Living with Annular Fissure: Lifestyle Changes and Medical Care

Shot of a young female doctor showing a patient a digital x-ray in an office.

An annular fissure is caused by age-related changes to the spine, which often do not cause symptoms but can cause back pain. Can understanding the causes help individuals manage lower back pain and help healthcare providers develop an effective treatment program?

Table of Contents

Annular Fissure

An annular fissure is a discogenic condition that affects the spine and can cause lower back pain. Also called an annular tear, it’s usually a wear-and-tear condition that happens over time rather than a condition caused by trauma. It usually happens when the fibers that make up the annulus or the tough outer covering of the intervertebral disc break or separate. To manage it, healthcare providers may recommend:

Making lifestyle changes.
Staying aware of how you go about daily activities and take steps to make adjustments, such as being mindful of unhealthy posture.
Start doing exercises that help make the back stronger.
Medical care if pain and other symptoms need to be managed.

Symptoms

Lower back pain may be a sign of an annular fissure, or there may be no symptoms. Symptoms can include:

Pain
Weakness
Numbness
Electrical sensations travel down one leg or arm if a cervical/neck tear is present.
Numbness and weakness may be caused by the nerves getting irritated or compressed near an annular tear. (Stadnik, T. W. et al., 1998)
These symptoms can also be similar to a herniated disc, which can be a complication of an annular fissure.
However, studies have shown that annular tears and herniated discs often go unnoticed because they have few obvious symptoms. (Jarvik, J. G. et al., 2005)

Annulus Function

The annulus comprises several layers of tough fibers/fibrocartilage that surround, contain, and protect the soft, liquid nucleus inside the disc. The layers of the annulus fibrosus crisscross to provide support. The nucleus is a shock absorber cushions the body’s weight on the spinal joints when sitting, standing, or moving. Its strength also allows the disc to buffer the jolts and jars it experiences. It also helps maintain the integrity of the intervertebral joint by supporting the space between the two vertebrae. When an annular fissure occurs, the fibers separate or tear off from insertion on the nearby spinal bone. A fissure can also be a break in the fibers of one or more layers. (Jarvik, J. G. et al., 2005)

Causes

An annular tear is not the standard term medical professionals use to describe or diagnose a fissure because the word tear suggests that trauma has led to the separation or break in the fibers. While an injury can cause an annular fissure, it’s usually caused by long-term wear and tear. (Guterl, C. C. et al., 2013) The tears are typically caused by age-related degenerative changes in the disc, which can also lead to degeneration in other areas of the spine. Wear and tear are caused by annular fissures due to an individual’s daily living habits, such as sitting, standing, walking, climbing stairs, and performing other routine movements.

Treatment

While a large annular fissure is not likely to improve without treatment, a small one could heal independently. However, once an area has torn, it becomes more likely to continue tearing. (Virginia Spine Institute, N.D.) Conservative treatment is usually enough to control pain and symptoms. Physical therapy and anti-inflammatory medication are the first line of treatment. (Cheng, J. et al., 2019) Medication can be over-the-counter or prescription. Physical therapy treatment includes exercises, traction, and other therapies. If these do not help with the symptoms, the provider may suggest a steroid injection to reduce inflammation and pain. It can take three to six months to recover from degenerative disc problems if doing a standard treatment plan that includes rest, low-impact therapy exercises, and anti-inflammatory treatments. (Cheng, J. et al., 2019)

In severe cases, surgery may be recommended, including disc replacement surgery. An annular tear is not a reason to have disc replacement surgery alone; it is only when there are degenerative changes in the vertebral disc that surgery might be necessary. (Yue, J. J. et al., 2012)

Improving Body Alignment

Not paying attention and being aware of how the body performs everyday activities can, over time, set the stage for an annular fissure and other musculoskeletal injuries. However, fixing daily movement and posture habits to prevent injuries can be done through simple adjustments. For example, strengthening the core and back muscles can reduce pressure on the spine and help prevent injuries. (Camp, C. L. et al., 2016) The idea is to improve joint and overall body alignment. Activities can include:

Strength training
Walking
Pilates classes
Yoga
Tai chi
Somatic exercises

These activities help with muscle balance and joint alignment, which are recommended prevention strategies that physical therapists use when working with individuals who need help with spinal problems.

Visiting a chiropractic and physical therapy team can help treat injuries and chronic pain syndromes, relieve pain, resolve musculoskeletal issues, and prevent future symptoms. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop a personalized care program for each patient through an integrated approach to treating injuries, improving flexibility, mobility, and agility to help return to normal and optimal function. If other treatments are needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments.

Back Pain Specialist

References

Stadnik, T. W., Lee, R. R., Coen, H. L., Neirynck, E. C., Buisseret, T. S., & Osteaux, M. J. (1998). Annular tears and disk herniation: prevalence and contrast enhancement on MR images in the absence of low back pain or sciatica. Radiology, 206(1), 49–55. doi.org/10.1148/radiology.206.1.9423651

Jarvik, J. G., Hollingworth, W., Heagerty, P. J., Haynor, D. R., Boyko, E. J., & Deyo, R. A. (2005). Three-year incidence of low back pain in an initially asymptomatic cohort: clinical and imaging risk factors. Spine, 30(13), 1541–1549. doi.org/10.1097/01.brs.0000167536.60002.87

Guterl, C. C., See, E. Y., Blanquer, S. B., Pandit, A., Ferguson, S. J., Benneker, L. M., Grijpma, D. W., Sakai, D., Eglin, D., Alini, M., Iatridis, J. C., & Grad, S. (2013). Challenges and strategies in the repair of ruptured annulus fibrosus. European cells & materials, 25, 1–21. doi.org/10.22203/ecm.v025a01

Virginia Spine Institute. (N.D.). Annular disc tear Understanding the Symptoms, Causes, and Treatments. www.spinemd.com/conditions/annular-disc-tear/

Cheng, J., Santiago, K. A., Nguyen, J. T., Solomon, J. L., & Lutz, G. E. (2019). Treatment of symptomatic degenerative intervertebral discs with autologous platelet-rich plasma: follow-up at 5-9 years. Regenerative medicine, 14(9), 831–840. doi.org/10.2217/rme-2019-0040

Yue, J. J., Telles, C., Schlösser, T. P., Hermenau, S., Ramachandran, R., & Long, W. D., 3rd (2012). Do presence and location of annular tear influence clinical outcome after lumbar total disc arthroplasty? A prospective 1-year follow-up study. International journal of spine surgery, 6, 13–17. doi.org/10.1016/j.ijsp.2011.09.001

Camp, C. L., Conti, M. S., Sgroi, T., Cammisa, F. P., & Dines, J. S. (2016). Epidemiology, Treatment, and Prevention of Lumbar Spine Injuries in Major League Baseball Players. American journal of orthopedics (Belle Mead, N.J.), 45(3), 137–143.

Discover the Amazing Health Benefits of Lemongrass

Dr. Alex Jimenez

lemon grass on white background — lemon grass on a white background

Can incorporating lemongrass into a diet help individuals manage anxiety, colds, fever, inflammation, and insomnia?

Table of Contents

Lemongrass

Lemongrass, or lemongrass or citronella, is a tall grass-like herb commonly used in Southeast Asian cooking. The lower stalks and bulbs of the plant have a fresh, clean, lemony scent that is sometimes added to marinades, teas, curries, and broths. In addition to its flavoring use, lemongrass’s essential oils are used for medicinal purposes, supported by scientific evidence.

