Female Hernia: Misdiagnosis and Treatment Options

By

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A young woman is running and doing sports in the park, standing with her hands on her stomach, feeling nauseous and near after exercise.

In females, hernia symptoms are often smaller and deeper without a noticeable lump and can mimic gynecological issues, with misdiagnoses being common. Can knowing the risk factors and how female hernias are treated help women get relief?

Table of Contents

Female Hernia

A hernia occurs when an internal structure pushes through a weak spot in the abdominal wall, the muscles, and the tissue covering the front of the torso. The more common include:

Groin hernia, known as an inguinal hernia.
Upper thigh or femoral hernia.

However, a hernia can develop anywhere from the ribcage to the upper thigh. Hernias are less common in women, have different symptoms than in men, and are often misdiagnosed. Lower abdominal and pelvic hernias present differently in women than men, who typically have a visible bulge. Instead, female hernias tend to be smaller, deeper, and less noticeable. They can also cause chronic pelvic pressure or pain that can be mistaken for gynecological problems.

Hernia Symptoms For a Woman

Hernias in women tend to be smaller and deeper than male hernias, with no lump showing. Instead, female hernias can cause chronic, deep pelvic pain and occasional sharp, stabbing pain that comes on fast and lingers. (Köckerling F., Koch A., & Lorenz R. 2019) Hernia pain worsens with exercise, laughing, coughing, or straining to evacuate the bowels. The pain is often described as:

Dull
Aching
Pinching
Sharp
Shooting
Burning

Inguinal hernia pain is usually felt at or above the groin and may radiate to the hip, lower back, vulva, or thigh. Many women find the pain increases during their menstrual cycle. The pain can also be exacerbated by any activity that generates extra pressure on the pelvic floor, including:

Prolonged sitting or standing.
Bending
Getting in or out of bed.
Getting in or out of a car.
Sexual intercourse

Emergency

Hernias in the pelvic area are at risk of becoming incarcerated hernias. An incarcerated hernia occurs when a portion of the intestine or other abdominal tissue becomes trapped in the hernial sac, making it impossible to push it back into place. If this gets trapped or strangulated, it can cause tissue death. Strangulated hernias are a medical emergency. Symptoms include:

Deep red or purple tissues.
The hernia bulge does not shrink when you lie down.

Other symptoms that warrant immediate medical attention include: (Johns Hopkins Medicine, 2025)

Worsening pain
Bloating
Difficulty with bowel movements
Nausea
Fever
A fast, racing heartbeat.

Contact a healthcare provider or the emergency room if experiencing any of the above symptoms.

Types

Hernias can occur anywhere on the abdominal wall. They may be caused by:

Internal pressure, such as during pregnancy.
A sports injury
Tissue weakness

Hernias in the lower abdomen or groin are typically indirect inguinal hernias. The inguinal canal comprises multiple layers of muscles and fascia that the thin round ligament threads through. Other groin and pelvic hernias include:

A direct inguinal hernia
A femoral hernia at the top of the inner thigh.
An obturator hernia in the front upper thigh, although this type is rare.

Other common hernias in women are:

Incisional hernia – at the site of a surgical incision
Umbilical hernia – around the belly button
Ventral hernia – abdominal midline

Less common hernias include:

Hiatal hernia – diaphragm
Perineal hernia – pelvic floor

Risk Factors

Risk factors for developing a hernia include: (Johns Hopkins Medicine, 2025)

Obesity
Frequent constipation
Abdominal or pelvic surgery.
Allergies with chronic sneezing.
A chronic cough.
Collagen defects or connective tissue disorders.

Pregnancy and repeated pregnancies are linked to an increased risk of hernia. Types that are more common in pregnancy include:

Umbilical hernia
Ventral hernia
Inguinal hernia

Umbilical hernias are the most common. However, only a small percentage of pregnant individuals get them. (Kulacoglu H. 2018)

Diagnosis

A hernia diagnosis is made with a physical examination and, if needed, imaging studies. Patients are asked to describe their symptoms precisely, where the pain is located, and any activities that exacerbate it. To check for a hernia, the healthcare provider will palpate for a hernia while the patient sits, stands, or coughs. Imaging tests can include:

Ultrasound
CT scan
Endoscopy – a camera is used to see inside the esophagus and stomach.

Misdiagnoses

Female hernia symptoms can be vague, which often points healthcare providers in the wrong direction. Female hernias are commonly misdiagnosed as: (Köckerling F., Koch A., & Lorenz R. 2019)

Cysts in the reproductive organs
Endometriosis
Fibroid tumors

Treatment

A small hernia that does not cause problems or pain may be treated with a wait-and-evaluate protocol. A hernia often worsens over time and could eventually require surgery. (University of Michigan Health, 2024) Self-care treatments include:

Rest (American Academy of Orthopaedic Surgeons, 2022)
Compression wraps (American Academy of Orthopaedic Surgeons, 2022)
Ice (Northeast Georgia Health System, 2022)
Over-the-counter pain medication (Northeast Georgia Health System, 2022)

Medical treatments usually start with conservative measures, including physical therapy, stretching, exercise, and rest. Physical therapists often use myofascial release techniques to relieve muscle spasms. Surgery may be needed to repair the weak area of the abdominal wall to relieve symptoms. (University of Michigan Health, 2024) Hernia repair surgery is typically performed as a laparoscopic surgery. (Köckerling F., Koch A., & Lorenz R. 2019) Most patients heal quickly from the surgery and can return to regular activities in a week or two.

Injury Medical Chiropractic and Functional Medicine Clinic

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

Lumbar Spine Injuries in Sports: Chiropractic Healing

References

Köckerling, F., Koch, A., & Lorenz, R. (2019). Groin Hernias in Women-A Review of the Literature. Frontiers in surgery, 6, 4. doi.org/10.3389/fsurg.2019.00004

Johns Hopkins Medicine. (2025). How to tell if you have a hernia. www.hopkinsmedicine.org/health/conditions-and-diseases/how-to-tell-if-you-have-a-hernia

Kulacoglu H. (2018). Umbilical Hernia Repair and Pregnancy: Before, during, after…. Frontiers in surgery, 5, 1. doi.org/10.3389/fsurg.2018.00001

University of Michigan Health. (2024). Inguinal hernia: Should I have surgery now, or should I wait? www.uofmhealth.org/health-library/za1162

American Academy of Orthopaedic Surgeons. (2022). Sports hernia. orthoinfo.aaos.org/en/diseases–conditions/sports-hernia-athletic-pubalgia/

Northeast Georgia Health System. (2022). Living with a hernia. Northeast Georgia Health System Improving the health of our community in all we do. www.nghs.com/2022/02/15/living-with-a-hernia

Delve Into Maslow’s Hierarchy of Needs In A Clinical Approach

By

Dr Alexander Jimenez DC, APRN, FNP-C

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Table of Contents

The Humanistic Perspective

Psychoanalytic theory and behaviorism helped the humanistic viewpoint gain popularity in the middle of the 20th century. Humanism refers to those who stress human potential and the capacity for change. However, biological determinism—the belief that the majority of human traits, both mental and physical, are predetermined at conception—is rejected by humanism. Individuals’ innate need for self-actualization and creativity is emphasized by the humanistic viewpoint, which focuses on how individuals grow. Moreover, it is fundamental to the humanistic viewpoint since it is the idea that development is seen as an ongoing process that is influenced more by an individual’s social and environmental conditions than by genetics or other natural elements. Carl Rogers and Abraham Maslow, two prominent humanistic thinkers, investigated the use of the human viewpoint in a therapeutic setting. Better knowledge of pain, suffering, and emotions is made possible, and a more optimistic approach is certain to enhance patient and nurse practitioner results.(Boston-Leary et al., 2024)

Functional Medicine’s Influence Beyond Joints-Video

Functional Medicine's Influence Beyond Joints | El Paso, Tx (2024)

Abraham Maslow’s Hierarchy of Needs

Abraham Maslow (1908–1970), an American humanistic psychologist, researched and concentrated on the capacity for development in healthy people. He thought that individuals work toward self-actualization and begin to accept others and themselves for who they are. He saw that a lot of individuals were able to enjoy themselves and live comparatively guilt-free because they had lost their inhibitions.

Since Maslow’s hierarchy of needs is a psychological theory that explains a pattern via which human motivations often arise at the next level by enabling the person to be fully satisfied with the previous level, many people start using it to encourage action at that point. In Maslow’s hierarchy of needs, motivation is primarily based on a number of separate underlying systems, some of which are generated and given precedence over others. (Kenrick et al., 2010) We have also learned a lot about the self thanks to Maslow’s beliefs. Maslow’s hierarchy of requirements has five levels that enable people to grow: safety, self-actualization, love and belonging, esteem, and physiological needs. The development of a person toward meeting their greatest wants is symbolized by these five phases.

Physiological Needs

Maslow asserts that the primary physical need for human life are physiological needs, which include food, water, sleep, shelter, sex, and preserving bodily homeostasis. Many individuals must have their physiological needs met, such as eating, drinking, sleeping, or breathing, in order to be driven by the requirements at a higher level. Many nurses in a hospital context move away from safety and physiological demands as they show resilience and stability and adjust to the changing needs of the healthcare system. (Hayre-Kwan et al., 2021)

Safety

The second stage—known as safety—begins to gain priority and develop into a dominating habit if a person’s physiological demands are roughly supplied. This may be achieved via earning money, accumulating assets, and looking for safe havens. That individual may think about what they desire after they are content and feel secure. Safety needs must include the need for personal, emotional, financial, and physical security because when physical safety is lacking due to environmental factors like war, natural disasters, family violence, childhood abuse, or institutional racism, many people may experience or re-experience post-traumatic stress disorder (PTSD) or transgenerational trauma.

Another example of environmental variables impacting safety is economic safety, which may be brought on by a lack of employment prospects and a financial crisis. A need for employment stability, grievance processes to shield individuals against unjustified power, savings accounts, insurance policies, etc. are some examples of how economic safety must show up when it is lacking. Because children typically need to feel protected, this level of Maslow’s hierarchy of needs tends to prevail in their lives.

Love & Belonging

According to Maslow’s hierarchy of wants, love and belonging come in at number three. The yearning for friendship, closeness, and belonging are all components of love and belonging. Being close to family and friends is something that many individuals want when they join a club or subscribe to a group. In order to preserve a positive nurse-patient connection, healthcare professionals must provide affection and belonging to people who are experiencing pain-like sensations. This will guarantee that the person’s needs and desires are acknowledged and provide them a positive outlook to lessen their suffering. (Xu et al., 2021) During childhood, the demand for protection may be subordinated to the need for love and belonging. This is seen as a bad thing among kids who cling to violent parents. This level of Maslow’s hierarchy has deficiencies that might negatively impact a person’s capacity to establish and sustain emotionally meaningful connections, such as institutionalization, neglect, shunning, or ostracism. Furthermore, the growth of an individual might be greatly impacted by these adverse events.

Esteem

Maslow’s hierarchy of needs places self-esteem at stage four. Self-esteem is the common human need to be appreciated and accepted by others. Everyone aspires to be someone at this point, therefore many seek respect, self-worth, and confidence from their peers. A person with money may purchase a high-end watch, for instance, whereas someone with a brain might write, ponder, or even work a lot. This results from the drive to compete and perform at the best level possible. Due to ego demands like status or respect, many individuals will also often pursue a career or pastime. Many individuals will worry about receiving respect, prestige, significance, and acknowledgment from others since most people desire to feel valued. Consequently, it is necessary to have self-respect and self-esteem. However, a person’s self-esteem may suffer if they don’t get positive comments, which might hinder their progress. Consequently, the root causes of their pain and suffering will be addressed. (Carroll et al., 2025)

Self-Actualization

Self-actualization is the last level in Maslow’s hierarchy of needs. The ability to eat, sleep, feel secure, fit in with a group, and yet feel unique are all examples of lower levels of requirements that must be met in order for individuals to reach the greatest level of their existence. When we get to the top, we may relax, be creative, and accept things as they are. It is still possible for any of the lower levels’ requirements to stay low even when there is no longer any pressure on particular demands. The drive to become the best version of oneself by achieving attainable goals is known as self-actualization. Self-actualization is a condition of self-fulfillment where individuals may reach their full potential in a way that is unique to them, according to humanistic ideology. This desire may be seen or focused on quite precisely by many people. A few instances are as follows:

Someone who aspires to be the perfect parent
Someone who aspires to express themselves via sports
Individuals who used their skills and aptitudes to create art as a self-expression.

