The Role of Vastus Lateralis in Knee Extension and Stability

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Male rehabilitologist using special massage gun to reduce muscle stiffness and tension and improve blood flow in the massaged muscles

The vastus lateralis is a muscle on the outside part of the thigh. Injuries to the muscle include strains, tendinitis, femoral nerve compression, and others. Can rehabilitation like heat and ice, massage, and strength and mobility exercises help individuals return to normal activities and function?

Vastus Lateralis Muscle

The vastus lateralis is the largest of the four quadriceps muscles on the thigh’s outer portion. The vastus lateralis helps extend the knee joint and maintain the knee position when walking or running. The vastus lateralis functions to work with the other quad muscles to help extend the knee joint.

Anatomy

Most muscles are attached to bone points of attachment, called the origin and insertion points. The vastus lateralis origin and insertion points are as follows (Vieira, EPL. 2017)

Origin

The origin is on the upper inter-trochanteric line of the femur or thigh bone.
It also arises from the base of the greater trochanter and the linea aspera, the supracondylar ridge, and the lateral intermuscular septum.

Insertion

From its origin, the muscle courses down the lateral thigh and inserts as part of the lateral quadriceps tendon on the tibial tubercle, an elevated portion of the upper shin.
The muscle is a large, flat structure with different attachments and a flat aponeurosis or sheath of connective tissue on the outer thigh.

The femoral nerve from lower back levels two, three, and four controls or innervates the muscle.
Blood supply to the muscle goes through the lateral circumflex femoral artery of the upper thigh.

Function

The muscle works with the other quadriceps muscles to extend or straighten the knee. The quads are responsible for functional activities like walking, running, climbing stairs, and getting up from a seated position. The vastus lateralis and the iliotibial band, which courses down the lateral thigh next to this muscle, form the lateral wall of the thigh. The vastus lateralis is on the opposite side of the vastus medialis muscle on the inner portion of the thigh. These muscles work together to maintain the appropriate position of the patella/kneecap in the femoral groove of the thigh bone. Malfunctioning these muscles properly can lead to knee pain from patellofemoral stress syndrome. (American Academy of Orthopaedic Surgeons, 2024)

Conditions

Many different injuries and conditions can affect the vastus lateralis and quad muscles, especially in athletes or active individuals. These injuries can cause vastus lateralis pain and other problems. (Timothy J. Von Fange, 2024) Some of the injuries and conditions include:

Patellofemoral Stress Syndrome – PFSS

This occurs when the kneecap tracks improperly in the femoral groove of the knee joint.
This leads to pain and difficulty when walking and running.

Vastus Lateralis Strain

A sudden force on the thigh can cause the quad muscle to be strained.
If the vastus lateralis suffers a pull injury, individuals may have pain, muscle swelling, thigh bruising, and walking difficulties.

Patellar Tendinitis

Irritation of the quad tendon that courses over the kneecap can cause patellar tendinitis.

Femoral Nerve Compression Weakness

The femoral nerve may become pinched or irritated from a herniated disc, lumbar stenosis, or arthritis.
Pain, numbness, tingling, or weakness in the thigh may result.

Iliotibial Band Friction Syndrome

Tight or weak muscles can irritate the IT band, and the vastus lateralis muscle can be affected.

Injury Rehabilitation

Injury to the vastus lateralis or quad muscles can cause pain, swelling of the thigh, or limited walking ability. Various treatments are available to help expedite recovery. A primary healthcare provider may recommend working with a physical therapy team. Self-care techniques can include:

Heat and Ice

Ice may be applied to the lateral thigh the first few days after injury to control pain and decrease swelling and inflammation.
Ice should be applied for 10 to 15 minutes.
Individuals may switch to heat two to three days after to promote circulation and improve tissue mobility.
Heat should be applied for 10 to 15 minutes.

Massage

Massage can help decrease pain and promote circulation.
Massage techniques can improve tissue mobility before stretching to help improve quadriceps motion.

Exercises and Stretching

A physical therapy team will prescribe certain exercises and stretches to help regain strength and range of motion. After an injury, quad stretching can improve the mobility and function of the muscle group.

Prone Towel Quad Stretch

Lie on your stomach and place a towel or strap around the ankle.
Bend the knee up, and gently pull on the towel to bend the knee fully.
A pulling sensation should be felt in the front of the thigh.
Hold the stretch for 30 seconds and release.
Repeat three times.

Half-kneeling Quad and Hip Flexor Stretch

Kneel on one knee.
Slowly move forward until a stretch is felt in the front of the hip and thigh.
Hold this position for 30 seconds.
Relax back to the starting position.
Repeat three times.

Back Exercises

If femoral nerve irritation coming from the lower back is causing thigh pain or weakness, exercises to release the nerve may be helpful and can include:

Prone press-ups
Supine lumbar flexion
Lumbar side glides

The exercises are designed to relieve pressure on the lumbar nerve, and postural correction exercises may be performed to maintain decompression.

Strengthening

Weakness to the vastus laterals and quads may be causing injury, and strengthening exercises may be prescribed during rehabilitation and can include:

Hip-strengthening exercises
Straight leg raises
Leg extension exercises
Lunges
Squats

Strengthening exercises should be done two to four times weekly with appropriate rest between sessions.

Functional Training

A physical therapist may recommend functional training to restore normal function. (Ramírez-delaCruz, M. et al., 2022)

Balance exercises and sport-specific plyometric training may be recommended to ensure the quad functions normally.
Most quadriceps and vastus lateralis muscle injuries heal within six to eight weeks.
Recovery may be shorter or longer depending on the nature of the injury.

Injury Medical Chiropractic and Functional Medicine Clinic

By understanding the anatomy and function of the vastus lateralis muscle, a healthcare provider can help individuals understand their specific injury and develop a treatment program to rehabilitate the muscle properly. At Injury Medical Chiropractic and Functional Medicine Clinic, we focus on what works for you and strive to develop fitness and better the body through research methods and total wellness programs. These natural programs use the body’s ability to achieve improvement goals, and athletes can condition themselves to excel in their sport through proper fitness and nutrition. Our providers use an integrated approach to create personalized programs, often including Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine principles.

Knee Injury Chiropractor

References

Vieira EPL. (2017). Anatomic study of the portions long and oblique of the vastus lateralis and vastus medialis muscles. J Morphol Sci., 28(4), 0-. www.jms.periodikos.com.br/article/587cb49f7f8c9d0d058b47a1/pdf/jms-28-4-587cb49f7f8c9d0d058b47a1.pdf

American Academy of Orthopaedic Surgeons. (2024). Patellofemoral pain syndrome. orthoinfo.aaos.org/en/diseases–conditions/patellofemoral-pain-syndrome/

Timothy J Von Fange. (2024). Quadriceps muscle and tendon injuries. UpToDate. www.uptodate.com/contents/quadriceps-muscle-and-tendon-injuries/print

Ramírez-delaCruz, M., Bravo-Sánchez, A., Esteban-García, P., Jiménez, F., & Abián-Vicén, J. (2022). Effects of Plyometric Training on Lower Body Muscle Architecture, Tendon Structure, Stiffness, and Physical Performance: A Systematic Review and Meta-analysis. Sports medicine – open, 8(1), 40. doi.org/10.1186/s40798-022-00431-0

Beginner Workouts: Start Your Fitness Journey with Ease

By

Dr. Alex Jimenez

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Couple doing home workout together — Couple doing triceps dips on living room couch while working out together at home

Can beginner workouts help individuals who want to improve their health by helping them lose weight and improve their quality of life?

Table of Contents

Beginner Workouts

Individuals new to exercise do not need to go through intense workout sessions to gain the benefits of physical activity. Basic exercises and beginner workouts that can be done at home or outdoors, whichever is better or more convenient, are recommended when starting a fitness regimen to lose weight and improve overall health.

Health Benefits

Basic exercise sessions are the building blocks of a fitness program. They encourage habits that lead to significant weight loss and lifelong weight management skills. Here are a few workouts considered easy because they don’t require gym equipment, their intensity can be adjusted to match an individual’s physical activity level, and some can be done from a chair or bed for those who have trouble standing for long periods. Exercising offers immediate benefits, including increasing brain health and improving mood and long-term effects like decreased disease risk. (Centers for Disease Control and Prevention, 2024)

Easy Exercises

For individuals who are completely new to exercise, low-intensity activity sessions can help burn more calories so long as they don’t compensate for the hunger that the physical activity creates by eating more. Combining diet with exercise is essential if weight loss is the goal. This can involve learning to eat lean protein, fruit, and vegetables and watching portion sizes. Studies of low-intensity exercise show the body burns fat when performing basic exercise and physical activities. (Lee D. et al., 2021) Another study looked at the effect of beginner workouts on cortisol levels. Cortisol is a hormone associated with abdominal weight gain when levels stay elevated for long periods. The study found that low-intensity exercise decreased circulating cortisol levels. (Gerber M. et al., 2020) Beginner exercises to lose weight also help individuals (Vina J. et al., 2012)

Increase self-confidence
Decrease stress levels
Improve sleep
Establish healthy habits
Burn calories to stimulate weight loss and sustain weight management.
Develop strong muscles

Basic exercise remains a core component of fitness programs for many. This includes individuals with type 2 diabetes, metabolic syndrome, and cardiovascular disease. (Apostolopoulos V. et al., 2014)

Easy Workouts

Types of beginner workouts include:

Bodyweight training
Chair workouts
Dancing workouts
Online workouts
Shadowboxing
Stairclimbing
Aqua jogging
Biking
Walking
Gardening and yard work

At-Home

Set short-term goals to complete three workouts during the first week, then gradually add workout days until you can perform some form of physical activity on most days. The type of exercise chosen is less important than the consistency of the program.

Bodyweight Training

No special gym equipment is needed to burn calories and build stronger muscles.
Take 10 to 15 minutes for five incline push-ups against a surface that allows the body to be at an incline, such as a countertop, bathroom sink, etc.
Five chair squats
Five walking lunges or stationary lunges, holding on to a countertop for support.
Repeat the sequence two to three times.

Chair Workout

Individuals who are uncomfortable standing for long periods use a sturdy chair and complete 10 to 15 minutes of movement with a seated workout several times weekly.

Dancing

Put on music and dance for 15 to 30 minutes.
No choreography is necessary.
The important thing is to move to the music.

Online Workouts

Many online workouts are free, and most offer easy workouts for beginners.

Shadowboxing

Shadowboxing is easy, with no equipment required, and it helps to decrease stress.

Stairclimbing

Take 10 minutes to walk up and down a flight of steps.
Those who don’t have a staircase available can use a step or platform.

Outdoors

Exercising outside provides extra perks. There are stress-relieving benefits to breathing fresh air and enjoying the outdoors.

Aqua Jogging

Try pool running or aqua jogging for those with joint pain when walking for long periods.
Floatation devices keep the upper body afloat.
Once in the water, walk without letting your feet touch the bottom of the pool.
If no floatation device is available, individuals can walk in the water with their feet on the pool floor.

Biking

Take a leisurely spin around the neighborhood
Ride on a continuous path or track requiring 20 to 30 minutes of pedaling.

Walking

A 30-minute walk workout can be counted as daily exercise.
Walk slowly for five minutes.
Pick up the pace for 20 minutes
Cool down and walk slowly for five minutes.

Gardening or Yard Work

Spending time in the garden or yard is a great way to work muscles and burn calories.
Digging, weeding, raking, and mowing are all recommended activities that count as exercise for beginners.

Injury Medical Chiropractic and Functional Medicine Clinic

Remember, as a beginner, the point is to get the body moving, establish a workout routine, and gradually build confidence to increase exercise enjoyment and health benefits. Workouts for beginners, especially those who still need to maintain an exercise program, are designed to develop life-long habits of well-being. At Injury Medical Chiropractic and Functional Medicine Clinic, we focus on what works for you and strive to develop fitness and better the body through research methods and total wellness programs. These natural programs use the body’s ability to achieve improvement goals, and athletes can condition themselves to excel in their sport through proper fitness and nutrition. Our providers use an integrated approach to create personalized programs, often including Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine principles.