Benefits

Lemongrass has been shown to help with common ailments, such as anxiety, colds, fever, inflammation, and insomnia. It can be eaten, rubbed on the skin, or inhaled as an aromatherapy treatment. When taken orally, it is often used to calm stomach discomfort and other gastrointestinal issues, including cramps and vomiting. (DeFilipps, R. A. et al., 2018) When used as a tea, it protects the stomach lining by treating stomach ailments, indigestion, and gastric ulcers. (Khan, Nida. 2020) Lemongrass or oil is applied to the skin to treat headaches and musculoskeletal pain. As an aromatherapy treatment, the oil extract may be inhaled to treat muscle pain, infections, colds, and flu symptoms. Consumed it can help treat:

Musculoskeletal pain
Sleeplessness
Rheumatism
Cough
Common cold
Fever
Anxiety
Hypertension
Diabetes
Epilepsy
Cancer prevention

However, a few studies support certain lemongrass benefits. Research has suggested that lemongrass oil added to a hair tonic may reduce dandruff. However, more studies are needed to confirm. (Chaisripipat, W. et al., 2015)

Essential Oil

Lemongrass essential oil has been studied and has been found to contain significant bioactive compounds that include:

Citral
Isoneral
Isogeranial
Geraniol
Geranyl acetate
Citronellal
Citronellol
Germacrene-D
Elemol

These compounds contain antifungal, antibacterial, antiviral, anticancer, and antioxidant properties. (Mukarram, M. et al., 2021) Research also shows that essential oils can be therapeutic agents for treating inflammatory skin conditions and help reduce dandruff because of their antimicrobial and anti-inflammatory properties. They can also inhibit the growth of the fungi associated with causing dandruff. (Khan, Nida. 2020)

Nutrition

One tablespoon of fresh lemongrass provides around five calories, most from carbohydrates/fiber and protein. (U.S. Department of Agriculture, 2018) It is a source of fiber, carbohydrates, and vitamins A, B, and C, strengthening the body’s immune system, repairing tissue damage, and promoting cell division. It also contains:

Magnesium – Necessary for protein synthesis, glycolysis, and muscle activity,
Selenium – Necessary for cognitive function and fertility.
Phosphorus – Necessary for DNA/RNA and cell membrane synthesis.
Zinc for wound healing, growth, and development. (Khan, Nida. 2020)

Minerals include:

Calcium – 3 milligrams
Potassium – 34 milligrams
Manganese – 0.2 milligrams
Magnesium – 2.9 milligrams
Iron – 0.4 milligrams

It also provides small amounts of vitamins, including A and C, folate, and niacin. However, lemongrass-flavored oil contains significantly more calories because it usually combines cooking oil with lemongrass extract.

Preparation and Storage

Lemongrass is becoming easier to find in stores. When choosing lemongrass, look for firm green stalks with healthy-looking bulbs attached. Some stores may sell the stalks with a good portion of the top removed. This is fine, as many recipes require using the bottom of the stalk or the bulb. To use lemongrass in teas, soups, broth, or other liquids, crush the stalks’ bottom area to release the aromatic oil. Then, immerse the pieces in the liquid to release the oils. Remove the stalks before eating or drinking the beverage. In other recipes, chopping or mincing the bulb or lower area of the stalks may be necessary before adding to a curry, salad, marinade, or stir-fry. Lemongrass can be wrapped in plastic and refrigerated for two to three weeks or frozen for up to 6 months.

Potential Side Effects

Lemongrass is safe for most when consumed in typical amounts in food. However, some concerns may arise when using it for medicinal purposes.

Used topically, lemongrass may cause skin irritation.
Additionally, consuming high amounts of lemongrass may cause dizziness, drowsiness, dry mouth, excess urination, and increased appetite. (Memorial Sloan Kettering Cancer Center, 2022)
High amounts of essential oil can damage liver and stomach mucous membranes, and excessive tea intake may also affect kidney function. (Memorial Sloan Kettering Cancer Center, 2022)
It is recommended that pregnant women should avoid lemongrass.
Additionally, individuals undergoing chemotherapy should avoid lemongrass because it may interfere with the actions of some chemotherapeutic agents.

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop a personalized treatment plan through an integrated approach to treating injuries and chronic pain syndromes, improving flexibility, mobility, and agility programs to relieve pain and help individuals return to optimal function. Our providers use an integrated approach to create customized care programs for each patient and restore health and function to the body through nutrition and wellness, functional medicine, acupuncture, Electroacupuncture, and sports medicine protocols. If the individual needs other treatment, they will be referred to a clinic or physician best suited for them. Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, nutritionists, and health coaches to provide the most effective clinical treatments.

Fighting Inflammation

References

DeFilipps, R. A., & Krupnick, G. A. (2018). The medicinal plants of Myanmar. PhytoKeys, (102), 1–341. doi.org/10.3897/phytokeys.102.24380

Khan, Nida. (2020). Therapeutic benefits of lemongrass and tea tree. Annals of Civil and Environmental Engineering. 4. 027-29. 10.29328/journal.acee.1001022.

Chaisripipat, W., Lourith, N., & Kanlayavattanakul, M. (2015). Anti-dandruff Hair Tonic Containing Lemongrass (Cymbopogon flexuosus) Oil. Forschende Komplementarmedizin (2006), 22(4), 226–229. doi.org/10.1159/000432407

Mukarram, M., Choudhary, S., Khan, M. A., Poltronieri, P., Khan, M. M. A., Ali, J., Kurjak, D., & Shahid, M. (2021). Lemongrass Essential Oil Components with Antimicrobial and Anticancer Activities. Antioxidants (Basel, Switzerland), 11(1), 20. doi.org/10.3390/antiox11010020

U.S. Department of Agriculture. (2018). Lemon grass (citronella), raw. Retrieved from fdc.nal.usda.gov/fdc-app.html#/food-details/168573/nutrients

Memorial Sloan Kettering Cancer Center. (2022). Lemongrass Purported Benefits, Side Effects & More. www.mskcc.org/cancer-care/integrative-medicine/herbs/lemongrass

The Importance of Neurological Physical Therapy for Rehabilitation

Dr. Alex Jimenez

Balance exercise with bosu ball, woman and doctor in gym. — Physiotherapist helping female patient with rehabilitation, balance exercise with bosu ball, woman and doctor during rehab physiotherapy in gym.

Can neurological physical therapy help individuals diagnosed with a recently acquired or chronic neurological condition gain strength and functioning?

Table of Contents

Neurological Physical Therapy

Neurological physical therapy can be extremely beneficial. It aims to restore functional mobility, strength, balance, and coordination in those with neurological conditions that affect their quality of life and ability to move around. It also helps recover from neurological injuries or prevent the progression and worsening of chronic neurological conditions. Depending on the severity of the condition, individuals may receive this therapy as an inpatient or outpatient. Exercise can help improve mobility, increase independence, and decrease the need for assistance, all of which can improve one’s quality of life.

Process

Neurological physical therapy is geared toward treating individuals with conditions affecting the brain and spinal cord, such as stroke, spinal cord injury, and Parkinson’s disease, to help restore mobility and function. The therapy is performed in hospitals, private practice physical therapy clinics, doctors’ offices, rehabilitation facilities, or at a patient’s home. Whether an individual needs inpatient or outpatient physical therapy will depend on the severity of the neurological condition.

