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A Beginner’s Guide to Central Nervous System Activation

By
Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP
-
African American woman cardio for weight loss aerobics workout on bike, active lifestyle, share health, regular workout

“For individuals about to engage in physical activity or exercise, how does central nervous system activation and warming up help the body prepare for the work ahead?”

Optimize Your Performance with Central Nervous System Activation

Central Nervous System Activation

A proper warm-up before physical activity or working out prepares the mind and body to reduce risks of injury, mentally and physically transition to physical activity work, and enhance performance. A well-designed warm-up also primes the central nervous system/CNS for activity. The central nervous system transmits messages to the muscles to prepare them for action. Central nervous system activation increases motor neuron recruitment and engages the sympathetic nervous system so the body can better handle the physical stressors. The process may seem complex, but priming the nervous system is as simple as warming up with light aerobic activity before getting into more explosive movements.

CNS

The CNS consists of the brain and spinal cord. This central communication system uses another part of the nervous system known as the peripheral nervous system or PNS to transmit and receive messages throughout the body. The PNS is connected to the entire body and the brain and spinal cord (CNS).

  • Nerves run throughout the body, receiving signals from the CNS to the muscles, fibers, and organs, transmitting various information back to the brain. (Berkeley University. N.D.)
  • There are two types of systems within the peripheral nervous system – somatic and autonomic.
  1. Somatic nervous system actions are those controlled by the person through voluntary actions like choosing to pick something up.
  2. The autonomic system is involuntary and generates actions like breathing or heartbeat. (Cleveland Clinic. 2020)

Properly preparing the body for an intense strength training session or other physical activity needs the correct messages to be sent through the autonomic nervous system.

Parasympathetic and Sympathetic States

The autonomic nervous system consists of two subcategories, which are parasympathetic and sympathetic.

  • The sympathetic nervous system helps the body get ready to face stress which includes physical stress. (R. Bankenahally, H. Krovvidi. 2016)
  • The fight, flight, or freeze response describes the sympathetic nervous system’s aspect.
  • The parasympathetic nervous system is responsible for relaxation and de-stressing.

Individuals are recommended to perform a few calming movements and actions after a workout to return the body to a parasympathetic state. This can be:

  • Stretching
  • Lying with the legs elevated
  • Relaxing yoga poses
  • Box breathing
  • Taking a warm shower or bath
  • Foam rolling
  • Massage

Returning the mind and body to a calm state helps with recovery and reduces stress hormone production. (National Academy of Sports Medicine. 2022)

Why Activate the CNS

Activating the CNS can increase performance and prevent injuries. The process wakes up and alerts the body for the activity. Individuals are recommended before beginning a training session, to communicate to the body about the physical stress it is about to endure and to prepare for the work ahead. This is a concept known as post-activation potentiation/PAP. (Anthony J Blazevich, Nicolas Babault. 2019) PAP helps increase force and power production, which enhances physical performance.

  • Whenever an individual trains, the brain adapts and learns what the body is doing and the purpose of the training.
  • Muscle memory describes this interaction.
  • Individuals who have started up a new strength training routine or after an extended break report feeling awkward for the first few sessions, or even weeks, depending on their experience. (David C Hughes, Stian Ellefsen, Keith Baar, 2018)
  • However, after a few sessions, the body is more adept at performing the movements and ready to increase resistance, repetitions, or both.
  • This has to do with the neural drive and muscle memory than it has to do with true potential physical abilities. (Simon Walker. 2021)
  • Training the CNS to be alert and pay attention can increase the development of a healthy mind-muscle connection combined with muscle memory. (David C Hughes, Stian Ellefsen, Keith Baar, 2018)

General Warm-Up

The first step is a general warm-up that should use large muscle groups and be of low intensity so as not to exhaust the body before beginning the actual training. General warm-up benefits central nervous system activation and the entire body include: (Pedro P. Neves, et al., 2021) (D C. Andrade, et al., 2015)

  • Increases blood circulation.
  • Assists the release of oxygen from hemoglobin and myoglobin.
  • Warms the muscles, so they contract more effectively.
  • Increases nerve impulse speed.
  • Increases nutrient delivery.
  • Lowers joints’ resistance through increased synovial fluid/joint lubrication.
  • Increases joint range of motion.
  • Improves joint resiliency.
  • Removes metabolic waste quicker.
  • Reduces risk of injury.

A general warm-up can be simple as any aerobic activity will work. This can include:

  • Performing bodyweight movements – light jumping jacks or jogging in place.
  • Treadmill
  • Rowing machine
  • Stair climber
  • Elliptical trainer

It is recommended to use the rating perceived exertion scale/RPE to determine the general warm-up effort. An exertion rating of between 5 to 6 is equivalent to moderate walking or a slow jog. Individuals should be able to speak clearly without taking a pause.

Try this strategy before the next workout to see increased performance and reduced injury risks.

Ankle Sprains Recovery

References

The nervous system. Berkeley University.

Cleveland Clinic. Nervous system: What it is, types, symptoms.

Bankenahally R, Krovvidi H. (2016) Autonomic nervous system: anatomy, physiology, and relevance in anesthesia and critical care medicine. BJA Education. 16(11):381-387. doi:10.1093/bjaed/mkw011

National Academy of Sports Medicine. Sympathetic vs. parasympathetic overtraining.

Blazevich, A. J., & Babault, N. (2019). Post-activation Potentiation Versus Post-activation Performance Enhancement in Humans: Historical Perspective, Underlying Mechanisms, and Current Issues. Frontiers in physiology, 10, 1359. https://doi.org/10.3389/fphys.2019.01359

Hughes, D. C., Ellefsen, S., & Baar, K. (2018). Adaptations to Endurance and Strength Training. Cold Spring Harbor perspectives in medicine, 8(6), a029769. https://doi.org/10.1101/cshperspect.a029769

Walker S. (2021). Evidence of resistance training-induced neural adaptation in older adults. Experimental gerontology, 151, 111408. https://doi.org/10.1016/j.exger.2021.111408

P. Neves, P., R. Alves, A., A. Marinho, D., & P. Neiva, H. (2021). Warming-Up for Resistance Training and Muscular Performance: A Narrative Review. IntechOpen. doi: 10.5772/intechopen.96075

Andrade, D. C., Henriquez-Olguín, C., Beltrán, A. R., Ramírez, M. A., Labarca, C., Cornejo, M., Álvarez, C., & Ramírez-Campillo, R. (2015). Effects of general, specific, and combined warm-up on explosive muscular performance. Biology of sport, 32(2), 123–128. https://doi.org/10.5604/20831862.1140426

Non-Binary & Inclusive Gender Affirming Healthcare

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

Can healthcare professionals implement an inclusive and positive approach for gender affirming healthcare for non-binary individuals?

Introduction

When it comes to many individuals looking for the right healthcare options for their ailments and general well-being, it can be scary and challenging to some, including many individuals within the LGBTQ+ community. Many individuals need to research when finding positive and safe healthcare facilities that listen to what the person is dealing with when getting a routine check-up or their ailments treated. Within the LGBTQ+ community, many individuals do find it difficult to express what is affecting their bodies due to past traumas of not being seen or heard due to their identities, pronouns, and orientation. This can cause numerous barriers between them and their primary doctor, leading to a negative experience. However, when medical professionals provide a positive, safe environment, listen to the person’s ailments, and be non-judgmental to their patients, they can open the doors to improving inclusive healthcare wellness within the LGBTQ+ community. Today’s article focuses on one identity within the LGBTQ+ community, known as non-binary, and how inclusive healthcare can be optimized while benefitting many individuals dealing with general aches, pains, and conditions within their bodies. Coincidentally, we communicate with certified medical providers who incorporate our patients’ information to provide a safe and positive experience in inclusive healthcare. We also inform them that there are non-surgical options to reduce the effects of general aches and pain while restoring their quality of life. We encourage our patients to ask amazing educational questions to our associated medical providers about their symptoms correlating with body pain in a safe and positive environment. Dr. Alex Jimenez, D.C., incorporates this information as an academic service. Disclaimer

 

What Is Non-Binary Gender?

 

The term non-binary is used within the LGBTQ+ community to describe a person who doesn’t identify as a male or female within the gender identity spectrum. Non-binary individuals can even fall under various gender identities that make them who they are. These can include:

  • Genderqueer: An individual who doesn’t follow the traditional gender norm.
  • Agender: An individual who doesn’t identify with any gender. 
  • Genderfluid: An individual whose gender identity is not fixed or can change over time.
  • Intergender: An individual who identifies as a combination of male and female.
  • Androgynous: An individual whose gender expression combines masculine and feminine traits.
  • Gender Non-Conforming: An individual who doesn’t conform to society’s expectation of gender identity. 
  • Transgender: An individual whose gender identity is different from their assigned gender at birth.

When it comes to non-binary binary individuals looking for healthcare treatment for their ailments, it can be a bit of a challenge as many individuals who identify as non-binary within the LGBTQ+ community have to deal with the socio-economic impact when getting treatment, which can lead to unnecessary stress when going in for a routine check-up or getting their ailments treated. (Burgwal et al., 2019) When this happens, it can lead to a negative experience for the individual and make them feel inferior. However, when healthcare professionals take the time to be properly trained, use the correct pronouns, and create an inclusive, positive, and safe space for individuals who identify as non-binary, it can open the doors to creating more of an inclusive awareness and lead to more appropriate care for the LGBTQ+ community. (Tellier, 2019)

 

Optimizing Your Wellness- Video

Optimizing Your Wellness | El Paso, Tx (2023)

Do you or your loved ones are dealing with consistent pain in their bodies that makes it difficult to function? Do you feel stress in different body locations that correlate with musculoskeletal disorders? Or do your ailments seem to be affecting your daily routine? More often than not, in today’s ever-changing world, many individuals are researching safe and inclusive healthcare treatments to reduce their ailments. It is an important aspect to many individuals within the LGBTQ+ community, as finding the appropriate care they need can be stressful. Many healthcare professionals must provide the best possible healthcare and interventions within the LGBTQ+ community to understand the health disparities that they are experiencing. (Rattay, 2019) When healthcare professionals create a negative experience with their patients within the LGBTQ+ community, it can cause them to develop socio-economic stressors that can overlap with their pre-existing condition, creating barriers. When disparities are associated with socio-economic stressors, it can lead to poor mental health. (Baptiste-Roberts et al., 2017) When this happens, it can lead to coping mechanisms and resilience that can correlate with serious implications for the person’s overall health and well-being. However, all is not lost, as many healthcare professionals are integrating into safe, affordable, and positive healthcare spaces for individuals who identify as non-binary. We here at Injury Medical Chiropractic and Functional Medicine Clinic will work on reducing the effects of health disparities while raising awareness to continuously improve positive and inclusive experiences for non-binary individuals seeking inclusive healthcare. Check out the video above to learn more about optimizing wellness to improve your health and well-being.

