. (Yoo & Marappa-Ganeshan, 2024) This ligament is one of the most injured structures affecting athletic performance. ACL injuries and tears can lead to many individuals having knee instability and an increased risk of future knee osteoarthritis. (Atik, 2024) This is because ACL injuries typically occur during physical activities involving sudden stops, jumps, or directional impacts to the knees.

 

How Does It Affect The Knees?

So, how do ACL injuries affect the knees of the individual? As stated earlier, the ACL is a crucial ligament that stabilizes the knee joint during movement. When that ligament is injured, it can cause pain-like symptoms like:

  • Pain
  • Limited range of motion
  • Knee instability
  • Altered biomechanics

This causes many people to have reduced physical activity levels, which can become a great economic burden to their daily routine. (Wang et al., 2020)  When dealing with ACL injuries, it can also affect the meniscus in the knees as cartilage erosion often accelerates and can potentially lead to early osteoarthritis, which correlates with ACL injuries. (Key et al., 2022) However, when a person is dealing with ACL injuries, there are numerous treatments to reduce the pain-like symptoms caused by ACL injuries and help restore knee mobility.

Overcoming An ACL Injury-Video

Overcoming an ACL Injury | El Paso, Tx (2023)

Non-Surgical Treatments For ACL Injuries

 

When finding the right treatment for ACL injuries, many individuals can incorporate non-surgical treatments as part of their customized treatment plan. Non-surgical treatments can vary and may be suitable for individuals with partial ACL tears and knee instability and who have been involved in low-impact sports. When athletic individuals are dealing with ACL injuries, by incorporating non-surgical treatments, they can address the impairments, achieve functional stability, and safely return to their physical activities while improving the neuromuscular system to achieve functional knee stability. (Diermeier et al., 2020) Non-surgical treatments can positively impact many individuals by relieving the overlapping pain-like issues affecting the knees and the severity of ACL injuries.

 

Chiropractic Care

Chiropractic care is one of the many non-surgical treatments that can benefit individuals dealing with ACL injuries. Chiropractic care incorporates mechanical and manual manipulation to diagnose and treat any musculoskeletal issues associated with ACL injuries and emphasizes the body’s natural ability to heal itself. For many athletic and non-athletic individuals with ACL injuries, chiropractic care can offer several benefits:

  • Pain management
  • Enhancing mobility and flexibility
  • Improving balance
  • Strengthening supporting muscles

Chiropractic care can help individuals by stretching and strengthening weak muscles and soft tissues that can help break down scar tissues that may have surrounded the knee while improving blood flow to the injured area. Chiropractors can also incorporate specific rehabilitation exercises and physical therapy for the individual, focusing on strength, flexibility, and stability in the knees and surrounding muscles.

 

Physical Therapy

Another form of non-surgical treatment is through physical therapy. Physical therapy can help many individuals with ACL injuries through strength training, balance, and range of motion exercises that are catered to strengthen the surrounding muscles and help maintain the knee’s stability, flexibility, and mobility. Stretching exercises like Pilates and Tai Chi are favorable for ACL rehabilitation as they are important for functional outcomes and ACL stability. (Giummarra et al., 2022) Additionally, many individuals can utilize a functional knee brace to provide additional support to the knees when doing any physical therapy, as they can help stabilize the knee and prevent unwanted movements that could exacerbate the ACL injury. While ACL injuries are serious, non-surgical treatments offer viable alternatives for many athletes. Individuals can effectively manage their injuries and lead active, fulfilling lives by focusing on physical therapy, utilizing supportive braces, and adopting lifestyle modifications.

 

References

Atik, O. S. (2024). The risk factors for second anterior cruciate ligament (ACL) tear after ACL reconstruction. Jt Dis Relat Surg, 35(2), 255-256. https://doi.org/10.52312/jdrs.2024.57920

Diermeier, T., Rothrauff, B. B., Engebretsen, L., Lynch, A. D., Ayeni, O. R., Paterno, M. V., Xerogeanes, J. W., Fu, F. H., Karlsson, J., Musahl, V., Svantesson, E., Hamrin Senorski, E., Rauer, T., Meredith, S. J., & Panther Symposium, A. C. L. T. C. G. (2020). Treatment after anterior cruciate ligament injury: Panther Symposium ACL Treatment Consensus Group. Knee Surg Sports Traumatol Arthrosc, 28(8), 2390-2402. https://doi.org/10.1007/s00167-020-06012-6

Giummarra, M., Vocale, L., & King, M. (2022). Efficacy of non-surgical management and functional outcomes of partial ACL tears. A systematic review of randomised trials. BMC Musculoskelet Disord, 23(1), 332. https://doi.org/10.1186/s12891-022-05278-w

Key, S., Baygin, M., Demir, S., Dogan, S., & Tuncer, T. (2022). Meniscal Tear and ACL Injury Detection Model Based on AlexNet and Iterative ReliefF. J Digit Imaging, 35(2), 200-212. https://doi.org/10.1007/s10278-022-00581-3

Wang, L. J., Zeng, N., Yan, Z. P., Li, J. T., & Ni, G. X. (2020). Post-traumatic osteoarthritis following ACL injury. Arthritis Res Ther, 22(1), 57. https://doi.org/10.1186/s13075-020-02156-5

Yoo, H., & Marappa-Ganeshan, R. (2024). Anatomy, Bony Pelvis and Lower Limb, Knee Anterior Cruciate Ligament. In StatPearls. https://www.ncbi.nlm.nih.gov/pubmed/32644659

Disclaimer

Exploring the Benefits and Drawbacks of Butter and Margarine

By
Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP
-
fresh olive butter in a container with bread on white background .

 Can knowing the difference between butter and margarine help Individuals looking to improve cholesterol levels?

Exploring the Benefits and Drawbacks of Butter and Margarine

Butter and Margarine

Individuals watching their cholesterol levels and switching from butter to margarine may have heard that it may be worse for heart health. What research has to say about the healthiest spread and the butter and margarine debate?