Newly acquired neurological conditions such as strokes or traumas like spinal cord injuries and traumatic brain injuries or TBIs often require inpatient rehabilitation.
Once the patient gains enough strength, coordination, and independence with movements like standing and walking, they can progress to outpatient physical therapy.
The patient will undergo a physical exam after a physical therapist has gathered enough information about medical history during the initial evaluation.
The therapist will check muscle strength, coordination, range of motion, reflexes, and the muscle tone of the arms and legs. They may also perform neurological tests to examine coordination, such as following moving objects with the eyes, touching the finger to the nose, and rapidly alternating movements.
The individual general level of attention, cognition, and sensation will also be assessed to determine if these areas have been affected by the neurological condition. (Cleveland Clinic, 2022)
The therapist will then assess the patient’s ability to perform movements called transfers, which are transitions to and from positions such as lying down to sitting up or standing up to sitting.
They will note if the patient can perform these movements independently or if they need assistance.
The initial evaluation will also include an assessment of balance, quality of gait, and whether the therapist needs to assist.
Depending on the severity of the neurological condition, the therapist may provide the patient with or recommend purchasing an assistive device to help walk.

Treatment Sessions

During therapy sessions, patients may receive the following interventions:

Gait Training

To improve walking ability, proper instruction on using assistive devices such as canes, walkers, and crutches.

Balance Training

To improve static/stationary and dynamic/while moving balance, both sitting unsupported to improve core control and standing upright with or without handheld support.

Therapeutic Activities

To improve independence with bed mobility skills like rolling and sitting up from lying down and transfers on and off beds, chairs, and toilets.
Therapeutic exercises for stretching and strengthening muscles and improving coordination and motor control.

Endurance Training

This can be done with cardiovascular equipment like treadmills, stationary bicycles, and ellipticals.

Vestibular Therapy Interventions

Balance exercises with head movements and exercises to treat a common cause of dizziness are used to improve eye movement control.
Examples are the Dix-Hallpike and Epley maneuvers.

Conditions

Neurological physical therapy can treat various conditions. Some neurological conditions are progressive, worsening over time, and require regular physical therapy and at-home exercises to maintain optimal health and wellness. Neurological conditions that can be treated with physical therapy include: (Cleveland Clinic, 2022)

Strokes – loss of blood supply to the brain.
Spinal cord injuries – damage to part of the central nervous system resulting in loss of movement and control.
Polyneuropathies – damage to the peripheral nerves.
Traumatic brain injuries – for example, concussions.
Cerebral palsy – a group of disorders affecting movement, balance, and posture.
Multiple sclerosis – a disabling disease of the brain and spinal cord.
Parkinson’s disease – a progressive nervous system disorder.
Guillain-Barre syndrome – an autoimmune disease attacking the nerves.
Amyotrophic lateral sclerosis/ALS, also known as Lou Gehrig’s disease.
Vertigo, including benign paroxysmal positional vertigo or BPPV.

Neurological conditions, like an automobile collision, can occur suddenly or be progressive, such as Parkinson’s. Physical therapy helps those individuals by increasing their use of weakened muscles, improving their motor control, coordination, and balance, and facilitating their independence with daily tasks and movements. Always seek immediate medical attention for any sudden, unexplained muscle weakness. Individuals who experience skeletal muscle weakness should discuss the type and duration of symptoms with their doctor, specialist, physical therapist, or chiropractor, as this might be a sign of a medical condition such as a neuromuscular disorder. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop a personalized treatment program through an integrated approach to treat injuries and chronic pain syndromes, improving flexibility, mobility, and agility, relieving pain, and helping individuals return to normal activities. If other treatments are needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments.

Personal Injury Rehabilitation

References

Cleveland Clinic. (2022). Neurological Exam. my.clevelandclinic.org/health/diagnostics/22664-neurological-exam

Managing Lupus and Sun Sensitivity: Tips and Strategies

Dr. Alex Jimenez

Cheerful young european woman doctor posing by window, holding clipboard — Cheerful attractive brunette young european woman doctor wearing medical uniform white coat and stethoscope posing at clinic or hospital next to window, holding clipboard, smiling at camera

Individuals with the autoimmune disease lupus may be more sensitive to sun exposure. Are there ways to help protect the skin?

Table of Contents

Lupus Sun Exposure

Lupus is an autoimmune disease in which the body mistakenly attacks the joints, muscles, and skin. Around 5 million individuals worldwide, and 1.5 million in the United States, have been diagnosed with lupus. The disease is most common in early to mid-adulthood, and 90% develop in women. (Lupus Foundation of America, 2021) For some, the symptoms manifest as joint swelling or muscle soreness. Skin rashes, mottling or red or purple marbled skin, and sun sensitivity are common lupus symptoms. (Medline Plus, 2024) While exposure to UV radiation from natural and artificial light can be damaging to everyone, minimal exposures can cause a flare-up for those with chronic lupus.

UV Radiation

Ultraviolet (UV) light is radiation emitted naturally by the sun. These rays have some health benefits, like the generation of vitamin D, but too much UV exposure can cause health problems. Exposure to too much sun and artificial sources of light can cause: (U.S. Environmental Protection Agency, 2024) (Centers for Disease Control and Prevention, 2024)

Sunburn
Skin damage
Skin cancer
Eye damage
Cataracts
Immune system suppression
Certain medications can impact individual sensitivity to the sun and UV radiation.

Sun Exposure

Lupus can increase photosensitivity or immune system reaction to the sun’s rays. This symptom affects 40% and 70% of individuals with lupus. (Lupus Foundation of America, 2021) UV radiation damages cells and alters DNA. However, the damage can be more severe in those with lupus because their cells are more sensitive, and damaged cells are removed from the body more slowly, which can cause an attack on the immune system. (Lupus Foundation of America, 2021)

Symptoms

UV light and certain artificial light sources can trigger reactions in those with lupus. These reactions can happen immediately or develop weeks later and include: (Lupus Foundation of America, 2013)

Itching
Stinging
Burning
Joint pain
Weakness
Fatigue
Headaches

Other symptoms of sun exposure triggers are: (Lupus Foundation of America, 2013) (Lupus Foundation of America, 2021)

Rashes
Skin lesions

Rashes or skin lesions that appear after sun exposure can come and go within hours or days, or they can last for months. (Lupus Foundation of America, 2013) UV light can also cause a lupus flare-up of symptoms, including fatigue, joint pain, tingling, and numbness. (Lupus Foundation of America, 2021)

Protection

Protecting the skin from UV radiation is recommended for everyone, but it is especially important for individuals with photosensitivity from lupus. Some strategies to protect the skin include.

Sunscreen

Applying sunscreen to the skin provides a chemical or physical barrier to UV radiation. (MD Anderson, 2024) Most commercial sunscreens offer a combination of protection:

Physical Barriers

These include minerals like titanium dioxide or zinc oxide.
The finely ground minerals lay on top of the skin’s surface and reflect UV rays away.

Chemical Absorbers

These offer a thin, protective film that absorbs UV rays before they can penetrate the skin.