How To Optimize Non-Binary Inclusive Healthcare?

When it comes to inclusive health care for non-binary individuals within the LGBTQ+ community, many healthcare providers must honor the individual’s gender identity while creating a positive and trusting relationship to reduce the ailments they are experiencing. By making a safe and positive experience for their patients, LGBTQ+ individuals will start to address to their doctors what issues they are experiencing, and it allows the doctor to come up with a personalized health care plan that is catered to them while improving their health outcomes. (Gahagan & Subirana-Malaret, 2018) At the same time, being an advocate and systemically improving, including gender-affirming care, can lead to positive results and benefit LGBTQ+ individuals. (Bhatt et al., 2022)

References

Baptiste-Roberts, K., Oranuba, E., Werts, N., & Edwards, L. V. (2017). Addressing Health Care Disparities Among Sexual Minorities. Obstet Gynecol Clin North Am, 44(1), 71-80. https://doi.org/10.1016/j.ogc.2016.11.003

 

Bhatt, N., Cannella, J., & Gentile, J. P. (2022). Gender-affirming Care for Transgender Patients. Innov Clin Neurosci, 19(4-6), 23-32. https://www.ncbi.nlm.nih.gov/pubmed/35958971

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9341318/pdf/icns_19_4-6_23.pdf

 

Burgwal, A., Gvianishvili, N., Hard, V., Kata, J., Garcia Nieto, I., Orre, C., Smiley, A., Vidic, J., & Motmans, J. (2019). Health disparities between binary and non binary trans people: A community-driven survey. Int J Transgend, 20(2-3), 218-229. https://doi.org/10.1080/15532739.2019.1629370

 

Gahagan, J., & Subirana-Malaret, M. (2018). Improving pathways to primary health care among LGBTQ populations and health care providers: key findings from Nova Scotia, Canada. Int J Equity Health, 17(1), 76. https://doi.org/10.1186/s12939-018-0786-0

 

Rattay, K. T. (2019). Improved Data Collection for Our LGBTQ Population is Needed to Improve Health Care and Reduce Health Disparities. Dela J Public Health, 5(3), 24-26. https://doi.org/10.32481/djph.2019.06.007

 

Tellier, P.-P. (2019). Improving health access for gender diverse children, youth, and emerging adults? Clinical Child Psychology and Psychiatry, 24(2), 193-198. https://doi.org/10.1177/1359104518808624

 

Disclaimer

Harnessing the Power of Regenerative Cells In Joint Health

By
Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP
-
Treating knee pain with platelet-rich plasma injection. Treatment of arthritis and osteoarthritis

“As the body ages, individuals want to stay active and maintain a healthy pain-free lifestyle. Can regenerative cells for arthritis and cartilage damage be the future of neuromusculoskeletal medicine and joint healing?”

Harnessing the Power of Regenerative Cells In Joint Health

Regenerative Cells For Arthritis and Cartilage Damage

Individuals want to continue to do the physical activities they love, which require healthy joints. Scientists are learning how to harness the abilities of regenerative cells to repair and regrow damaged and deteriorated cartilage. Current stem cell treatment of cartilage problems has not been shown to reverse the effects of arthritis and while studies show clinical improvement, further research is necessary. (Bryan M. Saltzman, et al., 2016)

Cartilage and How It Gets Damaged

Cartilage is a type of connective tissue. In the joints, there are a few types of cartilage. The most commonly referred to is the smooth lining known as articular or hyaline cartilage. This type forms a smooth layer of cushion on the end of a bone at the joint. (Rocky S. Tuan, et al., 2013)

  • The tissue is very strong and has the ability to compress and absorb energy.
  • It is very smooth allowing a joint to glide effortlessly through a limb’s range of motion.
  • When joint cartilage is damaged, the cushioning can wear down.
  • In traumatic injuries, a sudden force can cause the cartilage to break off and/or suffer damage, that exposes the underlying bone.
  • In osteoarthritis – degenerative or wear-and-tear arthritis,  the smooth layer can wear down thin and unevenly.
  • Eventually, the cushion wears away, the joints become inflamed and swollen and movements become stiff and painful.

There are treatments for arthritis and cartilage damage, but these treatments are usually focused on relieving symptoms by smoothing down the damaged cartilage or replacing the joint surface with an artificial implant, like knee replacement or hip replacement surgeries. (Robert F. LaPrade, et al., 2016)

Regenerative Cells

Regenerative stem cells are special cells that have the ability to multiply and develop into different types of tissue. In an orthopedic surgery setting for joint problems, stem cells are obtained from adult stem cell primary sources which are bone marrow and fatty tissue. These cells have the ability to develop into cartilage cells, called chondrocytes. (Rocky S. Tuan, et al., 2013)

  • They also help by stimulating the body to reduce inflammation, stimulate cell repair, and improve blood circulation.
  • This process is caused by cellular signals and growth factors to stimulate the body to activate the healing processes.
  • Once stem cells have been obtained, they need to be delivered to the area of cartilage damage.

Cartilage is a complex tissue that is described as a scaffold structure that is composed of collagen, proteoglycans, water, and cells. (Rocky S. Tuan, et al., 2013)

  • To regenerate cartilage, the complex tissues must also be reconstructed.
  • There are studies on types of tissue scaffolds engineered to recreate a similar type of cartilage structure.
  • The stem cells can then be injected into the scaffold, in hopes of restoring a normal type of cartilage.

Non-Surgical Arthritis Treatments

Standard treatments such as cortisone shots or physical therapies work as well and provide benefits that could be utilized in combination with regenerative cells for arthritis and cartilage damage in the near future. Data takes time and therefore how this impacts the long-term health of a joint needs continued research in terms of tissue engineering and cell delivery to determine the best approach to help individuals.

Arthritis

References

LaPrade, R. F., Dragoo, J. L., Koh, J. L., Murray, I. R., Geeslin, A. G., & Chu, C. R. (2016). AAOS Research Symposium Updates and Consensus: Biologic Treatment of Orthopaedic Injuries. The Journal of the American Academy of Orthopaedic Surgeons, 24(7), e62–e78. https://doi.org/10.5435/JAAOS-D-16-00086

Saltzman, B. M., Kuhns, B. D., Weber, A. E., Yanke, A., & Nho, S. J. (2016). Stem Cells in Orthopedics: A Comprehensive Guide for the General Orthopedist. American journal of orthopedics (Belle Mead, N.J.), 45(5), 280–326.

Tuan, R. S., Chen, A. F., & Klatt, B. A. (2013). Cartilage regeneration. The Journal of the American Academy of Orthopaedic Surgeons, 21(5), 303–311. https://doi.org/10.5435/JAAOS-21-05-303

Healthier Dishes Through Smart Food Substitutions

By
Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP
-
Variety of spices and herbs on table background. Cooking concept and ingredients at table top view

“For individuals looking to improve their quality of life, can substituting healthy meal ingredients be a simple step toward better health?”

Food Substitutions

Food Substitutions

Eating well does not mean having to give up favorite foods. Part of the enjoyment of home cooking is putting one’s own style on each dish. Individuals soon discover they prefer healthy food substitutions to the original high-fat, high-sugar, or high-sodium ingredients. Healthy swaps can be introduced gradually to allow the taste buds to adapt. It is possible to reduce:

  • Calories
  • Unhealthy fats
  • Sodium
  • Refined sugars

Simply making smart swaps that replace some ingredients with more beneficial ones.

Ingredients for Healthier Meals

Recipes are the sum of their parts. A dish made with multiple ingredients adds its own nutrition for healthy or unhealthy. Ingredients high in calories, saturated fat, added sugars, and/or sodium can make a dish less nutritious. By making strategic food substitutions, individuals can transform a high-calorie, high-fat, sugary dish into something more nutritious. When done regularly this adjustment leads to long-term healthy behavior changes. Making small adjustments leads to improvements in weight management, heart health, and risk of chronic diseases.

Substituting Unhealthy Fats and Oils

  1. Instead of baking with butter, try using applesauce, mashed avocados, or mashed bananas.
  2. These plant-based alternatives don’t overload the body with saturated fat.
  3. Try using half butter and half an alternative to cut calories and fats.
  4. For cooking, try sautéing, roasting, or pan-frying in olive or avocado oil.
  5. Both contain healthy monounsaturated fats.
  6. These oils can be used for dipping bread with dinner or for a quick snack.
  7. Fresh herbs or a dash of balsamic vinegar can add flavor.

Refined Sugars

Enjoying sweets can be healthy, but the objective is to be mindful of how much refined sugar is consumed. Sweet flavors send signals to the reward centers in the brain, increasing positive associations with sugar. However, eating high amounts of sugar can lead to:

Try to control how much sugar goes in.

  1. Consider incrementally scaling back on sugar in baked goods by adding three-fourths or half of the sugar.
  2. Try using fresh fruit as a natural sweetener.
  3. Mashed dates add caramel-like flavor without spiking blood sugar like white sugar.
  4. Maple syrup is another alternative.
  5. Experiment with options and combinations to keep refined sugars to a minimum.
  6. For soda or other sweetened beverages, consider going half with sparkling water and soda or juice.
  7. Sweeten water with fruit by steeping it in an infusion pitcher or bottle.

Sodium

Salt is another common excess in an individual diet. Sodium contributes to high rates of elevated blood pressure, heart attack, and stroke.

  • The CDC offers tips on how reducing sodium can improve health. (Centers for Disease Control and Prevention. 2018)
  • An array of other herbs and spices can amplify the flavor of meals.
  • Purchase or create various flavor blends.
  • For example, cumin, chili powder, oregano, and red pepper flakes can spice up a dish or a blend of thyme, paprika, garlic powder, and onion powder can add savory notes.
  • A study found that adding lemon juice to recipes could reduce sodium content and add tanginess. (Sunkist Growers. 2014)

Whole Grains

Individuals don’t have to choose brown rice or whole wheat pasta for every meal but try to select whole grains half of the time. Food substitutions that can help achieve the halfway point include:

  • Popcorn or whole wheat crackers instead of refined flour crackers.
  • Whole wheat pizza crust instead of regular crust.
  • Substitute brown rice for white in stir-fries or casseroles.
  • Oatmeal instead of refined grain cereal.
  • Whole wheat pasta for spaghetti and meatballs or other pasta dishes.
  • Quinoa as a side dish instead of white rice or couscous.