Exercise Prescription

References

Centers for Disease Control and Prevention. (2024). Benefits of Physical Activity. Retrieved from www.cdc.gov/physical-activity-basics/benefits/?CDC_AAref_Val=https://www.cdc.gov/physicalactivity/basics/pa-health/index.htm

Lee, D., Son, J. Y., Ju, H. M., Won, J. H., Park, S. B., & Yang, W. H. (2021). Effects of Individualized Low-Intensity Exercise and Its Duration on Recovery Ability in Adults. Healthcare (Basel, Switzerland), 9(3), 249. doi.org/10.3390/healthcare9030249

Gerber, M., Imboden, C., Beck, J., Brand, S., Colledge, F., Eckert, A., Holsboer-Trachsler, E., Pühse, U., & Hatzinger, M. (2020). Effects of Aerobic Exercise on Cortisol Stress Reactivity in Response to the Trier Social Stress Test in Inpatients with Major Depressive Disorders: A Randomized Controlled Trial. Journal of clinical medicine, 9(5), 1419. doi.org/10.3390/jcm9051419

Vina, J., Sanchis-Gomar, F., Martinez-Bello, V., & Gomez-Cabrera, M. C. (2012). Exercise acts as a drug; the pharmacological benefits of exercise. British journal of pharmacology, 167(1), 1–12. doi.org/10.1111/j.1476-5381.2012.01970.x

Apostolopoulos, V., Borkoles, E., Polman, R., & Stojanovska, L. (2014). Physical and immunological aspects of exercise in chronic diseases. Immunotherapy, 6(10), 1145–1157. doi.org/10.2217/imt.14.76

Managing Nerve Root Encroachment with Surgical Decompression

By

Dr. Alex Jimenez

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Male doctor explaining spinal anatomy with vertebral column model to patient in clinic. High quality photo

Individuals experiencing persistent pain, weakness, numbness, and tingling in the back could be suffering from nerve root encroachment. Could surgery ease nerve compression and improve symptoms for persistent and severe cases?

Table of Contents

Surgical Decompression

The pain, weakness, numbness, and tingling associated with nerve root encroachment are usually first treated with non-surgical therapies that include:

Anti-inflammatory medications
Physical therapy

This can be enough to address the irritation of the spinal nerve root. But when cases become severe, surgical decompression may be recommended and necessary. It can be done in a couple of different ways.

Causes and Symptoms

Vertebrae are bones in the spine. Small openings called foramina allow a spinal nerve root to pass through on each side of the vertebra. When nerve root encroachment is present, the spinal nerve root gets compressed, pinched, and trapped, which can cause peripheral symptoms such as numbness, tingling, pain, or weakness to develop. Nerve root encroachment is typically caused by normal aging degenerative wear and tear changes in the vertebrae. (Choi Y. K. 2019) These degenerative changes can include:

Facet joint hypertrophy
Ligament and bone hypertrophy
Disc disorders
Formation of bone spurs or osteophytes.

If these degenerative changes progress, they can encroach and compress a nerve root, leading to peripheral symptoms. (Choi Y. K. 2019)

When Surgery Is Recommended

When symptoms occur, initial treatment will involve:

Physical therapy
Chiropractic realignment
Massage therapies
Rest
Lifestyle adjustments
Nonsteroidal anti-inflammatories – NSAIDs
Corticosteroid injections into the spine

If conservative therapies don’t fully heal or improve symptoms or there are neurological problems like difficulty with balance or walking, then surgery may be recommended. Severe pain that limits normal function is an indication for surgery, and rapidly progressive weakness of the arms and/or legs or signs of cauda equina syndrome are indications for emergency surgery.

Surgery Options

Different types of spinal surgery may be performed. A neurosurgeon will decide the best procedure for each patient based on their case, age, medical conditions, and other factors. Specific spinal surgical decompression depends on what is causing the nerve compression. In most cases, it involves removing bone or tissue to relieve nerve pressure or provide support to stabilize the joint. The most common types of surgical decompression include: (Mayo Clinic Health System, 2022)

Laminectomy
Discectomy
Laminotomy
Foraminotomy
Fusion

Spinal surgical goals are to: (American Association of Neurological Surgeons, 2024)

Decompress pressure on the nerve roots.
Relieve pressure on the nerve roots.
Maintain the stability and alignment of the spine.
Improve the stability and alignment of the spine.

Anterior Surgery

The anterior approach to surgery means that the spine is accessed through the anterior/front of the spine. In this surgery, one or more discs and bone spurs may be removed through an incision in the front of the neck. (American Association of Neurological Surgeons, 2024) For example, an anterior cervical discectomy may alleviate pressure on one or more nerve roots in the neck. With an anterior lumbar interbody fusion, a surgeon removes a degenerative disc in the lower spinal area by going through a patient’s lower abdomen. (American Association of Neurological Surgeons, 2024) After the disc is removed, a structural device, usually made of bone, fills the space where it once was. This device encourages bone healing and helps the vertebrae’s bodies fuse.

Posterior Surgery

Posterior surgery means the spine is accessed through the posterior/back of the spine. An example is removing a thickened ligament, bone spur, or disc material in the neck. To do this, a small incision in the back of the neck may be made to remove part of the back of the vertebrae called the lamina. This is called a posterior cervical laminectomy. (American Association of Neurological Surgeons, 2024) A posterior lumbar interbody fusion removes a degenerative disc by going through the back. (American Association of Neurological Surgeons, 2024) Like the anterior approach, a structural device often contains bone to fill the space where the disc once was to fuse the bones.

Potential Risks

As with any surgery, it’s important that the individual and their healthcare provider carefully discuss the benefits and risks. Spinal surgical decompression includes: (Proietti L. et al., 2013)

Bleeding
Blood clots
Surgical site infection
Urinary tract infection
Lung infection
Intestinal blockage

There are also specific risks to the area of the spine being operated on and how it is surgically approached. For example, a cervical anterior procedure may injure the esophagus, trachea, or carotid artery. Likewise, damage to the C5 nerve root/C5 palsy can occur from cervical spinal decompressive surgery. This complication causes weakness, numbness, and pain in the shoulders. (Thompson S. E. et al., 2017) The spinal cord may also be injured during surgery and result in paralysis, although this is rare. (American Association of Neurological Surgeons, 2024)

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.

The Non-Surgical Solution

References

Choi Y. K. (2019). Lumbar foraminal neuropathy: an update on non-surgical management. The Korean journal of pain, 32(3), 147–159. doi.org/10.3344/kjp.2019.32.3.147

Mayo Clinic Health System. (2022). Decompress and stabilize: understanding types of back surgery. Speaking of Health. www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/understanding-types-of-back-surgery

American Association of Neurological Surgeons. (2024). Cervical spine. www.aans.org/patients/conditions-treatments/cervical-spine/

American Association of Neurological Surgeons. (2024). Lumbar spinal stenosis. www.aans.org/patients/conditions-treatments/lumbar-spinal-stenosis/

Proietti, L., Scaramuzzo, L., Schiro’, G. R., Sessa, S., & Logroscino, C. A. (2013). Complications in lumbar spine surgery: A retrospective analysis. Indian journal of orthopaedics, 47(4), 340–345. doi.org/10.4103/0019-5413.114909

Thompson, S. E., Smith, Z. A., Hsu, W. K., Nassr, A., Mroz, T. E., Fish, D. E., Wang, J. C., Fehlings, M. G., Tannoury, C. A., Tannoury, T., Tortolani, P. J., Traynelis, V. C., Gokaslan, Z., Hilibrand, A. S., Isaacs, R. E., Mummaneni, P. V., Chou, D., Qureshi, S. A., Cho, S. K., Baird, E. O., … Riew, K. D. (2017). C5 Palsy After Cervical Spine Surgery: A Multicenter Retrospective Review of 59 Cases. Global spine journal, 7(1 Suppl), 64S–70S. doi.org/10.1177/2192568216688189

Staying Hydrated: Key to a Healthy Body and Mind

By

Dr. Alex Jimenez

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Can individuals maintain proper hydration levels in their bodies to prevent spinal pain and other musculoskeletal conditions?

Table of Contents

Introduction

When making small changes to better their health and wellness, many understand that eating nutritional foods, exercising, and finding ways to reduce the pain and stress that environmental factors have affected the body. However, there is also another crucial component to a person’s health and wellness, and that is staying hydrated. Many individuals sometimes don’t realize that the human body contains about 60% of the water, which helps every vital organ, muscle, tissue, and vertebra in the body to function. However, many individuals who do not consume enough water due to a stressful event, exercising, or just wanting to drink sugary drinks will feel pain and discomfort in their bodies. This can range from mild headaches to back pain. Today’s article focuses on what spinal pain correlates with the back, why staying hydrated can reduce spinal pain and ways to stay hydrated. We talk with certified associated medical providers who inform our patients to maintain proper hydration to reduce the chances of spinal pain affecting their bodies. While asking their associated medical provider intricate questions, we advise patients to incorporate daily hydration levels as part of their routine to reduce the chances of spinal pain from returning. Dr. Alex Jimenez, D.C., includes this information as an academic service. Disclaimer.

Spinal Pain Is Correlated With The Back

Do you feel constant aches or pains after a stressful day? Do you feel like chugging gallons of water but still feel thirsty? Or have you been noticing that you have been dealing with limited mobility that has been causing you pain and discomfort in your lower back? These pain-like scenarios are multifactorial and can correlate with spinal pain affecting the back. Now, many people wonder why spinal pain is associated with back pain. The spine is crucial in allowing the individual to be upright and move around during daily activities. The spinal vertebrae discs are between the bones, which would enable shock absorption when a person twists, bends, or flexes so the bones don’t rub together. However, when the body ages, the spine does, too, which causes the intervertebral disc to gradually fall and change the dynamics of the affected spine segments. (Kos et al., 2019) To that point, when the intervertebral disc becomes compressed due to degeneration, it can lead to the development of back pain.

Since low back pain is a multifactorial musculoskeletal condition, many individuals often develop low back pain from numerous environmental risk factors like physical labor, excessive sitting or standing, poor dieting, and physical inactivity, which can cause individuals to have a loss of sensation, reduced reflexes, limited range of movements and tenderness can affect a person’s gait and posture. (Kabeer et al., 2023) When the spinal discs are being compressed, the water inside the disc becomes dehydrated and is linked to lower back pain. (Cheung et al., 2023) When the spinal discs are dehydrated in the spine due to improper hydration, it can lead to immobility, cause the disc to degenerate, and cause spinal structural defects that cause the surrounding muscles and tissues to have biomechanical instability and inflammation. (Hauser et al., 2022) When the body starts dehydrating, it retrieves water from the spine and other parts to sustain life and keep the vital organs functioning.

Eating Right To Feel Better- Video

Eating Right to Feel Better | El Paso, Tx (2023)

Why Staying Hydrated Can Reduce Spinal Pain

Proper hydration is key to reducing the chances of spinal pain. By staying hydrated with plain, pure water, individuals can stay focused, remove toxins from the body, aid in weight reduction, and reduce muscle and low back pain. (Nsiah-Asamoah & Buxton, 2021) Drinking at least 64 ounces of water a day can rehydrate the body and prevent future issues that can cause pain. Proper hydration allows the body to maintain cell activity and regulate body temperature, reducing the chances of pain affecting the body.