Questions of the Hierarchal Status

When talking about human behavior, Maslow’s hierarchy of needs serves as a crucial basis for comprehending the relationship between drive and motivation. As one moves up the ladder, each requirement is shown in the levels that call for motivation. Numerous significant problems begin to surface while examining the hierarchical structure.

The first concern is the path of advancement when a person advances both within and between levels. Maslow first highlighted the need of attending to lower-level needs before moving on to higher-level requirements. This original idea gave rise to an understanding of how different people are in how they see and value each fundamental need. For instance, females may prioritize their reproductive requirements above those of other people. According to Maslow, satisfying every need is not a prerequisite for fulfilling needs at a higher level. The next level of demands takes precedence after a person’s fundamental, lower-level wants have been mostly met. Higher-level wants, like self-actualization, might be satisfied before certain lower-level needs are completely satisfied.

Whether a person climbs unidirectionally from the base of the pyramid to the summit is a second, related topic. Multidirectional mobility throughout the phases is conceivable because a person’s requirements at a given period of life may be influenced by a variety of variables. In light of being laid off, an employee who is considering raising a family—the third stage of Maslow’s hierarchy—may need to concentrate on the second level, safety. The second and third levels of Maslow’s hierarchy of needs would take unemployment into account, even if this worker had created a feeling of safety and security. Because human existence and progress are dynamic rather than static, the hierarchy must allow for this fluctuation, which is why it is significant. The main idea behind Maslow’s theory is that because self-actualization is the aim, fundamental needs must be satisfied before one is inspired to pursue higher-level wants. This encourages the person to evaluate every need that must be met in order to achieve self-actualization with a positive connection. (Taormina & Gao, 2013) People will see improvements in their bodies and mentalities as well as better lifestyles as they begin to incorporate Maslow’s hierarchy of needs into their daily routines.

Injury Medical Chiropractic & Functional Medicine Clinic

We collaborate with licensed healthcare professionals who apply Maslow’s hierarchy of needs to our patients’ pain and suffering in a clinical setting. In addition to posing crucial queries to our affiliated healthcare professionals, we counsel individuals to incorporate minor adjustments into their everyday schedules and provide them a secure environment.This material is envisioned as an academic service by Dr. Alex Jimenez, D.C. Disclaimer.

References

Boston-Leary, K., Alexander, G. R., & Davis, S. (2024). Leveraging Maslow’s Hierarchy of Needs to Build Nursing’s More Inclusive Future. Nurs Adm Q, 48(1), 55-64. doi.org/10.1097/NAQ.0000000000000613

Carroll, A., Collins, C., & McKenzie, J. (2025). Physician wellbeing in a national rehabilitation hospital, a qualitative study utilizing Maslow’s hierarchy of needs as a framework for analysis. BMC Health Serv Res, 25(1), 175. doi.org/10.1186/s12913-025-12310-x

Hayre-Kwan, S., Quinn, B., Chu, T., Orr, P., & Snoke, J. (2021). Nursing and Maslow’s Hierarchy: A Health Care Pyramid Approach to Safety and Security During a Global Pandemic. Nurse Lead, 19(6), 590-595. doi.org/10.1016/j.mnl.2021.08.013

Kenrick, D. T., Griskevicius, V., Neuberg, S. L., & Schaller, M. (2010). Renovating the Pyramid of Needs: Contemporary Extensions Built Upon Ancient Foundations. Perspect Psychol Sci, 5(3), 292-314. doi.org/10.1177/1745691610369469

Taormina, R. J., & Gao, J. H. (2013). Maslow and the motivation hierarchy: measuring satisfaction of the needs. Am J Psychol, 126(2), 155-177. doi.org/10.5406/amerjpsyc.126.2.0155

Xu, J. X., Wu, L. X., Jiang, W., & Fan, G. H. (2021). Effect of nursing intervention based on Maslow’s hierarchy of needs in patients with coronary heart disease interventional surgery. World J Clin Cases, 9(33), 10189-10197. doi.org/10.12998/wjcc.v9.i33.10189

Disclaimer

Straight Leg Test: An Insight into Diagnosis

By

Dr Alexander Jimenez DC, APRN, FNP-C

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Lets assess where the pain is coming from.

Can the straight leg test help find the cause of back or hamstring pain in individuals experiencing it?

Table of Contents

Straight Leg Test

The straight leg raise test is often used to diagnose sciatica/radiculopathy, herniated discs, and other spinal problems. The healthcare provider giving the test performs most of the movement as they assess what’s causing the leg and/or back pain. The patient lies on their back with the legs straight. The provider will have the patient perform specific movements and inform them of how it feels. Then, they’ll raise the leg to see if and at what point symptoms begin to show. Providers often use this test alongside imaging studies.

Potential causes include a herniated disc or spondylolysis and a stress fracture in the spine. (Casiano V.E. et al., Back Pain. 2023)
Some studies suggest the straight leg test helps diagnose sciatica and other causes. (Pesonen J. et al., 2021)

Purpose

The straight leg raise is one of the most common manual tests done during physical exams. The straight leg raise test seeks to reproduce the pain or other symptoms in a controlled fashion to provide clues to what’s happening. It is a manual exam, and the healthcare provider will:

Position the patient
Moves the patient
Create pressure to see how well the patient can resist it

This is often used alongside imaging tests, such as an X-ray or CT scan. (Allegri M. et al., 2016) Its goal is to check for nerve movement and sensitivity of nerve tissue to compression. The straight leg lift test is neurodynamic because it uses movement to diagnose nerve problems. (Baselgia L.T. et al., 2017)

During the Test

Expect to feel some pain during the test, as the whole point is to see what aggravates the symptoms. They may be caused by:

Tight hip or back muscles
Back muscle spasms
Slipped disc
Spinal instability

Most of the tests are passive, with the provider doing the lifting. The patient can help achieve the most accurate result by staying as relaxed as possible and being clear about what is felt. (Pande K. 2015) The procedure:

The patient lies on their back with their legs straight.
The provider will ask the patient to turn one of the legs in.
This tells them what hip position affects the lower back symptoms.
They’ll then ask you to bring the leg toward the body’s center.
Then, they’ll lift the straight leg until the patient experiences symptoms.
Pain suggests a herniated disc.
If there is no pain, this also provides valuable information.
The procedure is repeated with the other leg.

Modifications

It’s important to let the examiner know about any limitations. The straight leg raise test has modifications if the patient cannot lift their leg while it’s straight or if they have difficulty lying on their back, which can also help avoid an injury during the test.

Variations

The healthcare provider may repeat the test with the ankle in a dorsiflexed position/raising the foot. Then, they’ll have the patient do it with their chin tucked into their chest. (Young R. et al., 2013) These variations can help check for nerve involvement in specific locations, such as the spinal cord or the dura mater, the membrane covering the brain and spinal cord. (Venne G. et al., 2017) The spinal cord nerves are likely involved and affected if the usual pain is in the back or leg but not the chin, neck, or foot. (Camino Willhuber GO, Piuzzi NS. 2023)

Injury Medical Chiropractic and Functional Medicine Clinic

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to build optimal health and wellness solutions. We focus on what works for you to relieve pain, restore function, prevent injury, and mitigate issues through adjustments that help the body realign itself. The clinic can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.

From Injury to Recovery with Chiropractic Care

References

Casiano, V. E., Sarwan, G., Dydyk, A. M., & Varacallo, M. A. (2025). Back Pain. In StatPearls. www.ncbi.nlm.nih.gov/pubmed/30844200

Pesonen, J., Shacklock, M., Suomalainen, J. S., Karttunen, L., Mäki, J., Airaksinen, O., & Rade, M. (2021). Extending the straight leg raise test for improved clinical evaluation of sciatica: validity and diagnostic performance with reference to the magnetic resonance imaging. BMC musculoskeletal disorders, 22(1), 808. doi.org/10.1186/s12891-021-04649-z

Allegri, M., Montella, S., Salici, F., Valente, A., Marchesini, M., Compagnone, C., Baciarello, M., Manferdini, M. E., & Fanelli, G. (2016). Mechanisms of low back pain: a guide for diagnosis and therapy. F1000Research, 5, F1000 Faculty Rev-1530. doi.org/10.12688/f1000research.8105.2

Baselgia, L. T., Bennett, D. L., Silbiger, R. M., & Schmid, A. B. (2017). Negative Neurodynamic Tests Do Not Exclude Neural Dysfunction in Patients With Entrapment Neuropathies. Archives of physical medicine and rehabilitation, 98(3), 480–486. doi.org/10.1016/j.apmr.2016.06.019

Pande K. (2015). The Use of Passive Straight Leg Raising Test: A Survey of Clinicians. Malaysian Orthopaedic Journal, 9(3), 44–48. doi.org/10.5704/MOJ.1511.012

Young, R., Nix, S., Wholohan, A., Bradhurst, R., & Reed, L. (2013). Interventions for increasing ankle joint dorsiflexion: a systematic review and meta-analysis. Journal of foot and ankle research, 6(1), 46. doi.org/10.1186/1757-1146-6-46

Venne, G., Rasquinha, B. J., Kunz, M., & Ellis, R. E. (2017). Rectus Capitis Posterior Minor: Histological and Biomechanical Links to the Spinal Dura Mater. Spine, 42(8), E466–E473. doi.org/10.1097/BRS.0000000000001867

Camino Willhuber, G. O., & Piuzzi, N. S. (2025). Straight Leg Raise Test. In StatPearls. www.ncbi.nlm.nih.gov/pubmed/30969539

Weight Resistance: Enhancing Sleep Through Exercise

By

Dr Alexander Jimenez DC, APRN, FNP-C

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For individuals looking to improve sleep, could weight training be the answer to increase healthy sleep?

Table of Contents

Weight Resistance Training

Researchers found that resistance weight training improves sleep quality, among other methods like diet and sleep hygiene practices. Resistance training may improve sleep by reducing anxiety and stress, benefiting heart health, and promoting muscle recovery. Researchers examined non-medication methods of improving sleep in younger and middle-aged adults, comparing exercise, diet, and sleep hygiene practices. The findings showed that for adults under 65, resistance training is the best non-pharmacological way to improve sleep quality. (Hirohama, K. et al., 2024) These findings reinforce that sleep and exercise lead to improved restful sleep. Resistance training is highly effective compared to aerobic exercise (running or cycling) in improving sleep quality. The research shows that resistance exercise has more profound benefits than aerobic training alone.

Resistance Training and Improved Sleep

Resistance training, also called strength training or weight training, is intended to build muscle and strength using resistance. This can include:

Your body weight
Resistance bands
Free weights
Weight-lifting machines

The mechanisms by which exercise alters sleep are unknown. However, the researchers point out that weight training may improve sleep by improving mental health issues such as anxiety and depression. (Cunningham J. E. A., & Shapiro C. M. 2018) (Carbone E. A. et al., 2023) Other research on resistance training and sleep found that resistance training helped decrease anxiety and stress. (Alley J. R. et al., 2015) Resistance training can benefit heart health as it increases blood circulation. This means the heart’s vessels don’t have to work as hard during sleep when blood pressure should naturally drop, which is known as nocturnal dipping, which is great for individuals with high blood pressure.

Another reason this training may help with sleep is its impact on the body. Previous research on resistance training and sleep suggests that since weight training stresses muscle tissue, it could signal the brain that sleep is needed to repair the damage (Iowa State University, 2022). The hormone adenosine, which helps promote sleep, is a key factor in why exercise increases adenosine levels and helps the body doze off. (Roig M. et al., 2022)

How Much Resistance Training Is Needed?

Sleep doctors advise patients to perform some form of daily movement or exercise to improve sleep. The amount of resistance training an individual needs depends on their circumstances, such as underlying conditions, injuries, fitness level, physical ability, and time.