Proper sunscreen application is crucial, regardless of which type is chosen. The recommended application is to apply a palmful of sunscreen every two hours or more often if it gets wet or sweaty. Look for sunscreens that offer broad-spectrum protection against:

Ultraviolet A (UVA) rays
Ultraviolet B (UVB) rays
A sun protection factor (SPF) of at least 30 is recommended.
Sunscreen can expire, so check the expiration dates regularly. (Skin Cancer Foundation, 2020) (MD Anderson 2024)

Protective Clothing

Most clothing offers protection against UV radiation.
Individuals can purchase clothing or hats with UV-blocking properties or washing products for their clothes to increase their level of UV protection. (American Cancer Society, 2024)
Sunglasses are also important against UV radiation, eye damage, and other problems.

Utilize Shade Areas

In the summer, the sun is strongest in most locations between 10 a.m. and 4 p.m. UV rays can pass through windows, and the body is exposed to UV radiation on cloudy days (American Cancer Society, 2024). Avoiding sunlight or other strong sources of UV radiation will help protect the skin. Staying indoors or in shaded areas is the best choice during these hours.

Seeing a Healthcare Provider

Lupus treatment varies and changes over time. Individuals with lupus schedule regular appointments with their healthcare provider to review treatment and symptoms, especially after sun exposure. Avoiding sun exposure by seeking shade and wearing sunscreen and protective clothing can help reduce the chances of experiencing a flare-up. Some cases of photosensitivity are mild, while others can require more intense treatments to avoid larger flare-ups.

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

Unlocking Pain Relief

References

Medline Plus. (2024). Lupus. Retrieved from medlineplus.gov/lupus.html

Lupus Foundation of America. (2021). Lupus facts and statistics. www.lupus.org/resources/lupus-facts-and-statistics

U.S. Environmental Protection Agency. (2024). Health effects of UV radiation. Retrieved from www.epa.gov/sunsafety/health-effects-uv-radiation

Centers for Disease Control and Prevention. (2024). UV radiation. Retrieved from www.cdc.gov/radiation-health/features/uv-radiation.html?CDC_AAref_Val=https://www.cdc.gov/nceh/features/uv-radiation-safety/index.html

Lupus Foundation of America. (2021). UV exposure: What you need to know. www.lupus.org/resources/uv-exposure-what-you-need-to-know

Lupus Foundation of America. (2013). Research on photosensitivity among people with lupus. www.lupus.org/resources/research-on-photosensitivity-among-people-with-lupus

MD Anderson Center. (2024). How does sunscreen work? www.mdanderson.org/cancerwise/how-does-sunscreen-work.h00-159698334.html

Skin Cancer Foundation. (2020). Ask the expert: Does sunscreen stay effective after its expiration date? www.skincancer.org/blog/ask-the-expert-does-a-sunscreen-stay-effective-after-its-expiration-date/

American Cancer Society. (2024). How do I protect myself from ultraviolet (UV) rays? www.cancer.org/cancer/risk-prevention/sun-and-uv/uv-protection.html

Burn More Fat with Walking: Effective Strategies Revealed

Dr. Alex Jimenez

Young women smiling at each other in sportswear. Running and doing sports with friends.

Can incorporating walking help accomplish health goals for individuals trying to burn fat?

Table of Contents

Walking To Burn Calories and Fat

Walking has many wonderful benefits that include:

Improving fitness
Strengthening bones
Easing joint pain
Improving mental health

What to know

Taking it easy at first and steadily working on the basics can help individuals reach their health goals. Two keys to burning more fat when walking are:

Walk with enough speed and intensity to burn fat for energy.
The longer you walk, the more stored fat is burned instead of the sugars for quick bursts of exercise.

While any exercise can burn calories, brisk walking and other aerobic exercises are especially recommended for burning internal abdominal visceral fat. This fat contributes to the waistline and increases the risk of diabetes and heart disease. (Bairapareddy, K. C. et al., 2018)

Fat-Burning Zone

The American Heart Association categorizes brisk walking at a pace of 2.5 miles per hour as a moderate-intensity aerobic activity. (American Heart Association, 2024) The target heart rate for exercising at this level of intensity should be 50% to 70% of an individual’s maximum heart rate. For more vigorous activities, the heart rate should be about 70% to 85% of an individual’s maximum heart rate. (American Heart Association, 2021) Working out at a low to moderate intensity can help burn fat because the body uses stored fat as fuel compared with workouts of higher intensity that depend on carbohydrates. (Carey D. G. 2009)

The heart rate range for this zone varies by age. An age heart rate zone chart can help individuals find the right numbers. While exercising, take your pulse to check your heart rate. Heart rate apps and pulse monitors have been built into activity monitors and smartwatches. While exercising in this zone, breathing is heavier, and there is a feeling of increased exertion and sweating, but individuals should be able to carry on a conversation. (Centers for Disease Control and Prevention, 2022)

Beginners should gradually build up walking time and speed.
A beginner’s walking plan starts with 15 minutes daily, five days a week, and continued improvement in walking technique.
Increase walking time by 5 minutes per session each week.

Increasing Walking Intensity

If the heart rate is still below 60% of the maximum heart rate, individuals need to intensify the workout to burn fat. Ways to do this include:

Adding Distance and Time

Make the walk longer to keep the body working harder and maintain a brisk pace. Adding additional minutes will burn additional stored fat. However, since not everyone has the time, there are other options.

Picking Up The Pace

Even for a short walk, make a goal to perform faster than normal, walking faster using correct posture, arm motion, and a powerful stride. It can help to time the walking route and challenge yourself to complete it faster each time. One study examined individuals walking 3.6 miles per hour, 4.1 mph, and 4.6 mph. Accelerating to 4.6 mph burned more than 50% more calories than going from 3.6 mph to 4.1 mph. (Schwarz, M. et al., 2006)

Adding Intervals

Intervals add intensity and also help increase the overall pace. The strategies above to walk faster incorporate intervals, where individuals increase their speed for a set distance or time, alternating with a slower pace. Research on individuals with diabetes found that those who did interval walking for four months lost six times as much weight as those who walked steadily. (Karstoft K. et al., 2013)

Adding Hills and/or Stairs

Incorporating hills or stair-climbing into some walking sessions helps you stay challenged and makes workouts more intense. If there is no access to outdoor hills or stairs, use a treadmill – start with a slight incline and work up to a steeper one, or get on a stair-stepping machine at the gym. There is no need to walk briskly on hills, as one study showed that walking slowly on an incline was an effective workout that didn’t cause knee joint stress, especially for obese individuals. (Haight, D. J. et al., 2014)

Switch Up Workouts

Mix up different walking workouts like intervals, short and fast walks, and long and moderate walks. Meditative, mindful walks also have stress-reducing benefits that help lower cortisol, which can contribute to weight gain. Individuals who can’t spend 45 continuous minutes walking make the most of the available time. Try and fit in two to four 15-minute walks at a brisk pace. It’s also recommended to include other types of moderate-intensity exercise and activities that include:

Bicycle riding on level terrain
Water aerobics
Using an elliptical trainer
Ballroom dancing
Gardening
Doubles tennis or pickleball

Challenge the body in new ways to burn fat, build muscle, and raise basal metabolic rate. With a boosted metabolism, the body burns more calories all day.

Sample Walking Workout

You can use a treadmill or walk outside. Make sure you have athletic shoes that are flat and flexible and have the proper support and cushioning for a long walk. Wear breathable clothing, which allows freedom of movement and wicks away sweat.