History

Butter was shown to be associated with an increased risk of heart disease because of its saturated fat content when margarine was developed as a substitute. Margarine is made from plant-based oils like canola, palm fruit, and soybeans. Nutritionists and researchers saw it as a healthier alternative. It is lower in saturated fat and has no cholesterol but contains high levels of trans fats, which raise unhealthy LDL cholesterol levels and lower healthy HDL  cholesterol levels. (Ginter, E., and Simko, V. 2016)

Margarine Trans Fat and Butter Saturated Fat

Most of margarine’s unsaturated fats undergo hydrogenation, creating harmful trans fats. Trans fat raises unhealthy LDL cholesterol levels more than saturated fat. The trans-fatty acids solidify and maintain margarine consistency at room temperature. Stick margarines, the hardest type, contain the most trans fats and are still sold despite what is known about the damage they can do. (Brouwer, I. A. et al., 2010) Clinical studies showed these trans fats are associated with a 28% increased risk of death from heart disease and a 34% increased risk of death. (de Souza, R. J. et al., 2015)

Margarine Types

Some softer and liquid margarine products contain less trans fat than stick versions. They are low in saturated fat and high in unsaturated fat. Individuals can determine how much trans fat the margarine has by its softness. Those that are more solid at room temperature contain more trans fats than those in a tub, which are softer. However, some soft options can contain trans fats. If the label has partially hydrogenated oil, it’s recommended to avoid it. (Garsetti, M. et al., 2016) Some newer margarines are enriched with plant sterols, which block cholesterol absorption and help lower LDL levels. These are healthy choices if trying to lower LDL. (Ras, R. T. et al., 2014)

Butter

Butter is primarily made up of saturated fat and cholesterol and comes in a stick and spread. One tablespoon of butter contains around 30 milligrams of cholesterol and 7 grams of saturated fat. The maximum amount allowed daily is 200 milligrams and 10 milligrams, respectively. Both types of fat are linked to rising cholesterol levels and the risk of heart disease. Butter from grass-fed cows is higher in omega-3 fatty acids, essential for heart health, making it far more nutritional than the more widely used butter from conventionally-fed cows. (Hebeisen, D. F. et al., 1993)

Other Options

Butter or margarine are not the healthiest options. Olive, avocado, and other vegetable-based spreads are the most heart-healthy options. (Yubero-Serrano, E. M. et al., 2019) Use avocado oil as a cooking oil when sautéing or roasting vegetables. Consider substituting applesauce, nut butters, or squash purees in baked goods. Look for soft versions of margarine as a bread spread that contain plant sterols and no hydrogenated oils.

Injury Medical Chiropractic and Functional Medicine Clinic uses an integrated approach to create personalized care plans for each patient to restore health and function to the body through Nutrition and Wellness, Functional Medicine, Acupuncture, Electro-Acupuncture, 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.

Enhancing Health Together: Multidisciplinary Evaluation and Treatment

References

Ginter, E., & Simko, V. (2016). New data on harmful effects of trans-fatty acids. Bratislavske lekarske listy, 117(5), 251–253. https://doi.org/10.4149/bll_2016_048

Brouwer, I. A., Wanders, A. J., & Katan, M. B. (2010). Effect of animal and industrial trans fatty acids on HDL and LDL cholesterol levels in humans–a quantitative review. PloS one, 5(3), e9434. https://doi.org/10.1371/journal.pone.0009434

de Souza, R. J., Mente, A., Maroleanu, A., Cozma, A. I., Ha, V., Kishibe, T., Uleryk, E., Budylowski, P., Schünemann, H., Beyene, J., & Anand, S. S. (2015). Intake of saturated and trans unsaturated fatty acids and risk of all cause mortality, cardiovascular disease, and type 2 diabetes: systematic review and meta-analysis of observational studies. BMJ (Clinical research ed.), 351, h3978. https://doi.org/10.1136/bmj.h3978

Garsetti, M., Balentine, D. A., Zock, P. L., Blom, W. A., & Wanders, A. J. (2016). Fat composition of vegetable oil spreads and margarines in the USA in 2013: a national marketplace analysis. International journal of food sciences and nutrition, 67(4), 372–382. https://doi.org/10.3109/09637486.2016.1161012

Ras, R. T., Geleijnse, J. M., & Trautwein, E. A. (2014). LDL-cholesterol-lowering effect of plant sterols and stanols across different dose ranges: a meta-analysis of randomised controlled studies. The British journal of nutrition, 112(2), 214–219. https://doi.org/10.1017/S0007114514000750

Hebeisen, D. F., Hoeflin, F., Reusch, H. P., Junker, E., & Lauterburg, B. H. (1993). Increased concentrations of omega-3 fatty acids in milk and platelet rich plasma of grass-fed cows. International journal for vitamin and nutrition research. Internationale Zeitschrift fur Vitamin- und Ernahrungsforschung. Journal international de vitaminologie et de nutrition, 63(3), 229–233.

Yubero-Serrano, E. M., Lopez-Moreno, J., Gomez-Delgado, F., & Lopez-Miranda, J. (2019). Extra virgin olive oil: More than a healthy fat. European journal of clinical nutrition, 72(Suppl 1), 8–17. https://doi.org/10.1038/s41430-018-0304-x

Dealing with Funny Bone Injuries: Causes and Treatments

By
Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP
-
cropped view of doctor in medical costume checking elbow of his young female patient, healthcare

Can understanding the location of the funny bone and how pain can be managed after injury help expedite recovery and prevention for individuals who have hit their funny bone?

Dealing with Funny Bone Injuries: Causes and Treatments

Elbow Funny Bone Nerve Injury

Behind the elbow is an area known as the “funny bone,” where the ulnar nerve has less tissue and bone protection. This is where part of the ulnar nerve passes around the back of the elbow. Because less tissue and bone protect the nerve in this area, taking a hit like bumping into something can cause an electric shock-like pain and a tingling sensation down the arm and to the outside fingers typical of an irritated nerve. Most injuries to the funny bone resolve quickly, and the pain disappears after a few seconds or minutes, but sometimes, an ulnar nerve injury can lead to more persistent symptoms.

Anatomy

The funny bone is not a bone but the ulnar nerve. The nerve runs down the arm, passing around the back of the elbow. (Dimitrova, A. et al., 2019) Because the ulnar nerve is on top of the elbow and there is very little fatty cushion, lightly bumping this spot can cause pain and tingling sensations down the forearm. Three bones comprise the junction of the elbow that include:

  • Humerus – arm bone
  • Ulna and radius – forearm bones

The humerus has a groove that protects and holds the ulnar nerve as it passes behind the joint. This is where the nerve can be injured or irritated when the nerve is hit or pinched against the end of the bone, causing the funny bone pain.

Electrical Pain Sensation

When hitting the ulnar nerve or funny bone where the ulnar nerve provides sensation, pain, and electrical/tingling sensations are experienced from the forearm to the outside fingers. This part of the arm and hand is called the ulnar nerve distribution. (American Academy of Orthopaedic Surgeons. 2024) The ulnar nerve provides sensation into most of the pinky finger and about half of the ring finger. Other nerves, including the median and radial nerve, supply sensation to the rest of the hand.

Treatment

Usually, a sharp jolt to the elbow quickly resolves. Some recommendations to help symptoms improve faster include:

  • Shaking the forearm and hand out.
  • Straightening out and bending the elbow to stretch the nerve.
  • Decreasing mobility of the elbow.
  • Applying ice to the area.
  • Taking anti-inflammatory medications.

Treating Long-Lasting Pain

In rare circumstances, injuries to the ulnar nerve can cause more persistent symptoms, a condition known as cubital tunnel syndrome. Cubital tunnel syndrome can happen after an injury or from elbow overuse. Individuals with cubital tunnel syndrome may benefit from wearing a splint at night. Standard-sized splints can be ordered online, but most are fabricated by an occupational or hand therapist. If symptoms become more long-lasting, surgery may be recommended to relieve pressure and tension on the ulnar nerve (American Academy of Orthopaedic Surgeons, 2024). The procedure decompresses the nerve by relieving any tight constrictions around it and releasing them. In severe cases, the nerve is repositioned to an area that doesn’t place as much pressure on the nerve, known as an ulnar nerve transposition.