General guidelines from the American Heart Association recommend strength training at least twice a week.
The guidelines for physical activity from the Department of Health and Human Services recommend adults do a muscle-strengthening activity at least two days each week in addition to at least 150 to 300 minutes of moderate-intensity aerobic activity.
The meta-analysis research found that a 55-minute resistance training session consisting of three sets of 10 to 12 exercises done three times a week positively affected sleep quality.
They added that higher intensity and frequency of training could have a greater effect on sleep.

In other research on exercise and sleep, study participants were grouped into resistance training, aerobic, and combination workouts – both resistance and aerobic exercise. Each group engaged in 60-minute training sessions three times a week, with the combination group doing 30 minutes of resistance training and 30 minutes of aerobic exercise each session. (Iowa State University, 2022) Resistance training increased sleep by an average of 40 minutes compared to about 23 minutes for those who did an hour of aerobic exercise. A combination of aerobic and resistance increased sleep by about 17 minutes. (American Heart Association, 2022)

Previous research on resistance training and sleep found that exercise at any time can improve sleep quality compared with no strength training. However, evening sessions tend to help individuals sleep a little better. (Alley J. R. et al., 2015) Resistance exercise may offer benefits regarding the ability to fall asleep and stay asleep for those with osteoporosis, sarcopenia, anxiety, or depression.

Strength Workouts

Resistance training that targets all the major muscle groups is the goal. The Iowa State University research had participants use 12 resistance machines to perform exercises, including:

Leg presses
Chest presses
Lat pulldowns
Bicep curls
Abdominal crunches
Participants performed three sets of eight to 12 reps at 50% to 80% of their one-rep max. (Iowa State University, 2022)
One of the studies had participants work out for 30 minutes using nine different resistance machines, completing three sets of 10 reps. (Alley J. R. et al., 2015)

However, individuals can also use dumbbells such as bicep curls or chest presses, barbells for deadlifts or back squats, resistance bands for lateral shoulder raises or leg extensions, or their body weight for movements such as chin-ups or push-ups.

Other Ways to Improve Sleep Without Meds

Other non-drug methods to improve sleep include a healthy diet, proper hydration, dietary changes, and stress management like meditation. Aerobic exercise is known to improve both sleep quantity and quality. (Kovacevic A. et al., 2018) Lifestyle behaviors outside exercise are also important for sleep. Sleep hygiene refers to having healthy sleep habits and behaviors at night. This includes optimizing pre-bedtime routines to prepare the mind and body for sleep and improving bedroom environments to ensure sleep support, meaning it is cool, dark, quiet, and free from distractions like phones. Another important method of improving sleep is listening to your body and not forcing yourself to stay up late when exhausted. Pushing the brain and body to stay up later leads to chronic sleep debt. Eating sugary and high-fat foods before bed can hinder sleep patterns. Drinking caffeine after dinner or close to bedtime can disrupt the sleep cycle, as well as alcohol consumption before bed can hurt sleep quality.

Injury Medical Chiropractic and Functional Medicine Clinic

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

Weight Loss Techniques

References

Hirohama, K., Imura, T., Hori, T., Deguchi, N., Mitsutake, T., & Tanaka, R. (2024). The effects of nonpharmacological sleep hygiene on sleep quality in nonelderly individuals: A systematic review and network meta-analysis of randomized controlled trials. PloS one, 19(6), e0301616. doi.org/10.1371/journal.pone.0301616

Cunningham, J. E. A., & Shapiro, C. M. (2018). Cognitive Behavioural Therapy for Insomnia (CBT-I) to treat depression: A systematic review. Journal of psychosomatic research, 106, 1–12. doi.org/10.1016/j.jpsychores.2017.12.012

Carbone, E. A., Menculini, G., de Filippis, R., D’Angelo, M., De Fazio, P., Tortorella, A., & Steardo, L., Jr (2023). Sleep Disturbances in Generalized Anxiety Disorder: The Role of Calcium Homeostasis Imbalance. International journal of environmental research and public health, 20(5), 4431. doi.org/10.3390/ijerph20054431

Alley, J. R., Mazzochi, J. W., Smith, C. J., Morris, D. M., & Collier, S. R. (2015). Effects of resistance exercise timing on sleep architecture and nocturnal blood pressure. Journal of strength and conditioning research, 29(5), 1378–1385. doi.org/10.1519/JSC.0000000000000750

Iowa State University. (2022). Pumping iron may improve sleep more than cardio workouts. www.news.iastate.edu/news/2022/03/03/resistance-exercise-sleep

Roig, M., Cristini, J., Parwanta, Z., Ayotte, B., Rodrigues, L., de Las Heras, B., Nepveu, J. F., Huber, R., Carrier, J., Steib, S., Youngstedt, S. D., & Wright, D. L. (2022). Exercising the Sleepy-ing Brain: Exercise, Sleep, and Sleep Loss on Memory. Exercise and Sport Sciences Reviews, 50(1), 38–48. doi.org/10.1249/JES.0000000000000273

American Heart Association. (2022). Resistance exercise may improve sleep more than aerobic exercise. www.heart.org/en/news/2022/03/03/resistance-exercise-may-improve-sleep-more-than-aerobic-exercise#:~:text=The%20results%20are%20considered%20preliminary,at%20night%2C%22%20Brellenthin%20said.

Kovacevic, A., Mavros, Y., Heisz, J. J., & Fiatarone Singh, M. A. (2018). The effect of resistance exercise on sleep: A systematic review of randomized controlled trials. Sleep medicine reviews, 39, 52–68. doi.org/10.1016/j.smrv.2017.07.002

Pinched Nerve in the Neck Relief Techniques Explained

By

Dr Alexander Jimenez DC, APRN, FNP-C

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Woman visiting manual therapist in hospital — Young woman complaining of neck pain while doctor examining her in hospital

Can physical therapy help individuals with a pinched nerve in the neck?

Pinched Nerve In The Neck

A pinched nerve in the neck can cause pain, numbness, and weakness that extends through the neck, shoulder, and arm. (American Academy of Orthopaedic Surgeons, 2024) Over-the-counter pain medications, resting the muscles, and gentle stretching can help. However, if you’re still in pain after a few days, see a healthcare provider. Common treatments include:

Rest
Over-the-counter (OTC) pain meds
Physical therapy
Steroid injections
Wearing a neck collar

Surgery is rarely needed, but it can provide relief if other treatments don’t help. Most of the time, a pinched nerve resolves within days or weeks.

How a Pinched Nerve in the Neck Feels

The term for neck nerve pain is cervical radiculopathy (cervical spine pain). Common symptoms of a pinched nerve in the neck are: (American Academy of Orthopaedic Surgeons, 2024)

Sharp pain that extends into the shoulder and arm.
The pain worsens, or there is a shooting sensation when turning the head.
Tingling or feeling of pins-and-needles in the fingers or hand.
Weakness in the arm, shoulder, or hand.
Numbness or loss of feeling.

Often, these symptoms occur only on one side. Some find their pain less when they lift their hand onto their head, which can relieve pressure on the nerve.

Causes

The cervical spine is the spinal cord area around the neck. It’s made up of seven vertebrae. Nerves branch off the spinal cords in the spaces between the vertebrae. Nerve compression occurs when the space between two vertebrae is reduced, putting pressure on the nerve, pinching it, and causing pain. Pinched nerves develop from age because the spinal discs between the vertebrae become compressed over time. Age causes about 70% to 80% of nerve compression. Other factors that cause pinched nerves include: (Harvard Health Publishing, 2021)

Degenerative disc disease
A herniated disc
Injuries like car accidents falls, or other trauma to the spine
Spinal stenosis

Self-Care Relief

If you have nerve pain and think it is a pinched nerve, self-care can help (National Institute of Neurological Disorders and Stroke, 2025)

Rest

Find a comfortable position and try to allow the muscles in your neck to relax and rest.

Heat or Ice

Warmth and coolness can relieve pain and inflammation.
Use a warm or cool compress for 15 minutes at a time.

Over-The-Counter Pain Medications

Pain medications, including nonsteroidal anti-inflammatory drugs (NSAIDs), can help bring relief.

Treatment for Severe Symptoms

If pain doesn’t resolve within a few days, or if it is so bad that you can’t go about daily activities, it’s recommended to see a healthcare provider. They can diagnose a pinched nerve after a physical exam and may also recommend imaging, including an X-ray, CT scan, MRI, or EMG, to reveal what’s causing the symptoms. After diagnosing the condition, the healthcare provider will develop a personalized treatment plan, which may include the following (Harvard Health Publishing, 2021)

Physical Therapy

Physical therapy can help build strength and flexibility in the neck.
This is especially important if there is frequent nerve pain in the same spot.

Cervical Collar

A soft cervical collar is a brace that fits around the neck.
It supports your head so the neck muscles can relax, facilitating healing.
The collar can also keep the head from turning in painful ways.

Oral Corticosteroids

Oral steroids like prednisone can help reduce inflammation.
If inflammation or swelling in the neck puts more pressure on the nerve, they can help.

Steroid Injections

Steroid shots right into the painful tissue reduce inflammation right away.

Muscle Relaxers

These medications keep the muscles in the neck from seizing up.
As the muscles relax, this brings pain relief.

Narcotic Pain Medications

Narcotic pain medications can be used short-term by individuals who have severe pain.
A healthcare provider will inform the patient of the benefits and drawbacks of these medications, which include opiates.

Neck Exercises

Gentle stretches can help alleviate the pain and strengthen the muscles. (National Health Service, 2025)

Chin to chest

Bring your chin toward your chest.
Hold for 20 seconds, then return to a neutral position.
Do this five times.

Eyes to Sky

Lean your head back and look toward the sky.
Hold for 20 seconds, then return to your starting position.
Do this five times.

Side to Side

Turn your head to the right as far as possible, bringing your chin in line with your shoulder.
Hold for 20 seconds, then turn as far as possible toward the left.
Repeat four times.

Ear to Shoulder

Bring your ear down toward your shoulder.
Hold for 20 seconds, then repeat the exercise on the other side.
Alternate between the right and left, stretching each side five times.

While it’s normal for exercises to hurt from stretching the muscles, they should never hurt more than a five on a pain scale of 1 to 10. If they do, stop exercising (National Health Service, 2025)

Healing Time

Healing and recovery depend on the severity of the injury. Some individuals find that the pain from a pinched nerve goes away in days, while for others, it can last for weeks. The pain goes away and then returns. If pain doesn’t go away with the conservative treatments or lasts more than a few days, talk with a healthcare provider or return for a second visit. Rarely do individuals need surgery to bring pain relief. The healthcare provider will discuss whether surgery is the best option and what to expect regarding pain relief. (American Academy of Orthopaedic Surgeons, 2024)

Injury Medical Chiropractic and Functional Medicine Clinic

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to build optimal health and wellness solutions. We focus on what works for you to relieve pain, restore function, prevent injury, and mitigate issues through adjustments that help the body realign itself. The clinic can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.

Revitalize and Rebuild with Chiropractic

References

American Academy of Orthopaedic Surgeons. OrthoInfo. (2024). Cervical radiculopathy (pinched nerve). orthoinfo.aaos.org/en/diseases–conditions/cervical-radiculopathy-pinched-nerve/

Harvard Health Publishing. Publishing, H. H. (2021). Treating a pinched nerve. www.health.harvard.edu/pain/treating-a-pinched-nerve

National Institute of Neurological Disorders and Stroke. (2025). Pinched Nerve Definition. Retrieved from www.ninds.nih.gov/health-information/disorders/glossary-neurological-terms#-P-

National Health Service. Service, N. H. (2025). Exercises for neck problems. www.nhsinform.scot/illnesses-and-conditions/muscle-bone-and-joints/neck-and-back-problems-and-conditions/exercises-for-neck-problems

Cheddar Cheese: Nutritional Breakdown and Benefits

By

Dr Alexander Jimenez DC, APRN, FNP-C

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Cheddar Cheese Grated and diceded in a wooden tray. wooden background. Top view.

While cheddar cheese’s high-calorie count and saturated fat content have nutritional drawbacks, can a moderate amount be an enjoyable part of a healthy diet?