Warmup

Start with 5 to 10 minutes of easy walking, increasing speed gradually.
The warmup is important to burn stored blood sugar and deplete the ready energy stored in the muscles.
This signals the body that a longer exercise session is underway.
As a result, the body prepares to burn stored fat.

Pick Up The Speed

To burn fat, the body needs to be in the fitness zone, with a heart rate of 60% to 70% of the maximum heart rate.
Check heart rate every 10 minutes to stay in the zone.

Stay In The Fitness Zone

For 30 to 50 minutes or more.
If your heart rate dips, pick up the speed.

Cool Down

End with 5 to 10 minutes at an easier pace to cool down.

Injury Medical Chiropractic and Functional Medicine Clinic

Using an integrated approach to treat and prevent injuries and chronic pain syndromes, improve flexibility, mobility, and agility, and help individuals return to normal activities, Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers, trainers, and specialists to develop a personalized fitness program. Each case is different and requires reviewing individual medical history and physical examination to determine the proper training plan. Dr. Jimenez has partnered with top trainers, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments and fitness training plans.

Weight Loss Techniques

References

Bairapareddy, K. C., Maiya, A. G., Kumar, P., Nayak, K., Guddattu, V., & Nayak, V. (2018). Effect of aerobic exercise on echocardiographic epicardial adipose tissue thickness in overweight individuals. Diabetes, metabolic syndrome and obesity : targets and therapy, 11, 303–312. doi.org/10.2147/DMSO.S145862

American Heart Association. (2024). American Heart Association Recommendations for Physical Activity in Adults and Kids. www.heart.org/en/healthy-living/fitness/fitness-basics/aha-recs-for-physical-activity-in-adults

American Heart Association. (2021). Target Heart Rates Chart. www.heart.org/en/healthy-living/fitness/fitness-basics/target-heart-rates

Carey D. G. (2009). Quantifying differences in the “fat burning” zone and the aerobic zone: implications for training. Journal of strength and conditioning research, 23(7), 2090–2095. doi.org/10.1519/JSC.0b013e3181bac5c5

Centers for Disease Control and Prevention. (2022). Measuring Physical Activity Intensity. Retrieved from www.cdc.gov/physicalactivity/basics/measuring/index.html

Schwarz, M., Urhausen, A., Schwarz, L., Meyer, T., & Kindermann, W. (2006). Cardiocirculatory and metabolic responses at different walking intensities. British journal of sports medicine, 40(1), 64–67. doi.org/10.1136/bjsm.2005.020198

Karstoft, K., Winding, K., Knudsen, S. H., Nielsen, J. S., Thomsen, C., Pedersen, B. K., & Solomon, T. P. (2013). The effects of free-living interval-walking training on glycemic control, body composition, and physical fitness in type 2 diabetic patients: a randomized, controlled trial. Diabetes care, 36(2), 228–236. doi.org/10.2337/dc12-0658

Haight, D. J., Lerner, Z. F., Board, W. J., & Browning, R. C. (2014). A comparison of slow, uphill and fast, level walking on lower extremity biomechanics and tibiofemoral joint loading in obese and nonobese adults. Journal of orthopaedic research : official publication of the Orthopaedic Research Society, 32(2), 324–330. doi.org/10.1002/jor.22497

Tips for Maintaining Correct Posture Throughout the Day

Dr. Alex Jimenez

hardworking handsome doctor with mask stretching his patient during appointment in hospital

For individuals who are feeling back pain, neck pain, or shoulder pain, can using postural techniques help decrease pain and develop strategies to maintain correct posture?

Table of Contents

Maintaining Correct Posture

Exercise and postural correction are two of the most important strategies to manage pain. (Robin McKenzie, the great spine guru PT, (May S. and Donelson R. 2008) However, it is not easy to maintain correct posture as the day progresses. While working or driving, most of us forget to be mindful of our posture; we slip back into unhealthy habits of sitting slouched, to the side, forward, etc, which often leads to continued pain and movement limitations. Studies on postural correction and its effect on overall back or neck pain levels are limited. (Lederman E. 2011) However, some studies show that a forward-head posture increases stress and load on the neck. (Hansraj K. K. 2014) If an individual has pain that improves with sitting upright, perhaps checking posture as the day progresses could be beneficial. There are ways to start changing posture and maintain the change. First, visit a physical therapist, spine specialist, or chiropractor to learn how to sit or stand to manage posture problems. They can teach individuals how to attain healthy posture and manage their condition. These strategies can then be used to maintain correct posture.

Lumbar Support

A lumbar roll/support is one of the simplest ways to attain and maintain a healthy sitting posture. These specialized pillows can help maintain the forward curve in the lower back. Maintaining the lumbar lordosis curve is essential for keeping stress off the back muscles, joints, and discs. Lumbar support pillows can be found in various stores, office supply stores, or purchased online. A physical therapist PT can help train individuals to use a lumbar roll properly.

Utilize the Slouch Overcorrect Exercise

The slouch overcorrect exercise is a simple maneuver for training the body to find and maintain its neutral position. It involves slowly shifting from a slouched position to an overcorrected postural position. Once posture is overcorrected, a slight relaxation from a fully erect posture will return to sitting properly. Practicing this exercise daily can help train the body to feel the muscles, listen to the body, and maintain proper posture. The muscles have memory, and the more often the body is placed in optimal posture, the muscles memorize their healthy, pain-free positioning.

Kinesiology Tape

Kinesiology tape is a flexible cotton adhesive that facilitates muscle contractions and inhibits muscle spasms and pain. (Han J. T. et al., 2015) Using the tape is a simple way to help facilitate the postural support muscles. The tape can be applied to the middle trapezius and rhomboid muscles to help support the shoulder blades and spine. Kinesiology tape for postural control also gently pulls on the muscles when slouching to remind the individual to sit up or stand straight.

Scapular Stabilization Exercises

A physical therapist or chiropractor can help improve posture through targeted exercises. Strengthening the muscles attached to the shoulder blades can help individuals better control their posture. (Shiravi S. et al., 2019) Exercises like the prone T, I, or Y can help improve the muscles’ neuromuscular recruitment to maintain correct posture.

Use an Alarm

Setting an alarm while working can help train the body to maintain correct posture. Most of us sit at a computer, desk, or workstation with proper posture, but depending on what we’re working on, we eventually slouch, lean to the side, or have a forward head posture. Pretty much all computers and phones have an alarm setting or app. Use the alarm or timer to go off every 20 to 30 minutes. When the alarm rings, look at your posture to recognize what you’re doing, get up and move around to stretch the body, sit and readjust, reset the alarm, and continue working. As you get better at maintaining appropriate posture, you won’t need the alarm anymore, and readjusting will become automatic.

Chiropractic Team

Sitting and standing with unhealthy posture can significantly cause back, neck, and shoulder pain. By visiting a chiropractic and physical therapy team and learning to attain and maintain correct posture, you can quickly relieve pain, resolve musculoskeletal issues, and prevent future pain symptoms. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop a personalized care plan for each patient through an integrated approach to treating injuries and chronic pain syndromes, improving flexibility, mobility, and agility programs to relieve pain and help return to normal and optimal function. If other treatments are needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments.