Ways to Stay Hydrated

There are ways to stay hydrated and allow the body to have proper hydration levels. Incorporating hydrating fruits and vegetables can help aid in proper hydration as these fruits and vegetables contain about 90% water and the essential nutrients. Additionally, when individuals try to get their hydration levels back up, they are encouraged to drink more fluids as they prefer, especially if they feel unwell. This is to ensure that the body is hydrated enough so that individuals can receive subcutaneous or intravenous fluid supplements combined with regular fluid intake. (Li et al., 2023) Another way many individuals can stay hydrated is to combine non-surgical treatments like chiropractic care and spinal decompression to help realign and lengthen the spine to reduce unwanted pressure on the spinal discs and rehydrate them. The combination of non-surgical treatments and drinking plenty of hydrating fluids can help many individuals dealing with back pain associated with the spine as they start to make small changes to their routine and can live a life pain-free.

References

Cheung, S. T. Y., Cheung, P. W. H., & Cheung, J. P. Y. (2023). Why Are Some Intervertebral Discs More Prone to Degeneration?: Insights Into Isolated Thoracic “Dysgeneration”. Spine (Phila Pa 1976), 48(12), E177-E187. doi.org/10.1097/BRS.0000000000004632

Hauser, R. A., Matias, D., Woznica, D., Rawlings, B., & Woldin, B. A. (2022). Lumbar instability as an etiology of low back pain and its treatment by prolotherapy: A review. J Back Musculoskelet Rehabil, 35(4), 701-712. doi.org/10.3233/BMR-210097

Kabeer, A. S., Osmani, H. T., Patel, J., Robinson, P., & Ahmed, N. (2023). The adult with low back pain: causes, diagnosis, imaging features and management. Br J Hosp Med (Lond), 84(10), 1-9. doi.org/10.12968/hmed.2023.0063

Kos, N., Gradisnik, L., & Velnar, T. (2019). A Brief Review of the Degenerative Intervertebral Disc Disease. Med Arch, 73(6), 421-424. doi.org/10.5455/medarh.2019.73.421-424

Li, S., Xiao, X., & Zhang, X. (2023). Hydration Status in Older Adults: Current Knowledge and Future Challenges. Nutrients, 15(11). doi.org/10.3390/nu15112609

Nsiah-Asamoah, C. N. A., & Buxton, D. N. B. (2021). Hydration and water intake practices of commercial long-distance drivers in Ghana: what do they know and why does it matter? Heliyon, 7(3), e06512. doi.org/10.1016/j.heliyon.2021.e06512

Disclaimer

Meeting the Daily Vegetable Consumption Guidelines

By

Dr. Alex Jimenez

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Portrait of young nutritionist woman holding a bowl of fruits and vegetables — Portrait of young nutritionist woman holding a bowl of natural and organic fruits and vegetables standing at medical consultation. Healthy lifestyle and nutrition concept.

Does an individual’s ideal daily intake of vegetables depend on age, sex, and activity level?

Table of Contents

Daily Serving of Vegetables

Vegetables are vital to a healthy diet. Every type offers various nutrients in a unique combination of vitamins, minerals, and phytochemicals. Plus, they are low in fat and calories and packed with fiber. The U.S. Department of Agriculture and other health organizations recommend eating a variety for optimal health. An age guide recommends the number of cups of vegetables that babies and older adults should consume daily. The U.S. Centers for Disease Control and Prevention reports that very few individuals meet the vegetable consumption guidelines, putting them at risk for chronic diseases like diabetes and heart disease. (U.S. Centers for Disease Control and Prevention, 2017)

What Is a Serving?

Current Dietary Guidelines recommend 2 1/2 cups of vegetables or nine servings daily. However, the amount varies by age. Serving sizes are also based on the type of vegetable. Overall, individuals are recommended to consume a variety each day. For most vegetables, a serving equals the amount that will fill one measuring cup. However, a serving of raw leafy greens like spinach and lettuce is two cups (U. S. Department of Agriculture, 2020), and eight ounces of vegetable juice also counts as one cup serving. For those who don’t have a measuring cup or kitchen scale, here are some one-cup equivalents for certain vegetables.

One large tomato
One medium potato
One large ear of corn
One large sweet pepper
One large sweet potato
Two medium carrots
Five or six broccoli florets

Another way is to use tablespoons—one cup contains around 16 tablespoons, which can be used when calculating servings for babies, toddlers, and young children.

Babies

Most babies are ready to eat solid foods between four and six months. There’s no ideal order, so starting with vegetables is fine. Starting babies with foods like peas, carrots, and squash could help encourage a preference for these foods that will carry on into adulthood, as babies tend to gravitate toward sweet flavors and may only want applesauce and pears, which could lead to not wanting to eat vegetables. It is recommended to start with a few teaspoons at a time. Eventually, they will eat about three or four tablespoons of baby food, like cereal or purees, a few times a day, which can fill about half a cup.

Toddlers 2-3

Toddlers age two to three should consume one cup of vegetables each day. If that sounds like a lot, remember that one cup can be spread throughout the day—it doesn’t have to be finished in a single meal. It also means one cup of various vegetables, not just one type. For example, some baby carrots during breakfast, steamed broccoli for lunch, and roasted sweet potatoes with dinner. Each serving can include four tablespoons that will become one serving. And if the only vegetable the toddler will eat is corn, that’s okay. There are also ways to disguise vegetables so they will eat them, like spinach or kale, which can disappear into a fruit smoothie. Children under five can choke on uncooked fruits and vegetables, so make sure whatever form is safe.

Young Children 4-8

Boys and girls in this age group should eat one and a half cups of vegetables daily. Regarding preparation, it’s fine to eat raw and cooked veggies. However, four-year-olds are still at risk of choking on raw vegetables. Cut carrots, bell peppers, and other vegetables into pieces no larger than a half-inch long so they won’t get stuck in their throat if inadvertently swallowed without chewing properly. And steamed, baked, and roasted vegetables are the healthiest.

Tweens 9-13

During the tween years, nutritional needs vary slightly based on sex. The recommended daily amount for girls is at least two cups. For boys, the recommendation is at least two and a half cups. Tweens of either gender who are especially active benefit from eating more than the suggested minimum. Research shows that boys eat fewer vegetables and fruits than girls. (Bere E. et al., 2008) Offer as much variety of vegetables and ways to prepare to find the ones they enjoy most.

Teens 14-18

Teenage girls should eat at least two and a half cups of vegetables daily, and boys eat at least three cups. Active teens who get 30 minutes of exercise daily may need more. However, it can be harder to monitor their vegetable intake as kids get older and spend more time eating away from home. In all family meals, try to include a variety of healthy prepared vegetables like:

Raw in salads
Steamed
Roasted
Baked as a side dish
Folded into omelets
Added to soups and stews
Layered on pizzas

Make it easy for teenagers to have vegetables between meals. Pre-cut carrots, celery, and bell peppers can be kept front and center in the fridge alongside hummus or guacamole for dipping.

Young Adults 19-30

The recommended daily amount of vegetables for individuals ages 19 to 30 is the same as for teens: at least three cups daily for men and at least two and a half cups for women. Those who exercise should include more. If a busy lifestyle makes getting all the vegetables needed difficult, take advantage of options like smoothies, including vegetables, pre-tossed salads, and prepped-for-cooking vegetables at the store. They may be more expensive, but if the time saved makes it easier to eat vegetables, it may be worth it, and eventually, individuals will learn how to prepare their own. Kitchen gadgets, like a smoothie blender, can help with faster preparations.

Adults 31-50

As with young adults, the amount of vegetables should be at least two and a half cups daily for women, three cups for men, and more for those who work out or are physically active.

Older Adults 51-Up

Because the body’s metabolism slows down, individuals 51 and older are advised to cut calories to prevent weight gain. This also applies to calories from vegetables. Women 51 and older should consume around two cups of vegetables daily, and men should consume around two and a half cups. Active older adults should continue to factor in the amount of physical activity with vegetable intake. Individuals should talk to their doctor or see a nutritionist if they want more specific guidance on what to include in their diet.

Injury Medical Chiropractic and Functional Medicine Clinic

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

Nutrition Fundamentals

References

U.S. Centers for Disease Control and Prevention. (2017). Only 1 in 10 adults get enough fruits or vegetables. Retrieved from archive.cdc.gov/#/details?url=https://www.cdc.gov/media/releases/2017/p1116-fruit-vegetable-consumption.html

U. S. Department of Agriculture. (2020). Vegetables. Retrieved from www.myplate.gov/eat-healthy/vegetables

Bere, E., Brug, J., & Klepp, K. I. (2008). Why do boys eat less fruit and vegetables than girls?. Public health nutrition, 11(3), 321–325. doi.org/10.1017/S1368980007000729

Effectively Managing Peptic Ulcers: Tips and Remedies

By

Dr. Alex Jimenez

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Confident female doctor with medical stethoscope introducing and explaining treatment guidelines, medication, care, therapy to patients. concept of treatment, service, consultation, health insurance

For individuals with chronic pain conditions, what are the risks of developing peptic ulcers?

Table of Contents

NSAIDs and Peptic Ulcers

A peptic ulcer is a sore in the lining of the stomach or duodenum, the first area of the small intestine. The most common symptom is a burning stomach pain that may come and go for several days or weeks. Other symptoms include:

Feeling full
Feeling bloated
Belching
Heartburn
Nausea
Stress and spicy foods can worsen ulcers but do not cause them.

A peptic ulcer is a sore that occurs in the mucosal lining of the stomach, small intestine, or esophagus. It is caused by stomach acids or other digestive juices damaging the stomach or duodenum lining. When the ulcer is in the stomach, it might also be called a gastric ulcer. The acid can create a painful open sore that may bleed. The most common cause of a peptic ulcer is a type of bacteria called Helicobacter pylori (H. pylori). A second, less common cause of peptic ulcers is the use of non-steroidal anti-inflammatory medications or NSAIDs like aspirin, ibuprofen, and naproxen. (Fashner J. & Gitu A. C. 2015) Using over-the-counter NSAIDs for the occasional headache or achy back won’t cause a peptic ulcer. Rather, peptic ulcer disease is something that can occur with longer-term use, especially at high doses, such as for chronic pain associated with arthritis or other inflammatory conditions. (National Institute of Diabetes and Digestive and Kidney Diseases, 2022)

NSAIDs and Ulcer Development

NSAIDs can cause ulcers because they can interfere with the stomach’s ability to protect itself from gastric acids as they slow the production of protective mucus in the stomach and change its structure. (National Institute of Diabetes and Digestive and Kidney Diseases, 2022) While these acids are vital to the digestive process, they can compromise the stomach’s protective barriers. The stomach has three protections against gastric acid:

Foveolar cells that line the stomach produce a protective mucus.
Bicarbonate is produced by the foveolar cells, which help neutralize stomach acid.
Blood circulation aids in repairing and renewing cells in the stomach’s mucosal layer.

Specific lipids called prostaglandins, which the body makes, affect pain receptors. NSAIDs work to reduce pain by blocking enzymes involved in the production of certain prostaglandins. Prostaglandins also protect the stomach’s mucosal layer, which can be broken when depleted. Suppressing the body’s natural defenses against gastric acids can lead to inflammation in the stomach lining. Over time, this can cause a capillary blood vessel to rupture, causing bleeding and the development of an open, ulcerative sore. (Bjarnason I. et al., 2018)

Symptoms

A peptic ulcer may cause symptoms in the digestive tract, but some individuals may have no symptoms. The most common symptom is upper abdominal pain, which can feel dull or burning. The pain can range in severity, with some experiencing mild discomfort and others having severe pain. Most of the time, the pain will occur after a meal, but it might also happen at night for some. It could go on from a few minutes to a few hours. (National Institute of Diabetes and Digestive and Kidney Diseases, 2022) Other symptoms are less common but can include:

Bloating
Burping
Gas
Nausea
Vomiting
Loss of appetite
Weight loss
Feeling sick in the stomach.
Feeling full after even a small meal.