Table of Contents

Cheddar Cheese

Cheddar is a hard, cow’s milk cheese known for its dense, layered texture and nutty flavor. It is a favorite cheese served in quesadillas, mac and cheese, or on burgers. However, cheddar cheese nutrition isn’t considered ideal.

Nutrition

Nutrition information for 1 ounce/28 grams of cheddar cheese. (U.S. Department of Agriculture, 2019)

Calories – 120
Fat – 10 grams
Sodium – 190 milligrams
Carbohydrates – 0 grams
Fiber – 0 grams
Sugars – 1 grams
Protein – 7 grams
Calcium – 201.6 milligrams
Vitamin A – 95.7 micrograms
Vitamin B12 – 0.3 micrograms

Carbohydrates

Cheddar contains zero carbohydrates, meaning it has no fiber and little sugar.

Fats

Most health concerns focus on fat and saturated fat content. (Lordan R. et al., 2018)
Whole-milk cheddar is high in total fat – 10 grams per ounce.
Saturated fat – 6 grams per ounce.
Traditionally, nutrition recommendations have advised consuming a diet low in saturated fat to reduce the risk of cardiovascular disease.
However, research suggests saturated fat in whole foods like cheese may not harm heart health. (Astrup A., Geiker N. R. W., & Magkos F. 2019)
Further research is needed to determine the pros and cons of saturated fat in dairy. (Hirahatake K. M. et al., 2020)

Protein

It provides 7 grams per 1-ounce serving, and protein accounts for over 30% of cheddar’s calories.
This can significantly add to one’s daily intake.

Vitamins and Minerals

Calcium is a micronutrient at 200mg (or 20% of daily value) per ounce.
One ounce provides 10% daily vitamin A recommendation and 14% phosphorus, plus small amounts of zinc, selenium, and riboflavin.
Cheddar cheese can be relatively high in sodium at 190mg per ounce if trying to cut down on salt. (U.S. Department of Agriculture, 2019)

Health Benefits

Builds Healthy Bones

With a healthy calcium content, cheddar can contribute to maintaining bone health.
Getting enough calcium is critical to preventing osteoporosis/degeneration of bone density. (Malmir H., Larijani B., & Esmaillzadeh A. 2020)

Builds Muscle

Protein performs a variety of functions in the body.
Protein helps build muscle; it’s necessary to produce enzymes, give structure to cells, maintain fluid balance, and more. (Carbone J. W., & Pasiakos S. M. 2019)

Calorie-Dense

Cheddar is calorie-dense, which increases its satisfaction factor.

May Help Weight Loss

There is the belief that cheese causes weight gain; however, the full-fat dairy paradox, which goes against dietary guidelines, is the idea that full-fat dairy products may be healthier than low-fat or fat-free dairy,
Research now suggests removing fat from dairy products may make them more likely to cause weight gain, making full-fat the better choice for weight management. (Soltani S., & Vafa M. 2017)

Compatible With Keto and Low-Carb Diets

Because of cheddar’s high fat percentage, it’s compatible with high-fat nutrition plans.
With zero carbohydrates, cheddar also fits well in low-carb diets.

Low Lactose

Cheddar is one of the harder, aged cheeses that’s quite low in lactose.
This means lactose-intolerant individuals can often eat it without unpleasant symptoms like bloating, stomach upset, and gas.

Allergies

Although it is low in lactose, cheddar still contains casein and whey, two components that can trigger an immune response in individuals with a dairy allergy. (He, M. et al., 2017)

Storage and Safety

Cheddar does not technically require refrigeration. However, storing it in the fridge will help it last longer. According to the USDA, unopened cheddar can last up to six months in the refrigerator, and opened packages can last three to four weeks. Because it’s a hard cheese, cheddar even takes well to freezing, but this will not extend its life more than refrigeration. The USDA estimates cheddar can be frozen for about six months.

Preparation

Cheddar can be added to any number of cheesy dishes or, of course, served alone with crackers. It doesn’t require high heat to become nice and melty. Try adding a whole-grain base and veggies to increase the nutrients in dishes like cheesy casseroles, Mexican dishes, sandwiches, or pasta.

Injury Medical Chiropractic and Functional Medicine Clinic

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop highly effective treatment plans through an integrated approach for each patient and restore health and function to the body through nutrition and wellness, functional medicine, acupuncture, Electroacupuncture, and integrated medicine protocols. We focus on what works for you to relieve pain, restore function, prevent injury, and mitigate issues through adjustments that help the body realign itself. The clinic can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.

Osteoporosis

References

U.S. Department of Agriculture. FoodData Central. (2019). Cheddar Cheese. Retrieved from fdc.nal.usda.gov/food-details/494681/nutrients

Lordan, R., Tsoupras, A., Mitra, B., & Zabetakis, I. (2018). Dairy Fats and Cardiovascular Disease: Do We Really Need to be Concerned?. Foods (Basel, Switzerland), 7(3), 29. doi.org/10.3390/foods7030029

Astrup, A., Geiker, N. R. W., & Magkos, F. (2019). Effects of Full-Fat and Fermented Dairy Products on Cardiometabolic Disease: Food Is More Than the Sum of Its Parts. Advances in nutrition (Bethesda, Md.), 10(5), 924S–930S. doi.org/10.1093/advances/nmz069

Hirahatake, K. M., Astrup, A., Hill, J. O., Slavin, J. L., Allison, D. B., & Maki, K. C. (2020). Potential Cardiometabolic Health Benefits of Full-Fat Dairy: The Evidence Base. Advances in nutrition (Bethesda, Md.), 11(3), 533–547. doi.org/10.1093/advances/nmz132

Malmir, H., Larijani, B., & Esmaillzadeh, A. (2020). Consumption of milk and dairy products and risk of osteoporosis and hip fracture: a systematic review and Meta-analysis. Critical reviews in food science and nutrition, 60(10), 1722–1737. doi.org/10.1080/10408398.2019.1590800

Carbone, J. W., & Pasiakos, S. M. (2019). Dietary Protein and Muscle Mass: Translating Science to Application and Health Benefit. Nutrients, 11(5), 1136. doi.org/10.3390/nu11051136

Soltani, S., & Vafa, M. (2017). The dairy fat paradox: Whole dairy products may be healthier than we thought. Medical journal of the Islamic Republic of Iran, 31, 110. doi.org/10.14196/mjiri.31.110

He, M., Sun, J., Jiang, Z. Q., & Yang, Y. X. (2017). Effects of cow’s milk beta-casein variants on symptoms of milk intolerance in Chinese adults: a multicentre, randomised controlled study. Nutrition journal, 16(1), 72. doi.org/10.1186/s12937-017-0275-0

Scaphoid Fracture: Causes, Symptoms, and Treatments

By

Dr Alexander Jimenez DC, APRN, FNP-C

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Individuals who have fractured their scaphoid bone may experience pain and swelling in the wrist just below the thumb. Can immobilization with a cast and physical therapy help?

Table of Contents

Scaphoid Fracture

A scaphoid fracture is a break in one of the wrist’s small or carpal bones. This type of fracture occurs most often after a fall onto an outstretched hand. Symptoms typically include swelling and pain in the wrist just below the base of the thumb. These fractures can be difficult to diagnose since they don’t always appear on an X-ray. If the X-ray is negative and the healthcare provider suspects a scaphoid fracture, an MRI may be necessary. Surgery may be required in more severe cases or when the injury is not healing correctly. (American Academy of Orthopaedic Surgeons, 2023)

A Break In The – Navicular Bone

The scaphoid is one of eight carpal bones in the wrist. It is located just below the thumb’s base and is shaped like a kidney bean. This bone can be identified by holding a thumbs-up position and feeling for the hollow between the two tendons below your thumb. The scaphoid is located at the base of the hollow. A break in the scaphoid bone most commonly occurs in the middle of the bone but can also happen at either end. A scaphoid fracture can be displaced or non-displaced (American Academy of Orthopaedic Surgeons, 2023)

Displaced Fracture

It is when the bone fragments have moved out of alignment.

Non-displaced Fracture

It is when the fragments are still in their normal location in the hand.

The scaphoid’s blood supply comes from a small vessel that enters the most distant part of the bone and flows back through the bone. Because of this one small blood supply, a fracture in the center can stop the circulation to the proximal portion of the bone. Because of this, scaphoid fractures need immediate diagnosis and treatment.

Symptoms

Pain or deep aching on the thumb-side of the wrist, typically after a fall on an outstretched arm, could be a scaphoid fracture. Other symptoms experienced include: (American Academy of Orthopaedic Surgeons, 2023)

Tenderness at the base of the hollow area.
Pain at the base of the hollow area.
Swelling in the wrist
Difficulty gripping objects

Pain can become worse from: (American Academy of Orthopaedic Surgeons, 2023)

Grasping
Pulling
Pushing
Pinching

Diagnosis

A healthcare provider will evaluate the hand for tenderness and pain in the hollow and/or the bone. If a break is suspected, they will order an X-ray. (Clementson M., Björkman A., & Thomsen N. O. B. 2020) Many patients are diagnosed with a wrist sprain when they have a fracture. Diagnosis can be difficult because the fracture often doesn’t appear on X-rays until weeks after the healing process starts. Physicians commonly treat a wrist injury as a scaphoid fracture initially and then repeat X-rays within two weeks. (American Academy of Orthopaedic Surgeons, 2023) If the injury doesn’t show on an X-ray, the provider may order an MRI, as these fractures can be easier to see on an MRI. An MRI can help ensure appropriate treatment immediately. (Wong S. B. S., & Peh W. C. G. 2019)

Treatment

If a wrist fracture is diagnosed, the wrist will be immobilized in a cast. However, a healthcare provider may also put the wrist in a cast if the X-ray is negative but they suspect a fracture. This will stabilize the injury until an MRI can be performed. With immobilization and follow-up treatment, scaphoid fractures often heal without surgery. Repeat X-rays are taken over several weeks or months so the provider can make sure the injury is healing correctly. If it is not healing correctly, surgery may be recommended. (Clementson M., Björkman A., & Thomsen N. O. B. 2020) If the fracture is displaced, healing correctly may be a challenge. In this case, a physician may recommend initial surgery to reposition the bones. (Clementson M., Björkman A., & Thomsen N. O. B. 2020) This type of surgery involves pinning the bone in place with screws.

Healing Time

With treatment, non-displaced fractures can heal in 6 weeks, while most displaced fractures take 10 to 12 weeks. (Clementson M., Björkman A., & Thomsen N. O. B. 2020)
Scaphoid fractures can take longer than this, and sometimes, they don’t heal. (American Academy of Orthopaedic Surgeons, 2023)

Recovery

With the wrist in a cast, individuals will be instructed on activities to avoid placing even a small amount of strain (American Academy of Orthopaedic Surgeons, 2023)

Lifting
Pushing
Pulling objects that weigh more than one pound.
Sports activities
Throwing
Climbing
Using tools or machinery that vibrate.

Rehabilitation is an important part of healing because immobilization takes a long time. Wrist range-of-motion exercises can be started, followed by strengthening exercises for the wrist flexors and extensors. Supination, pronation, and grip exercises are also part of physical therapy.

Complications

Scaphoid fractures can lead to serious complications, especially when not properly treated. These include: (American Academy of Orthopaedic Surgeons, 2023) (Almigdad A. et al., 2024)

Nonunion

This describes a fracture that fails to heal.

Carpal Collapse

This is a form of degenerative arthritis.

Osteoarthritis

This condition causes degeneration of the cartilage in the joint.

Avascular Necrosis

This is when the blood supply to the bone is reduced or cut off, causing the bone to die.

Injury Medical Chiropractic and Functional Medicine Clinic

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to build optimal health and wellness solutions. We focus on what works for you to relieve pain, restore function, prevent injury, and mitigate issues through adjustments that help the body realign itself. The clinic can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.