Scapular Winging In-Depth

References

May, S., & Donelson, R. (2008). Evidence-informed management of chronic low back pain with the McKenzie method. The spine journal : official journal of the North American Spine Society, 8(1), 134–141. doi.org/10.1016/j.spinee.2007.10.017

Lederman E. (2011). The fall of the postural-structural-biomechanical model in manual and physical therapies: exemplified by lower back pain. Journal of bodywork and movement therapies, 15(2), 131–138. doi.org/10.1016/j.jbmt.2011.01.011

Hansraj K. K. (2014). Assessment of stresses in the cervical spine caused by posture and position of the head. Surgical technology international, 25, 277–279.

Han, J. T., Lee, J. H., & Yoon, C. H. (2015). The mechanical effect of kinesiology tape on rounded shoulder posture in seated male workers: a single-blinded randomized controlled pilot study. Physiotherapy theory and practice, 31(2), 120–125. doi.org/10.3109/09593985.2014.960054

Shiravi, S., Letafatkar, A., Bertozzi, L., Pillastrini, P., & Khaleghi Tazji, M. (2019). Efficacy of Abdominal Control Feedback and Scapula Stabilization Exercises in Participants With Forward Head, Round Shoulder Postures and Neck Movement Impairment. Sports health, 11(3), 272–279. doi.org/10.1177/1941738119835223

Exploring Voluntary Muscles: Their Importance and Function

Dr. Alex Jimenez

Professional chiropractor or physiotherapist helps to heal a young woman's back. Doctor fixes the patient lying on a couch of a modern rehabilitation clinic Concept of physical rehabilitation.

Skeletal muscles attached to the arms, legs, neck, back, and trunk bones are voluntary and consciously controlled. Weakness or inability to control these muscles can signal a health issue like a neuromuscular disorder or electrolyte imbalance. Can recognizing the symptoms can help healthcare providers develop effective treatment programs?

Table of Contents

Voluntary Muscles

Voluntary muscles are the skeletal muscles that attach to bones and control movement of the limbs, head, neck, and body under an individual’s conscious control. Skeletal muscles are controlled by neuromuscular signals from the brain that communicate with individual muscle fibers and cause them to contract.

Difference

Voluntary muscles are skeletal muscles that contract and relax under conscious control.
These muscles attach to bones and regulate movement of the body.
Involuntary muscles are not under conscious control.
Involuntary muscles involve automatic internal processes needed for survival, like controlling blood vessels and organs like the heart, lungs, and digestive system.
They contract and relax automatically and receive signals from the autonomic nervous system, which regulates internal bodily functions.

Voluntary

Voluntary muscles are skeletal muscles that comprise 40% of the body’s weight and 50% to 75% of the body’s proteins. These muscles can convert chemical and mechanical energy to cause voluntary muscle contraction and movement. (Trovato F.M. et al., 2016) Skeletal muscle comprises fascicles or bundled units of multiple muscle fibers or muscle cells. Each muscle fiber consists of a cross-banded structure further divided into myofibrils containing thick myosin and thin actin myofilaments, which give the muscle its stripe appearance, and the structure gives the characteristic striated structure. (Trovato F.M. et al., 2016) Muscle contraction occurs when these myofilaments move closer together, stimulated by the release of the neurotransmitter acetylcholine from nerve cells that communicate with the muscle fiber.

Involuntary

The autonomic nervous system controls involuntary muscles, regulating their contraction and relaxation. This system also controls the activity of organs and blood vessels for essential daily functions, including breathing, circulation, digestion, heartbeat regulation, and urination. Most involuntary muscles are composed of smooth muscles. Smooth muscles do not have the striated structure of skeletal muscles and consist of sheets or layers of smooth muscle cells. When the autonomic nervous system stimulates these muscle cells to contract by releasing hormones or other chemical signals, smooth muscle cells shorten through the movement of actin and myosin myofilaments. Involuntary smooth muscles include the blood vessel walls, diaphragm, intestines, and bladder. (Webb R. C. 2003) One exception of an involuntary muscle is the myocardium, or heart muscle. The myocardium comprises a specialized cardiac muscle cell found only in the heart. Cardiac muscle is striated like skeletal muscle but is controlled by the autonomic nervous system and pacemaker cells, causing it to contract automatically and rhythmically.

Weakened Voluntary Muscles

Skeletal muscle diseases, neuromuscular disorders, and other causes can weaken muscles. Neuromuscular or skeletal muscle disorders affect the nerves that send electrical signals to voluntary skeletal muscles to control movement. When the nerves are damaged, communication between the nerves and muscles becomes disrupted. This can result in significant muscle weakness, atrophy, and loss of function. Most neuromuscular disorders are genetic or caused by issues with the immune system. Nerves communicate with muscles through the release of neurotransmitters at the neuromuscular junction, which is the space between a nerve cell and muscle fiber. Neuromuscular disorders can damage the nerve or the neuromuscular junction. Neuromuscular disorder symptoms can include: (Cleveland Clinic, 2023)

Numbness and tingling
Muscle weakness
Muscle twitches, cramps, or spasms
Muscle pain
Muscle atrophy
Decreased coordination
Balance problems
Drooping eyelids and double vision from eye muscle weakness.
Difficulty swallowing due to weakness of the pharynx.
Difficulty breathing due to weakness of the diaphragm.

Common Neuromuscular Disorders

Amyotrophic Lateral Sclerosis – ALS

More commonly known as Lou Gehrig’s disease, it is a genetic disorder that results from hardening of the spinal cord.
It causes damage to the nerves that control muscles and voluntary movement.

Charcot-Marie-Tooth Disease

This is a class of peripheral nerve disorders that cause muscle weakness, atrophy, and loss of sensation, most commonly in the legs and feet.
It is a genetic disorder caused by a gene mutation that damages myelin, or the insulating sheath that surrounds all nerves and supports the conduction of electrical signals.

Multiple Sclerosis – MS

MS causes degeneration of the myelin sheath surrounding nerves, decreasing the impulses along the nerves to muscles.
It can result in muscle weakness, which is often more severe on the dominant side of the body.
There are different forms of MS, but the condition is often progressive and gets worse over time if left untreated.

Muscular Dystrophies

These are genetic diseases characterized by gradual loss of motor function, muscle weakness and atrophy, walking gait problems, progressive respiratory failure, and cardiomyopathy.
There are nine types of muscular dystrophy, all caused by genetic mutations.

Myasthenia Gravis

This is an autoimmune disease that causes inflammation throughout the body.
An autoimmune disease occurs when the immune system attacks healthy cells by mistake.
With myasthenia gravis, the body produces antibodies that attack the receptors for acetylcholine, reducing the body’s ability to contract muscles.
This leads to muscle weakness, atrophy, and fatigue.

Myopathies

These are diseases of muscles that cause muscle weakness and atrophy.
Depending on the type, they may progress and get worse over time.

Electrolyte Imbalances

Muscle weakness can result from altered sodium, potassium, calcium, or magnesium levels.

Always seek immediate medical attention for any sudden, unexplained muscle weakness. Individuals who experience skeletal muscle weakness should discuss the type and duration of symptoms with their doctor, specialist, physical therapist, or chiropractor, as this might be a sign of a medical condition such as a neuromuscular disorder. Working with a chiropractic team can help expedite healing. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop a personalized treatment program through an integrated approach to treat injuries and chronic pain syndromes, improving flexibility, mobility, and agility, relieving pain, and helping individuals return to normal activities. If other treatments are needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments.