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution that helps individuals return to normal. Our providers create personalized care plans for each patient, including Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine principles through an integrated approach to treat injuries and chronic pain syndromes to improve ability through flexibility, mobility, and agility programs to relieve pain. If other treatment is needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments.

Chiropractic Treatment For Carpal Tunnel Syndrome

References

Dimitrova, A., Murchison, C., & Oken, B. (2019). Local effects of acupuncture on the median and ulnar nerves in patients with carpal tunnel syndrome: a pilot mechanistic study protocol. Trials, 20(1), 8. https://doi.org/10.1186/s13063-018-3094-5

American Academy of Orthopaedic Surgeons. (2024). Ulnar nerve entrapment at the elbow. https://orthoinfo.aaos.org/en/diseases–conditions/ulnar-nerve-entrapment-at-the-elbow-cubital-tunnel-syndrome/

Clinical Approach to Recognizing Trafficking – Part 2: Best Practices for Intervention

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

How can healthcare professionals recognize and establish protocols for individuals who are being trafficked and provide a safe place?

Introduction

Today, we will look at part two of this series, which is about recognizing trafficking in a clinical setting. Today’s article in this two-part series of recognizing trafficking helps inform many healthcare professionals to understand the roles and protocols for identifying trafficking that is affecting their patients and help provide a safe, positive space for them. We discuss with certified associated medical providers who consolidate our patients’ information to assess and identify trafficking in the clinic while taking the proper protocols to ensure patient safety. We also inform and guide patients while asking their associated medical provider intricate questions to integrate and provide them with a safe and positive space. Dr. Jimenez, D.C., includes this information as an academic service. Disclaimer.

 

Health Care Professional’s Role in Identifying Trafficking

Even though they may come across victims of human trafficking and have the chance to step in, many healthcare professionals believe they lack the knowledge and self-assurance needed to recognize these victims and offer them the kind of aid they need. As an illustration:

  • Just 37% of social workers and medical professionals surveyed again had any training in recognizing and supporting victims of human trafficking (Beck et al., 2015).
  • It is extremely hard for processors to identify and aid victims because traffickers move their victims around a lot and employ various strategies to evade discovery. Frequently, it could be your final interaction with the victim (Macy & Graham, 2012).
  • There can be a companion who comes across as very domineering, who won’t let the patient spend time alone with you, or who insists on filling out paperwork or talking on the patient’s behalf.
  • It’s possible that neither the victim nor their friend will have identification or insurance paperwork and will just pay in cash.
  • The victim or their companion may refuse to answer questions.
  • The victim may decline additional testing and follow-up care.
  • The victim may have physical injuries, sexually transmitted diseases, and signs of psychosocial stress.
  • The victim may not know the city and state that they are in.
  • The victim may appear fearful when asked questions or in the presence of their companion.
  • The victim may exhibit feelings of shame, guilt, helplessness, or humiliation.
  • You may notice inconsistencies in basic information, such as age, name, address, work history, or information regarding living status and daily activities.
  • If the patient does not speak English, where are they from, and how did they arrive?
  • If the patient is a minor, who and where is the guardian?
  • The victim may have unusual tattoos to indicate that they are the “property” of their trafficker.

 

Recognizing the Signs of Trafficking

You can more easily spot possible victims and offer the right help if you are aware of the typical warning indicators of human trafficking. The following are typical signs that someone is being trafficked. Naturally, not all victims or forms of trafficking will exhibit all of the indicators. Work and Living Conditions (National Human Trafficking Hotline, n.d.):

  • The victim may not be able to come and go on their own or leave their current home or work situation.
  • Human trafficking victims are often minors who are forced to engage in commercial sex acts.
  • The individual may work in the commercial sex industry and be under the control of a pimp or manager.
  • The victim may be required to work unusual or excessively long hours.
  • The victim may receive little, if any, pay or may only receive tips.
  • The victim may be subjected to unusual or extreme restrictions at work or may not be allowed to take breaks.
  • The victim may owe a large debt to their “employer.”
  • The victim may have been lured to their current work or living situation through false promises about the nature of their work or living environment.
  • The victim’s home or work location may have unusually high security, such as opaque or boarded-up windows, bars on windows, high fences, and security cameras.
  • The victim may be required to live at their work location.
  • The victim may experience various signs of abuse at the hands of their employer.
  • The victim may not be paid directly. Instead, the money is directed to the supervisor or manager, who deducts a large percentage for living expenses and other debts.
  • The victim may be forced to meet unreasonable daily quotas.
  • The victim may be forced to work in unsafe work environments without the proper safety equipment.

 

Chiropractic Care for Healing After Trauma-Video

Chiropractic Care for Healing After Trauma | El Paso, Tx (2024)

Best Practice Guidelines for Interviewing Trafficking Individuals

As a healthcare provider, you must continuously weigh the different courses of action at every interview process step. To establish trust and ensure safety, practitioners must, above all, put aside preconceived notions and assumptions about the victims and their behavior (Hodge, 2014; DeBoise, 2014; Hemmings, Jakobowitz, & Abas, 2016). Zimmerman and Watts (2003) suggest that the World Health Organization has produced rules for every phase of the interview process, which include the following recommendations:

  • It’s critical to keep in mind that every trafficking scenario and survivor is distinct, making it crucial to pay attention to and accept each person’s account.
  • It could take some time for victims to open up and be willing to talk about their experiences because it can be hard for them to build rapport and trust.
  • You should take precautions to protect both you and the victim because you should anticipate that the victim is at risk of psychological, bodily, social, and legal harm.
  • To prevent further upsetting the victim, you should consider the risks and advantages before beginning the interview process, as it can be a traumatic experience in itself.
  • While you should direct victims to available resources when necessary, you should avoid making unfulfilled promises or pledges.
  • The amount of time it takes for victims of human trafficking to be prepared to embrace change might vary greatly. Some victims can be eager to look for new possibilities and to improve their circumstances. Some people can be less likely to accept assistance because they haven’t developed enough trust issues or because they fear retaliation from their trafficker.
  • Depending on the situation, many service providers or interpreters must be present during the interview. Everyone taking part in the interview process ought to be reasonably knowledgeable about human trafficking, including how traffickers manipulate their victims and how to interact with them in a way that respects their cultural differences. To maintain anonymity and ensure the victim can communicate freely and honestly, you should refrain from using interpreters who are acquainted with the victim or who live in the same neighborhood.
  • Having an emergency safety plan in place is crucial to shielding the victim from harm—both from others and self-harm.
  • Consent must always be obtained voluntarily for all interventions, including interviews. For many victims who have never known autonomy or self-determination, this may be a foreign idea.
  • Avoid using legal or technical jargon.