In rare cases, individuals with peptic ulcers may see blood in their stool or have black stools because blood is present. Blood coming from one or more peptic ulcers could also be visible in vomit. Call a healthcare provider right away if there is blood in stool or vomit, as this can be a sign of excessive bleeding or other serious problems. (National Institute of Diabetes and Digestive and Kidney Diseases, 2022)

Diagnosis

When peptic ulcer symptoms occur, a healthcare provider may order several tests to determine the cause. For individuals who are receiving NSAIDs for chronic pain, a healthcare provider may already have a high suspicion that the medication is the cause or is contributing to peptic ulcer disease. Because infection with H. pylori is the most common cause, it is normally ruled out through a breath, blood, or stool test. (National Institute of Diabetes and Digestive and Kidney Diseases, 2022) Tests to look for ulcers inside the upper digestive tract can include:

Upper GI Series

Patients drink a barium substance to help the internal organs appear on imaging.
A series of X-rays are taken.

Upper Endoscopy

A flexible tube with a camera is used to look inside the esophagus, the stomach, and the duodenum.
Patients are sedated during the procedure, and small pieces of tissue are taken from the lining for further testing. (National Institute of Diabetes and Digestive and Kidney Diseases, 2022)

Risk Factors

All NSAIDs have the potential to cause indigestion, gastric bleeding, and ulcers. However, some individuals are more susceptible to developing peptic ulcer disease than others. Peptic ulcers caused by NSAIDs are more likely to occur in individuals who: (National Institute of Diabetes and Digestive and Kidney Diseases, 2022)

Are 70 or older
Have a history of ulcers
Take corticosteroids
Take high-dose NSAIDs
Take NSAIDs regularly for a long time
Take more than two types of NSAIDs
Use aspirin daily, including low-dose aspirin, for cardioprotective purposes.
Take blood thinners
Drink alcohol regularly
Smoke

Studies suggest that 25% of those who use NSAIDs long-term will develop an ulcer, but only a small percentage will go on to develop serious complications. (Lanza F. L. et al., 2009)

Treatment

NSAID-induced ulcers usually heal once the NSAID is stopped. Certain treatments may be recommended to expedite the healing process depending on the severity of the peptic ulcer. In severe cases, surgery may be recommended to repair the damage.

Medications

A healthcare provider may recommend taking one or more medications. Over-the-counter options may include:

Antacids help neutralize stomach acid.
A proton pump inhibitor or PPI, such as omeprazole, lowers acid levels in the stomach. (Begg M. et al., 2023)
Bismuth subsalicylate – Pepto-Bismol or Kaopectate. (National Institute of Diabetes and Digestive and Kidney Diseases, 2022)

Prescription Medications

These might be recommended and can include the following:

An H2-blocker, which prevents the production of stomach acid by blocking histamine
Prescription PPIs such as Aciphex – rabeprazole or Konvomep – omeprazole and sodium bicarbonate.
Mucosal protective agents, or MPAs, maintain the mucosal layer in the stomach. (National Institute of Diabetes and Digestive and Kidney Diseases, 2022)

The bigger problem for individuals is how to manage pain when the medications are discontinued. For individuals with chronic pain, this may require the help of a physical therapy team, including a pain management healthcare provider. Certain medications called COX inhibitors could be used to control pain for some. COX inhibitors have been shown to work for pain relief and are associated with fewer digestive side effects than other types of NSAIDs. These meds have also been shown to have cardiovascular side effects, however, so it’s usually recommended they be used at the lowest dosage. (Scarpignato C. et al., 2015)

Lifestyle Adjustments

Lifestyle adjustments may be recommended to heal peptic ulcers, including:

Avoiding foods that worsen symptoms.
Avoiding caffeine
Avoiding alcohol
Quitting smoking

Surgery

In some cases, surgery may be recommended, but this is more often the case when there are complications as a result of the ulcer, such as:

Serious bleeding
Perforation or a hole in the stomach or small intestine (Lee C. W. & Sarosi G. A. Jr 2011)
Obstruction or bowel blockage

Prevention

Avoiding long-term and high-dose use of NSAIDs or not using these medications can help protect and prevent peptic ulcers. For individuals who have to take an NSAID due to a condition they are trying to manage, a healthcare provider may prescribe one of the meds used to treat peptic ulcers to prevent them from occurring. Some believe that spicy food and stress cause ulcers, but that has been discredited. (Cleveland Clinic, 2022) Most individuals who take NSAIDs will not experience peptic ulcer disease. (Drini M. 2017) However, those who have chronic pain and who are receiving high doses should be aware of the potential.

Injury Medical Chiropractic and Functional Medicine Clinic

Individuals who have any concerns about the use of NSAIDs and how the digestive system will be affected should ask a healthcare provider if there are ways to prevent ulcers and if those measures should be implemented while receiving high doses of NSAIDs. Left untreated, ulcers can lead to complications, which is why it is important to get a diagnosis and receive treatment. 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 naturally.

Root Causes of Gut Dysfunction

References

Fashner, J., & Gitu, A. C. (2015). Diagnosis and Treatment of Peptic Ulcer Disease and H. pylori Infection. American family physician, 91(4), 236–242.

National Institute of Diabetes and Digestive and Kidney Diseases. (2022). Peptic ulcers (stomach ulcers). Retrieved from www.niddk.nih.gov/health-information/digestive-diseases/peptic-ulcers-stomach-ulcers

Bjarnason, I., Scarpignato, C., Holmgren, E., Olszewski, M., Rainsford, K. D., & Lanas, A. (2018). Mechanisms of Damage to the Gastrointestinal Tract From Nonsteroidal Anti-Inflammatory Drugs. Gastroenterology, 154(3), 500–514. doi.org/10.1053/j.gastro.2017.10.049

Lanza, F. L., Chan, F. K., Quigley, E. M., & Practice Parameters Committee of the American College of Gastroenterology (2009). Guidelines for prevention of NSAID-related ulcer complications. The American journal of gastroenterology, 104(3), 728–738. doi.org/10.1038/ajg.2009.115

Begg, M., Tarhuni, M., N Fotso, M., Gonzalez, N. A., Sanivarapu, R. R., Osman, U., Latha Kumar, A., Sadagopan, A., Mahmoud, A., & Khan, S. (2023). Comparing the Safety and Efficacy of Proton Pump Inhibitors and Histamine-2 Receptor Antagonists in the Management of Patients With Peptic Ulcer Disease: A Systematic Review. Cureus, 15(8), e44341. doi.org/10.7759/cureus.44341

Scarpignato, C., Lanas, A., Blandizzi, C., Lems, W. F., Hermann, M., Hunt, R. H., & International NSAID Consensus Group (2015). Safe prescribing of non-steroidal anti-inflammatory drugs in patients with osteoarthritis–an expert consensus addressing benefits as well as gastrointestinal and cardiovascular risks. BMC medicine, 13, 55. doi.org/10.1186/s12916-015-0285-8

Lee, C. W., & Sarosi, G. A., Jr (2011). Emergency ulcer surgery. The Surgical clinics of North America, 91(5), 1001–1013. doi.org/10.1016/j.suc.2011.06.008

Cleveland Clinic. (2022). Can stress give you an ulcer? health.clevelandclinic.org/can-stress-give-you-an-ulcer

Drini M. (2017). Peptic ulcer disease and non-steroidal anti-inflammatory drugs. Australian prescriber, 40(3), 91–93. doi.org/10.18773/austprescr.2017.037

Concussion Tests: Noninvasive Assessment of Brain Function

By

Dr. Alex Jimenez

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in a modern clinic in a small therapist s office, a young girl doctor with a stethoscope conducts an appointment with a young guy patient diagnosing a problem

What type of concussion tests are there to help establish the extent of head injuries and help assess improvement during recovery?

Table of Contents

Concussion Tests

A concussion is a temporary change in brain function that occurs from a traumatic brain injury or TBI. It can cause problems with thinking and mood and can take weeks to years to heal. Concussion tests are done after a suspected head injury and are also used after diagnosis to assess healing progress. They are noninvasive tests that measure brain functions. Several tests vary in how they are given and what they measure.

Tests

A mild or moderate traumatic brain injury can cause damage to the brain that is not detectable with brain imaging tests. However, the damage can cause serious symptoms, including headaches, emotional changes, difficulty concentrating, and memory problems. (Haider M. N. et al., 2021) The effects of a concussion can be hard to describe, but concussion testing can help identify and quantify these changes. For individuals who don’t have time to heal or experience further brain injuries while recovering, the effects can be prolonged and worsen. This is one reason why concussion testing is vital to get a diagnosis and follow medical recommendations to avoid further injury to the brain. Diagnosis can help set goals, adjust, and assess how the effects improve over time. With improvement, individuals can participate in rehabilitation and follow their doctor’s instructions for gradually returning to work, school, and other activities.

Measurements

Concussion tests can measure subtle aspects of brain function, like visual or auditory perception and response speed (Joyce A. S. et al., 2015). The damage sustained can impair these abilities, like slow decision-making. A traumatic brain injury can be associated with serious injuries, like a skull fracture, swelling, bruise, or bleeding in the brain. These injuries can be detected with imaging tests and often require surgery or other interventions. Brain damage from bleeding or swelling would cause focal neurological symptoms and signs, including partial vision loss, numbness, and weakness. Individuals can have a concussion along with detectable brain injuries or in the absence of detectable brain injuries.

Types of Tests

There are several types of concussion tests. Individuals may have one or more of these, depending on the standard test that is used in their school, sports league, or by their doctor. These can include:

Online Checklists

Several different online checklists are available for concussion screening.
These tests may include questions about symptoms and are often used as self-tests but are not intended to replace an evaluation by a medical professional.

Baseline and Post-Injury Tests

Many schools and sports leagues conduct preseason skill measurements, including memory tests or tests of speed and accuracy, either in an interview form or with computer testing.
Individuals might be asked to retake the test that is used as a comparison if they have experienced a traumatic brain injury.

Standardized Assessment of Concussion – SAC

This five-minute test can be done on the sidelines after a sports injury or later.
It evaluates orientation, immediate memory, neurologic function, concentration, and delayed recall. (Kaufman M. W. et al., 2021)

King-Devick Concussion Test

This two-minute test can be performed on the sidelines after a sports injury or later to assess language, eye movement, and attention. (Krause D. A. et al., 2022)

Post-Concussion Symptom Scale

This test includes 22 questions involving neurocognitive factors, including difficulty concentrating or remembering, physical symptoms like headaches and dizziness, and emotional symptoms like sadness or irritability. (Langevin P. et al., 2022)

Sport Concussion Assessment Tool – SCAT

This test includes an on-field assessment noting concussion symptoms, memory assessment using Maddocks questions (a short list of specific questions), Glasgow Coma Scale (GCS), and cervical spine assessment.
An off-field assessment involves the evaluation of cognitive, neurological, balance, and delayed recall. (Kaufman M. W. et al., 2021)

Buffalo Concussion Physical Examination – BCPE

A modified physical examination that assesses neck tenderness and range of motion, head, jaw, and face abnormalities, eye movements examination, and coordination. (Haider M. N. et al., 2021)
After a concussion, individuals will also have a physical examination, including a full neurological examination, in a doctor’s office.

Results

A doctor will diagnose based on symptoms, physical examination, and concussion test results. For example, for individuals who have broken several bones and are taking powerful pain medications, concussion test results can be abnormal even if they did not experience a concussion. The results of concussion testing can be compared with results before the head injury. Often, baseline testing is required for participation in certain sports leagues at professional and amateur levels. A low score can indicate that head injury has impaired brain function. Sometimes, testing can be done within a few hours of the head trauma and then again a few days later. Responses of individuals who did not have measurements taken before a head injury can be compared with the average results of people their age.