Chiropractic Massage Therapy

References

Trovato FM, I. M., Conway N, Castrogiovanni P. (2016). Morphological and functional aspects of human skeletal muscle. J Funct Morphol Kinesiol., 1(3), 289-302. doi.org/https://doi.org/10.3390/jfmk1030289

Webb R. C. (2003). Smooth muscle contraction and relaxation. Advances in physiology education, 27(1-4), 201–206. doi.org/10.1152/advan.00025.2003

Cleveland Clinic. (2023). Mitochondrial diseases. my.clevelandclinic.org/health/diseases/15612-mitochondrial-diseases

Homemade Electrolyte Drink: Replenish Your Body Naturally

Dr. Alex Jimenez

Sports women group, grass and bottle in circle for toast, celebration and diversity with team build.

Replenishing electrolytes and maintaining hydration is essential for individuals who work out, fitness enthusiasts, and those who play recreational or serious sports and want to improve overall health. Can making a homemade sugar-free electrolyte drink help individuals achieve health goals faster?

Table of Contents

Homemade Electrolyte Drink

Sports drinks can help replenish the body’s lost electrolytes. Individuals who follow a low-carb diet and exercise or who are on a low-carb diet and get sick need double the added electrolytes. There is evidence that electrolytes are very effective in regulating the body’s fluid balance, especially during and after exercise or illness, and for those on a strict low-carb diet. (Maughan R. J. 1991)

Why More Electrolytes Are Needed

On a low-carb diet, insulin levels drop, so the kidneys retain less sodium. As the body excretes water, important minerals, such as the electrolytes calcium, sodium, magnesium, chloride, and potassium, are also excreted from the body’s system. Therefore, it is important to replenish them to avoid negative symptoms like lightheadedness and dehydration—especially when exercising or ill. (Bostock E. C. S. et al., 2020)

Two tablespoons of lemon juice contain almost the same amount of potassium in an 8-ounce sports drink.
A pinch of salt supplies 110 milligrams of sodium, the same amount in 8 ounces of a sports drink.

Individuals can make a low-carb homemade electrolyte sports drink. Many sports drinks contain a lot of sugar and other additives. The science behind why many of these drinks contain sugar is that a quick hit of sugar provides glucose for replenishing energy stores. Most individuals benefit from having small amounts of carbohydrates during heavy exercise. However, those who want to avoid sugar might want a sugar-free option to replace fluids and electrolytes.

Basic Recipe

Homemade Electrolyte Drink Mix:

1 cup or 8 ounces of non-carbonated water
Two tablespoons of lemon juice
A small pinch of salt—a teaspoon contains 2,300 milligrams of sodium, but the body needs 1/20th of a teaspoon.
Flavoring and sweetener for taste are optional. Try unsweetened Kool-Aid, Crystal Light Drink Mix, or sugar-free flavored syrups.
If avoiding artificial sweeteners, Stevia could be an option.

Sports Drink Ingredients

What goes into most sports drinks and adapting to a low-carb diet?

Water

Water is a primary ingredient, as the goal is to hydrate the body.

Sugar

Sports drinks can contain a lot of sugar, but only about half the sugar of most commercial beverages. For example,

A 20-ounce bottle of Gatorade has about 34 grams of sugar.
A 20-ounce soda has about 69 grams of sugar.

Sports drinks have less sugar to prevent gastrointestinal cramping during exercise and strenuous physical activity. Although Gatorade contains less sugar than soda, depending on individual health goals, it may not be the best option. Studies of nutritional needs during exercise for those restricting carbohydrates are not extensive. However, it is known that when individuals cut carbs, their bodies switch from primarily using carbohydrates to using fat for energy. This change, known as keto-adaptation, can take two to three weeks. Native populations, like the Inuit, traditionally ate a very low-carbohydrate diet and could maintain vigorous endurance for a long time without ill effects. (Phinney S. D. 2004) This suggests that bodies adapt to using fat for energy during physical activity and exercise over time. However, cutting carbohydrates too much and too soon can lead to symptoms like the keto flu. (Harvard Medical School, 2018). Individuals may need to replace carbohydrates during training for longer, more vigorous workouts, such as running longer than an hour. In addition, what is eaten before and after exercise can also affect physical performance. Working with a registered dietitian, nutritionist, or health coach could be helpful to achieve specific fitness goals.

Electrolytes

Electrolytes are molecules of certain minerals that contain an electrical charge. The nervous system runs on those charges generated by manipulating molecules called ions. (Faber D. S. and Pereda A. E. 2018) Every body function that depends on the nervous system, which includes muscle movement, breathing, digestion, thinking, etc., requires electrolyte activity. Those who exercise strenuously for long periods, individuals who follow a low-carb diet, or those with illness may need extra salt and potassium. Sports drinks contain small amounts of sodium and potassium. A balanced diet will supply plenty of minerals for electrolyte needs for individuals engaged in moderate exercise.

Using an integrated approach to treat and prevent injuries and chronic pain syndromes, improve flexibility, mobility, and agility, and help individuals return to normal activities, Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop a personalized treatment, nutrition, and fitness programs. Each case is different and requires reviewing individual medical history and physical examination to determine the proper and most effective plan. Dr. Jimenez has teamed up with top trainers, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments and training.

Is Intermittent Fasting the Ultimate Weight Loss Hack?

References

Maughan R. J. (1991). Fluid and electrolyte loss and replacement in exercise. Journal of sports sciences, 9 Spec No, 117–142. doi.org/10.1080/02640419108729870

Bostock, E. C. S., Kirkby, K. C., Taylor, B. V., & Hawrelak, J. A. (2020). Consumer Reports of “Keto Flu” Associated With the Ketogenic Diet. Frontiers in nutrition, 7, 20. doi.org/10.3389/fnut.2020.00020

Phinney S. D. (2004). Ketogenic diets and physical performance. Nutrition & metabolism, 1(1), 2. doi.org/10.1186/1743-7075-1-2

Harvard Medical School, Harvard Health Publishing, Marcelo Campos, M., Contributor. (2018). What is keto flu? Harvard Health Blog. www.health.harvard.edu/blog/what-is-keto-flu-2018101815052

Faber, D. S., & Pereda, A. E. (2018). Two Forms of Electrical Transmission Between Neurons. Frontiers in molecular neuroscience, 11, 427. doi.org/10.3389/fnmol.2018.00427

Choosing the Right Pickleball Footwear: A Guide for Players

Dr. Alex Jimenez

Couple playing pickleball outdoor at daylight. Outdoor sport leisure activity. Bright blue sky

Proper shoes are highly recommended when playing sports, whether professional or recreational. Can wearing pickleball footwear help increase optimal performance and prevent injuries?

Table of Contents

Pickleball Footwear

Pickleball has become quite popular because individuals of all ages and abilities can play it. Although it is a relatively new sport, it emerged in 1965. (USA Pickleball, 2021) It’s now one of the fastest-growing sports, with over 8 million players nationwide. (Brandon, 2023) The game can be played with most shoes designed for sports, like running or cross-fit shoes. There are shoes specifically for pickleball that improve traction, enhance stability and cushioning, and increase impact absorption. For those getting into the game long-term, investing in high-quality pickleball footwear is a worthwhile investment that can contribute to long-term enjoyment and injury prevention.