Furthermore, it’s critical to remember that trauma survivors may suffer after treatment can have a lasting effect on all facets of their lives, making psychological, emotional, and physical safety a top priority. It is reasonable to presume that the person provides the most accurate account of their experience at that time. A person’s guarded, defensive, and belligerent behavior may be only their coping mechanism for their trauma. (V. Greenbaum, 2017)

 

How to Report Known or Suspected Trafficking

The best way to report suspected trafficking is by calling the National Human Trafficking Hotline or texting the number 711 if the patient responds affirmatively to the evaluation questions if your findings imply that they might be victims of human trafficking. Additionally, you can text 233733. Basic details about the case will be requested from you, such as (National Human Trafficking Hotline, n.d.):

  • the location of the suspected trafficking
  • the name of the alleged trafficker, if possible
  • your city and state
  • how you learned about the hotline

Health care providers who know or believe that a youngster is being abused, neglected, or abandoned should report their concerns to law enforcement or the relevant child welfare agency right away, as they are required reporters under child abuse and neglect statutes. You can report abuse online or by calling the Department of Children and Families Abuse Hotline in the state you are residing in.

 

Documenting Physical Findings

Physical findings should be meticulously and precisely recorded using written descriptions, freehand sketches that have been identified and annotated, and digital or film photos with the patient’s consent. Regarding photography, the picture should show the patient’s face and the lesion or injury measured using a coin, ruler, or other common object. The photo should include a piece of paper bearing the date the picture was taken. More photos can capture up close shots of every pertinent lesion or injury. Serial follow-up photos over seven to ten days can be used to record the healing or advancement of ecchymoses and other injury-related symptoms. A statement identifying the photographer and attesting to the accuracy and integrity of the images ought to be incorporated into the chart. Before any photos are taken, consent for the photographic documentation should be sought and recorded. Patients should be aware of their rights, which include the ability to decline all photographic documentation or limit it to a limited number of specified locations.

 

In addition to providing essential medical care, the healthcare professional should work to establish an environment where each patient feels respected, comfortable, cared for, validated, and empowered to reveal if they so choose. If the patient does not feel “ready” to demonstrate in the clinical environment, disclosure may happen later. As a result, for at-risk patients, every single clinical interaction should be seen as a step toward their eventual safety.

 

Laws & Policies for Human Trafficking

The United States has enacted a variety of laws and policies designed to prevent human trafficking, punish the perpetrators, and protect the survivors. One of these laws and policies is the Trafficking Victims Protection Act law or the TVPA (U.S. Congress).

 

This is the centerpiece of federal human trafficking legislation. The act focuses on three primary areas:

  • The TVPA seeks to prevent human trafficking through increased training and awareness.
  • The act seeks to protect trafficking victims by providing them access to services using federal funds similar to other refugees.
  • The act establishes trafficking and related crimes as federal offenses subject to stiff penalties.

One way that the legislation protects victims of human trafficking is that it absolves them of consequences for engaging in criminal activities that arise from their trafficking experience, such as entering the nation using fraudulent documents or working without the proper authorization. In addition, families of trafficking victims are qualified for T visas, which let them stay in the nation to support federal law enforcement in their pursuit of the offenders. After three years, victims can then apply to become permanent residents. Depending on the specific circumstances, many individuals may be entitled to assistance and benefits, such as access to the Witness Security Program and reparations. In addition, individuals between 16 and 24 could qualify for the Job Corp program and work permits.

 

Others criticize the TVPA. Usually, the onus is on the victim to prove their innocence or compulsion first. Second, the act emphasizes sex trafficking more than other types of human trafficking, which ignores how intricate human trafficking is. Only victims and survivors of “severe” types of trafficking who are prepared to cooperate with the investigation and prosecution of their offenders are eligible for the services provided under the act. This ignores the severity of the abuse the victims endured and the degree of mistrust and terror they might harbor toward both the abuser and others in positions of power.

 

Preventing Trafficking Through Awareness, Interventions, & Resources

In the shadows, human trafficking flourishes. We eradicate the shadows where human traffickers lurk by increasing public and health practitioner awareness of the problem (Hodge, 2008; Gozdziak & MacDonnell, 2007). For instance, putting up signs and pamphlets on human trafficking can not only help to enhance public awareness but also boost the chance that victims may come forward on their own. Brochures and posters are free from the Campaign to Rescue and Restore Victims of Trafficking.

 

When assisting victims of human trafficking, practitioners and service providers need to be able to engage with a variety of governmental, legal, medical, and social service organizations and institutions. Generally speaking, there are three main categories into which the care and services that a victim falls (Dell et al., 2019; Johnson, 2012; Oram & Domoney, 2018):

  • Immediate Services
  • Services Related to Recovery
  • Services About Reintegration

 

Resources for Providers

The National Human Trafficking Resource Center’s referral database can be consulted by providers looking to connect with local programs that assist victims of human trafficking or who need assistance for a victim or survivor. Many healthcare providers can check out the website to provide helpful resources in their local area.

 

Conclusion

Any human trafficking violates fundamental rights. Since human trafficking has many underlying roots, eradicating the issue would need different approaches on various fronts. When it comes to addressing racism, poverty, oppression, prejudice, and other factors that lead to human trafficking, healthcare professionals need to be dedicated to facing this issue both within their patient population and in partnership with colleagues from different disciplines. Physicians, social workers, counselors, and other health care professionals are required by their code of ethics to lead in addressing power abuses and advancing social justice. Practitioners can accomplish this, among other things, by teaching others and themselves about the intricate dynamics and international scope of human trafficking.

 

References

Beck, M. E., Lineer, M. M., Melzer-Lange, M., Simpson, P., Nugent, M., & Rabbitt, A. (2015). Medical providers’ understanding of sex trafficking and their experience with at-risk patients. Pediatrics, 135(4), e895-902. https://doi.org/10.1542/peds.2014-2814

DeBoise, C. (2014). Human Trafficking and Sex Work: Foundational Social-Work Principles. Meridians: Feminism, Race, Transnationalism, 12(1), 227–233. https://muse.jhu.edu/article/541879/pdf

Dell, N. A., Maynard, B. R., Born, K. R., Wagner, E., Atkins, B., & House, W. (2019). Helping Survivors of Human Trafficking: A Systematic Review of Exit and Postexit Interventions. Trauma Violence Abuse, 20(2), 183-196. https://doi.org/10.1177/1524838017692553

Gozdziak, E., & MacDonnell, M. (2013, March 4). Closing the Gaps: the Need to Improve Identification and Services to Child Victims of Trafficking by School of Foreign Service – Georgetown University – Issuu. Issuu.com. https://issuu.com/georgetownsfs/docs/gozdziak-closing-the-gaps

Greenbaum, V. J. (2017). Child sex trafficking in the United States: Challenges for the healthcare provider. PLoS Med, 14(11), e1002439. https://doi.org/10.1371/journal.pmed.1002439