More whole grains equals more fiber and B vitamins to help sustain energy, prevent blood sugar spikes, and promote digestive health. Eating more whole grains has been linked with a reduced risk of heart disease (Caleigh M Sawicki, et al. 2021) and a lower risk of colon cancer. (Glenn A. Gaesser. 2020)

Finding the right combination of each of these substitutions takes time. Go slow and taste often to see how each substitution affects a recipe’s taste and texture.

Boost Metabolism

References

Zong, G., Li, Y., Wanders, A. J., Alssema, M., Zock, P. L., Willett, W. C., Hu, F. B., & Sun, Q. (2016). Intake of individual saturated fatty acids and risk of coronary heart disease in US men and women: two prospective longitudinal cohort studies. BMJ (Clinical research ed.), 355, i5796. https://doi.org/10.1136/bmj.i5796

American Heart Association. Saturated fat.

Harvard T.H. Chan School of Public Health. Different dietary fat, different risk of mortality.

Faruque, S., Tong, J., Lacmanovic, V., Agbonghae, C., Minaya, D. M., & Czaja, K. (2019). The Dose Makes the Poison: Sugar and Obesity in the United States – a Review. Polish journal of food and nutrition sciences, 69(3), 219–233. https://doi.org/10.31883/pjfns/110735

Harvard Health Publishing. The sweet danger of sugar.

American Heart Association. How much sugar is too much?

Centers for Disease Control and Prevention. How to Reduce Sodium Intake.

Sunkist Growers. Sunkist Growers and Chefs from Johnson & Wales University Release New S’alternative® Research.

Sawicki, C. M., Jacques, P. F., Lichtenstein, A. H., Rogers, G. T., Ma, J., Saltzman, E., & McKeown, N. M. (2021). Whole- and Refined-Grain Consumption and Longitudinal Changes in Cardiometabolic Risk Factors in the Framingham Offspring Cohort. The Journal of nutrition, 151(9), 2790–2799. https://doi.org/10.1093/jn/nxab177

Gaesser G. A. (2020). Whole Grains, Refined Grains, and Cancer Risk: A Systematic Review of Meta-Analyses of Observational Studies. Nutrients, 12(12), 3756. https://doi.org/10.3390/nu12123756

Discover the Benefits of Hiring A Health Coach: Tips to Get Started

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

“Individuals striving to be healthy may not know where or how to start. Can hiring a health coach help individuals start their wellness journey and reach their goals?”

Discover the Benefits of Hiring A Health Coach: Tips to Get Started

Hiring A Health Coach

It’s easy to get caught up in the desire to make changes, but it is another thing to actually set a consistent plan in motion. Hiring a health coach can help individuals understand the information, develop an effective wellness routine that suits their lifestyle, and achieve health and wellness goals. A primary healthcare provider could be a resource and have referrals to reputable health coaches in the area.

What Do They Do?

Health coaches are experts in helping individuals reach health and wellness goals. This can be:

  • Reducing stress
  • Improving self-care
  • Focusing on nutrition
  • Starting exercise
  • Improving quality of life

A health coach helps create a plan and makes it happen.

  • Health and wellness coaches use motivational interviewing and evidence-based approaches to empower individuals in their wellness journey. (Adam I Perlman, Abd Moain Abu Dabrh. 2020)
  • They help identify areas that need improvement, develop a plan, and encourage the individual all the way like a personal fitness trainer.
  • Health coaches work with physicians and/or other health professionals in a clinical setting or as individual providers.
  • Their role is to provide a holistic approach to health and wellness.

Services Provided

Health coaches can provide and assist with: (Shivaun Conn, Sharon Curtain 2019)

  • Diet and nutrition
  • Exercise, movement
  • Sleep
  • Mental and emotional health
  • Occupational wellness
  • Relationship building
  • Social skills building

A health coach is someone who helps organize and balance various aspects of an individual’s life so they can learn to maintain optimal health.

  • They will help overcome barriers when struggling.
  • A health coach listens and provides support for whatever an individual’s goals may be.
  • A health coach is there until the goal is reached.

Qualifications

It is important to ensure the providers being considered have the necessary qualifications. Because some certification programs offer a focus on specific areas like nutrition, it’s recommended to identify what is needed before choosing a health coach. Health coaches do not need a university degree, however, many certifications are affiliated with colleges and have educational partnerships that qualify coursework and award college credits. Training to become a health coach consists of: (Shivaun Conn, Sharon Curtain 2019)

  • Health
  • Fitness
  • Goal setting
  • Coaching concepts
  • Nutritional concepts
  • Motivational interviewing
  • Stress management
  • Changing behaviors

Health Goal Examples

Health coaching is not a one-size-fits-all approach. A primary healthcare provider or physician provides a diagnosis and medical plan, and a health coach helps guide and support the individual through the plan. However, hiring a health coach does not require a medical condition to employ services. A few examples of health goals that health coaches address include:

  • Improving quality of life
  • Reducing stress and management
  • Lifestyle habits
  • Weight loss
  • Exercise
  • Physical activity
  • Emotional and psychological health
  • Quitting smoking

Finding a Health Coach

A few things to consider.

Health Goals

  • Determine goals and expectations.
  • There are many types of health coaches and some may specialize, therefore try to determine the expertise needed to achieve the goals.

Budget

  • Determine how much money will be invested, as many insurance providers do not cover the cost of a health coach.
  • Health coaches may charge between $50 to $300 per session.
  • Some will offer packages, memberships, and/or discounts.

Certifications

  • Look into their certification.
  • Is it accredited?
  • This will ensure choosing a coach who has received the training and expertise needed to provide quality care.

Compatibility

  • Consult with potential coaches.
  • Ask questions and see if they are compatible with specific health goals.
  • Interview as many as needed.

Availability/Location

  • Virtual sessions, in-person meetings, and/or a combination?
  • How long are the sessions?
  • Frequency of meetings?
  • Finding a coach that is flexible and convenient will help maintain a healthy coach/client relationship.

Multidisciplinary Evaluation and Treatment

References

Perlman, A. I., & Abu Dabrh, A. M. (2020). Health and Wellness Coaching in Serving the Needs of Today’s Patients: A Primer for Healthcare Professionals. Global advances in health and medicine, 9, 2164956120959274. https://doi.org/10.1177/2164956120959274

Conn, S., & Curtain, S. (2019). Health coaching as a lifestyle medicine process in primary care. Australian journal of general practice, 48(10), 677–680. https://doi.org/10.31128/AJGP-07-19-4984

An Introductory Guide To Regenerative Cells

By
Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP
-
Nuclear transfer, Stem cells made from the cell nucleus

“Individuals dealing with various conditions and diseases and ongoing research to find treatments, where do human regenerative cells come from?”

An Introductory Guide To Regenerative Cells

Regenerative Cells

Regenerative cells are stem cells that are specialized to potentially develop into many different types of cells. They are unlike any other cell because:

  • Being unspecialized they have no specific function in the body.
  • They can become specialized cells like – brain, muscle, and blood cells.
  • They can divide and renew continually for a long period.
  • Blood stem cells are currently the only type that is regularly used in treatment.
  • For leukemia or lymphoma, only adult cells are used in a procedure known as a bone marrow transplant. (Cleveland Clinic. 2023)
  • For regenerative cell research, the cells can come from different sources, including adult donors, genetically altered human cells, or embryos.

Bone Marrow Transplants

  • Bone marrow cells produce all of the body’s blood cells, including red and white blood, and platelets.
  • Hematopoietic stem cells are those found in bone marrow that is the parent for the different types of cells.
  • Hematopoietic cells are transplanted in individuals with cancer to replenish bone marrow.
  • The procedure is often used during high-dose chemotherapy that destroys the existing cells in the bone marrow.
  • Donated stem cells are injected into a vein and settle in the bone marrow where they begin to produce new healthy blood cells. (Cleveland Clinic. 2023)

Peripheral Blood Transplants

  • For some time the only source to extract hematopoietic cells was from bone marrow.
  • Researchers found that many of these cells were freely circulating in the blood.
  • Scientists learned how to extract the cells from the blood and transplant them directly.
  • This type of transplant is a peripheral blood stem cell transplant/PBSCT and has become the more common procedure, however, both methods are still used. (Cleveland Clinic. 2023)
  • PBSCT is less invasive and does not require the removal of marrow from the hip bone.

Somatic Cells

Embryonic Cells

Embryonic stem cells were first grown in a laboratory in 1998 for reproductive research, which created controversy because they were extracted from human embryos that were destroyed or harvested for science. Today their primary use is for research into treatments and potential cures for:

Embryonic cells are pluripotent, which means they can grow into the three types of germ cell layers – ectoderm, mesoderm, and endoderm – that make up the human body and can develop into each of the more than 200 types of cells. (National Institutes of Health. 2016)

Induced Pluripotent Cells

  • Induced pluripotent stem cells/iPSCs are somatic cells that have been genetically reprogrammed to behave like embryonic cells.
  • iPSCs are usually skin or blood cells that undergo genetic programming. (Pavel Simara, Jason A Motl, Dan S Kaufman. 2013)
  • iPSCs were first developed in 2006.
  • A major advantage of iPSCs over somatic and embryonic cells is that iPSCs can be generated to match the patient.
  • This means that a laboratory can tailor-make cells from an individual’s own cells or tissues.

Spine Injuries In Athletes

References

Cleveland Clinic. Stem Cell Transplant (Bone Marrow Transplant).

National Institutes of Health. Stem Cell Basics.

Simara, P., Motl, J. A., & Kaufman, D. S. (2013). Pluripotent stem cells and gene therapy. Translational research : the journal of laboratory and clinical medicine, 161(4), 284–292. https://doi.org/10.1016/j.trsl.2013.01.001

Finkbeiner, S. R., & Spence, J. R. (2013). A gutsy task: generating intestinal tissue from human pluripotent stem cells. Digestive diseases and sciences, 58(5), 1176–1184. https://doi.org/10.1007/s10620-013-2620-2

Al-Shamekh, S., & Goldberg, J. L. (2014). Retinal repair with induced pluripotent stem cells. Translational research : the journal of laboratory and clinical medicine, 163(4), 377–386. https://doi.org/10.1016/j.trsl.2013.11.002

A Guide to Different Types of Back Pain Specialists

By
Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP
-
Osteopath readjusting a patient's lumbar spine while lying on the treatment table

“Back problems and discomfort symptoms are a common ailment that many types of healthcare providers diagnose and treat it. Can knowing a little about what each back pain specialist does and what they have to offer help in choosing a provider?”