Skateboarding Injury Treatment

References

American Academy of Orthopaedic Surgeons. (2023). Scaphoid fracture of the wrist. orthoinfo.aaos.org/en/diseases–conditions/scaphoid-fracture-of-the-wrist

Clementson, M., Björkman, A., & Thomsen, N. O. B. (2020). Acute scaphoid fractures: guidelines for diagnosis and treatment. EFORT open reviews, 5(2), 96–103. doi.org/10.1302/2058-5241.5.190025

Wong, S. B. S., & Peh, W. C. G. (2019). The role of magnetic resonance imaging in the evaluation of scaphoid fractures. Journal of Medical Radiation Sciences, 66(1), 3–4. doi.org/10.1002/jmrs.316

Almigdad, A., Al-Zoubi, A., Mustafa, A., Al-Qasaimeh, M., Azzam, E., Mestarihi, S., Khair, Y., & Almanasier, G. (2024). A review of scaphoid fracture, treatment outcomes, and consequences. International orthopaedics, 48(2), 529–536. doi.org/10.1007/s00264-023-06014-2

Cauda Equina: A Guide to Diagnosis and Treatment

By

Dr Alexander Jimenez DC, APRN, FNP-C

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Physical therapy with mechanical traction to relieve back pain and stiffness by gently stretching the spine, reducing pressure, and enhancing mobility for improved recovery.

Cauda equina syndrome/CES is a rare condition in which the nerves in the lower back are compressed. It can include sciatica as one of its symptoms. Individuals presenting with symptoms that could be CES are advised to see a healthcare provider as soon as possible, as delaying treatment can lead to permanent damage.

Cauda Equina Syndrome

A cluster of nerve roots called the cauda equina, Latin for horse’s tail, sends and receives messages to the legs, bladder, and other body parts. Cauda equina syndrome is a rare condition in which nerve roots in the lower spinal cord are compressed. This compresses the nerves and disrupts motor and sensory function in the bladder and lower extremities. The most common cause is a ruptured or herniated disc in the lumbar area. This usually occurs when a severe disc herniation compresses the nerve bundle at the base of the spinal cord, causing significant neurological dysfunction like bladder/bowel issues and numbness in the saddle area. If found early, it is treated with surgery within 24 to 48 hours of symptom onset.

Initial Signs

Symptoms can occur acutely, in hours, or gradually over weeks or months. One of the first signs and most common symptoms is urinary retention, where the bladder fills, but there is no normal sensation or urge to urinate. (American Association of Neurological Surgeons, 2024) Other symptoms include: (Gardner A., Gardner E., & Morley T. 2011)

Severe low back pain
Sciatica
Pain, numbness, or weakness in one or both legs
Saddle anesthesia, which is numbness or other nerve sensations around the anus and the area that sits.
A loss of reflexes in the extremities
Sexual dysfunction that comes suddenly
Loss of bowel control
Overflow urination

There are two stages based on urinary symptoms (Fairbank J., & Mallen C. 2014)

CES-Incomplete CES-I

This is characterized by symptoms that include unusual urinary sensation, loss of desire to urinate, poor urinary stream, and having to strain to urinate. (Gardner A., Gardner E., & Morley T. 2011)

CES-Retention CES-R

Bladder control is completely lost.

Causes

The most common cause is a ruptured or herniated disc in the lumbar area. Other possible causes may include: (American Association of Neurological Surgeons, 2024)

Trauma or injury to the spine

that leads to fractures or dislocations (gunshots, falls, auto accidents)

Tumors or Infections

It can compress the cauda equina nerve bundle.

Spinal Stenosis

Narrowing of the spinal column can be either congenital or acquired.

Bone Spurs

Spurs in the spinal canal can compress the nerves. (American Association of Neurological Surgeons, 2024)

Tuberculosis or Pott’s Paralysis

Pott’s paralysis is a neurological complication of tuberculosis (TB) of the spine.
TB is a bacterial infection that usually affects the lungs but can spread to the spine.

Iatrogenic Side Effects

Injuries or illnesses that result from medical or surgical treatment

Spinal Lesions or Malignant Tumors

A spinal lesion refers to any abnormal growth or damage within the spine.
It can include benign (noncancerous) and malignant (cancerous) tumors.
A malignant tumor is a cancerous growth within the spine; essentially, a malignant tumor is a type of spinal lesion with the potential to spread to other parts of the body.

Spinal Infection, Inflammation, Hemorrhage, or Fracture

A spinal infection refers to a bacterial, fungal, or viral infection that occurs within the bones of the spine (vertebrae) or the surrounding tissues, potentially causing pain, inflammation, and, in severe cases, neurological complications like weakness or paralysis;
Spinal inflammation is a general term for swelling or irritation within the spinal column.
Spinal hemorrhage” indicates bleeding within the spinal canal.
A spinal fracture refers to a break in one or more of the vertebrae in the spine.

Spinal Arteriovenous Malformations (AVMs)

A spinal arteriovenous malformation (AVM) is a rare condition in which the arteries and veins in the spinal cord tangle abnormally.
This can damage the spinal cord over time.

Complications from Lumbar Surgery

Lumbar surgery can have several complications, including infections, blood clots, nerve damage, and spinal fluid leaks.

Spinal Anesthesia

Spinal anesthesia is a regional anesthesia that blocks pain and sensation in the lower body.
It involves injecting a local anesthetic medication into the subarachnoid space surrounding the spinal cord.
The exact cause is not fully understood, but it can involve direct nerve root injury from the needle, inflammation caused by the anesthetic, or a spinal hematoma compressing the nerve roots.

Spinal Birth Defects

Birth defects of the spinal cord, such as spina bifida. (American Association of Neurological Surgeons, 2024)
Infection of the tissues (meninges) that cover the cauda equina and spinal cord.
An abscess pressing on the cauda equina.

Diagnosis

Diagnosis requires a medical history of symptoms, general health, activity level, and a physical exam to assess strength, reflexes, sensation, stability, alignment, and motion. (American Association of Neurological Surgeons, 2024) Testing includes:

Blood Tests

These test for infections.

MRI

These yield three-dimensional images of the spinal cord, nerve roots, and surrounding areas.

Myelography

X-ray or computerized tomography (CT) imaging is enhanced by the injection of contrast material into the cerebrospinal fluid spaces, which can show displacement of the spinal cord or spinal nerves.

Specialized Nerve Testing

This could be nerve conduction velocity tests and testing electrical activity in muscles or electromyography.

Treatment

The extent of urinary problems can determine treatment protocols. A CES diagnosis is usually followed by emergency surgery within 24 to 48 hours to relieve compression of the nerves. Moving quickly is essential to prevent permanent complications such as nerve damage, incontinence, or leg paralysis. (American Association of Neurological Surgeons, 2024)

Depending on the cause, corticosteroids also may be prescribed to reduce swelling.
Antibiotics may be needed if an infection is responsible for CES.
For situations in which a tumor is the cause, surgery to remove it may be necessary, followed by chemotherapy and/or radiation.
The outcome with CES-I during surgery is generally favorable.
Those whose CES has deteriorated to CES-R tend to have a less favorable prognosis.

Post Surgery Therapy

After surgery, CES can be challenging to deal with. If bladder function has been impaired, recovery of control can take time.

It may be necessary to use a catheter or to wear disposable underwear. (American Association of Neurological Surgeons, 2024)
Frequent urinary infections are also a potential complication.
Loss of bladder or bowel control can be psychologically distressing, impacting social life, work, and relationships.
Sexual dysfunction can also occur, contributing to relationship difficulties or depression.

Therapy with a mental health professional may be recommended. When damage is permanent, it will be important to include family and friends in the adjustment to living with a chronic condition. Psychological counseling and/or a support group can be helpful. Other specialists who can help include: (American Academy of Orthopaedic Surgeons, 2024)

Occupational therapist
Physical therapist
Physiotherapist
Sex therapist
Social worker

Injury Medical Chiropractic and Functional Medicine Clinic

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to build optimal health and wellness solutions. We focus on what works for you to relieve pain, restore function, prevent injury, and mitigate issues through adjustments that help the body realign itself. The clinic can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.

Disc Herniation

References

American Association of Neurological Surgeons. (2024). Cauda Equina Syndrome. www.aans.org/patients/conditions-treatments/cauda-equina-syndrome/

Gardner, A., Gardner, E., & Morley, T. (2011). Cauda equina syndrome: a review of the current clinical and medico-legal position. European Spine Journal: official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 20(5), 690–697. doi.org/10.1007/s00586-010-1668-3

Fairbank, J., & Mallen, C. (2014). Cauda equina syndrome: implications for primary care. The British journal of general practice: the journal of the Royal College of General Practitioners, 64(619), 67–68. doi.org/10.3399/bjgp14X676988

American Academy of Orthopaedic Surgeons. (2024). Cauda equina syndrome. orthoinfo.aaos.org/en/diseases–conditions/cauda-equina-syndrome

Left Side Lower Back Pain: What You Need to Know

By

Dr Alexander Jimenez DC, APRN, FNP-C

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Spine problems, showing issue on model. Woman is on the consultation with doctor in clinic.

Should individuals experiencing lower left back pain see a healthcare provider if it lasts more than a few weeks?

Left Side Lower Back Pain

Lower left back pain can impact your ability to go about your day. If left-side lower back pain lasts longer than a week, it is considered chronic back pain, which can severely impact one’s quality of life. This type of pain has various causes. Muscle or spine and nerve damage, including sciatica, can cause pain. Organs in the lower back, including the kidneys, can cause pain. Pregnancy-related changes, fibromyalgia, and other conditions can cause lower left-side back pain in females.

Causes

Back pain is common and affects almost everyone. (National Institute of Arthritis and Musculoskeletal and Skin Diseases, 2023) Lower left back pain can have many causes, ranging from muscle and spine issues to organ infections. One way to help tell what’s causing the symptoms is to determine whether there is also sciatica, sharp or burning pain that radiates down one side of the body. It happens when the sciatic nerve gets compressed or irritated. Possible causes include (Penn Medicine, 2020)

Muscle Injury

A muscle injury from an accident or injury can be a cause that can appear with or without sciatica.
If this is the cause, you’ll notice that the pain improves with rest but worsens after you’ve sat for a long time or after getting up from sleep.
There may also be a limited range of motion, tenderness, or swelling.

Arthritis or Bone Conditions

Arthritis and bone issues, like osteoporosis, can also be a cause.
This can happen if the arthritis is in the left hip or the root cause is on the right side, but the body compensates by overusing muscles on the left side of the back.

Unhealthy Posture and Body Positioning

Unhealthy postures and body positioning can contribute to back pain and musculoskeletal problems.
To avoid straining the muscles, try sitting and standing straight and keeping all the joints at a 90-degree angle.
Move around every 20-30 minutes and stretch out.

Kidneys

The kidneys are located in the middle back.
Kidney infections or kidney stones could cause pain on the left side.
Other symptoms include pain when urinating, fever, and nausea.

Ulcerative Colitis

Ulcerative colitis, inflammation of the large intestine, can also cause lower left back pain in some cases.
If this is the cause, there may also be abdominal pain, cramping, nausea, and fatigue.

Uterine-Related Pain

Several conditions related to the uterus can cause back pain symptoms, including PMS, period cramps, endometriosis, and more.
Sometimes, these conditions cause pain on both sides, but some individuals may experience pain just on the left side.

Pregnancy

The weight gain, hormonal changes, and limited movement can also contribute to lower left back pain. (Cedars Sinai, 2024)

Spinal Disease

If one of the discs or vertebrae in the spine slips out of place or becomes damaged, this can cause upper, middle, or lower back pain.
A healthcare provider will order imaging studies to determine what’s causing the pain symptoms. (National Institute of Arthritis and Musculoskeletal and Skin Diseases, 2023)

Sciatica

Some causes can also cause sciatica.

In many cases, over-the-counter anti-inflammatory medications can help with sciatica. If it persists, it is recommended to see your healthcare provider to find the root cause. The causes include: (Aguilar-Shea, A. L. et al., 2022)

Herniated disc

A disc that pops out of place can add pressure to the sciatic nerve.

Spinal Stenosis

Spinal stenosis, or spine narrowing, can also cause sciatic symptoms.

Spondylolisthesis

Occurs when vertebrae are out of alignment, leading to sciatic symptoms.

Pregnancy

Pregnancy-related growth and bodily changes oftentimes lead to sciatic nerve symptoms and sensations.