Hemmings, S., Jakobowitz, S., Abas, M., Bick, D., Howard, L. M., Stanley, N., Zimmerman, C., & Oram, S. (2016). Responding to the health needs of survivors of human trafficking: a systematic review. BMC Health Serv Res, 16, 320. https://doi.org/10.1186/s12913-016-1538-8

Hodge, D. R. (2008). Sexual trafficking in the United States: a domestic problem with transnational dimensions. Soc Work, 53(2), 143-152. https://doi.org/10.1093/sw/53.2.143

H.R.3244 – 106th Congress (1999-2000): Victims of Trafficking and Violence Protection Act of 2000. (2019). Congress.gov. https://www.congress.gov/bill/106th-congress/house-bill/3244

Johnson, B. (2016). Aftercare for Survivors of Human Trafficking. Scribd. https://www.scribd.com/document/324584925/Aftercare-for-Survivors-of-Human-Trafficking

Macy, R. J., & Graham, L. M. (2012). Identifying domestic and international sex-trafficking victims during human service provision. Trauma Violence Abuse, 13(2), 59-76. https://doi.org/10.1177/1524838012440340

National Human Trafficking Hotline. (2023). National Statistics. Humantraffickinghotline.org. https://humantraffickinghotline.org/en/statistics

Oram, S. (2021). Responding to the mental health needs of trafficked women. European Psychiatry, 64(S1), S12-S12. https://doi.org/10.1192/j.eurpsy.2021.55

Zimmerman, C., & Watts, C. (2003). Ethical and safety recommendations for intervention research on violence against women. Www.who.int. https://www.who.int/publications/i/item/9789241510189

Disclaimer

Exploring the Myths and Realities of Hot Yoga and Toxin Release

By
Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP
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Group of young and sporty people doing Matsyendrasana or Lord of the Fishes pose during yoga class exercise in spacious bright studio

Can knowing about the health benefits of hot yoga help individuals decide if it is right for them?

Exploring the Myths and Realities of Hot Yoga and Toxin Release

Hot Yoga

The body has a system for ridding itself of what it can’t use or doesn’t need, called toxins. Individuals may have heard that they can sweat out toxins by doing various hot yoga styles. Hot yoga, practiced in a heated room, has become popular. The standard room temperature is around 105 degrees Fahrenheit with 40% humidity. (Mayo Clinic 2020) Because of the temperatures, hot yoga is not for everyone, and those with heart problems or dizziness are recommended to stick with regular classes. However, the detoxification medical benefits may not be there, or there is still insufficient research to confirm.

Body Detoxification

Broken down by the liver, the toxins in the blood or bile are filtered in the kidneys or intestines and removed in urine or stool. (Boyer J. L. 2013) Sweat is not part of the removal equation. The function of sweat is to cool the body down when it becomes overheated. This can happen during strenuous activity, when overdressed, or in summer. Sweat comprises primarily water with trace amounts of urea, lactic acid, and minerals. (Baker L. B. 2019) Except for water, none of the products in sweat are excreted in large enough quantities to alter or improve metabolic function. The sodium excreted in sweat is quickly re-absorbed through the skin’s epithelial sodium channels, which does little to alter the sodium levels in the blood. (Hanukoglu I. et al., 2017)

Environmental Toxins

The body is exposed to all sorts of toxins daily, including pollution and pesticides in the air, preservatives in our foods, and detergents and cosmetics on our skin. (Hunt P. 2011) Sweat-based exercise to remove these toxins is still unfounded.

Sweating In Hot Yoga

Many think that sweating in a hot yoga class will cleanse the alcohol or unhealthy foods. Yoga won’t help sweat these things out, but the practice still provides benefits that help burn some fat from the calories consumed. Exercising helps burn fat regardless of the temperature of the surroundings. (Swift, D. L. et al., 2014) The benefits include:

  • Increased circulation to deliver more oxygenated blood to the muscles.
  • Improved muscle tone and flexibility.
  • Stress relief.

Instead of sweating out the toxins, minimize exposure by eating a healthy, balanced diet, using natural products, and reading the labels of products placed on or in the body.

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness program that fully benefits the individual to get back to normal. Using an integrated approach to treat injuries and chronic pain syndromes, the ability to relieve pain is improved through flexibility, mobility, and agility programs. Our providers create personalized care plans for each patient, including Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine. If other treatment is needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments.

Body Signals Decoded

References

Mayo Clinic. (2020). What is hot yoga? Mayo Clinic Orthopedics and Sports Medicine. https://sportsmedicine.mayoclinic.org/news/what-is-hot-yoga/

Boyer J. L. (2013). Bile formation and secretion. Comprehensive Physiology, 3(3), 1035–1078. https://doi.org/10.1002/cphy.c120027

Baker L. B. (2019). Physiology of sweat gland function: The roles of sweating and sweat composition in human health. Temperature (Austin, Tex.), 6(3), 211–259. https://doi.org/10.1080/23328940.2019.1632145

Hanukoglu, I., Boggula, V. R., Vaknine, H., Sharma, S., Kleyman, T., & Hanukoglu, A. (2017). Expression of epithelial sodium channel (ENaC) and CFTR in the human epidermis and epidermal appendages. Histochemistry and cell biology, 147(6), 733–748. https://doi.org/10.1007/s00418-016-1535-3

Hunt P. (2011). Toxins all around us. Exposure to the chemicals in everyday objects poses a hidden health threat. Scientific American, 305(4), 14.

Swift, D. L., Johannsen, N. M., Lavie, C. J., Earnest, C. P., & Church, T. S. (2014). The role of exercise and physical activity in weight loss and maintenance. Progress in cardiovascular diseases, 56(4), 441–447. https://doi.org/10.1016/j.pcad.2013.09.012

Improve Your Health with Proper Sitting Posture

By
Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP
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Physiotherapist is conducting a consultation in a bright office, the patient complains of back pain

For individuals who sit at work for long hours, can years of practicing unhealthy posture be corrected through a step-by-step approach to ensure optimal body position while sitting?

Improve Your Health with Proper Sitting Posture

Sitting Posture

Sitting up straight with a healthy posture requires the conscious alignment of the hips, pelvis, lower back, upper back, shoulders, neck, and head. Learning or retraining oneself to maintain correct sitting posture can relieve lower back pain, improve respiration and digestion, and reduce tension in the neck and shoulders. (Albarrati, A. et al., 2018) It starts by paying attention to posture throughout the day and correcting it whenever forward head posture, leaning, or slouching develops. Targeted exercises can also help build upper-body strength, and stretching can stabilize and strengthen the core muscles, lower back, and pelvic joints. (Albarrati, A. et al., 2018)

Sit Up Straight Guide

Sitting up straight can be uncomfortable because it is not a natural position for the body to be in for an extended time. Nowadays, work, school, appointments, and other activities require us to sit much longer than intended. The muscles also have to work against gravity, leading to muscle exhaustion, slouching, and slumping, which can cause chronic back, leg, neck, and/or shoulder pain. (Jung, K. S. et al., 2020)

Sitting up straight may seem simple, but the focus tends to be on straightening just the lower/lumbar spine. This posture is unsustainable and exhausts and stresses the upper and lower back. (Jung, K. S. et al., 2020) The whole body needs to be considered when protecting the stability and balance of the spine. Learning and maintaining the ability to sit up straight is a process that requires practice.  Find a comfortable chair to sit in, and follow these steps to achieve the optimal postural alignment (Canadian Centre for Occupational Health and Safety, 2022)

Knee Spacing

  • The hips should be at a roughly 90-degree angle.