Back Pain Specialists

Back Pain Specialists

Nowadays individuals have options for treating back pain. Primary healthcare providers, general practitioners, pediatricians, and emergency room workers are usually the first to examine the injury or problem. If they are unable to properly diagnose or treat the injury, they will refer the individual to a specialist. Specialists include:

  • Osteopaths
  • Chiropractors
  • Orthopedists
  • Rheumatologists
  • Neurologists
  • Neurosurgeons.

They specialize in chronic conditions and diseases like arthritis or problems like herniated discs. Complementary and alternative providers treat individuals solely or with help from a care team. They look at the whole body and focus on improving overall function.

Family and General Practitioners

When neck or back pain begins a regular doctor that’s usually a family or general practitioner/GP or primary care provider PCP is a recommended place to start. They will:

  • Order diagnostic tests.
  • Recommend exercises and stretches.
  • Prescribe medication.
  • Refer the patient to a physical therapist or other back pain specialist.

However, studies suggest general providers can be uninformed and slow to adopt new back treatments. (Paul B. Bishop, Peter C. Wing. 2006) It is recommended to research possible treatment options, ask a lot of questions during an appointment, and ask or request a referral to a specialist.

Pediatricians

Pediatricians diagnose and treat children. They cover a wide range of issues including back problems and injuries. As with a general practitioner or primary care provider, a child’s pediatrician is the place to start. Depending on the child’s needs, they’ll refer them to the proper specialist.

Emergency Healthcare Providers

When there is serious neck or back trauma, individuals need to go to the emergency room. Trauma can include automobile collisions, sports accidents, work accidents, and/or personal home accidents. Someone with a possible spinal injury should not be moved. (W Yisheng, et al., 2007) Go to the ER if there is back pain with loss of bowel or bladder control, or the legs become progressively weaker. These are symptoms of an emergency condition known as cauda equina syndrome. (American Association of Neurological Surgeons. 2023)

Orthopedists

Orthopedists and orthopedic surgeons treat the musculoskeletal system, which includes:

  • Muscles
  • Bones
  • Joints
  • Connective tissues
  • Cartilage

Common orthopedic issues include:

  • Repetitive stress injuries
  • Sports injuries
  • Bursitis
  • Tendonitis
  • Ruptured discs
  • Nerve impingement
  • Scoliosis
  • Osteoporosis
  • Osteoarthritis

Orthopedics can overlap with other specialties. As orthopedists and rheumatologists both treat arthritis and orthopedic surgeons and neurosurgeons do some of the same procedures that include spinal fusions and discectomies.

Rheumatologists

A rheumatologist treats autoimmune, inflammatory, and musculoskeletal conditions that can include different types of arthritis, lupus, and Sjogren’s syndrome. A primary care provider may refer a patient to a rheumatologist if they have symptoms that include:

  • Sacroiliitis – inflammation of the sacroiliac joint at the base of the spine.
  • Axial spondylosis – a form of spinal arthritis.
  • Axial spondylosis – spinal arthritis that causes the bones to fuse together.
  • Rheumatologists can also treat spinal stenosis or advanced osteoarthritis as they overlap with orthopedists.

Neurologists

A neurologist specializes in the function of the nervous system. They treat disorders of the brain, spinal cord, and nerves that include:

  • Parkinson’s disease
  • Multiple sclerosis
  • Alzheimer’s disease
  • Chronic back or neck pain

They are experts in the origins of pain. (David Borsook. 2012) However, a neurologist does not perform spine surgery.

Neurosurgeons

A neurosurgeon specializes in nervous system surgical procedures that include the brain, spine, and spinal cord. However, neurosurgeons do not provide overall treatment for back pain because they are usually the last to be seen after exhausting all other treatment options.

Osteopaths

An osteopath is a licensed physician who practices medicine using conventional treatments and osteopathic manipulative medicine. They have the same education as an MD plus 500 hours of musculoskeletal system studies. (National Library of Medicine. 2022) They take the same exams and are licensed as an MD. Many osteopaths are primary care providers. For back pain, they will focus on:

  • Posture rehabilitation and training.
  • Stretching
  • Therapeutic massage
  • Spinal manipulation

The goal is to relieve pain and muscle tension, increase mobility, and improve musculoskeletal function.

Physiatrists

Physiatrists are holistic providers that focus on physical function. They can be thought of as a primary care provider plus a physical therapist. These back pain specialists provide rehabilitation for various types of conditions and injuries including:

  • Back pain
  • Sports injuries
  • Stroke
  • Often they will coordinate a team of specialists to develop a targeted treatment plan.

Chiropractor

Chiropractic is a hands-on alternative medicine. The goal is to restore neuromusculoskeletal function by realigning the spine to its proper form. They do this with spinal manipulations, non-surgical mechanical decompression, traction, and massage techniques. (Michael Schneider, et al., 2016)

  • The purpose of most chiropractic adjustments is to relax and retrain tight muscles and increase flexibility.
  • Chiropractic helps to relieve stiff muscles and restore range of motion.

Individuals may not be referred to a chiropractor if they:

  • Have loose-joints
  • Have connective tissue problems or conditions.
  • Have osteoporosis/thinning bones

All types of back pain specialists provide various forms of therapy that may be able to help.

Spinal Decompression in Depth

References

Bishop, P. B., & Wing, P. C. (2006). Knowledge transfer in family physicians managing patients with acute low back pain: a prospective randomized control trial. The spine journal : official journal of the North American Spine Society, 6(3), 282–288. https://doi.org/10.1016/j.spinee.2005.10.008

Yisheng, W., Fuying, Z., Limin, W., Junwei, L., Guofu, P., & Weidong, W. (2007). First aid and treatment for cervical spinal cord injury with fracture and dislocation. Indian journal of orthopaedics, 41(4), 300–304. https://doi.org/10.4103/0019-5413.36991

American Association of Neurological Surgeons. Caudia Equina Syndrome.

Borsook D. (2012). Neurological diseases and pain. Brain : a journal of neurology, 135(Pt 2), 320–344. https://doi.org/10.1093/brain/awr271

National Library of Medicine. Doctor of osteopathic medicine.

Schneider, M., Murphy, D., & Hartvigsen, J. (2016). Spine Care as a Framework for the Chiropractic Identity. Journal of chiropractic humanities, 23(1), 14–21. https://doi.org/10.1016/j.echu.2016.09.004

Identifying Causes of Foot Nerve Pain: What You Need to Know

By
Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP
-
Shock wave therapy, the magnetic field, rehabilitation, physiotherapist doctor performs surgery on a patient's heel.

“Individuals that experience nerve pain in the foot could be caused by a number of different conditions, can recognizing the most common causes help in developing an effective treatment plan?”

Identifying Causes of Foot Nerve Pain: What You Need to Know

Nerve Pain In The Foot

These sensations can feel like a burning, shooting, electrical, or stabbing pain and can happen while in motion or at rest. It can occur on the top of the foot or through the arch. The area closest to the nerve may be sensitive to the touch. A number of different conditions can cause nerve pain in the foot, including:

  • Morton’s neuroma
  • Pinched nerve
  • Tarsal tunnel syndrome
  • Diabetic peripheral neuropathy
  • Herniated disc

Morton’s Neuroma

Morton’s neuroma involves the nerve that runs between the third and fourth toes, but can sometimes occur between the second and third toes becoming thicker. Typical symptoms include a burning or shooting pain in the area, usually while walking. (Nikolaos Gougoulias, et al., 2019) Another common symptom is the sensation of pressure beneath the toes like the sock is bunched up underneath. Treatments can include:

  • Arch supports
  • Cortisone injections to decrease swelling
  • Footwear modifications – can include lifts, orthotics combined with metatarsal pads, and rocker soles, to provide cushion where needed.

Things that increase the risk of developing the condition include:

  • Regularly wearing high-heels – the condition occurs more frequently in women.
  • Shoes that are too tight.
  • Participating in high-impact sports like running.
  • Having flat feet, high arches, bunions, or hammertoes.

Pinched Nerve

A pinched nerve can feel like shooting or burning pain. Nerve entrapment can occur in various regions of the foot or the area on top of the foot may feel sensitive. Causes can be caused by: (Basavaraj Chari, Eugene McNally. 2018)

  • Trauma that causes swelling.
  • Blunt impact.
  • Tight shoes.

Treatment can include:

  • Massage
  • Physical therapy
  • Rest
  • Footwear modifications
  • Anti-inflammatories.

Things that increase the risk of developing a pinched nerve in the foot include:

  • Poor-fitting footwear.
  • Repetitive stress injury.
  • Trauma to the foot.
  • Obesity.
  • Rheumatoid arthritis.

Tarsal Tunnel Syndrome

Another type of nerve entrapment is tarsal tunnel syndrome. Tarsal tunnel syndrome is “anything that produces compression on the posterior tibial nerve.” (American College of Foot and Ankle Surgeons. 2019) The tibial nerve is located near the heel. Symptoms include numbness and foot cramps, burning, tingling, or shooting sensations that often radiate from the instep/arch. Both can worsen while the foot is at rest, like when sitting or sleeping. Treatment can consist of:

  • Placing padding in the shoe where the foot is being compressed to relieve the pain.
  • Custom foot orthotics.
  • Cortisone shots or other anti-inflammatory treatments.
  • Surgery may be necessary to release the nerve.

Conditions that compress the tibial nerve and can lead to tarsal tunnel syndrome include:

  • Flat feet
  • Fallen arches
  • Ankle sprain
  • Diabetes
  • Arthritis
  • Varicose veins
  • Bone spurs

Diabetic Peripheral Neuropathy

Long-term high blood sugar/glucose associated with diabetes can lead to a form of nerve damage known as peripheral neuropathy. (Centers for Disease Control and Prevention. 2022) Neuropathy pain feels like burning or shooting pain, or the sensation of walking on bubble wrap that usually shows up overnight. The pain can come and go as well as a gradual loss of feeling in the feet that begins in the toes and moves up the foot. It’s estimated that around half of individuals with diabetes will eventually develop neuropathy. (Eva L. Feldman, et al., 2019) Treatments can include:

  • Physical therapy massage to increase circulation.
  • Topical treatments with capsaicin.
  • Vitamin B.
  • Blood sugar management.
  • Alpha lipoic acid.
  • Medication.