Muscle Spasms

Spasms like piriformis syndrome, a spasm of the muscle in the buttocks, can cause back pain.

Surgery

It’s normal to have back pain for up to six weeks after a back procedure.
However, if there is new or worsening lower left back pain after surgery, consult the healthcare provider. (Penn Medicine, 2017)

Describing Symptoms

Knowing how to describe your symptoms when seeing a healthcare provider is helpful. Answering these questions can help explain symptoms (National Institute of Arthritis and Musculoskeletal and Skin Diseases, 2023)

Have you had any accidents or injuries?
Did the pain come on suddenly or gradually?
Are you experiencing any limits to your range of motion?
Do you have any numbness or tingling?
What helps with the pain?
What makes the pain worse?
Do you have other symptoms, like a fever or trouble urinating?

Self Care

Self-care includes rest, ice, heat, and over-the-counter anti-inflammatory medications.
Non-steroidal anti-inflammatory drugs can help with pain.
Sleeping on a firm mattress and maintaining a healthy posture can help manage and improve symptoms. (See Q. Y., Tan J. B., & Kumar D. S. 2021)

Prescribed Treatment

Your healthcare provider may recommend massage, chiropractic care, and acupuncture treatments.
If pain can’t be managed at home, your healthcare provider may suggest prescription medications, including muscle relaxers.
These can allow the tissue to heal and reduce your pain as well.
If you have severe sciatica or vertebrae that have slipped out of place, the healthcare team might recommend a steroid injection into the lower left back to reduce pain by reducing inflammation.
In addition to prescription treatments, your healthcare provider might recommend physical therapy to retrain movements, build strength, and help prevent back pain.

Moving Around

It’s important not to move too much. Rest is important for healing, although don’t stop moving entirely. These tips can also help (National Institute of Arthritis and Musculoskeletal and Skin Diseases, 2023)

Sleep on a firm mattress that will support your back.
Get a comfortable, ergonomic chair for your job.
If you work on your feet, learn to practice healthy posture and use shoes and insoles to facilitate and maintain correct posture.
Once you’ve healed, building your core strength may help avoid lower back pain in the future.

Injury Medical Chiropractic and Functional Medicine Clinic

Talk with a healthcare provider and request a referral to a specialist who can help with long-term management. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to build optimal health and wellness solutions. We focus on what works for you to relieve pain, restore function, prevent injury, and mitigate issues through adjustments that help the body realign itself. The clinic can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.

Lower Back Pain Chiropractor Treatment

References

National Institute of Arthritis and Musculoskeletal and Skin Diseases. (2023). Back pain. Retrieved from www.niams.nih.gov/health-topics/back-pain

Penn Medicine, B. T., MD. (2020). 4 reasons you may have back pain on only one side. Penn Medicine. www.pennmedicine.org/updates/blogs/musculoskeletal-and-rheumatology/2017/november/back-pain-on-one-side

Cedars Sinai. (2024). Back pain during pregnancy. www.cedars-sinai.org/health-library/diseases-and-conditions/b/back-pain-during-pregnancy.html

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

Penn Medicine, V. G., MD. (2017). Back pain that won’t go away—even with surgery. Penn Medicine. www.pennmedicine.org/updates/blogs/musculoskeletal-and-rheumatology/2017/november/back-pain-that-wont-go-away

See, Q. Y., Tan, J. B., & Kumar, D. S. (2021). Acute low back pain: diagnosis and management. Singapore Medical Journal, 62(6), 271–275. doi.org/10.11622/smedj.2021086

Peroneal Tendon Injuries: Types and Treatments

By

Dr Alexander Jimenez DC, APRN, FNP-C

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a physiotherapist performing an ultrasound on the ankle to check for injury

Are individuals with high foot arches or participating in sports involving repetitive ankle motion at risk for developing peroneal tendon injuries?

Table of Contents

Peroneal Tendon Injuries

The peroneal tendons connect the muscles of the outer side of the lower leg to the foot. They may be acute—occurring suddenly—or chronic—developing over time. The basic types of peroneal tendon injuries are tendonitis, tears, and subluxation.

Anatomy and Function

The two major peroneal muscles (peroneus longus and peroneus brevis) are outside the lower leg, next to the calf muscles. The peroneal tendons run along the outer side of the ankle and attach to the foot, connecting these muscles to bone. They help stabilize the ankle joint, point the foot downward (plantarflexion), and turn the foot outward (eversion). In normal gait, the motion of the peroneal muscles is balanced by the muscles that invert the foot or rock the foot inward from the ankle. The two peroneal tendons sit one on top of the other right behind the fibula (the smaller lower leg bone). This closeness can contribute to problems with the peroneal tendons, as they rub together behind the ankle.

Tendonitis

The most common problem is inflammation or tendonitis. The tendons are usually inflamed just behind the fibula bone at the ankle joint. This part of the fibula is the bump on the outside of the ankle, and the peroneal tendons are located just behind that bony prominence. Tendonitis can either result from repetitive overuse or an acute injury. Common symptoms of tendonitis include:

Pain behind the ankle
Swelling over the peroneal tendons
Tenderness of the tendons
Pain usually worsens if the foot is pulled down and inwards, stretching the peroneal tendons.
X-rays of the ankle are taken.
MRI may show inflammation and fluid around the tendons. (Walt J. & Massey P. 2023)

Typical treatment of peroneal tendonitis is accomplished by:

Ice application

Applying ice to the area can help reduce swelling and control pain.

Rest

Resting is important to allow the tendon to heal.
A supportive device (walking boot or ankle brace) or crutches can help in severe cases.
Braces and boots provide support, reduce tendons’ stress, and allow rest and inflammation to subside.

Anti-inflammatory Medications

Motrin or Aleve are anti-inflammatory and can reduce the swelling around the tendon.

Physical Therapy

Physical therapy can help restore normal ankle joint mechanics, help with swelling and pain relief, and correct strength imbalances.

Cortisone Injections

Cortisone injections are low-risk if administered to the area around the tendon and not more often than every three months.
Ultrasound guidance can help ensure the medication is injected into the correct area. (Walt J. & Massey P. 2023)

Tendon Tears

Tears can occur and are more likely to happen in the peroneus brevis tendon. Tears are believed to be the result of two issues with the tendon. One is the blood supply. Tears of the peroneus brevis tendon almost always occur in the area where the blood supply and nutrition of the tendon are the poorest.

The second issue is the closeness between the two tendons, causing the peroneus brevis tendon to be wedged between the peroneus longus tendon and the bone. (Saxena A., & Bareither D. 2001) Tears of the peroneus brevis tendon are often treated with the same treatments for tendonitis. About half of the tears diagnosed by imaging are found to be asymptomatic. For individuals who don’t find lasting relief from symptoms, surgery may be necessary. Surgical options for peroneal tendon tears (Dombek M. F. et al., 2001)

Tendon Debridement and Repair

During a tendon debridement, the damaged tendon and the surrounding inflammatory tissue are removed.
The tear can be repaired, and the tendon can be tubularized to restore its normal shape.

Tenodesis

A tenodesis is a procedure where the damaged area of the tendon is sewn to the normal tendon.
In this case, the damaged segment of the peroneal tendon is removed, and the ends left behind are sewn to the adjacent remaining peroneal tendon.
Tenodesis is often recommended for tears involving more than 50% of the tendon. (Castilho R. S. et al., 2024)

Depending on the surgical procedure, Recovery after surgery can take several weeks of restricted weight-bearing and immobilization. Following immobilization, therapy can begin. Recovery is usually six to 12 weeks, depending on the surgery, but a full return to sports and activities may take several months. Risks of surgery include infection, stiffness, skin numbness near the incision, persistent swelling, and persistent pain.

Injury Medical Chiropractic and Functional Medicine Clinic

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

The Difference of Using Custom Foot Orthotics

References

Walt, J., & Massey, P. (2025). Peroneal Tendon Syndromes. In StatPearls. www.ncbi.nlm.nih.gov/pubmed/31335074

Saxena, A., & Bareither, D. (2001). Magnetic resonance and cadaveric findings of the “watershed band” of the Achilles tendon. The Journal of foot and ankle surgery: official publication of the American College of Foot and Ankle Surgeons, 40(3), 132–136. doi.org/10.1016/s1067-2516(01)80078-8

Dombek, M. F., Orsini, R., Mendicino, R. W., & Saltrick, K. (2001). Peroneus brevis tendon tears. Clinics in podiatric medicine and surgery, 18(3), 409–427.

Castilho, R. S., Magalhães, J. M. B., Veríssimo, B. P. M., Perisano, C., Greco, T., & Zambelli, R. (2024). Minimally Invasive Peroneal Tenodesis Assisted by Peroneal Tendoscopy: Technique and Preliminary Results. Medicina (Kaunas, Lithuania), 60(1), 104. doi.org/10.3390/medicina60010104

Managing Periodic Limb Movements of Sleep: Tips and Strategies

By

Dr Alexander Jimenez DC, APRN, FNP-C

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Physiotherapist or chiropractor doing manipulative spine treatment on mature patient.

For individuals experiencing periodic limb movements of sleep, can understanding how movements at night may relate to other sleep disorders help bring healthy sleep?

Table of Contents

Periodic Limb Movements of Sleep

Periodic limb movements of sleep (PLMS) are involuntary, repetitive leg and sometimes arm movements during sleep. PLMS is one of the sleep disorders that may cause disruptive movement of the legs, like restless legs syndrome (RLS). It can lead to sleep disruption, insomnia, and daytime sleepiness.

Causes

The exact cause of PLMS is unknown, but it is thought to be related to:

Underlying medical conditions (e.g., restless legs syndrome, sleep apnea)
Nerve dysfunction
Neurochemical imbalances (e.g., dopamine, iron)

Symptoms

Repetitive leg and/or arm movements during sleep, typically lasting 0.5-5 seconds.
It may be accompanied by sensations of tingling, crawling, or pulling in the legs.
It can cause sleep disturbances, leading to daytime fatigue.

Type of Movements

Periodic limb movements during sleep (PLMS) consist of sudden jerking movements of the legs that occur involuntarily during sleep, which the affected individual may not realize is happening. It can be kicking, twitching, or extension of the legs.

Restless legs syndrome (RLS) symptoms are noted when awake.
PLMS occurs during sleep. (Walters A. S., & Rye D. B. 2009)
The movements associated often consist of flexion or extension at the ankle.
In some cases, this can also occur at the knee.
It may occur on one side or alternate back and forth between the left and right sides. (Cleveland Clinic, 2023)
It tends to increase with age and often but is not always accompanied by restless leg symptoms.

If PLMS causes daytime impairment, such as significant sleep disruption, excessive daytime sleepiness, and insomnia, it may be diagnosed as periodic limb movement disorder (PLMD). (Sleep Foundation, 2024)

Diagnosis

PLMS is diagnosed through a sleep study (polysomnography), which records brain waves, eye movements, muscle activity, and breathing patterns during sleep. As part of the study, superficial electrodes are placed on the legs and sometimes the arms to detect muscle contractions or movements.

In individuals with PLMS, repetitive movements at least four in a row may last from 1/2 second to 5 seconds.
The movements may be more significant if they are associated with arousal or awakenings from sleep.
They also may be deemed important if they become disruptive to a bed partner.
No further treatment may be necessary when noted in isolation on a sleep study without associated symptoms or impacts.
If another disorder cannot explain the movements, PLMS may be the likely diagnosis.
Again, if the movements lead to sleep disruption, insomnia, and excessive daytime sleepiness, it is called PLMD.
Isolated PLMS noted on a sleep study, without consequence, are insignificant and do not require treatment with medication.

Restless leg syndrome is diagnosed based on clinical criteria of having an uncomfortable feeling in the legs associated with an urge to move that occurs in the evening when lying down and is relieved by movement. (Stefani, A., & Högl, B. 2019)

Treatment

Treatment for PLMS depends on the underlying cause and severity of symptoms. Options include:

Medications (e.g., dopamine agonists, iron supplements)
Lifestyle changes (e.g., exercise, avoiding caffeine before bed)
Treating the underlying medical condition

In general, it is unnecessary to treat PLMS if the individual affected has no complaints of sleep disruption. Treatment can be considered if it causes:

Partial or total arousal from sleep
Contributes to insomnia
Undermines sleep quality
Also, if the movements are disruptive to a bed partner, getting them under control may be desirable.