Knee Position

  • The knees should be at a 90-degree angle level with the hips.
  • Use a pillow to achieve the right knee position if the seat is too low.

Keep the Feet Flat on the Floor

  • If feet don’t reach the floor, place a footstool, box, book, or other flat object underneath them.

Sitting Bones

  • Also known as the ischial tuberosities, these are two knobby bones on the underside of the pelvis.
  • Feel around to find them.

Pelvis Adjustment

  • Shift the body so that the sitting bones are directly under the pelvis rather than situated too far back, stressing the lower back or too far forward, leading to slumping.

Spine Check

  • There should be a slight spinal curve, and one should be able to slip a hand between the lower back and the back of the chair.

Shoulder Check

  • The shoulders should be level and vertically aligned with the hips.
  • If the shoulder blades are pulled back or the shoulders are lifted or curled forward, relax them into a neutral position.

Head Positioning

  • The head tends to tilt too far forward while sitting as work and the day progresses.
  • Adjust the head position to align the neck with the upper spine.
  • The head should be slightly tilted forward, with the ears aligned with the shoulders.

Check for Pain and Discomfort

  • Pain may be due to structural imbalances of the spine, pelvis, or hips.
  • Use a lumbar chair support or place a rolled-up towel or cushion at the lower back to keep the back straight.

Added Tips

Tools and tricks to help prevent and avoid back, hip, and neck pain.

Chairs

  • All the bells and whistles for an ergonomic desk chair are unnecessary.
  • Focus on features like adjustable seat height and lumbar support. The correct seat depth recommendations are deeper if tall and shallower if short. (van Niekerk, S. M. et al., 2012)

Cushions

  • If sitting on a cushion or using one to bolster the back or hips, recommendations are not to go too soft.
  • Cushions that are too soft allow the ability to shift from one hip to the next, often without realizing it.
  • They usually eventually flatten and lose support.

Monitor Position

  • There is no point in sitting straight if the monitor is too high or too low.
  • The monitor should be at eye level to maintain the proper head and shoulder alignment.
  • If the monitor is too low, place a box or book underneath it.
  • If it is too high, raise the chair’s height and place a footrest under the feet to keep them flat.

Avoid Crossing Legs or Feet

  • Crossing the legs or feet places stress on the opposite hip, thigh, and knee and wears the body out faster.
  • If the hips or legs are tiring prematurely, the individual is not sitting correctly or in the wrong chair.

Use Comfortable Footwear

  • Maintaining flat feet on the floor while sitting is imperative.
  • This is not possible in high heels or platform shoes.
  • Change into a comfortable pair of flat shoes while sitting.

Take Regular breaks

  • Even with an ergonomic desk chair, the body is not meant to be sitting for hours and hours.
  • Get up at least every hour, walking and stretching to reactivate the muscles and circulation.

Try a Sitting-Standing Desk

Sitting up straight requires body alignment awareness, stable core muscles, and balanced pelvis, hips, spine, shoulders, neck, and head positioning. It may take some time before these steps become normal, but they will become second nature with perseverance and practice. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution that fully benefits the individual to get back to normal. Using an integrated approach to treat injuries and chronic pain syndromes to improve ability through flexibility, mobility, and agility programs to relieve pain. Our providers create personalized care plans for each patient, including Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine principles. If other treatment is needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments.

Posture and Mobility

References

Albarrati, A., Zafar, H., Alghadir, A. H., & Anwer, S. (2018). Effect of Upright and Slouched Sitting Postures on the Respiratory Muscle Strength in Healthy Young Males. BioMed research international, 2018, 3058970. https://doi.org/10.1155/2018/3058970

Jung, K. S., Jung, J. H., In, T. S., & Cho, H. Y. (2020). Effects of Prolonged Sitting with Slumped Posture on Trunk Muscular Fatigue in Adolescents with and without Chronic Lower Back Pain. Medicina (Kaunas, Lithuania), 57(1), 3. https://doi.org/10.3390/medicina57010003

Canadian Centre for Occupational Health and Safety. (2022). Working in a sitting position – good body position. Retrieved from https://www.ccohs.ca/oshanswers/ergonomics/sitting/sitting_position.html

van Niekerk, S. M., Louw, Q. A., & Hillier, S. (2012). The effectiveness of a chair intervention in the workplace to reduce musculoskeletal symptoms. A systematic review. BMC musculoskeletal disorders, 13, 145. https://doi.org/10.1186/1471-2474-13-145

Understanding and Recognizing Trafficking in a Chiropractic Clinic (Part 1)

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

How do healthcare professionals provide a clinical approach to recognizing trafficking to individuals seeking a safe environment?

Introduction

 Around the world, there is a phenomenon that local media and organizations are paying more attention to and that many people should be aware of. This is known as trafficking, and it can encompass a wide range of activities, from forced labor in various industries to sex work. While most individuals of trafficking are usually young women or children, it can affect many individuals of all ages and backgrounds. Many survivors of trafficking are compelled to live with the psychological and physical injuries they sustained from the mistreatment they endured at the hands of their traffickers. This course aims to give medical professionals and others in allied fields an understanding of the realities of human trafficking, as well as the kinds of resources and interventions that can be used to help many individuals trafficking in this two-part series. Today’s article overviews trafficking and how it can impact the individual. In part two, we will discuss the roles and protocols of how healthcare professionals can identify trafficking while providing a safe and positive space for the individual. We discuss with certified associated medical providers who consolidate our patients’ information to assess and identify trafficking in the clinic. We also inform and guide patients while asking their associated medical provider intricate questions to integrate a customized treatment plan for their pain and provide them with a safe and positive space. Dr. Jimenez, D.C., includes this information as an academic service. Disclaimer.

 

The Definition of Trafficking

It can be challenging to define trafficking since it frequently coexists with other problems like forced marriage, sexual assault, domestic abuse, and forced labor. (Hume & Sidun, 2017)  As the United Nations stated, trafficking encompasses the following activities: “as recruitment, transportation, transfer, harboring, or receipt of many individuals using the threat or use of force to achieve the consent of a person having control over another person, for exploitation.” (United Nations Human Rights Office of the High Commissioner, n.d.)  The following components of this definition include:

Additionally, the definition of trafficking also has the following divisions that are also feasible (United Nations Office on Drugs and Crime, n.d.):

  • Act: This is a reference to the different forms of human trafficking, including the hiring, transferring, receiving, and harboring of individuals.
  • Means: Coercion, force, fraud, kidnapping, deception, abuse of power or weakness, or providing cash or other rewards to someone in a position of authority over the victim are typically used to carry out trafficking.
  • Purpose: Traffickers engage in forced labor, prostitution, sexual exploitation, forced servitude, slavery, and even organ harvesting to further their financial interests.