Individuals with diabetes have an increased risk of developing peripheral neuropathy if:

  • Blood sugar is not well-controlled.
  • Diabetes has been present for many years.
  • Kidney disease.
  • Smoke.
  • Overweight or obese.

Herniated Disc

Nerve pain in the foot can be caused by spinal issues. A herniated disc in the lower back can irritate and compress the nerves, causing pain that radiates down the leg and foot. Additional symptoms usually include muscle weakness in the legs and/or numbness and tingling. Most herniated discs don’t require surgery and get better with conservative treatment. (Wai Weng Yoon, Jonathan Koch. 2021) If symptoms don’t improve or worsen, a healthcare provider may recommend surgery. Herniated discs are most common in young and middle-aged adults. Increased chances of developing a herniated disc can come from:

  • Degenerative changes in the spine from normal age wear and tear.
  • Physically demanding job.
  • Lifting incorrectly.
  • Overweight or obese.
  • Genetic predisposition – family history of herniated discs.

Spinal Stenosis

Spinal stenosis occurs when the spaces in the spine begin to narrow, creating pressure on the spinal cord and nerve roots. It is usually caused by wear and tear on the spine as the body ages. Stenosis in the lower back can cause burning pain in the buttocks and leg. As it progresses pain can radiate into the feet along with numbness and tingling. Conservative treatment consists of physical therapy exercises and non-steroidal anti-inflammatory medications/NSAIDs. (Jon Lurie, Christy Tomkins-Lane. 2016) Cortisone injections can be beneficial and if the condition worsens, surgery may be an option. Risk factors include:

  • Age 50 or older.
  • A narrow spinal canal.
  • Previous injury.
  • Previous spinal surgery.
  • Osteoarthritis that is affecting the back.

Other Possible Causes

Other conditions can result in nerve damage and pain symptoms and sensations. Examples include: (Nathan P. Staff, Anthony J. Windebank. 2014)

  • Vitamin deficiencies (Nathan P. Staff, Anthony J. Windebank. 2014)
  • Physical trauma – after surgery or an automobile or sports accident.
  • Certain cancer, antiviral medications, or antibiotics.
  • Complex regional pain syndrome.
  • Tumors that irritate and/or compress a nerve.
  • Liver or kidney disease.
  • Infectious diseases – Lyme disease complications or viral infections.

Nerve pain in the foot is definitely a reason to see a healthcare provider. Early diagnosis can help prevent symptom progression and future problems. Once the cause of the pain has been identified, the healthcare team can work together to develop a personalized treatment plan to release compressed nerves and restore mobility and function. See a healthcare provider right away if the pain and symptoms worsen, or if there are difficulties standing or walking.

Chiropractic After Accidents and Injuries

References

Gougoulias, N., Lampridis, V., & Sakellariou, A. (2019). Morton’s interdigital neuroma: instructional review. EFORT open reviews, 4(1), 14–24. https://doi.org/10.1302/2058-5241.4.180025

Chari, B., & McNally, E. (2018). Nerve Entrapment in Ankle and Foot: Ultrasound Imaging. Seminars in musculoskeletal radiology, 22(3), 354–363. https://doi.org/10.1055/s-0038-1648252

American College of Foot and Ankle Surgeons. Tarsal tunnel syndrome.

Centers for Disease Control and Prevention. Diabetes and nerve damage.

Feldman, E. L., Callaghan, B. C., Pop-Busui, R., Zochodne, D. W., Wright, D. E., Bennett, D. L., Bril, V., Russell, J. W., & Viswanathan, V. (2019). Diabetic neuropathy. Nature reviews. Disease primers, 5(1), 42. https://doi.org/10.1038/s41572-019-0097-9

Yoon, W. W., & Koch, J. (2021). Herniated discs: when is surgery necessary?. EFORT open reviews, 6(6), 526–530. https://doi.org/10.1302/2058-5241.6.210020

Lurie, J., & Tomkins-Lane, C. (2016). Management of lumbar spinal stenosis. BMJ (Clinical research ed.), 352, h6234. https://doi.org/10.1136/bmj.h6234

Staff, N. P., & Windebank, A. J. (2014). Peripheral neuropathy due to vitamin deficiency, toxins, and medications. Continuum (Minneapolis, Minn.), 20(5 Peripheral Nervous System Disorders), 1293–1306. https://doi.org/10.1212/01.CON.0000455880.06675.5a

Regenerative Medicine: Exploring Regenerative Cell Therapy

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

“Nowadays, individuals trying to avoid surgery have more therapy options. Can regenerative medicine help treat neuromusculoskeletal injuries?”

Regenerative Medicine: Exploring Regenerative Cell Therapy

Regenerative Medicine

Regenerative medicine utilizes the body’s raw cells and is used in cancer treatment and to reduce the risk of infections. (American Cancer Society. 2020) Researchers are looking for other ways to use these cells in medical therapies.

What are These Cells

Therapy

Regenerative cell therapy uses these cells as a treatment for a disease or condition.

  • Regenerative cells are given to individuals to replace cells that have been destroyed or have died.
  • In the case of cancer, they may be used to help the body regain the ability to produce regenerative cells after treatment. (American Cancer Society. 2020)
  • For individuals with multiple myeloma and certain types of leukemia, regenerative cell therapy is used to eliminate cancer cells.
  • The therapy is called graft-versus-tumor effect/GvT, where a donor’s white blood cells/WBCs are used to eliminate the cancerous tumor. (American Cancer Society. 2020)

What They Can Treat

This is a new treatment that is still going through research. The Food and Drug Administration has only approved it for certain cancers and conditions that affect the blood and immune system. (Centers for Disease Control and Prevention. 2019) Regenerative cell therapy is FDA-approved to treat: (National Cancer Institute. 2015)

  • Leukemia
  • Lymphoma
  • Multiple myeloma
  • Neuroblastoma
  • It is also used to decrease the risk of infection after regenerative cell transplantation in individuals with blood cancers. (U.S. Food & Drug Administration. 2023)

Researchers are studying how these cells can treat other conditions. Clinical trials are analyzing how to use the therapy for neurodegenerative diseases like:

  • Parkinson’s
  • Alzheimer’s
  • Multiple sclerosis – MS
  • Amyotrophic lateral sclerosis – ALS. (Riham Mohamed Aly. 2020)

Cell Types

During regenerative cell therapy, the cells are given through an intravenous line. The three places where blood-forming cells can be obtained are bone marrow, the umbilical cord, and blood. Transplants can include: (American Cancer Society. 2020)

Autologous

  • The cells are taken from the individual who will be receiving the therapy.

Allogeneic

  • The cells are donated by another individual.

Syngeneic

  • The cells come from an identical twin, if there is one.

Safety

The therapy has shown to provide benefits but there are risks.

  • One risk is known as graft-versus-host disease – GVHD.
  • It occurs in one-third to half of allogeneic recipients.
  • This is where the body does not recognize the donor’s white blood cells and attacks them causing problems and symptoms throughout the body.
  • To treat GVHD medications are given to suppress the immune system to stop attacking the donor cells. (American Cancer Society. 2020)

Other potential risks can include: (American Cancer Society. 2020)

  • Cancer relapse
  • New cancer
  • Hepatic veno-occlusive disease
  • Post-transplant lymphoproliferative disorder – PTLD

Future Possibilities

The future of regenerative cell therapy is promising. Research is ongoing to find out how these cells can treat conditions and find new ways to treat and cure diseases.
Regenerative medicine has been researched for over twenty years for conditions like macular degeneration, glaucoma, stroke, and Alzheimer’s disease. (National Institutes of Health. 2022) This therapy is a new medical treatment that could be used in future therapies as part of a multidisciplinary approach to neuromusculoskeletal injuries and conditions.

Quick Patient Initiation Process

References

American Cancer Society. (2020). How stem cell and bone marrow transplants are used to treat cancer.

National Institutes of Health. (2016). Stem cell basics.

Centers for Disease Control and Prevention. (2019). Stem cell and exosome products.

National Cancer Institute. (2015). Stem cell transplants in cancer treatment.

U.S. Food & Drug Administration. (2023). FDA approves cell therapy for patients with blood cancers to reduce risk of infection following stem cell transplantation.

Aly R. M. (2020). Current state of stem cell-based therapies: an overview. Stem cell investigation, 7, 8. https://doi.org/10.21037/sci-2020-001

American Cancer Society. (2020). Stem cell or bone marrow transplant side effects.

National Institutes of Health. (2022). Putting stem cell-based therapies in context.

Treating a Broken Collarbone: What You Need to Know

By
Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP
-
Senior patient having medical examination at orthopedist office.

“For individuals with a broken collarbone, can conservative treatment help in the rehabilitation process?”

Treating a Broken Collarbone: What You Need to Know

Broken Collarbone

Broken collarbones are very common orthopedic injuries that can occur in any age group. Also known as the clavicle, it is the bone over the top of the chest, between the breastbone/sternum and the shoulder blade/scapula. The clavicle can be easily seen because only skin covers a large part of the bone. Clavicle fractures are extremely common, and account for 2% – 5% of all fractures. (Radiopaedia. 2023) Broken collarbones occur in:

  • Babies – usually during birth.
  • Children and adolescents – because the clavicle does not fully develop until the late teens.
  • Athletes – because of the risks of being hit or falling.
  • Through various types of accidents and falls.
  • The majority of broken collarbones can be treated with nonsurgical treatments, usually, with a sling to let the bone heal and physical therapy and rehabilitation.
  • Sometimes, when clavicle fractures are significantly shifted out of alignment, surgical treatment may be recommended.
  • There are treatment options that should be discussed with an orthopedic surgeon, physical therapist, and/or a chiropractor.
  • A broken collarbone is not more serious than other broken bones.
  • Once the broken bone heals, most individuals have a full range of motion and can return to the activities before the fracture. (Johns Hopkins Medicine. 2023)

Types

Broken clavicle injuries are separated into three types depending on the location of the fracture. (Radiopaedia. 2023)

Mid-Shaft Clavicle Fractures

  • These occur in the central area which can be a simple crack, separation, and/or fractured into many pieces.
  • Multiple breaks – segmental fractures.
  • Significant displacement – separation.
  • Shortened length of the bone.