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

Haider, M. N., Cunningham, A., Darling, S., Suffoletto, H. N., Freitas, M. S., Jain, R. K., Willer, B., & Leddy, J. J. (2021). Derivation of the Buffalo Concussion Physical Examination risk of delayed recovery (RDR) score to identify children at risk for persistent postconcussive symptoms. British journal of sports medicine, 55(24), 1427–1433. doi.org/10.1136/bjsports-2020-103690

Joyce, A. S., Labella, C. R., Carl, R. L., Lai, J. S., & Zelko, F. A. (2015). The Postconcussion Symptom Scale: utility of a three-factor structure. Medicine and science in sports and exercise, 47(6), 1119–1123. doi.org/10.1249/MSS.0000000000000534

Kaufman, M. W., Su, C. A., Trivedi, N. N., Lee, M. K., Nelson, G. B., Cupp, S. A., & Voos, J. E. (2021). The Current Status of Concussion Assessment Scales: A Critical Analysis Review. JBJS reviews, 9(6), e20.00108. doi.org/10.2106/JBJS.RVW.20.00108

Krause, D. A., Hollman, J. H., Breuer, L. T., & Stuart, M. J. (2022). Validity Indices of the King-Devick Concussion Test in Hockey Players. Clinical journal of sport medicine: official journal of the Canadian Academy of Sport Medicine, 32(3), e313–e315. doi.org/10.1097/JSM.0000000000000938

Langevin, P., Frémont, P., Fait, P., & Roy, J. S. (2022). Responsiveness of the Post-Concussion Symptom Scale to Monitor Clinical Recovery After Concussion or Mild Traumatic Brain Injury. Orthopaedic journal of sports medicine, 10(10), 23259671221127049. doi.org/10.1177/23259671221127049

Preventing and Treating Elbow Pain Caused From Lifting

By

Dr. Alex Jimenez

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Buying Large Flower Pot — Caucasian Men Buying Large Wooden Flower Pot.

Elbow pain from lifting is a common symptom among individuals who lift weights, heavy objects, children, grocery bags, etc. Depending on the underlying cause, can conservative treatments relieve and heal elbow pain?

Preventing and Treating Elbow Pain Caused From Lifting

Table of Contents

Elbow Pain Caused By Lifting

Elbow pain from lifting can result from weight training, repetitive daily tasks, or job duties like lifting small children or heavy objects. Pain can manifest at the sides or the front of the elbow. Most minor injury cases can be treated with ice, rest, and medications at home. However, pain after lifting can also be a sign of a serious injury, such as a tendon rupture/tear.

Minor Pain From Lifting

Lifting puts pressure on the tendons connecting the wrist and upper arm to the bones in the elbow joint. Minor elbow pain can occur from temporary inflammation in any of these structures after lifting an object. Tendonitis occurs when a tendon becomes inflamed, often from overuse or lifting something too heavy, and ranges from mild to severe. Mild tendonitis typically causes pain during the activity and improves with rest. (American Academy of Orthopaedic Surgeons, 2020) Common forms of tendonitis include:

Tennis elbow – tendonitis on the outside of the elbow
Golfer’s elbow – tendonitis on the inside of the elbow.
Biceps tendonitis – at the front of the elbow. (Kheiran A. Pandey, A. & Pandey R. 2021)

Self-Care

Self-care can help reduce elbow pain after lifting and include: (American Academy of Orthopaedic Surgeons, 2020)

Ice

Add ice to the affected area for up to 20 minutes daily to decrease elbow pain.

Rest

Avoid lifting heavy objects as much as possible when pain is present.

Wearing A Brace

If the pain is at the tendons on the inside or outside of your elbow, try wearing a wrist brace to limit the use of your wrist muscles that connect to this area.

Stretching

Gently stretching the wrist flexors and extensors can help reduce elbow pain after lifting. Stretches can be performed several times daily, even after symptoms have resolved. (American Academy of Orthopaedic Surgeons, 2024)

Hold the arm out in front with the palm down. Keep the elbow straight.
Bend the wrist down so that the fingers are pointing toward the ground.
With the other hand, gently pull the wrist further down until a stretch is felt along the back of the forearm.
Hold this position for 15 seconds.
Repeat five times.
Next, bend the wrist upward so the fingers point toward the ceiling.
Using the other hand, gently pull the hand backward until the stretch is felt along the front of the forearm.
Hold for 15 seconds.
Repeat five times.

Medication

Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) can help manage elbow pain caused from lifting and include: (American Academy of Orthopaedic Surgeons, 2023)

Advil/Motrin – ibuprofen
Aleve – naproxen
Bayer – aspirin
Tylenol – acetaminophen

Healing

Mild cases can improve after a few days of self-care, whereas more pronounced elbow symptoms can take several weeks, months, or even a year. (Kheiran A. Pandey, A. & Pandey R. 2021) If self-care doesn’t work, physical therapy may be recommended. A physical therapy team can use various modalities and treatments to help reduce pain and inflammation from elbow injuries. The therapy can include targeted exercises to strengthen weak muscles and stretch tight muscles that might contribute to the condition. In addition, the therapy team will help individuals modify their lifting technique to help prevent further injury.

Moderate to Severe Elbow Pain

In addition to sharp, severe pain, serious elbow pain caused from lifting have distinct symptoms, including: (American Academy of Orthopaedic Surgeons, 2022)

Bruising
Swelling
Elbow weakness that suddenly happens.

A biceps tendon rupture is a rare but serious injury usually caused from lifting. In addition to other visible signs of the injury, there will be a bulge at the top of the upper arm because the muscle bunches up as it is no longer attached to the elbow. (American Academy of Orthopaedic Surgeons, 2022) Individuals may hear an audible popping sound if an elbow ligament or tendon gets torn while lifting. (Johns Hopkins Medicine, 2024)

Treatment

Treatment depends on the severity of the injury, but most cases resolve on their own with rest and, if necessary, physical therapy. Conditions that cause severe pain require orthopedic surgeon expertise. These physicians specialize in treating musculoskeletal system injuries. Imaging such as X-rays, MRIs, or CT scans are often used to determine the extent of damage. Individuals with tendon or ligament tears in the elbow may need surgery to regain full range of motion and strength in their arm. After surgery, physical therapy will help restore function.

Injury Medical Chiropractic and Functional Medicine Clinic

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

Shoulder Pain Chiropractic Treatment

References

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

Kheiran, A., Pandey, A., & Pandey, R. (2021). Common tendinopathies around the elbow; what does current evidence say?. Journal of clinical orthopaedics and trauma, 19, 216–223. doi.org/10.1016/j.jcot.2021.05.021

American Academy of Orthopaedic Surgeons. (2024). Therapeutic exercise program for epicondylitis (tennis elbow/golfer’s elbow). orthoinfo.aaos.org/globalassets/pdfs/2024-therapeutic-exercise-program-for-lateral-and-medial-epicondylitis.pdf

American Academy of Orthopaedic Surgeons. (2023). What are NSAIDs? orthoinfo.aaos.org/en/treatment/what-are-nsaids/

American Academy of Orthopaedic Surgeons. (2022). Biceps tendon tear at the elbow. orthoinfo.aaos.org/en/diseases–conditions/biceps-tendon-tear-at-the-elbow

Johns Hopkins Medicine. (2024). Ulnar collateral ligament. www.hopkinsmedicine.org/health/conditions-and-diseases/ulnar-collateral-ligament-ucl-injuries-of-the-elbow

Preventing Dehydration During Pregnancy: Importance and Tips

By

Dr. Alex Jimenez

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Health during pregnancy, Pregnant woman drinking water sitting on sofa

For pregnant individuals, dehydration during pregnancy increases the risk of health problems for the individual and the fetus. Is it possible to prevent dehydration by drinking more water and managing morning sickness?

Table of Contents

Pregnancy Dehydration

Maintaining proper hydration is an important part of a healthy pregnancy. Dehydration during pregnancy can occur for several reasons. A pregnant body needs more water to support the increased physical demands. Pregnant individuals need more water than non-pregnant ones and risk losing more water throughout the day. (American College of Obstetricians and Gynecologists, 2023) Pregnant individuals need eight to 12 glasses of water daily to prevent dehydration. Risks of dehydration during pregnancy include:

Low amniotic fluid levels and preterm contractions.
Early symptoms can include decreased urination, increased thirst, and dry mouth.
Serious symptoms can include dizziness, confusion, fainting, and low blood pressure.
In severe cases, intravenous/IV intervention may be required to replenish fluids.

Maintaining hydration can help the body meet increased pregnancy needs. (Mulyani E. Y. et al., 2021)

Causes

The body’s physiological changes during pregnancy cause it to require more water. Pregnant individuals need more water and lose more water throughout the day. Dehydration happens when the body loses more water than it takes in. Factors that contribute to dehydration during pregnancy include: (Song, Y. et al., 2023)

Increased Blood Volume

A pregnant body requires increased blood circulation.
Blood volume increases as much as 30% to 45%.
The body needs more water to keep up with the increased volume.

Changes In The Urinary System

The kidneys often increase slightly in size during pregnancy.
This causes changes in the urinary system, causing the body to lose more water.

Changes In The Respiratory System

The increased demands on the body cause increased breathing.
Each time the body exhales, it loses water through the breath.

Increased Metabolism

Pregnancy causes the adrenal and thyroid functions to become slightly hyperactive.
This leads to increased metabolism and sweating.
When the body loses water through sweat, dehydration risks increase.

Increased Nutrition

A pregnant individual requires 300 extra daily calories, which increases to 450 additional daily calories in late pregnancy.
Eating more means the individual needs added hydration to support digestion and prevent constipation.

Morning Sickness

Nausea and vomiting are common.
Morning sickness causes fluid loss, increasing the risk of dehydration.
Individuals who are nauseated throughout the day also may have trouble drinking the proper amount of water. (American College of Obstetricians and Gynecologists, 2023)

Symptoms

Becoming mildly dehydrated during pregnancy is common, and early symptoms may include: (National Library of Medicine, 2023)

Increased thirst
Dry mouth
Chapped lips
Headaches
Dark yellow urine
Decreased urination
Constipation

If the body does not acquire enough water when mildly dehydrated further symptoms can present and include fatigue, dizziness, feeling overheated, and having Braxton Hicks contractions or tightening and release of the uterus that are not from labor contractions. (Mulyani E. Y. et al., 2021)

Emergency Symptoms

Severe dehydration can lead to serious pregnancy complications and require immediate medical care. Emergency signs and symptoms include: (National Library of Medicine, 2023)

Irritability
Confusion
Sunken eyes
Fainting
Low or no urine
Low blood pressure
Rapid heart and breathing rate
Shock

Risks

Staying hydrated is essential, and hydration status affects health and pregnancy outcomes. When pregnant, the body needs extra water to produce enough amniotic fluid, which fills the amniotic sac with the fetus. When amniotic levels are low, the fetus has little room to grow and move. This can lead to delayed growth and development and potential umbilical cord issues. If the umbilical cord becomes compressed, the baby cannot receive oxygen and nutrients, which can quickly lead to an emergency. (Song, Y. et al., 2023) Chronic, untreated dehydration during pregnancy increases the risk of complications and can include (Aziz M. M. et al., 2018) (Song Y. et al., 2023)

Preterm contractions
Decreased birth weight and length
Reduced head circumference and chest circumference
Neural tube defects – malformations in early development of the brain and spine.
Low milk production

Rehydrating and Adding Electrolytes

Individuals must drink eight to 12 glasses of water daily to prevent dehydration (American College of Obstetricians and Gynecologists, 2020). Rehydration with water and electrolytes, essential minerals the body needs for normal function, may also be recommended. Ask a healthcare provider if they recommend consuming electrolytes through sports drinks, Pedialyte, coconut water, or electrolyte powders.

Prevention

Dehydration prevention can be done through (American College of Obstetricians and Gynecologists, 2020)

Drinking 12 glasses of water per day.
Drink between meals if drinking water is difficult because of nausea or feeling full.
Always have a water bottle, and drink what is possible when nausea is not manifesting.
Other recommended sources can include milk, natural fruit juices, and broth.
To reduce water loss, avoid high-caffeine or sugar drinks.
Take frequent breaks and drink more water when in the heat.