While the terms are occasionally used synonymously, human trafficking and people smuggling are not the same. Human smuggling is the transportation of a person into the nation by illicit means; it is voluntary, as the person smuggled usually offers compensation to another individual or party to achieve this purpose (Lusk & Lucas, 2009).

 

 

The broad term of human trafficking in the Trafficking Victims Protection Act includes both labor trafficking and sex trafficking. Sex trafficking is when someone is under the age of 18 and is obtained, patronized, or solicited for a commercial sex act by deception, force, or compulsion. The forced, coerced, or fraudulent submission of an individual to slavery, debt bondage, involuntary servitude, or peonage is considered labor trafficking. According to the U.S. Congress, the TVPA does not require that trafficking take place if a person is physically moved from one location to another.

 

The Statistics Of Trafficking

Determining the actual extent of the problem is challenging due to the complexity of the human trafficking issue and the fact that both the offenders and the victims frequently go unnoticed. A few published estimates from academics, researchers, and organizations and agencies responsible for recording and monitoring occurrences of human trafficking are as follows:

  • According to estimates from the International Labour Organization, there are over 40 million victims of human trafficking worldwide. (International Labour Organization, n.d.)
  • Over 51,000 complaints of cases of human trafficking have been received by the National Human Trafficking Hotline since 2007 (National Human Trafficking Hotline, n.d.).
  • The number of persons thought to be trafficked in the United States varies greatly from year to year, with estimates ranging from 40,000 to 50,000. (Weizter, 2007)
  • Most anti-trafficking programs tend to center on sex trafficking because of its sensationalized aspect (Saiz-Echezarreta, Alvarado, & Gomez-Lorenzini, 2018).
  • In 2017, the United States Department of Justice obtained 1,045 convictions for offenses related to human trafficking, a 78% increase from 2015. (International Labour Organization, n.d.).
  • According to the International Labour Organization, over 15 million people are in forced marriages, 4.8 million people are victimized by sex trafficking, and forced labor trafficking claims the lives of almost 25 million people globally. (International Labour Organization, 2017)
  • In the US, Florida is the third-most popular destination for victims of human trafficking. In 2018, there were 767 reports of human trafficking incidents in Florida and close to 1,900 contacts with the National Human Trafficking Hotline. There was almost 70% of sex trafficking, 16.5% of labor trafficking, and 7.5% of both sex and labor trafficking combined. Of the victims, 56% were adults, and 69% were female (National Human Trafficking Hotline, n.d.).

 

Data Collection Challenges

The current ICD-10-CM abuse codes could not adequately distinguish victims of human trafficking from other abuse victims, even though an increasing number of caregivers are trained to recognize and record individuals of different forms of human trafficking. Clinicians couldn’t properly identify a condition or arrange the resources needed to administer treatment without the right codes. Additionally, this made it impossible to critically monitor the existence and recurrence of human labor or sexual exploitation.

 

June 2018 saw the publication of the first ICD-10-CM codes for categorizing abuse related to human trafficking, as requested by the American Heart Association’s Hospitals Against Violence program. The proposal for the modification came from the AHA’s Central Office on ICD-10, which collaborated with Catholic Health Initiatives, the Human Trafficking Initiative at Massachusetts General Hospital, and the Freedom Clinic. With effect from FY 2019, certain ICD-10-CM codes can be used to collect data on adult or child forced labor or sexual exploitation, whether it is proven or suspected. These new codes may be issued in addition to other current ICD-10-CM codes for abuse, neglect, and other maltreatment. These codes received support from different hospitals and health systems. Furthermore, there exist novel codes that can be utilized to record an individual’s past labor or sexual exploitation history, examine, rule out, and observe instances of exploitation, and identify multiple, repeating perpetrators of maltreatment and neglect through an external cause of code (Macias-Konstantopoulos, 2018).

 

The ICD-10-CM provides specific abuse codes for a range of abuse experiences, such as physical abuse of an older adult, sexual abuse of a child, and violence against a spouse or partner. Similar to how disease diagnosis codes are used, tracking the frequency and trends of particular abuse types, their relationships to other injuries and illnesses, and the kinds of resources that might be needed to stop the abuse are all made feasible by recording abuse using the relevant ICD-10-CM code. Adopting prevention strategies, creating best practices for treatment, introducing new services and payment methods, and establishing new financing and research fields are all made possible by using these codes as the primary diagnosis (Macias-Konstantopoulos, 2018).

 

Documenting particular types of violence and abuse alone does not give a full picture of the abuse experience. Every abuse experience is a result of a complex interaction between several variables, including the physical surroundings, social and familial dynamics, and personal risks and vulnerabilities. Healthcare professionals can respond to illnesses and injuries connected to abuse as well as underlying health-related social and mental requirements more effectively when these aspects are assessed, documented, and coded using ICD-10-CM Z codes. Similarly, applying ICD-10-CM S, T, V, W, X, and Y codes to record and classify external causes of morbidity as well as the nature, purpose, and mechanism of injury can help shed light on how abuse and violence are committed and pave the way for further preventative measures (Macias-Konstantopoulos, 2018).

 

Required Actions

  • Coders should be aware of and start using the ICD-10-CM codes for forced labor and sexual exploitation as they examine a patient’s medical records to determine which ICD-10-CM codes to include.
  • Hospitals and health systems should inform those who need to know—doctors, nurses, other medical professionals, and coding specialists, among others—about the significance of gathering data on forced labor and sexual exploitation of people.
  • By keeping track of verified and suspected cases within the healthcare system, hospitals, and health systems can better monitor victim requirements and find ways to enhance community health. This practice also offers an additional means of gathering data to help the systemic creation of a service and resource infrastructure, as well as attempts to prevent harm and inform public policy.

The accompanying chart illustrates the distinction between focused and comprehensive assessment, documentation, and coding of abuse. It also highlights how these differences may affect medical professionals’ reactions to cases and their comprehension of the kinds of resources that may be required to help victims of human trafficking (Macias-Konstantopoulos, 2018).