Distal Clavicle Fractures

  • These happen close to the end of the collarbone at the shoulder joint.
  • This part of the shoulder is called the acromioclavicular/AC joint.
  • Distal clavicle fractures can have similar treatment options as an AC joint injury.

Medial Clavicle Fractures

  • These are less common and often related to injury to the sternoclavicular joint.
  • The sternoclavicular joint supports the shoulder and is the only joint that connects the arm to the body.
  • Growth plate fractures of the clavicle can be seen into the late teens and early 20s.

Symptoms

Common symptoms of a broken collarbone include: (National Library of Medicine: MedlinePlus. 2022)

  • Pain over the collarbone.
  • Shoulder pain.
  • Difficulty moving the arm.
  • Difficulty raising the arm from the side.
  • Swelling and bruising around the shoulder.
  • The bruising can extend down to the chest and armpit.
  • Numbness and tingling down the arm.
  • Deformity of the collarbone.
  1. In addition to swelling, some individuals may have a bump in the place where the fracture occurred.
  2. It can take several months for this bump to fully heal, but this is normal.
  3. If the bump appears inflamed or irritated, inform a healthcare provider.

Clavicular Swelling

  • When the sternoclavicular joint swells up or gets bigger, it is referred to as clavicular swelling.
  • It is commonly caused by trauma, disease, or an infection that affects the fluid found in the joints. (John Edwin, et al., 2018)

Diagnosis

  • At the healthcare clinic or emergency room, an X-ray will be obtained to assess for the specific type of fracture.
  • They will perform an examination to ensure the nerves and blood vessels surrounding the broken collarbone are unsevered.
  • The nerves and vessels are rarely injured, but in severe cases, these injuries can occur.

Treatment

Treatment is accomplished either by allowing the bone to heal or by surgical procedures to restore the proper alignment. Some common treatments for broken bones are not used for clavicle fractures.

  • For example, casting a broken collarbone is not done.
  • In addition, resetting the bone or a closed reduction is not done because there is no way to hold the broken bone in proper alignment without surgery.

If surgery is an option the healthcare provider looks at the following factors: (UpToDate. 2023)

Location of Fracture and Degree of Displacement

  • Nondisplaced or minimally displaced fractures are usually managed without surgery.

Age

  • Younger individuals have an increased ability to recover from fractures without surgery.

Shortening of the Fracture Fragment

  • Displaced fractures can heal, but when there is a pronounced shortening of the collarbone, surgery is probably necessary.

Other Injuries

  • Individuals with head injuries or multiple fractures can be treated without surgery.

Patient Expectations

  • When the injury involves an athlete, heavy job occupation, or the arm is the dominant extremity, there can be more reason for surgery.

Dominant Arm

  • When fractures occur in the dominant arm, the effects are more likely to be noticeable.

The majority of these fractures can be managed without surgery, but there are situations where surgery can produce better results.

Supports for Non-surgical Treatment

  • A sling or figure-8 clavicle brace.
  • The figure-8 brace has not been shown to affect fracture alignment, and many individuals generally find a sling more comfortable. (UpToDate. 2023)
  1. Broken collarbones should heal within 6–12 weeks in adults
  2. 3–6 weeks in children
  3. Younger patients are usually back to full activities before 12 weeks.
  4. The pain usually subsides within a few weeks. (UpToDate. 2023)
  5. Immobilization is rarely needed beyond a few weeks, and with a doctor’s clearance light activity and gentle motion rehabilitation usually begins.

Long-Lasting Injuries

References

Radiopaedia. Clavicular fracture.

Johns Hopkins Medicine. Clavicle fractures.

National Library of Medicine: MedlinePlus. Broken collarbone – aftercare.

UpToDate. Clavicle fractures.

Edwin, J., Ahmed, S., Verma, S., Tytherleigh-Strong, G., Karuppaiah, K., & Sinha, J. (2018). Swellings of the sternoclavicular joint: review of traumatic and non-traumatic pathologies. EFORT open reviews, 3(8), 471–484. https://doi.org/10.1302/2058-5241.3.170078

Foot Detox: Boost Your Health and Wellness

By
Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP
-
Woman do foot bath herself at home

“For individuals with aches and pains throughout their body, can a foot detox help bring relief?”

Foot Detox For Pain Relief

Foot Detox

A foot detox involves soaking the feet in an ionic bath to help remove toxins from the body. They can also be performed using acupressure, scrubs, foot masks, and pads. Combined with eliminating toxins, detox is also believed to help enhance blood circulation and provide body pain and discomfort relief. However, current evidence is limited and there has been no evidence to support that toxins can be released from the feet using an ionic bath. However, they have been found to provide other benefits, which include:

  • Relaxation
  • Lower stress levels
  • Enhanced skin health and hydration.
  • Reduced inflammation in individuals with skin disorders.

Foot detoxes are considered generally safe, but individuals are recommended to speak to their healthcare provider.

Potential Benefits

The potential health benefits include:

  • Reduces inflammation and swelling.
  • Improves stress levels and mood.
  • Can help with weight management.
  • Can help with heart health and increased blood circulation.
  • Relieves aches and pains.
  • Balances pH levels.
  • Eliminate harmful pathogens and microorganisms.

However, most reports surrounding the benefits of foot detox are not proven by research investigating whether the health claims are scientifically accurate. One study in 2012 found that foot detoxes did not produce the intended results and could not help remove toxins from the body. (Deborah A. Kennedy, et al., 2012) Other research surrounding foot baths and massages showed that they could help reduce symptoms of mood disorders like schizophrenia because of the relaxing effect they produce. (Kazuko Kito, Keiko Suzuki. 2016)

Ways Toxins are Removed From the Body

Toxins are filtered out of the body in a variety of ways. Breathing out expels carbon dioxide from the body. Another way is through the body’s natural processes. The body has organs and other systems to filter out and release toxins.

  • Specific organs, such as the liver, kidneys, and lymph nodes, filter and remove harmful and unneeded substances. (UW Integrative Health. 2021)
  • The health claims surrounding toxin removal through the feet are currently insubstantial because no evidence supports the effectiveness and the anecdotal evidence is not based on science.
  • Water tested after foot detoxes did not detect any toxins. (Deborah A. Kennedy, et al., 2012)

Types

Foot detoxes can be an enjoyable experience that can help relieve sore feet, relax the body, and offer relief for certain foot ailments. They could be an excellent addition to a self-care routine. Some of the most commonly used natural foot detoxes include the following.

Epsom Salt Foot Bath

Apple Cider Vinegar

  • Apple cider vinegar foot baths are made by diluting 1 cup of vinegar in warm water and soaking the feet for 20–30 minutes.
  • There is limited research available to confirm the health claims.
  • The studies that have been done have found the reverse effect, that bathing the feet in apple cider vinegar and water can irritate the skin. (Lydia A Luu, et al., 2021)

Baking Soda and Sea Salt

Sea salt combined with baking soda dissolved in a bath and soak the feet for up to 30 minutes. While research is limited, some evidence supports the health benefits associated with sea salt that include: (Ehrhardt Proksch, et al., 2005)

  • Enhances skin hydration.
  • Improve skin barrier function. (Kanwar A. J. 2018)
  • Reduces inflammation in skin conditions, like atopic dermatitis.

Foot baths should be avoided for the following:

  • There are open sores on the feet that could be irritated by salt and other foot bath ingredients.
  • Individuals with a pacemaker or any electrical body implant.
  • Pregnant women.
  • Consult a healthcare provider before trying any new health protocols.

Foot Orthotics Benefits

References

Kennedy, D. A., Cooley, K., Einarson, T. R., & Seely, D. (2012). Objective assessment of an ionic footbath (IonCleanse): testing its ability to remove potentially toxic elements from the body. Journal of environmental and public health, 2012, 258968. https://doi.org/10.1155/2012/258968

Kito, K., & Suzuki, K. (2016). Research on the Effect of the Foot Bath and Foot Massage on Residual Schizophrenia Patients. Archives of psychiatric nursing, 30(3), 375–381. https://doi.org/10.1016/j.apnu.2016.01.002

UW Integrative Health. Improving your health by removing toxins from your body.

Akyuz Ozdemir, F., & Can, G. (2021). The effect of warm salt water foot bath on the management of chemotherapy-induced fatigue. European journal of oncology nursing: the official journal of European Oncology Nursing Society, 52, 101954. https://doi.org/10.1016/j.ejon.2021.101954

Vakilinia, S. R., Vaghasloo, M. A., Aliasl, F., Mohammadbeigi, A., Bitarafan, B., Etripoor, G., & Asghari, M. (2020). Evaluation of the efficacy of warm salt water foot-bath on patients with painful diabetic peripheral neuropathy: A randomized clinical trial. Complementary therapies in medicine, 49, 102325. https://doi.org/10.1016/j.ctim.2020.102325

Luu, L. A., Flowers, R. H., Gao, Y., Wu, M., Gasperino, S., Kellams, A. L., Preston, D. C., Zlotoff, B. J., Wisniewski, J. A., & Zeichner, S. L. (2021). Apple cider vinegar soaks do not alter the skin bacterial microbiome in atopic dermatitis. PloS one, 16(6), e0252272. https://doi.org/10.1371/journal.pone.0252272

Proksch, E., Nissen, H. P., Bremgartner, M., & Urquhart, C. (2005). Bathing in a magnesium-rich Dead Sea salt solution improves skin barrier function, enhances skin hydration, and reduces inflammation in atopic dry skin. International journal of dermatology, 44(2), 151–157. https://doi.org/10.1111/j.1365-4632.2005.02079.x

Kanwar A. J. (2018). Skin barrier function. The Indian Journal of Medical Research, 147(1), 117–118. https://doi.org/10.4103/0971-5916.232013

Maintaining Gut Flora Balance

By
Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP
-
Conception of healthy eating. With woman. Doctor in formal clothes is working in the cabinet.

For individuals with stomach issues, can maintaining gut flora balance promote and improve gut health?

Maintaining Gut Flora Balance

Gut Flora Balance

Maintaining gut flora balance is part of optimal digestive health. Gut microbiota, gut microbiome, or gut flora, are the microorganisms, including bacteria, archaea, fungi, and viruses that live in the digestive tract. The type and amount of bacteria present depend on their location in the body which could be the small intestine and colon. This is the storage housing for waste/stool, and the colon comprises hundreds of different types of bacteria, which have specific jobs and functions.