Minor Dehydration Treatment

Most pregnant individuals can safely treat mild dehydration at home. Call a healthcare provider if there are any concerns about symptoms. To treat minor dehydration, rest in a cool area and replenish fluids. Drink water, a sports drink, or a rehydration solution like Pedialyte. If symptoms do not improve, contact a healthcare provider. (Song Y. et al., 2023)

Injury Medical Chiropractic and Functional Medicine Clinic

Fortunately, treating and preventing dehydration is possible by drinking plenty of water throughout the day, avoiding drinks with caffeine or sugar, and taking frequent breaks. 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 associated medical professionals to integrate a treatment plan to improve the body’s flexibility and mobility and resolve musculoskeletal issues.

Pregnancy and Sciatica: How Chiropractic Can Help

References

American College of Obstetricians and Gynecologists. (2023). Nutrition during pregnancy. www.acog.org/womens-health/faqs/nutrition-during-pregnancy

Mulyani, E. Y., Hardinsyah, Briawan, D., Santoso, B. I., & Jus’at, I. (2021). Effect of dehydration during pregnancy on birth weight and length in West Jakarta. Journal of nutritional science, 10, e70. doi.org/10.1017/jns.2021.59

Song, Y., Zhang, F., Lin, G., Wang, X., He, L., Li, Y., Zhai, Y., Zhang, N., & Ma, G. (2023). A Study of the Fluid Intake, Hydration Status, and Health Effects among Pregnant Women in Their Second Trimester in China: A Cross-Sectional Study. Nutrients, 15(7), 1739. doi.org/10.3390/nu15071739

American College of Obstetricians and Gynecologists. (2023). Morning sickness: nausea and vomiting. www.acog.org/womens-health/faqs/morning-sickness-nausea-and-vomiting-of-pregnancy

National Library of Medicine. MedlinePlus. (2023). Dehydration. Retrieved from medlineplus.gov/dehydration.html

Aziz, M. M., Kulkarni, A., Tunde-Agbede, O., Benito, C. W., & Oyelese, Y. (2018). Are Women With Threatened Preterm Labor More Dehydrated Than Women Without It? Journal of obstetric, gynecologic, and neonatal nursing: JOGNN, 47(5), 602–607. doi.org/10.1016/j.jogn.2018.05.006

American College of Obstetricians and Gynecologists. (2020). How much water should I drink during pregnancy? www.acog.org/womens-health/experts-and-stories/ask-acog/how-much-water-should-i-drink-during-pregnancy

Unlocking the Beneficial Properties of HIIT Workouts

By

Dr. Alex Jimenez

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For individuals that are trying to change up their daily routine, can incorporating the beneficial properties of a HIIT workout reduce pain?

Table of Contents

Introduction

When it comes to a person’s health and wellness, they need to exercise for at least 30 minutes. However, many individuals have hectic lifestyles, which correlates to a lack of time to work out, leading to various health conditions that can develop over time and lead to pain and discomfort. Around the world, many adults should get 150 to 300 minutes of exercise to reduce pain in their body system. This can include doing chores, exercising at home, or going to the gym. But people who want to get in a quick workout within their busy schedules can opt for a HIIT workout or high-intensity interval training. In today’s article, we will look at what HIIT is, its beneficial effects on the body, and how important it is to incorporate a HIIT workout as part of a daily routine. We talk with certified associated medical providers who inform our patients to include a HIIT workout in their daily routine. While asking their associated medical provider intricate questions, we advise patients to formulate a customized treatment plan to help with chronic pain affecting their bodies through various exercise routines. Dr. Alex Jimenez, D.C., includes this information as an academic service. Disclaimer.

What is HIIT?

Do you experience any weight changes that cause difficulty maintaining your ideal weight? How often do you feel stressed and tired after a hectic day that you don’t have time for yourself? Or do you feel unusual aches and pains in your body that make you feel fatigued throughout the day? When it comes to individuals making small changes in their health and well-being, try to work out with the minimum time they have but also achieve the benefits of a full workout, can try HIIT. HIIT, or high-intensity interval training, is defined by exercise activities that target 80% of the individual’s max heart rate with alternative explosive bursts of full-throttle efforts with rest periods. (Coates et al., 2023)

Additionally, a HIIT workout usually involves cardio and resistance training as part of its sub-categories. This is generally incorporated into gyms and fitness centers and still requires both a warm-up, recovery intervals, and cool-down to ensure that the body is getting the full beneficial properties and effects from a HIIT workout. This is because a HIIT workout involves an active, high-intensity training session that is less than 15 minutes long and helps improve cardiometabolic health and cardiovascular endurance. (Atakan et al., 2021)

Optimize Your Wellness- Video

Optimizing Your Wellness | El Paso, Tx (2023)

The Beneficial Properties of HIIT

Since HIIT has beneficial properties, many individuals experiencing low back pain from stress, excessive sitting or standing, or lifting heavy objects can utilize HIIT workouts as part of their exercise routine. HIIT workouts for lower back pain can help through general resistance and core strength training, which helps improve muscle strength and decrease the pain and deconditioning of the trunk muscles. (Verbrugghe et al., 2020) The other beneficial properties of HIIT are that it can help improve a person’s cardiorespiratory system or stamina. This helps maintain healthy endurance levels and causes them to increase the length or intensity of a HIIT workout while enjoying the health benefits it can provide. (Martin-Smith et al., 2020)

Incorporating HIIT As Part of A Routine

Additionally, anyone who wants to do a HIIT workout routine can do it since it is perfect for a quick workout in a short amount of time. Individuals with busy schedules can complete a workout with alternating bursts of exercises and rest periods that can build up a person’s endurance. With a HIIT workout, many individuals will begin to notice that they have more energy throughout the day and start making changes to improve their lives.

References

Atakan, M. M., Li, Y., Kosar, S. N., Turnagol, H. H., & Yan, X. (2021). Evidence-Based Effects of High-Intensity Interval Training on Exercise Capacity and Health: A Review with Historical Perspective. Int J Environ Res Public Health, 18(13). doi.org/10.3390/ijerph18137201

Coates, A. M., Joyner, M. J., Little, J. P., Jones, A. M., & Gibala, M. J. (2023). A Perspective on High-Intensity Interval Training for Performance and Health. Sports Med, 53(Suppl 1), 85-96. doi.org/10.1007/s40279-023-01938-6

Gjellesvik, T. I., Becker, F., Tjonna, A. E., Indredavik, B., Lundgaard, E., Solbakken, H., Brurok, B., Torhaug, T., Lydersen, S., & Askim, T. (2021). Effects of High-Intensity Interval Training After Stroke (The HIIT Stroke Study) on Physical and Cognitive Function: A Multicenter Randomized Controlled Trial. Archives of Physical Medicine and Rehabilitation, 102(9), 1683-1691. doi.org/10.1016/j.apmr.2021.05.008

Guimaraes, G. V., Ciolac, E. G., Carvalho, V. O., D’Avila, V. M., Bortolotto, L. A., & Bocchi, E. A. (2010). Effects of continuous vs. interval exercise training on blood pressure and arterial stiffness in treated hypertension. Hypertens Res, 33(6), 627-632. doi.org/10.1038/hr.2010.42

Martin-Smith, R., Cox, A., Buchan, D. S., Baker, J. S., Grace, F., & Sculthorpe, N. (2020). High Intensity Interval Training (HIIT) Improves Cardiorespiratory Fitness (CRF) in Healthy, Overweight and Obese Adolescents: A Systematic Review and Meta-Analysis of Controlled Studies. Int J Environ Res Public Health, 17(8). doi.org/10.3390/ijerph17082955

Verbrugghe, J., Agten, A., Stevens, S., Hansen, D., Demoulin, C., Eijnde, B. O., Vandenabeele, F., & Timmermans, A. (2020). High Intensity Training to Treat Chronic Nonspecific Low Back Pain: Effectiveness of Various Exercise Modes. J Clin Med, 9(8). doi.org/10.3390/jcm9082401

Disclaimer

What to Know About Possible Side Effects of Pain Meds

By

Dr. Alex Jimenez

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doctor in glasses looking at woman while sitting near table

For individuals who may need to take pain medications to manage an injury or condition, can knowing the potential side effects help in treatment?

Table of Contents

Medications For Pain Side Effects

Over-the-counter and prescription pain medications can help relieve physical discomfort and distress but can also cause side effects. Patients may not manifest side effects when using certain meds or experience mild, limited, severe, or intolerable effects. Pain medication side effects can include:

Allergic reactions
Upset stomach
Bruising
Dizziness

However, medication side effects don’t affect everyone in the same way.

Pain Relief

The patient and their healthcare provider can decide whether they risk developing side effects and which effects they are more predisposed to. Individuals may be susceptible to side effects from certain medications but are likely to tolerate others. For example, individuals with a history of ulcers may be recommended to avoid anti-inflammatories. For those who have trouble sleeping, it is recommended to avoid pain meds that are known to interfere with sleep.

Reading Labels and Asking Questions

When taking over-the-counter medications, read the label for side effects, then weigh the possible risks against the medicine’s benefits for pain relief. Ask a pharmacist or healthcare provider about anything that is not understood. Some side effects are medical emergencies, such as allergic reactions. Recognizing the signs of an allergic reaction and being prepared to call for emergency help if symptoms present. (American Academy of Allergy, Asthma & Immunology, 2024) These can include:

Itching
Hives
Rash
Mouth or facial swelling
Shortness of breath

If a healthcare provider prescribes medication, discuss the anticipated risks and benefits. The prescription will come with a label that lists the side effects associated with the drug.

Opioid Risks

Opioids are powerful prescription meds, usually used for severe, short-term use, like post-surgery pain or after a severe traumatic injury. Some effects of opioids include: (Plein L. M. and Rittner H. L. 2018) Common side effects include sedation, constipation, and nausea. Chronic use can lead to depression and/or sexual dysfunction. With narcotics, there is the risk of addiction that can change an individual’s life, as addiction can be difficult to overcome. One of the reasons the CDC published a guideline on opioid prescriptions was because of the number of overdoses and deaths.

The CDC recommends that practitioners not prescribe opioids as a first-line treatment for chronic back pain.
The CDC recommends that healthcare providers initially treat patients with chronic back or neck pain using non-pharmacological therapies or medications other than opioids.
Opioids should only be used if the expected benefits for pain and function are anticipated to outweigh the risks to the patient.

With more than half of regular opioid users experiencing back pain, they aren’t proven to help return individuals to work or normal life faster, nor did they improve functioning when used for the treatment of an acute episode. (Deyo R. A. Von Korff M. and Duhrkoop D. 2015) The effectiveness of opioids is about 30% for short-term relief and did not improve physical functioning.

Examples and Comparisons

Examples of common medications used to treat back pain.

Advil

Active Ingredient – Ibuprofen
Drug Class – NSAID
Over-the-counter or Prescribed – Available over-the-counter
Side Effects – GI-related symptoms and Reye’s Syndrome in children

Aleve and Other Generic Brands

Active Ingredient – Naproxen
Drug Class – NSAID
Over-the-counter or Prescribed – Available as both depending on strength.
Side Effects – GI-related symptoms, headaches

Tylenol and Other Generic Brands

Active Ingredient – Acetaminophen
Drug Class Analgesic – pain reliever
Over-the-counter or Prescribed – Available as both and can be prescribed with codeine.
Side Effects – Potential liver damage

Lyrica

Active Ingredient – Pregabalin
Drug Class – Anticonvulsant
Over-the-counter or Prescribed – Prescribed FDA-approved for shingles pain and neuropathy in diabetes. Other uses off-label.
Side Effects – Dizziness, drowsiness, swelling, weight gain.