 

Beyond the Surface: Understanding the Effects of Personal Injury- Video

Beyond the Surface: Understanding the Effects of Personal Injury | El Paso, Tx (2024)

Common Misconceptions of Trafficking

There is a misconception that trafficking entails the kidnapping and crossing of national or international borders for various activities to individuals. This misconception fails to acknowledge that individual trafficking can be of any ethnicity, gender, or country and that it can happen almost anywhere and in any sector of the economy. A handful of the widespread myths about human trafficking are as follows:

  • Myth: Physical violence is a common part of trafficking. Traffickers frequently employ nonviolent tactics, such as deception, manipulation, intimidation, and deceit, to coerce their victims into exploitative circumstances, even while physical violence plays a role in many of their crimes.
  • Myth: Sexual exploitation is a necessary component of trafficking. It’s likely the most well-known type of trafficking, but commercial sexual exploitation of victims is also a frequent practice. However, experts think that labor trafficking is more commonplace throughout the world.
  • Myth: Only undocumented foreign nationals are victims of trafficking. The Polaris Project operates the National Human Trafficking Hotline, which has handled thousands of cases of trafficking involving foreign nationals who are lawfully employed or residing in the United States.
  • Myth: Only illicit or covert sectors are involved in trafficking. Trafficking has been documented concerning several legitimate industries, including manufacturing, restaurants, cleaning services, and construction.
  • Myth: Transporting a person across state or national borders is a part of trafficking. Human smuggling is the illicit movement of persons across state or national borders. There can be trafficking even when there is no cross-border travel. A person may even become a victim of trafficking in their own house or hometown.
  • Myth: Trafficking is always a part of the commercial sex trade. Any commercial sex with kids is invariably seen as human trafficking. Adult commercial sex is only classified as trafficking when the victim is coerced, compelled, or deceived into doing it against their will.

 

Common Forms of Trafficking

 There are many forms of trafficking as many individuals that were trafficked are categorized into the following:

  • Sex Trafficking
  • Bonded Labor/Forced Labor
  • Child Labor
  • Child Conscription

 

The Impact & Consequences of Trafficking on Individuals

For someone who has never experienced human trafficking, it might be challenging to understand why so many victims choose to remain silent or show such a strong willingness to cooperate with their traffickers (Johnson, 2012). According to Baldwin, Fehrenbacher, and Eisenman (2015), the victim’s compliance and quiet are influenced by the following elements, which the quiet Compliance Model explains:

Coercion: Traffickers use violence, intimidation, and depriving the individual of basic needs to force them into obedience. Traffickers may employ psychological strategies, including isolation, degrading treatment, and induced tiredness in addition to physical force. As a result, the individual experiences a distorted sense of reality and feels helpless.

Collusion: The victim’s cooperation with their traffickers in trafficking or other illicit activities may result from a combination of factors, including fear, loneliness, total dependence, and even a sense of identification with the trafficker.

Contrition: The victims’ guilt and regret for their acts, despite the coerced collaboration, only serve to guarantee their quiet (Johnson, 2013).

Trafficking individuals are susceptible to a wide range of health issues, including chronic illnesses brought on by inadequate working conditions or malnourishment, unwanted pregnancies, severe injuries, and STDs. It’s crucial to remember that emotional issues are often experienced as physical illnesses or sensations in certain cultures. For instance, depression, stress, or anxiety may manifest as symptoms of exhaustion, headaches, or gastrointestinal issues (Greenbaum, 2018; Zimmerman, Hossain, & Fun, 2008).

 

Conclusion

It is important to recognize the signs of trafficking in individuals who have been dealing with these issues. In part 2 of this series, we will look at how healthcare workers are identified and what procedures to take when a patient is trafficked. This allows the individual to know they are in a safe and positive environment to get the help they deserve.

 

References

Baldwin, S. B., Fehrenbacher, A. E., & Eisenman, D. P. (2015). Psychological Coercion in Human Trafficking. Qualitative Health Research, 25(9), 1171-1181. https://doi.org/10.1177/1049732314557087

Greenbaum, V. J. (2017). Child sex trafficking in the United States: Challenges for the healthcare provider. PLoS Med, 14(11), e1002439. https://doi.org/10.1371/journal.pmed.1002439

Hume, D. L., & Sidun, N. M. (2017). Human Trafficking of Women and Girls: Characteristics, Commonalities, and Complexities. Women & Therapy, 40(1-2), 7-11. https://doi.org/10.1080/02703149.2016.1205904

International Labour Organization. (2024, January 28). What is forced labor?www.ilo.org. https://www.ilo.org/topics/forced-labour-modern-slavery-and-human-trafficking/what-forced-labour

International Labour Organization. (2022, September 12). Global Estimates of Modern Slavery: Forced Labour and Forced Marriage | International Labour Organization.www.ilo.org. https://www.ilo.org/publications/major-publications/global-estimates-modern-slavery-forced-labour-and-forced-marriage

Johnson, B. (2016). Aftercare for Survivors of Human Trafficking. Scribd. https://www.scribd.com/document/324584925/Aftercare-for-Survivors-of-Human-Trafficking

Lusk, M., & Lucas, F. (2008). The challenge of human trafficking and contemporary slavery. Journal of Comparative Social Welfare, 25(1), 49–57. https://doi.org/10.1080/17486830802514049

Macias-Konstantopoulos, W. L. (2018). Diagnosis Codes for Human Trafficking Can Help Assess Incidence, Risk Factors, and Comorbid Illness and Injury. AMA J Ethics, 20(12), E1143-1151. https://doi.org/10.1001/amajethics.2018.1143

National Human Trafficking Hotline. (2023). National Statistics. Humantraffickinghotline.org. https://humantraffickinghotline.org/en/statistics

Florida | National Human Trafficking Hotline. (n.d.). Humantraffickinghotline.org. https://humantraffickinghotline.org/en/statistics/florida

Parreñas, R. S., Hwang, M. C., & Lee, H. R. (2012). What Is Human Trafficking? A Review Essay. Signs: Journal of Women in Culture and Society, 37(4), 1015–1029. https://doi.org/10.1086/664472

Saiz Echezarreta, V., Alvarado, C., & Gómez-Lorenzini, P. (2018). Advocacy of trafficking campaigns: A controversy story. Comunicar, 26(55), 29–38. https://doi.org/10.3916/c55-2018-03

United Nations. (2000). Special Treaty Event Protocol to Prevent, Suppress and Punish Trafficking in Persons, Especially Women and Children, supplementing the United Nations Convention against Transnational Organized Crime (New York, 15 November 2000). https://www.unodc.org/documents/treaties/Special/2000_Protocol_to_Prevent_2C_Suppress_and_Punish_Trafficking_in_Persons.pdf

United Nations. (2024). Human Trafficking. United Nations: Office on Drugs and Crime. https://www.unodc.org/unodc/en/human-Trafficking/Human-Trafficking.html

Weitzer, R. (2007). The Social Construction of Sex Trafficking: Ideology and Institutionalization of a Moral Crusade. Politics & Society, 35(3), 447-475. https://doi.org/10.1177/0032329207304319

Zimmerman, C., Hossain, M., Yun, K., Gajdadziev, V., Guzun, N., Tchomarova, M., Ciarrocchi, R. A., Johansson, A., Kefurtova, A., Scodanibbio, S., Motus, M. N., Roche, B., Morison, L., & Watts, C. (2008). The health of trafficked women: a survey of women entering posttrafficking services in Europe. Am J Public Health, 98(1), 55-59. https://doi.org/10.2105/AJPH.2006.108357

 

 

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