Unhealthy Flora

The more common pathogens are bacteria that can cause illness if left unchecked, including germs like streptococcus/strep throat or E. coli/urinary tract infections and diarrhea. Other common germs found in the colon include: (Elizabeth Thursby, Nathalie Juge. 2017)

Clostridioides Difficile

  • C. diff overgrowth can cause watery foul-smelling stools daily, and abdominal pain and tenderness.

Enterococcus Faecalis

  • Enterococcus faecalis is a cause of post-surgical abdominal and urinary tract infections.

Escherichia Coli

  • E. coli is the most common cause of diarrhea in adults.
  • This bacteria is present in almost every healthy adult’s colon.

Klebsiella

  • Klebsiella overgrowth is associated with a Western diet that consists of various meat and animal products.

Bacteroides

  • Bacteroide overgrowth is associated with colitis, which causes painful inflammation of the colon.

Healthy Flora

Healthy bacteria like Bifidobacteria and Lactobacillus, help maintain gut flora balance and keep the unhealthy bacteria in check. Without healthy flora, the entire colon can become overrun by bad flora, which can result in symptoms like diarrhea and/or illness. (Yu-Jie Zhang, et al., 2015) These protective, microscopic germs have important functions that include:

  • Assisting with vitamin synthesis – vitamins B and K in the small intestine.
  • Increases immune system function.
  • Maintaining regular bowel movements.
  • Maintaining a clean colon naturally without the need for colon cleansers.
  • Destroying the unhealthy bacteria.
  • Preventing unhealthy bacteria overgrowth.
  • Breaking up gas bubbles from food fermentation.

Bacterial Dismantling

Whether labeled as healthy bacteria or unhealthy, they are both single-celled organisms that can be destroyed quite easily. Sometimes, it is necessary, like when having to take antibiotics to kill a strep throat infection. However, the antibiotics also kill the beneficial bacteria, which can lead to compounding problems that can include: (Mi Young Yoon, Sang Sun Yoon. 2018)

  • Bowel irregularity – diarrhea and constipation.
  • Yeast overgrowth – can cause itching, burning around the anus and lead to vaginal and oral yeast infections.
  • Dysbiosis – the technical name for a lack of healthy bacteria or a bacterial imbalance.
  • Complications for individuals suffering from irritable bowel syndrome.

There are different ways to destroy bacteria including.

  • Individuals who need to take antibiotics to cure an infection. (Eamonn M M Quigley. 2013)
  • Chronic laxative use.
  • Fiber supplementation overuse.
  • Prolonged diarrhea – can flush out the bad and good bacteria.
  • Stress
  • Completing a bowel prep, like those required for a colonoscopy.

Diagnosing Gut Flora Issues

Many times, problems with gut flora will correct themselves, and no action is required. However, individuals facing chronic bowel problems, like colitis or inflammatory bowel disease, may require medical intervention of their colon’s bacteria.

  • Comprehensive Digestive Stool Analysis/CDSA is a stool test that checks what type and amount of bacteria are present, nutrient absorption rates/digestion speed, and how well food is digested.
  • If there is a significant difference in the proportion of unhealthy versus beneficial bacteria, a healthcare provider may suggest taking a probiotic or a live microbial supplement to help repopulate and maintain gut flora balance.

Gut Dysfunction

References

Thursby, E., & Juge, N. (2017). Introduction to the human gut microbiota. The Biochemical journal, 474(11), 1823–1836. https://doi.org/10.1042/BCJ20160510

Zhang, Y. J., Li, S., Gan, R. Y., Zhou, T., Xu, D. P., & Li, H. B. (2015). Impacts of gut bacteria on human health and diseases. International journal of molecular sciences, 16(4), 7493–7519. https://doi.org/10.3390/ijms16047493

Yoon, M. Y., & Yoon, S. S. (2018). Disruption of the Gut Ecosystem by Antibiotics. Yonsei medical journal, 59(1), 4–12. https://doi.org/10.3349/ymj.2018.59.1.4

Quigley E. M. (2013). Gut bacteria in health and disease. Gastroenterology & hepatology, 9(9), 560–569.

Tennis Weight Training

By
Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP
-
Young woman playing tennis

“Tennis requires strength, power, and endurance. Can combining tennis weight training into a player’s fitness regimen that is broken up into phases achieve optimal results?”

Tennis Weight Training

Tennis Weight Training

In professional sports that utilize weight lifting, the training is often broken up into seasonal phases. (Daniel S Lorenz, Michael P Reiman, John C Walker. 2010) Each phase consists of specific objectives that contribute to and build upon the previous phase. This is known as periodization. Tennis is played year-round indoors and outdoors. This is an example of a tennis weight training program to build up strength.

Pre-Season

  • In the early pre-season, players prepare to rebuild their strength after a break.
  • The emphasis is on building functional strength and some muscle.

Late Pre-Season

  • In late pre-season, players workout to get ready for the start of the season.
  • Here, the emphasis is on building maximum power.

In Season

  • In season, regular practice, play, and competition get underway and players are in top condition.
  • In this phase, strength and power maintenance is the focus.

Season Break

  • This is when players need to relax for a while.
  • However, players need to keep active if they want to maintain some level of fitness.
  • The emphasis is on rest and recovery with the maintenance of light activity, like cross-training and light gym workouts.
  • Research has shown that taking a break from serious strength training does help the body recover and rebuild. (Daniel Lorenz, Scot Morrison. 2015)
  1. This is a three-phase all-around program.
  2. The first phase concentrates on building basic strength and muscle
  3. The second phase on power delivery.
  4. Players who play year-round can continue with the power program once they build the basics.
  5. Players who take a break for longer than six weeks should start again with the strength program.

Pre-Season – Phase One

Strength and Muscle

  • The focus is on lifting heavy weights, but not going full force to begin training the nervous system to work with the muscle fibers.
  • Some muscle building or hypertrophy/building muscle size will happen during strength development.
  • Strength is the foundation for the power development phase.

Exercises:

  1. Duration: 6-8 weeks
  2. Workout Days: 2-3, with at least one day, however, two are recommended between sessions.
  3. Reps: 8-10
  4. Sets: 2-4
  5. Rest between sets: 1-2 minutes
  • Barbell squat, dumbbell squat, or sled hack squat
  • Romanian deadlift
  • Dumbbell bent-over row
  • Dumbbell triceps extension or machine pushdown
  • Cable wood chop
  • Lat pulldown to the front with a wide grip
  • Reverse crunch

Things to Remember

Use the Proper Weight

  • Adjust the weight so that the last reps are heavy but don’t cause a complete failure.

Balance the Lower Half

  • The posterior chain of the hips, the gluteals/buttocks, the upper legs, and the abdominals are of equal importance and require equal attention. (Eline Md De Ridder, et al., 2013)
  • Squats and deadlifts build strength and power in this region.

Follow Proper Form

  • For upper body exercises like the dumbbell press, lat pulldown, and wood chops the proper form needs to be followed.
  • Keep the forearms in a vertical plane with the upper arms.
  • Do not extend excessively at the bottom of the movement.
  • Remember to protect the vulnerable shoulder joint.

Listen to The Body

  • Strength training is physically and mentally challenging.
  • Individuals who are not able to recover from a session with only one rest day are recommended to move the program to two sessions per week.
  • Muscle soreness or delayed onset muscle soreness – DOMS – is normal, however, joint pain is not.
  • Monitor arm and shoulder reactions during this phase.
  • Stop if any joint pain or discomfort is felt.

Late Pre-Season – In-Season – Phase Two

Power

Power is the ability to move the heaviest loads in the shortest time and is the combination of strength and speed. In this phase, the player builds on the strength developed in phase one with tennis weight training that will increase the ability to move a load at high velocity.

  • Power training requires lifting weights at high velocity and with explosiveness.
  • The body needs to rest adequately between repetitions and sets so that each movement is done as fast as possible.
  • The number of sets can be less than phase one because there is no point in training at this level when the body is fatigued.

Exercises

  1. Duration: Ongoing
  2. Days per week: 2
  3. Reps: 8 to 10
  4. Sets: 2-4
  5. Rest between repetitions: 10 to 15 seconds​
  6. Rest between sets: at least 1 minute or until recovered
  • Barbell or dumbbell hang clean
  • Cable push-pull
  • Cable wood chop
  • One arm cable raises
  • Medicine ball push press
  • Medicine ball standing twist with a partner or alone – 6×15 repetitions fast and recover between sets.

Reminders When Preparing For the Season

Recovery Time

  • In power training, it’s important that the body has relatively recovered for each repetition and set so that the individual can maximize the movement.
  • The weights should not be as heavy and the rest periods sufficient.

Push When Possible

  • Rest is important, at the same time, the player needs to push through reasonably heavy loads to develop power against significant resistance.
  • When doing medicine ball twists, do a full set at maximum, then sufficiently rest before the next one.
  • If doing the medicine ball exercises alone, use a lighter ball and keep the ball in your hands while twisting.

In Season – Phase Three

When the season begins training does not stop in order to help maintain strength and power.

Strength and Power Maintenance

  • Alternate phase one and phase two for a total of two sessions each week.
  • Every fifth week, skip weight training to achieve optimal recovery.

Key Points

Things to keep in mind during the season.

Avoid Overscheduling

  • Avoid strength training on the same day when practicing on the court.
  • If the weight training has to be both on the same day, try to separate the workouts into morning and afternoon sessions.

Plan Time

  • Rest completely from strength training one week out of every six.
  • Light gym work is fine.
  • During the season, use intuition when it comes to working out at the gym.
  • Individuals with limited time, stick to court skills training instead of tennis weight training.

Off Season

If there is an off-season, this is the time for emotional and physical decompression and full-body recovery.

  • For several weeks, forget about weight training and do other things.
  • Stay fit and active with cross-training or other physical activities but keep it light to prevent injuries.

It is recommended to consult a coach, trainer, sports chiropractor, and/or physical therapist to develop a program specific to an individual’s needs, fitness goals, and access to resources.

Spine Injuries In Sports

References

Lorenz, D. S., Reiman, M. P., & Walker, J. C. (2010). Periodization: current review and suggested implementation for athletic rehabilitation. Sports health, 2(6), 509–518. https://doi.org/10.1177/1941738110375910

Lorenz, D., & Morrison, S. (2015). CURRENT CONCEPTS IN PERIODIZATION OF STRENGTH AND CONDITIONING FOR THE SPORTS PHYSICAL THERAPIST. International journal of sports physical therapy, 10(6), 734–747.