Neurontin

Active Ingredient – Gabapentin
Drug Class – Anticonvulsant
Over-the-counter or Prescribed – Prescribed FDA-approved for shingles pain
Side Effects – Dizziness, drowsiness, allergic reaction, withdrawal, and seizures.

Injury Medical Chiropractic and Functional Medicine Clinic

Chiropractic therapy is among the more conservative treatment options and may be tried first. 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.

Chronic Body Pain Recovery

References

American Academy of Allergy, Asthma & Immunology. (2024). Anaphylaxis Symptoms & Diagnosis. www.aaaai.org/conditions-treatments/allergies/anaphylaxis

Plein, L. M., & Rittner, H. L. (2018). Opioids and the immune system – friend or foe. British journal of pharmacology, 175(14), 2717–2725. doi.org/10.1111/bph.13750

Deyo, R. A., Von Korff, M., & Duhrkoop, D. (2015). Opioids for low back pain. BMJ (Clinical research ed.), 350, g6380. doi.org/10.1136/bmj.g6380

Dealing with Low Back Leg Pain: Causes and Treatments

By

Dr. Alex Jimenez

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Female African American deliverer having lover back pain while loading packages in a van. — Black female courier experiencing pain in lower back while unloading packages from a mini van.

Lower back leg pain depends on specific symptoms and their duration. Can having a better idea of symptoms help individuals inform their medical providers to develop an effective treatment plan?

Table of Contents

Low Back Leg Pain

Lower back leg pain, sciatica, and weakness of the lower-extremity muscles are often diagnosed as a herniated (compressed or ruptured) disc. Nerves surrounding the spine are sensitive to irritation and pressure caused by a disc shifting out of position or physical damage to the disc and surrounding area, ranging from mild to severe. This is why it is important to be evaluated by a healthcare provider. Treatment depends on the type of spinal disc herniation and the severity, but getting an early medical evaluation helps ensure optimal outcomes. Non-surgical conservative treatments are often effective, but some cases may require more aggressive treatment, especially if the pain persists.

Spine and Nerves

Spinal discs are the shock absorbers between vertebrae. They consist of a tough outer layer, annulus fibrosis, covering a soft gel core, nucleus pulposus. When a disc is damaged, it can bulge and irritate surrounding nerves. In more severe cases, the annulus fibrosis can weaken and tear, allowing the material to leak and compress the spinal cord or nerves. As the nerves are not functioning properly, abnormal signals may be sent to and from the brain. The most common lower back herniations occur in the lumbar region, where five vertebrae near the base of the spine are classified from top to bottom as L1 through L5. (Dydyk A.M. et al., 2023) Pain resulting from an injury to this part of the spine can be debilitating because it may involve sciatic nerve irritation. Herniated disc causes are generally a combination of age-related degeneration, being overweight/obese, trauma, a sedentary lifestyle, and overloading of the spine. (Cleveland Clinic, 2021)

Symptoms

The most common symptoms include:

Back Pain

Caused by nerve irritation, muscle spasms, and inflammation.

Radiculopathy

Abnormal signaling of the nerves.

Electrical Shooting Pain

Nerve pressure can cause abnormal sensations, commonly experienced as electric shooting pains.
For low back herniations, the shocks go down one or both legs.

Tingling – Numbness

There are often abnormal sensations such as tingling, numbness, or pins and needles down one or both legs.

Muscle Weakness

Nerve signals may be interrupted, causing lower-body muscle weakness. (Dydyk A.M. et al., 2023)

Bowel – Bladder Symptoms

These symptoms may signal cauda equina syndrome, a rare condition resulting from a herniated disc between the L5 vertebrae and the first vertebrae of the sacrum.

Diagnosis

Diagnosing a herniated disc as the cause of low back leg pain involves testing sensation, muscle strength, and reflexes. MRI also aids this process (American Association of Neurological Surgeons, 2024). MRIs can often show herniated discs and other abnormalities, especially in older patients.

Treatment

A herniated disc treatment plan is based on patient symptoms, physical examination findings, and imaging results. Most herniated disc symptoms resolve themselves in four to six weeks. Lower back pain is generally treated conservatively through:

Topical pain ointments or creams for muscle spasms.
Non-surgical decompression relieves pressure, activates healing, and restores circulation and nutrients.
Chiropractic adjustments realign the spine and musculoskeletal system.
Massage loosens the muscles and maintains their relaxation.
NSAIDs to reduce inflammation. (Cleveland Clinic, 2021)
Total rest is never recommended, even if movement is challenging,
Exercise and stretching help avoid muscle degeneration and strengthen the muscles.
Relaxation techniques and other natural pain therapies can help manage symptoms and restore overall health.
Pain-blocking injections which can include anesthetics or corticosteroids at the source (Cleveland Clinic, 2021)
Surgery is recommended only when conservative treatments are ineffective after six weeks, if there is significant muscle weakness from nerve damage, or if motor functions are compromised. (American Association of Neurological Surgeons, 2024)

Injury Medical Chiropractic and Functional Medicine Clinic

Chiropractic therapy is among the more conservative treatment options and may be tried first before proceeding with surgery. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other associated medical professionals to integrate a treatment plan to improve the body’s flexibility and mobility and resolve musculoskeletal issues.

Disc Herniation

References

Dydyk AM, Ngnitewe Massa R, Mesfin FB. Disc Herniation. [Updated 2023 Jan 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: www.ncbi.nlm.nih.gov/books/NBK441822/

Cleveland Clinic. (2021). Herniated disc. my.clevelandclinic.org/health/diseases/12768-herniated-disk

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

Colles’ Fracture: Diagnosis and Treatment Options

By

Dr. Alex Jimenez

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Close up of female physical therapist working with senior man

Can physical therapies help individuals with a Colles’ or wrist fracture?

Table of Contents

Colles’ Fracture

A broken wrist or Colles fracture can be a painful and stressful experience. Individuals may be unable to perform their jobs or engage in recreational activities. A Colles fracture is a break in the radius bone of the forearm that occurs near the wrist, usually about an inch from the end of the bone. It’s a common type of broken wrist often caused by falling on an outstretched hand. (American Academy of Orthopaedic Surgeons, 2022) As the individual lands on their hand, the end of the radius bone breaks off and gets pushed toward the inner wrist. If the wrist is flexed when falling on the hand, the radius may break and move toward the front of the wrist. This is called a Smith’s fracture. (Matsuura, Y. et al., 2017) A physical therapy team can help improve functional mobility to quickly and safely return to normal activity.

Symptoms

Individuals who have suffered trauma to their wrist or have fallen onto their hand or wrist may have a Colles fracture. Common signs and symptoms of a wrist or Colles fracture include: (American Academy of Orthopaedic Surgeons, 2022)

Bruising
Loss of mobility in the wrist.
Swelling in the arm, wrist, or hand.
Pain
Visible deformity or a lump on the backside of the forearm near the wrist.

Initial Treatment

Individuals who have fallen and injured their wrist and hand and suspect a Colles fracture seek immediate medical attention. Call a healthcare provider or report to a local emergency clinic. Left untreated, it can result in complications and permanent loss of arm and hand function. (American Academy of Orthopaedic Surgeons, 2022)

An X-ray will show a wrist fracture.

Because of the pain and swelling, it is recommended that individuals put an ice pack on their wrists and hands until they can get to a healthcare provider or emergency room. The R.I.C.E. principle can help control swelling and lessen pain until a medical professional can provide treatment. The initial treatment is to reduce the fracture. This is where a healthcare provider situates the broken bone or bones back into the correct position to ensure proper healing. This is done manually if the fractured bone is not too far out. If the fracture is severe, a surgical procedure known as an open reduction internal fixation or ORIF may be required to reduce the fracture. (American Academy of Orthopaedic Surgeons, 2022)

Once the fracture has been reduced, it must be immobilized. This is done with a cast or a brace. Individuals may also be required to wear a sling. They may need to visit a physical therapist to learn how to wear the sling properly. It is essential to keep the bones immobilized for proper healing. Consult a healthcare provider for questions about cast, sling, or brace.

Physical Therapy

After four to six weeks of immobilization, a healthcare provider may remove the cast and refer a physical therapist or team. (American Academy of Orthopaedic Surgeons, 2022) A physical therapist may measure and evaluate pain, swelling, range of motion, and strengthening. The physical therapist may assess the surgical scar tissue and analyze the hand, wrist, and arm function of individuals who underwent an ORIF procedure to reduce the fracture. After the initial evaluation, a physical therapist will work with the patient to develop an appropriate plan of care to help improve the impairments and functional limitations. The therapist may prescribe a specific exercise program as well.

Pain and Swelling

Individuals may experience pain and swelling around their wrists and hands.
A physical therapist can provide individuals with various treatments and modalities to help decrease swelling and pain.

Range of Motion

After a Colles’ fracture, individuals may lose hand, wrist, and elbow mobility.
The shoulder may also be tight, especially after wearing a sling.
Range of motion exercises for the hand, wrist, and elbow can be prescribed.

Strength

Loss of strength is common after a Colles’ fracture.
Exercises focusing on hand, wrist, and elbow strength may be prescribed.
At-home exercises and stretches will get the best results from physical therapy.

Scar Tissue

Individuals who have had an ORIF procedure will likely have scar tissue that has developed around the surgical site.
A physical therapist may perform scar tissue massage and mobilization to help improve mobility and can train patients how to self-massage.

Injury Medical Chiropractic and Functional Medicine Clinic

After a few weeks of physical therapy, individuals should notice their mobility and strength improve while pain and swelling decrease. Individuals will find it easier to use their arms and hands to perform functional activities. While the fracture should be fully healed six to eight weeks after injury, individuals may still be limited for potentially 12 to 16 weeks. At Injury Medical Chiropractic and Functional Medicine Clinic, we focus on what works for every patient to restore function. If other treatment is needed, individuals will be referred to a clinic or physician best suited to their injury, condition, or ailment.

Personal Injury Rehabilitation

References

American Academy of Orthopaedic Surgeons. (2022). Distal radius fractures (broken wrist). orthoinfo.aaos.org/en/diseases–conditions/distal-radius-fractures-broken-wrist/

Matsuura, Y., Rokkaku, T., Kuniyoshi, K., Takahashi, K., Suzuki, T., Kanazuka, A., Akasaka, T., Hirosawa, N., Iwase, M., Yamazaki, A., Orita, S., & Ohtori, S. (2017). Smith’s fracture generally occurs after falling on the palm of the hand. Journal of orthopaedic research : official publication of the Orthopaedic Research Society, 35(11), 2435–2441. doi.org/10.1002/jor.23556

Experience the Beneficial Results of a Ketogenic Diet – Improve Your Health and Fitness

By

Dr. Alex Jimenez

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Can individuals dealing with pain and inflammation in their bodies can incorporate a ketogenic diet and have beneficial results?

Table of Contents

Introduction

When it comes to a person’s health and wellness journey, many people often wonder where to start making changes in their bodies. Many people begin exercising not only to reduce stress levels in the musculoskeletal system but also to help clear their minds. This is a great cause, as any form of physical activity can help reduce muscle fatigue and weakness and strengthen the extremities and quadrants in the musculoskeletal system. However, even though exercising is part of the health and wellness journey, another component plays a crucial part in the health and wellness journey: eating nutritional foods and dieting. Now, dieting can be scary for some newcomers who are just entering their health and wellness journey, but when people start making small changes to their eating habits, like incorporating more vegetables and fruits in their meals, making more meals at home, and doing portion control to eat enough till they are full can provide beneficial results. These small changes can empower individuals to take control of their health and wellness journey. Dieting and changing eating habits can give useful results for people dealing with chronic issues correlated with environmental factors. In today’s article, we will look at a particular diet known as the ketogenic diet, its beneficial properties, and how to incorporate it to reduce chronic conditions affecting the body. We talk with certified associated medical providers who provide our patients’ information to assess how incorporating the ketogenic diet can help reduce chronic conditions. We also inform patients while asking their associated medical provider intricate questions to formulate customized treatment plans to help with chronic conditions by incorporating the ketogenic diet along with physical activities. Dr. Alex Jimenez, D.C., includes this information as an academic service. Disclaimer.