Prescription medications can be effective in treating PLMS. (Cleveland Clinic, 2023) Many of the meds used to treat RLS can be helpful. These may include benzodiazepines (clonazepam), Mirapex (generic name pramipexole), and ropinirole. Movements may also occur with obstructive sleep apnea events, and then the treatment would target the breathing disorder.

Injury Medical Chiropractic and Functional Medicine Clinic

Individuals who struggle with sleep or other sleep disorders that impact their ability to get restful sleep should consult with their healthcare provider about getting an assessment and treatment to restore health. Individuals can recover and regain the benefits of quality rest through healthy sleep practices and lifestyle accommodations. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to build optimal health and wellness solutions. We focus on what works for you to relieve pain, restore function, prevent injury, and help mitigate issues through adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.

Revitalize and Rebuild with Chiropractic Care

References

Walters, A. S., & Rye, D. B. (2009). Review of the relationship of restless legs syndrome and periodic limb movements in sleep to hypertension, heart disease, and stroke. Sleep, 32(5), 589–597. doi.org/10.1093/sleep/32.5.589

Cleveland Clinic. (2023). Periodic limb movement disorder (PLMD). my.clevelandclinic.org/health/diseases/14177-periodic-limb-movements-of-sleep-plms

Sleep Foundation. (2024). Periodic Limb Movement Disorder What it is, what it feels like, its possible causes, and how it’s addressed. www.sleepfoundation.org/periodic-limb-movement-disorder

Stefani, A., & Högl, B. (2019). Diagnostic Criteria, Differential Diagnosis, and Treatment of Minor Motor Activity and Less Well-Known Movement Disorders of Sleep. Current treatment options in neurology, 21(1), 1. doi.org/10.1007/s11940-019-0543-8

How to Deal with Triceps Tendonitis: Causes and Solutions

By

Dr Alexander Jimenez DC, APRN, FNP-C

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Massage therapist treats injury of professional athlete male patient. Sports gun shock massages in medical office of gym. Percussion therapy for regeneration massage of athletic body. Physiotherapy

Triceps tendonitis can be frustrating, especially when you need to rest from normal activities. Can knowing the causes, symptoms, and diagnosis help individuals understand the treatment and prevention of the condition?

Triceps Tendonitis

Tendons are connective tissue that attach muscles to bones, enabling the joints to move. Triceps tendonitis is inflammation of the tendon at the back of the elbow. It is most often caused by overuse of the triceps muscles. The condition can cause pain, swelling, and loss of function. It’s common in jobs that require regular hammering, shoveling, and overhead reaching, as well as in weightlifters, gymnasts, and boxers.

Causes

The triceps muscle runs along the back of the upper arm and is attached to the point of the elbow by a tendon. This muscle straightens the elbow. Tendonitis develops from repeatedly straightening the elbow against resistance. This causes tiny tears in the tissue, which leads to inflammation. Triceps tendonitis commonly occurs from repetitive manual labor tasks or sports activities like throwing sports, gymnastics, or boxing. Exercises that target the triceps muscle can cause tendonitis to develop, including kickbacks, dips, push-ups, and bench presses. For this reason, triceps tendonitis is also known as weightlifter’s elbow. (Orthopedic & Spine Center, N.D.)

Symptoms

Inflammation leads to a series of chemical reactions in the area of the injury. There are five main symptoms of inflammation:

Redness
Warmth
Swelling
Pain
Loss of function

With triceps tendonitis, the pain and stiffness are felt at the back of the elbow. Weakness may also present when using the affected arm. Tendonitis usually causes more pain with movement than when resting. Pain can occur when straightening the elbow, which puts tension on the triceps, or bending the elbow, which stretches the tendon.

Diagnosis

A healthcare provider will ask questions and perform a physical exam to diagnose tendonitis. (Harvard Health Publishing, 2014) A healthcare provider will ask you to describe the pain and the activities that make it better or worse. The elbow will be assessed for movement issues, swelling, or deformities that could indicate a worse injury, like a tendon tear. A healthcare provider will order X-rays or other imaging, such as MRI, to assess for a bone fracture or more extensive damage to the tendon.

Treatment

Several types of treatments include self-care, physical therapy, and medications.

Self Care

Triceps tendonitis can be treated at home if symptoms are addressed early. These include:

Rest

Rest the triceps tendon by avoiding activities that cause pain for a few days.

Ice

Apply ice to the triceps tendon for 15 to 20 minutes, two to three times daily.
Massage the area with an ice cube for several minutes.

Range of Motion Exercises

Decrease stiffness in the elbow with gentle range of motion exercises.
Slowly bend and straighten the elbow in a pain-free range, 10 times.
Repeat several times per day.

Physical Therapy

Physical therapists use various therapies and tools when treating tendonitis, including (Prall J. & Ross M. 2019)

PT Modalities

Physical therapy modalities are used to decrease pain, inflammation, and stiffness.
Examples include ultrasound, electrical stimulation, and light therapy.

Manual Therapy

Manual techniques for tendonitis include soft tissue massage, friction massage, stretching, and joint mobilization.

Exercise

Stretching and strengthening exercises that target the triceps muscle and any other muscle weakness that might have contributed to the condition.

Activity Modification

A therapist will look at the activities that led to the tendonitis and ensure you use the correct form and proper body mechanics.
Sometimes, a physical therapist can make on-site changes in the work environment to help prevent further injury.

Medications

Medications that are used to treat the condition (Aurora Health Care, 2025)

NSAIDs

Nonsteroidal anti-inflammatory medications are often used to treat tendonitis.
Many are available over-the-counter, including Aleve, Bayer, and Advil.
These medications can also be prescribed in higher doses by a healthcare provider.

Pain-Relievers

Additional over-the-counter medications such as Tylenol can help decrease pain.

Oral Steroids

These medications might be prescribed for short-term use to decrease inflammation if over-the-counter medications are ineffective in treating symptoms.
Long-term use of oral steroids can cause more damage to the tendons. (Spoendlin J., Meier C., Jick S. S., & Meier C. R. 2015)

Corticosteroid Injections

Tendonitis is frequently treated with an injection of steroid medication to decrease inflammation.
However, having multiple injections in the same area can eventually cause tendons to weaken more. (NYU Langone Health, 2024)

Platelet-Rich Plasma

PRP is made by taking a small amount of blood and separating the platelets or cells that release growth factors to promote healing.
The liquid is then injected into the tendon.
PRP is controversial; some studies support its use, while others do not.
While PRP may show some promise, insurance may not cover PRP treatments because of the ambiguity in the clinical data.

Injury Medical Chiropractic and Functional Medicine Clinic

Prevention is key. Warming up before a workout, stretching, and using the proper form can help prevent triceps tendonitis. Temporarily halting activities to address symptoms can prevent more serious injury. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to build optimal health and wellness solutions. We focus on what works for you to relieve pain, restore function, prevent injury, and help mitigate issues through adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.

From Inflammation to Healing

References

Orthopedic & Spine Center. (N.D.). Triceps Tendonitis or Weightlifter’s Elbow. www.osc-ortho.com/resources/elbow-pain/triceps-tendonitis-or-weightlifters-elbow/

Harvard Health Publishing. (2014). Tendonitis. www.health.harvard.edu/diseases-and-conditions/tendonitis

Prall, J., & Ross, M. (2019). The management of work-related musculoskeletal injuries in an occupational health setting: the role of the physical therapist. Journal of Exercise Rehabilitation, 15(2), 193–199. doi.org/10.12965/jer.1836636.318

Aurora Health Care. (2025). Tendonitis symptoms & treatment. www.aurorahealthcare.org/services/orthopedics/conditions/tendonitis

Spoendlin, J., Meier, C., Jick, S. S., & Meier, C. R. (2015). Oral and inhaled glucocorticoid use and risk of Achilles or biceps tendon rupture: a population-based case-control study. Annals of Medicine, 47(6), 492–498. doi.org/10.3109/07853890.2015.1074272

NYU Langone Health. (2024). Therapeutic injections for bursitis & tendinitis in adults. nyulangone.org/conditions/bursitis-tendinitis/treatments/therapeutic-injections-for-bursitis-tendinitis

The Surprising Health Benefits of Parsley Tea

By

Dr Alexander Jimenez DC, APRN, FNP-C

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Happy couple sitting at table and enjoying hot tea — Positive and smiling young couple spending free time together at home while sitting at table with smartphone and pot of hot brew

Can drinking parsley tea help improve overall health?

Table of Contents

Parsley Tea

Parsley is commonly used as a garnish and to increase flavor in dishes. Some use parsley leaves instead of salt in their food to reduce their sodium intake. It is widely available in grocery stores and can be grown at home. Parsley tea is an herbal tea. Surprisingly, parsley tea benefits health, but not all of this is supported by scientific evidence. There are different kinds of parsley:

Curly leaf (Petroselinum crispum)
Flat leaf (Petroselinum neapolitanum) or Italian parsley.
Parsley is high in vitamins A, B, C, E, and K.
Parsley also provides fiber, iron, copper, calcium, and potassium.

The kind used in tea is up to you, based on flavor preferences.

Benefits

Parsley is believed to have various benefits, some of which are derived from consuming parsley tea. For example, parsley is used to freshen breath; however, adding sugar reduces dental benefits. Many women also suggest that parsley helps to ease menstrual cramps, and others say that consuming parsley or tea helps them eliminate excess water weight. However, further research is needed to support its benefits that include: (Ganea M. et al., 2024)

Asthma
Cough
Digestive problems
Menstrual problems
Fluid retention and swelling (edema)
Urinary tract infections
Kidney stones
Cracked or chapped skin
Bruises
Insect bites
Liver disorders
Tumors

Preparation

The quickest way to enjoy parsley tea is to use a parsley tea bag. Brands are available online and in health food stores. Parsley tea bags are manufactured using dried leaves, which can be stored in a cool, dry place and last much longer than fresh parsley. The herb is inexpensive, and making parsley tea at home is also cheap and easy.

Choose Parsley

Flat or curly.
Remove the leaves from the stems.
Gather about 1/8-1/4 cups of leaves for each cup of tea.
Place the leaves at the bottom of your cup or in a tea infuser.
Note: you can also use a French press to make parsley tea.
To do so, place the loose leaves at the bottom of the French press.

Heat Water

Once boiling, fill the cup or press with hot water.

Allow the Leaves to Steep

For about four minutes.
Steep longer if you prefer a stronger cup.
If you are new to parsley tea, start with a weaker cup and gradually increase the strength as you get used to the taste.

Remove the Parsley Leaves

With a spoon, remove the infuser and discard the leaves.
If you use a press, place the plunger on top and slowly press down to separate the leaves from the tea.
Flavor your tea with lemon or a little sugar (optional).

Side Effects

The FDA generally recognizes parsley as safe (GRAS). However, consuming large amounts—more than you would typically consume in amounts commonly found in food—can be dangerous. Having a cup of tea daily is not considered a large amount, but if you make tea with parsley oil or ground parsley seeds, your intake could be much higher than normal. Individuals who consume too much parsley may experience anemia and liver or kidney problems. (Alyami F. A., & Rabah D. M. 2011) Individuals who have diabetes, fluid retention, high blood pressure, or kidney disease should talk to their doctor to see if consuming parsley is safe for them, as it may cause side effects that can worsen their condition. Patients who undergo surgery are advised to avoid parsley in the two weeks before their procedure.

Injury Medical Chiropractic and Functional Medicine Clinic

Injury Medical Chiropractic and Functional Medicine Clinic focuses on and treats injuries and chronic pain syndromes through personalized care plans that improve ability through flexibility, mobility, and agility programs to relieve pain. Our providers use an integrated approach to create customized care plans for each patient and restore health and function to the body through nutrition and wellness, functional medicine, acupuncture, electroacupuncture, and various 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.