De Ridder, E. M., Van Oosterwijck, J. O., Vleeming, A., Vanderstraeten, G. G., & Danneels, L. A. (2013). Posterior muscle chain activity during various extension exercises: an observational study. BMC musculoskeletal disorders, 14, 204. https://doi.org/10.1186/1471-2474-14-204

Fixed Sagittal Imbalance

By
Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP
-
Back pain often occurs with employees who work in warehouses, Because they have to pull, lift, and push goods throughout the day of work.

“Individuals with fixed sagittal imbalance, a condition where the normal curve of the lower spine is greatly reduced or absent altogether that can cause pain and difficulty balancing. Can chiropractic treatment, physical therapy, and exercise help improve the condition?”

Fixed Sagittal Imbalance

Fixed Sagittal Imbalance

The condition is commonly known as flat back syndrome and can be present at birth or can happen as a result of surgery or a medical condition.

  • It can also happen for other reasons, including degenerative disc disease, traumatic injury, or as a result of spinal surgery. (Columbia University Irving Medical Center. 2023)
  • Individuals with flat back syndrome position their head and neck too far forward.
  • A major symptom is difficulty standing for long periods of time.

Symptoms

The spine has two curves. The lumbar spine in the lower back and cervical spine in the neck curve inward. The thoracic spine in the upper back curves outward. The curves are part of the spine’s natural alignment. They help the body balance and maintain the center of gravity.

  • If these curves begin to disappear the body can have trouble and difficulty standing up straight.
  • The loss of curvature causes the head and neck to pitch forward, making it hard to walk and do regular normal activities.
  • Individuals have to flex their hips and knees and adjust their pelvis in order to stand up straight. (Columbia University Irving Medical Center. 2023)
  • There is a tendency to stoop forward which gradually increases and can even feel like the body is falling forward.
  • By the end of the day, the body is exhausted from the strain of trying to maintain balance.

Causes

Some causes of fixed sagittal imbalance include: (Columbia University Irving Medical Center. 2023)

  • Congenital – present at birth.
  • Degenerative disc disease.
  • Ankylosing spondylitis – a type of inflammatory arthritis of the spine.
  • Compression fractures of the vertebrae – for example, caused by osteoporosis.
  • The condition used to be common after spine surgery to correct scoliosis/abnormal curvature of the spine.
  • The devices implanted could cause flat back syndrome, especially for older individuals.
  • However, new and updated surgical techniques have decreased the complications.

Diagnosis

A doctor will ask about medical history, injuries, or back surgery. This will followed by a physical exam, that can include:

  • A musculoskeletal exam.
  • A neurologic exam.
  • A gait examination will assess standing and walking ability.
  • The gait exam is done because the gait can change to compensate for the loss of the curvature.
  • X-ray imaging will show spinal alignment.
  • Other possible sources of symptoms will be considered before a diagnosis can be confirmed.

Treatment

Treatment often involves physical therapy and exercise, bracing to provide increased support, and sometimes surgery.

  • Physical therapy typically begins with stretching and targeted strengthening exercises to improve posture.
  • The goal is to reverse the pattern of muscle imbalance that keeps the lower back flat.
  • Exercises to strengthen the neck, rear shoulder muscles, back, core, and buttocks can include: (National Health Service. n.d.)
  • Abdominal stretches
  • Hamstring stretches.
  1. Hamstring stretches improve the alignment of the lumbar spine.
  2. Hold the stretch for about 30 seconds at a time.
  3. Repeat three to five times once or twice a day.
  • Back extensions
  • Chest stretches
  • Planking
  • Side-lying leg raises
  • Seated rows in a gym or pull-ups

In severe cases, patients may need corrective surgery. A few options include: (Columbia University Irving Medical Center. 2023)

A chiropractor and/or physical therapist can recommend exercises and other forms of treatment. (Won-Moon Kim, et al., 2021)

Life-Changing Chiropractic Relief

References

Columbia University Irving Medical Center. Flatback syndrome.

National Health Service. Common posture mistakes and fixes.

Lee, B. H., Hyun, S. J., Kim, K. J., Jahng, T. A., Kim, Y. J., & Kim, H. J. (2018). Clinical and Radiological Outcomes of Posterior Vertebral Column Resection for Severe Spinal Deformities. Journal of Korean Neurosurgical Society, 61(2), 251–257. https://doi.org/10.3340/jkns.2017.0181

Kim, W. M., Seo, Y. G., Park, Y. J., Cho, H. S., & Lee, C. H. (2021). Effect of Different Exercise Types on the Cross-Sectional Area and Lumbar Lordosis Angle in Patients with Flat Back Syndrome. International journal of environmental research and public health, 18(20), 10923. https://doi.org/10.3390/ijerph182010923

Sciatic Endometriosis

By
Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP
-
Young woman with back spine pain ache sitting on sofa

“Can combining chiropractic treatment with the common therapies of medication, exercise, and/or physical therapy help relieve sciatic endometriosis pain symptoms?”

Sciatic Endometriosis

Sciatic Endometriosis

Sciatic endometriosis is a condition in which endometrial cells (tissue that resembles the lining of the uterus) grow outside of the uterine lining and compress the sciatic nerve. This places stress and pressure on the nerve causing back, pelvic, hip, and leg pain, especially before and during the menstrual cycle. It can also cause pain, irregular periods, and infertility. (The American College of Obstetricians and Gynecologists. 2021)

  • These areas of endometrial tissue growth are also known as lesions or implants.
  • Women with sciatic endometriosis often experience leg pain and weakness around the time of their menstrual cycle. (Lena Marie Seegers, et al., 2023)
  • Sciatic endometriosis can also cause pain when urinating, during a bowel movement, during sex, and fatigue, and irregular vaginal bleeding.

The Sciatic Nerve

  • Typically, endometrial lesions grow and attach to the ovaries, fallopian tubes, bladder, intestines, rectum, or peritoneum/abdominal cavity lining. (The American College of Obstetricians and Gynecologists. 2021)
  • The abnormal growth may be caused by higher-than-normal levels of estrogen.
  • Researchers believe that endometriosis is related to retrograde menstruation, which causes menstrual blood to flow back into the pelvis instead of out through the vagina. (World Health Organization. 2023)
  • Sometimes, the cells grow in the area of the pelvis right above the sciatic nerve. (Adaiah Yahaya, et al., 2021)
  • The sciatic nerve is the longest nerve in the body and travels down the back of each leg. (Johns Hopkins Medicine. 2023)
  • When endometrial lesions place pressure on the sciatic nerve, they can cause irritation and inflammation leading to severe pelvic pain, which makes it harder to conceive. (Liang Yanchun, et al., 2019)

Symptoms

Some women with endometriosis experience no symptoms or misinterpret the symptoms as typical premenstrual syndrome/PMS signs. The most common signs and symptoms of sciatic endometriosis include:

  • Difficulty walking or standing.
  • Loss of sensation, muscle weakness, and reflex alteration.
  • Limping.
  • Balance problems.
  • Bloating and nausea.
  • Constipation or diarrhea before or after a period.
  • Painful, heavy, and/or irregular periods.
  • Bleeding between periods.
  • Pain during sex, urination, and bowel movements.
  • Pain in the stomach, pelvis, lower back, hips, and buttocks. (MedlinePlus. 2022)
  • Weakness, numbness, tingling, burning, or dull aching sensations in the back of one or both legs.
  • Foot drop or trouble lifting the front of the foot. (Center for Endometriosis Care. 2023)
  • Infertility.
  • Fatigue.
  • Depression and anxiety.

Diagnosis

Endometriosis, including sciatic endometriosis, typically cannot be diagnosed with a pelvic examination or ultrasound by themselves. A healthcare provider may need to perform a biopsy using laparoscopy and discuss menstrual cycles, symptoms, and medical history.

  • The laparoscopy procedure involves making tiny incisions and taking a tissue sample with tools attached to a thin tube with a camera. (MedlinePlus. 2022)
  • Imaging tests, like magnetic resonance imaging/MRI, and computed tomography/CT scans, can help provide essential information about the location and size of any endometrial lesions. (The American College of Obstetricians and Gynecologists. 2021)

Treatment

Symptoms can sometimes be temporarily relieved with over-the-counter/OTC pain relievers. Depending on the condition and severity a healthcare provider may prescribe hormonal treatment to prevent new endometrial implants from growing. These can include:

Sciatica In Depth

References

The American College of Obstetricians and Gynecologists. Endometriosis.

Seegers, L. M., DeFaria Yeh, D., Yonetsu, T., Sugiyama, T., Minami, Y., Soeda, T., Araki, M., Nakajima, A., Yuki, H., Kinoshita, D., Suzuki, K., Niida, T., Lee, H., McNulty, I., Nakamura, S., Kakuta, T., Fuster, V., & Jang, I. K. (2023). Sex Differences in Coronary Atherosclerotic Phenotype and Healing Pattern on Optical Coherence Tomography Imaging. Circulation. Cardiovascular imaging, 16(8), e015227. https://doi.org/10.1161/CIRCIMAGING.123.015227

World Health Organization. Endometriosis.

Yahaya, A., Chauhan, G., Idowu, A., Sumathi, V., Botchu, R., & Evans, S. (2021). Carcinoma arising within sciatic nerve endometriosis: a case report. Journal of surgical case reports, 2021(12), rjab512. https://doi.org/10.1093/jscr/rjab512

Johns Hopkins Medicine. Sciatica.

Yanchun, L., Yunhe, Z., Meng, X., Shuqin, C., Qingtang, Z., & Shuzhong, Y. (2019). Removal of an endometrioma passing through the left greater sciatic foramen using a concomitant laparoscopic and transgluteal approach: case report. BMC women’s health, 19(1), 95. https://doi.org/10.1186/s12905-019-0796-0

MedlinePlus. Endometriosis.

Center for Endometriosis Care. Sciatic endometriosis.

Chen, S., Xie, W., Strong, J. A., Jiang, J., & Zhang, J. M. (2016). Sciatic endometriosis induces mechanical hypersensitivity, segmental nerve damage, and robust local inflammation in rats. European journal of pain (London, England), 20(7), 1044–1057. https://doi.org/10.1002/ejp.827

Siquara de Sousa, A. C., Capek, S., Howe, B. M., Jentoft, M. E., Amrami, K. K., & Spinner, R. J. (2015). Magnetic resonance imaging evidence for perineural spread of endometriosis to the lumbosacral plexus: report of 2 cases. Neurosurgical focus, 39(3), E15. https://doi.org/10.3171/2015.6.FOCUS15208

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