What Is the Ketogenic Diet?

Do you often feel extremely thirsty throughout the day, and do you chug at least a couple of gallons of water daily? Do you feel heat or see redness in various locations around your body that seem tender when touched? Or do your joints become stiff in the mornings when you wake up and feel better throughout the entire day? Often, people have a love-hate relationship with food. However, it all depends on what the person is eating and what environmental factors correlate with their food. So, when a person has chronic conditions that cause pain and inflammation in their joints, muscles, and organs, the negative side effects are that the food they consume can induce the inflammatory effects. In contrast, the positive impact of food can help individuals dampen the pain and inflammation in the body. (Fifi & Holton, 2020) Many individuals dealing with inflammation and pain in their bodies can incorporate a ketogenic diet to reduce the inflammatory effects.

Now, what is the ketogenic diet? The ketogenic diet is where carbohydrates are low, and various levels of lean proteins and healthy fats induce ketosis. (McGaugh & Barthel, 2022) This, in turn, helps with alternating the metabolic pathways to induce weight loss, improve health conditions like lipid profile improvements, and reduce hyperglycemia. When environmental factors like obesity, sedentary lifestyles, or physical inactivity can cause chronic issues like lipedema, the body will cause overlapping risk profiles to induce inflammation. When the body is dealing with lipedema, it can cause the body to be in a constant inflammatory state that induces cell damage and cell death through apoptosis. Hence, when a person is going to do a ketogenic diet, it can help reduce the inflammatory effects while alleviating pain symptoms. (Verde et al., 2023)

Eating Right To Feel Better-Video

The Beneficial Properties Of A Ketogenic Diet

One of the beneficial properties that a person can take with a ketogenic diet is that it can help reduce cardiovascular diseases with its anti-inflammatory properties. Since a ketogenic diet helps place the body in a state of nutritional ketosis, incorporating omega-3 fatty acids can help the body exert systemic anti-inflammatory effects and begin healing. (Dynka et al., 2023) At the same time, the ketogenic diet can help individuals who are suffering from chronic conditions like epilepsy, diabetes, or obesity to not only induce weight loss but also help improve body composition. (Sjodin et al., 2020) This is because when individuals get a customized treatment plan incorporating the ketogenic diet, it must include physical activities that help strengthen muscles in the body’s quadrants. In contrast, the ketogenic diet helps slow down muscle glycogen depletion. Additionally, the ketogenic diet is beneficial by:

Reducing glucose levels so individuals with diabetes don’t need insulin.
Restrict carbohydrate intake
Moderate protein consumption
Increasing fat consumption for calories (Dowis & Banga, 2021)

Ketogenic Diet Reducing Chronic Conditions

When it comes to the ketogenic diet, many individuals have dealt with chronic conditions like epilepsy, diabetes, or cardiovascular conditions. Understand that incorporating a healthy diet filled with healthy fats, lean protein, plenty of fruits and vegetables, and physical activity can benefit many individuals in the long run. The ketogenic diet can help the liver by producing more ketone bodies to help with the production of ATPs and reduce ROS (reactive oxygen species); this, in turn, helps improve a person’s quality of life. (Abboud et al., 2021) Informing individuals who are dealing with chronic conditions that they must make small changes to their routines. This can be incorporated into their customized treatment plan and help reduce the pain-like effects from the person’s chronic conditions correlating to the inflammatory effects. The ketogenic diet can be a stepping stone to a person’s health and wellness and help them be motivated to see positive results.

References

Abboud, M., AlAnouti, F., Georgaki, E., & Papandreou, D. (2021). Effect of Ketogenic Diet on Quality of Life in Adults with Chronic Disease: A Systematic Review of Randomized Controlled Trials. Nutrients, 13(12). doi.org/10.3390/nu13124463

Dowis, K., & Banga, S. (2021). The Potential Health Benefits of the Ketogenic Diet: A Narrative Review. Nutrients, 13(5), 1654. doi.org/10.3390/nu13051654

Dynka, D., Kowalcze, K., Charuta, A., & Paziewska, A. (2023). The Ketogenic Diet and Cardiovascular Diseases. Nutrients, 15(15). doi.org/10.3390/nu15153368

Fifi, A. C., & Holton, K. F. (2020). Food in Chronic Pain: Friend or Foe? Nutrients, 12(8). doi.org/10.3390/nu12082473

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Cervical Arthritis: Exploring Treatment Options

By

Dr. Alex Jimenez

-

a rehabilitator massages the neck of an elderly woman

For individuals with cervical arthritis, can physical therapies help manage symptoms and bring pain relief?

Cervical Arthritis

Cervical spondylosis, more commonly known as cervical arthritis or arthritis of the neck, refers to the wearing down of neck bones, discs, tendons, ligaments, and joints. The primary symptoms are neck pain and stiffness. However, it is also possible to have cervical spondylosis and not have any symptoms. The condition affects over 85% of individuals over age 65. (American Academy of Orthopaedic Surgeons, 2021) Treatment can consist of conservative therapies and includes physical therapies, alternative medicine therapies, at-home self care, and over-the-counter and prescription medications. Severe cases of cervical spondylosis are treated with surgery to repair damaged parts of the spine.

Symptoms

Neck pain and headaches at the back of the head are usually the first symptoms. (Kazeminasab S. et al., 2022) The neck can also feel stiff, with worse morning symptoms that improve throughout the day. (Johns Hopkins Medicine, 2024) Symptoms can range from mild discomfort to severe pain. As cervical spondylosis progresses, individuals can experience:

Inability to turn the head or bend the neck.
A clicking or grinding noise when turning the neck.
Tenderness with pressure on the neck.
Pain that radiates to the shoulders or shoulder blades.
Pain and symptoms that disrupt sleep, sometimes causing waking up throughout the night.
Symptoms that decrease with rest.

More severe symptoms include:

Cervical Bone Spurs – Osteophytes

Some with cervical spondylosis have bony growths that can place pressure on the spinal nerves (a pinched nerve) (Bon Secours, 2024). Compression of spinal nerve roots produces cervical radiculopathy, which leads to pain, tingling, and weakness that radiates into the shoulders, arms, and hands.

Cervical Myelopathy

This refers to spinal impingement that leads to spinal cord dysfunction. (Spinal cord dysfunction is a nervous system disorder with interruptions in the spinal cord’s motor, sensory, and autonomic functions.) Symptoms include pain, tingling, numbness, muscle spasms, and weakness in areas below the neck. Spinal cord dysfunction can affect mobility, hand use, and bladder or bowel function control.

Causes

Where degenerative changes are commonly associated with cervical spondylosis, other conditions, and factors can lead to it and include:

Autoimmune Diseases

Rheumatoid arthritis and psoriatic arthritis can cause chronic inflammation in the cervical spine.

Trauma

Neck trauma, including injury and repetitive stress on the neck.
Cervical spondylosis is commonly seen in occupations that involve neck-stressing activities, such as sports.

Age

Wearing down of the spinal discs cartilage between the vertebrae.
Developing cervical spondylosis increases with age, especially after 40. (Kazeminasab S. et al., 2022)

Genetics

Genetic components have been identified in connection with cervical spondylosis, meaning that some types of arthritis that lead to spinal damage are hereditary. (Kazeminasab S. et al., 2022)

Treatment

Treatment begins conservatively, using protocols to preserve function and avoid surgery. Nonsurgical treatments include medications, physical therapy, at-home exercises, and alternative medicine. The treatment method a healthcare provider chooses will depend on how severe the spondylosis is and other factors like age, how much pain is being experienced, the cause, and overall health. The main objectives are to relieve pain, prevent long-term damage to the spinal cord and nerves, and help maintain performing daily activities. (Bon Secours, 2024)

Medications

Medicines used to treat cervical spondylosis include:

Nonsteroidal Anti-inflammatory Drugs NSAIDs

NSAIDs, including ibuprofen and naproxen sodium, are available without a prescription to relieve pain and inflammation.
A healthcare provider can prescribe a more powerful NSAID to help manage severe symptoms.

Corticosteroids

A corticosteroid injection or a short course of an oral corticosteroid, like prednisone, can ease pain and reduce inflammation.

Muscle Relaxants

If cervical spondylosis causes muscle spasms, a healthcare provider can prescribe cyclobenzaprine, a muscle relaxant, to manage symptoms.

Antidepressants

Some types of antidepressants can ease neck pain from cervical spondylosis.

Anti-seizure Meds

Some anti-seizure drugs can cause nerve pain resulting from damaged nerves.

Physical Therapies

Physical therapy will help manage pain and stiffness and keep muscles loose and relaxed.
A physical therapist will teach the patient exercises to stretch and strengthen neck and shoulder muscles.

At-Home Self Care

At-home exercises can help relieve pain, stiffness, and swelling. Some can include:

Reducing inflammation and stress on the neck through posture training.
At-home targeted stretches and exercises will help bring pain relief.
Ice treatment reduces swelling.
Heat will increase circulation.
A neck brace may be recommended briefly to avoid muscle weakness and stiffness.

Alternative Medicine

Chiropractic adjustments and massage therapy are alternative treatments that will help manage cervical spondylosis.
Chiropractic adjustments can relieve neck pain and stiffness. (American Chiropractic Association, 2024)
X-rays are done before to ensure it is safe. (Jenkins H. J. et al., 2018)
Acupuncture can also be beneficial in reducing neck pain and increasing energy circulation. (Gu C. L. et al., 2019)
Various therapeutic massage therapies will help relieve neck pain and stiffness. Talk to a healthcare provider before starting treatment so they can advise on whether neck massages are safe.

Surgery

A healthcare provider may recommend surgical treatment when all other treatments have failed, if neurological symptoms are severe, or if neck arthritis causes extreme pain or disability. Surgery to treat cervical spondylosis can involve removing bone spurs, part of the cervical vertebra, or a herniated disc. The removed portions of the cervical spine are fused with hardware and bone grafts.

Injury Medical Chiropractic and Functional Medicine Clinic

Chiropractic therapy is among the more conservative treatment options and may be tried first before proceeding with surgery. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution.

Arthritis Explained

References

American Academy of Orthopaedic Surgeons. (2021). Cervical spondylosis (arthritis of the neck). orthoinfo.aaos.org/en/diseases–conditions/cervical-spondylosis-arthritis-of-the-neck/

Kazeminasab, S., Nejadghaderi, S. A., Amiri, P., Pourfathi, H., Araj-Khodaei, M., Sullman, M. J. M., Kolahi, A. A., & Safiri, S. (2022). Neck pain: global epidemiology, trends and risk factors. BMC musculoskeletal disorders, 23(1), 26. doi.org/10.1186/s12891-021-04957-4

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

Bon Secours. (2024). Cervical osteoarthritis (arthritis in the neck). www.bonsecours.com/health-care-services/spine-care/conditions/cervical-osteoarthritis

American Chiropractic Association. (2024). Neck pain. www.acatoday.org/patients/neck-pain-and-chiropractic/

Jenkins, H. J., Downie, A. S., Moore, C. S., & French, S. D. (2018). Current evidence for spinal X-ray use in the chiropractic profession: a narrative review. Chiropractic & manual therapies, 26, 48. doi.org/10.1186/s12998-018-0217-8

Gu, C. L., Yan, Y., Zhang, D., & Li, P. (2019). An evaluation of the effectiveness of acupuncture with seven acupoint-penetrating needles on cervical spondylosis. Journal of pain research, 12, 1441–1445. doi.org/10.2147/JPR.S199798