Optimizing Your Wellness

References

Ganea, M., Vicaș, L. G., Gligor, O., Sarac, I., Onisan, E., Nagy, C., Moisa, C., & Ghitea, T. C. (2024). Exploring the Therapeutic Efficacy of Parsley (Petroselinum crispum Mill.) as a Functional Food: Implications in Immunological Tolerability, Reduction of Muscle Cramps, and Treatment of Dermatitis. Molecules (Basel, Switzerland), 29(3), 608. doi.org/10.3390/molecules29030608

Alyami, F. A., & Rabah, D. M. (2011). Effect of drinking parsley leaf tea on urinary composition and urinary stones’ risk factors. Saudi journal of kidney diseases and transplantation: an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia, 22(3), 511–514.

What is the Push-Pull Workout Method? A Complete Guide

By

Dr Alexander Jimenez DC, APRN, FNP-C

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Trainer helping group doing exercise with resistance bands — Full body of male instructor supporting man doing exercise with elastic resistance band during fitness training with class in spacious studio

Can a push-pull workout routine be an option for individuals who want focused training on specific muscle groups and balanced muscle development throughout the body?

Push-Pull Strength Training

A “push-pull” workout is a training style in which you split your exercise routine into separate days dedicated to “push” exercises (targeting muscles like the chest, shoulders, and triceps) and “pull” exercises (targeting muscles like the back and biceps). This allows focused training on each muscle group by isolating their primary movement patterns—pushing away from the body or pulling towards it. The workout often accompanies a separate leg day to complete the full-body workout. This routine comes from bodybuilding. Bodybuilders use this method to maximize their workouts and rest periods. By splitting their workouts into push exercises one day and pull exercises another, they can work out more often without overtraining. (Castanheira R. P. M. et al., 2017)

Upper Body Push Exercises

These exercises involve all the movements that push the weights away from your body. These exercises typically focus on the quads, outer thighs, chest, shoulders, and triceps. (Collins P. 2009)

Pushups

Push-ups are a versatile bodyweight exercise that engages multiple muscle groups, including the chest, shoulders, triceps, and core.

Chest Presses

Chest presses are exercises that target the pectoral muscles (chest muscles).
They can be performed with various equipment and techniques, providing a comprehensive workout for the chest.

Chest Flies

Chest flies are a weightlifting exercise that targets the pectoral muscles (chest muscles).
They are performed by lying on a bench and extending the arms outward with weights in each hand.
The weights are then lowered in an arc motion until they are slightly below chest level before being raised back to the starting position.

Overhead Presses

An overhead press is a weight-training exercise that involves pushing a weight above your head.
Also known as a shoulder, military, or strict press.

Lateral Raises

Lateral raises are an isolation exercise that targets the lateral deltoid muscle on the shoulder’s side.
They raise the arms laterally (out to the sides) while slightly bending at the elbows.

Bent Arm Lateral Raises

A bent-over lateral raise is a weightlifting exercise that strengthens the rear deltoids, the muscles on the back of the shoulders.
It also works other upper and lower body muscles, including the trapezius, rhomboids, triceps, hamstrings, and lower back.

Front Raises

Front raises are a weight training exercise that targets the shoulder muscles.
They can also help build strength and stability in the upper body.

Dips

Dips are an upper-body exercise that uses your body weight to strengthen your triceps and chest.

Triceps Extensions

Triceps extensions are resistance exercises that target the triceps muscles in the back of the upper arm.
They involve extending the arms at the elbows while keeping the shoulders stationary.

Skull Crushers

Skull crushers are a weightlifting exercise that targets the triceps muscles in the upper arms.
They are performed by lying on a bench or floor, holding a weight (such as a dumbbell or barbell) overhead, and then lowering it towards the forehead while keeping the elbows slightly bent.
This exercise helps to strengthen and build muscle mass in the triceps.

Upper Body Pull Exercises

Pull exercises are movements where you are pulling the weight toward your body. These exercises primarily use the biceps, hamstrings, glutes, and back muscles. A routine set up in which you do a push routine one day and a pull routine the next without working the same muscles two days in a row.

Barbell Rows

Often referred to as a “bent-over row” due to the hinged position of your body during the movement.
A barbell row is a weightlifting exercise in which you bend over at the hips, grasp a barbell with an overhand grip, and pull the weight toward your stomach.
This exercise primarily targets the upper back muscles, including the latissimus dorsi, while also engaging the core and posterior chain muscles.

One Arm Rows

A variation of the bent-over row, a one-arm row, also known as a single-arm dumbbell row, is an upper-body exercise that targets the back muscles using a dumbbell and a bench.

Double arm rows

A “double arm row” is a rowing exercise in which you simultaneously pull a weight toward your body using both arms, typically with a barbell or dumbbell.
This exercise engages your upper back muscles, including the latissimus dorsi, trapezius, and rhomboids.
To effectively target the back muscles, you maintain a bent-over position. Essentially, it’s the opposite movement of a chest press, but you use both arms simultaneously.

Barbell High Rows

A barbell high row, also known as a wide row, is an exercise that uses a barbell to work the upper and mid back muscles.

Dumbell Pullovers

Dumbbell pullovers are a weightlifting exercise that targets the chest, back, and shoulder muscles.

Seated Rows with Resistance Bands

A “seated row with bands” is an exercise where you sit on the ground, loop a resistance band around your feet, and then pull the handles towards your chest, mimicking a rowing motion.
By squeezing the shoulder blades together, this motion primarily targets the upper back muscles, including the latissimus dorsi and rhomboids.
You are essentially performing a seated row movement using the tension of a resistance band instead of weights.

Lat Pulls with Resistance Band

Lat pulls with a resistance band are a back exercise that strengthens the latissimus dorsi muscles and can improve posture.

Back extensions

Back extensions are an exercise that strengthens and isolates the lower back muscles, also known as the erector spinae.

Seated Alternating Rows

A seated alternating row is an exercise that targets the upper back, biceps, and lats.
It can be performed using a resistance machine or with a band.

Renegade Rows

A renegade row is a full-body exercise that combines a plank with a dumbbell row.
It’s an advanced exercise that targets the upper body, back, shoulders, and core.

Biceps Curls

A bicep curl involves bending the arm at the elbow towards the body, strengthening the biceps, the large muscles in the front of the upper arm.

Home Equipment

Resistance bands and a quality pair of adjustable dumbbells are recommended for home training. These don’t take up much space and can be used for most upper-body exercises. To set up a more dedicated space for workouts, add a weight bench or a full home gym to increase your push-pull training options.

Benefits

Push-pull workouts are great for anybody, whether you’re a bodybuilder or just someone lifting weights to be strong and fit. This routine is usually spread out over three days of training, allowing for shorter workouts. These can help you stay committed despite a busy schedule and are easier than longer, total-body workouts. These exercises can also be done with a cable pulley system or resistance bands.

Day 1 might be a push upper body workout.
Day 2 might be a lower-body workout.
Day 3 might be the pull upper body workout.

First, push-pull workouts allow you to work your muscles without overstressing them. (Castanheira R. P. M. et al., 2017) Second, although they are more frequent, push-pull workouts are shorter, so you can do more because your other muscles are resting. Third, push-pull routines are more interesting and contain more variety, as they can be done in various ways.

Alternating Workouts

Trainers recommend changing workouts every 6-12 weeks to avoid hitting a plateau, which can delay weight loss (American Council on Exercise, 2001). For example, you could do a push-pull routine for a few weeks and then switch to a different training method, pyramid training. Then, return to total body workouts, which you can do up to 3 non-consecutive days a week. Circuit training may be an option because the quick workouts allow you to get your cardio in simultaneously. (Haltom R. W. et al., 1999) With so many different training methods, there’s no need to do the same workouts repeatedly.

Injury Medical Chiropractic and Functional Medicine Clinic

For those who are easily bored with weight training and prefer a variety of exercises, this can be a refreshing way to stay focused and avoid burnout. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to build optimal health and wellness solutions. We focus on what works for you to relieve pain, restore function, prevent injury, and help mitigate issues through adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.

Transform Your Body

References

Castanheira, R. P. M., Ferreira-Junior, J. B., Celes, R. S., Rocha-Junior, V. A., Cadore, E. L., Izquierdo, M., & Bottaro, M. (2017). Effects of Synergist vs. NonSynergist Split Resistance Training Routines on Acute Neuromuscular Performance in Resistance-Trained Men. Journal of strength and conditioning research, 31(12), 3482–3488. doi.org/10.1519/JSC.0000000000001762

Collins, P. (2009). Functional Fitness. Germany: Meyer & Meyer Sport, Limited.

American Council on Exercise. (2001). Weight Loss Plateaus and Pitfalls. ACE. contentcdn.eacefitness.com/assets/education-resources/lifestyle/fitfacts/pdfs/fitfacts/itemid_69.pdf

Haltom, R. W., Kraemer, R. R., Sloan, R. A., Hebert, E. P., Frank, K., & Tryniecki, J. L. (1999). Circuit weight training and its effects on excess postexercise oxygen consumption. Medicine and science in sports and exercise, 31(11), 1613–1618. doi.org/10.1097/00005768-199911000-00018

Understanding Rotator Cuff Tears: Causes and Treatments

By

Dr Alexander Jimenez DC, APRN, FNP-C

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Could older individuals who do not have symptoms of shoulder pain or loss of shoulder and arm function have a rotator cuff tear?

Table of Contents

Rotator Cuff Tear Physical Therapy

A rotator cuff tear is a common injury to the four muscles and tendons surrounding and stabilizing the shoulder joint. Studies have shown that (Geary M. B., & Elfar J. C. 2015)

30% of those under the age of 70
70% of those over age 80 have a rotator cuff tear.

Physical therapy is often recommended as a first-line initial treatment for rotator cuff pain. In most cases, a rotator cuff tear will not need surgical treatment. Determining when surgery is necessary depends on several factors a patient can discuss with their healthcare provider.

Causes

Overuse and repetitive motions
Trauma (e.g., falls, collisions)
Age-related degeneration

Symptoms

Shoulder pain, especially with overhead or rotational movements
Weakness and difficulty raising the arm
Clicking or grinding sounds in the shoulder
Limited range of motion

Treatment

The goal of physical therapy for a rotator cuff tear is not necessarily to heal the torn tendon but to relieve pain and improve strength by reducing inflammation and restoring shoulder joint mechanics. This is achieved through physical therapy, ice application, anti-inflammatory treatments like medications, and cortisone injections.

Physical Therapy

The goal of physical therapy is to improve the function of the muscles that surround the shoulder. Physical therapy targets the smaller muscles around the shoulder that are commonly neglected. By strengthening these muscles, the treatment can help compensate for damaged tendons and improve the mechanics of the shoulder joint. A chiropractic physical therapy team will develop a personalized exercise program. Generally, rehabilitation will start with gentle range of motion exercises that can be accomplished using the arms to lift a mobility stick/wand overhead.

Shoulder Pulleys

These improve shoulder range of motion and flexibility.

Isometric Exercises

These exercises are for the rotator cuff muscles and may then be started.
This exercise can improve the contracting of the muscles around the shoulder and offer more support to the shoulder joint.

Scapular Stabilization Exercises

These can also be done to improve the muscles surrounding the shoulder blade’s function.
This can help improve how the shoulder joint, arm, and scapulae move together when using the arm.

Advanced Strengthening

Advanced exercises can be done with a dumbbell or resistance band.

Consult your healthcare provider or physical therapist before starting these or any other exercises for a rotator cuff tear. Doing exercises correctly prevents further pain, injury, or shoulder problems. Specific, focused exercises can help expedite and regain normal shoulder function.

Injury Medical Chiropractic and Functional Medicine Clinic

The prognosis for rotator cuff tears depends on the severity of the tear and the individual’s overall health. With proper treatment, most people can regain the full function of their shoulders. However, some may experience ongoing pain or limitations in severe cases. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to build optimal health and wellness solutions. We focus on what works for you to relieve pain, restore function, prevent injury, and help mitigate issues through adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.

Shoulder Pain Chiropractic Treatment

References

Geary, M. B., & Elfar, J. C. (2015). Rotator Cuff Tears in the Elderly Patients. Geriatric orthopaedic surgery & rehabilitation, 6(3), 220–224. doi.org/10.1177/2151458515583895