The Demands of Pickleball

Like tennis or table tennis, pickleball involves dynamic and fast-paced movements, including lateral strides, pivoting, and quickly changing direction. The body has to move forward, backward, and side to side across the court and pivot. When chasing the ball, to control the shots, produce power, decrease the risk of injury, and change direction while maintaining balance, the feet, body, and shoes must work together to make all this possible. One consideration depends on where the game will be played, whether flat ground or a harder surface. Wearing sneakers or tennis shoes is recommended for flat-ground play, as they provide supportive cushioning and shock absorption. For harder surfaces like concrete or hardwood courts, specialized shoes like those designed for pickleball are recommended.

Benefits

Some of the benefits of investing in pickleball footwear include.

Optimal Traction

Traction is incredibly important in pickleball. Optimal traction can help players execute quick movements, maintain stability, and prevent slips and falls. When looking for the right shoes, consider traction-specific materials like rubber, nylon, and leather. Individuals are most likely to find rubber pickleball shoes because they’re cheaper and commonly used in other outdoor sport-specific shoes, such as soccer. Nylon is more expensive but offers better traction than rubber and is often used in high-tech sneakers because it provides significant shock absorption and long-term durability. Leather is the most expensive material but offers the best grip. Because of its natural look and feel, it is also becoming more popular in sneakers.

Stability and Support

Moving from side to side in a lateral fashion requires players to be on top of their balance and maintain steadiness when making shots. Pickleball shoes are designed to support stability and can help reduce injuries like sprains.

Impact Absorption Cushioning

Pickleball footwear is designed similarly to running shoes, with cushioned comfort and a midsole that offers shock absorption and reduces the impact felt in the joints, including the knees, lower back, and feet. Individuals can find pickleball footwear that utilizes various sports technologies, like gel inserts or responsive foam, which can help cushion and reduce the impact on the joints. When cushioned, the body can maintain more balance, promote positive movement habits, prevent muscular fatigue and joint pain, help reduce overall stress, and allow individuals to play harder without experiencing pain. Long-term benefits result in a stronger, more flexible body.

Proper Fit and Considerations

Make sure that the pickleball shoes fit well and provide adequate support. Measure your feet using a ruler or measuring tape, and have the measurements handy while shopping. Suggestions include:

Look for shoes that fit snugly but don’t allow the feet to move around too much during play.
Pay attention to arch support.
Individuals with high arches should look for shoes with adjustable straps or more supportive materials built into the sole.

Using an integrated approach to treat and prevent injuries and chronic pain syndromes, improve flexibility, mobility, and agility, and help individuals return to normal activities, Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop a personalized fitness program. Each case is different and requires reviewing individual medical history and physical examination to determine the proper training plan. Dr. Jimenez has teamed up with top trainers, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments if other training is needed.

Custom Foot Orthotics

References

USA Pickleball. (2021). History of the game. usapickleball.org/what-is-pickleball/history-of-the-game/

Mackie, B. Pickleheads. (2024). Pickleball statistics. www.pickleheads.com/blog/pickleball-statistics#h-key-pickleball-statistics

Headache Self-Care Techniques to Alleviate Pain

Dr. Alex Jimenez

woman with headache depression stress health problem migraine. High quality photo

For individuals dealing with headaches, can utilizing self-care techniques help ease symptoms?

Table of Contents

Headaches Self Care

There are different self-pain-relieving approaches to ease headache-related pain that use non-medication options. While headache self-care pain-relieving techniques can help temporarily, they are recommended to help ease headache symptoms until professional treatment is available. Individuals are encouraged to try multiple strategies to find the right treatment regimen that works for them, which is usually a process of trial and error. Self-care headache relief maneuvers can include temple massages, breathing exercises, exercise, or applying a cold pack to the head.

Self-Care Relief

Commonly used for tension headaches or migraine, a few examples of self-care techniques include (Espí-López G. V. et al., 2016)

Massaging the temples, neck, or scalp with the hand, fingers, or a massage tool.
Applying a cold pack to the affected area.
Heat can be used on the affected area, like a headband or a hot shower.
Compression such as a handkerchief or belt wrapped tightly around the head or pressing firmly on the painful area.

Compression is more commonly utilized in migraineurs versus scalp massage in people with tension headaches. This is often due to the throbbing sensation caused by a migraine versus a tension headache, which feels like a tight grip or band around the head.

Individuals with cluster headaches are more likely to utilize unique approaches, such as covering one ear, rotating the head, shallow breathing, moving around, or closing the nostril on the same side as the head pain.

Other Complementary Options

Other complementary therapies for headache and migraine care include: (Millstine D. et al., 2017)

Trigger point release massage
Progressive muscle relaxation
Aerobic exercise
Yoga
Deep breathing exercises
Meditation
Cognitive-Behavioral Therapy

Various scientific studies support the potential benefit of these complementary therapies. However, individuals should talk with a healthcare provider to choose the best strategy for their headache type and their unique needs/goals. Working with a chiropractic team can help expedite healing. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop a customized treatment plan through an integrated approach to treating injuries and chronic pain syndromes, improving flexibility, mobility, and agility, relieving pain, and helping individuals return to normal activities. If other treatments are needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments.

Tension Headaches and Chiropractic Care

References

Espí-López, G. V., Zurriaga-Llorens, R., Monzani, L., & Falla, D. (2016). The effect of manipulation plus massage therapy versus massage therapy alone in people with tension-type headache. A randomized controlled clinical trial. European journal of physical and rehabilitation medicine, 52(5), 606–617.

Millstine, D., Chen, C. Y., & Bauer, B. (2017). Complementary and integrative medicine in the management of headache. BMJ (Clinical research ed.), 357, j1805. doi.org/10.1136/bmj.j1805

Intuitive Eating: Listening to Your Body for Better Health

Dr. Alex Jimenez

Can understanding the philosophy of intuitive eating help individuals achieve and maintain health goals by breaking free from diets and getting healthy by improving their relationship with food and exercise?

Table of Contents

Intuitive Eating

Intuitive eating is a non-diet approach to eating that focuses on listening to the body with internal body cues. Strict food rules are the main reason diets don’t work and negatively impact overall health and well-being. (Linardon, J., & Mitchell, S. 2017) Intuitive eating is characterized by eating in response to physiological hunger and satiety cues rather than emotional cues. The body was born to eat when hungry and stop when full. However, this natural way of eating can get lost in emotions, food rules, and restrictions. Fortunately, getting back to intuitive eating is possible for everyone.

How Does It Work?

Intuitive eating is a non-diet approach that steps away from a diet mentality and applies healthy behaviors around food. It focuses on unlearning external rules, like diet rules and expectations of what and how much to eat, and emphasizes internal cues like hunger, fullness, and how foods make you feel. It is based on principles that help build a healthier relationship with food. Individuals become aware of what to eat, how much to eat, and when to eat naturally, without worry or guilt.

Mindful Eating

Mindful eating is not the same thing as intuitive eating. Individuals can think of mindful eating as a skill or practice, while intuitive eating is a philosophy.

Principles

Understanding the ten core principles and how they work together is important.

Remove The Diet Mentality

Let go of the quick fixes and gimmick diets. These offer false hope that weight loss is easy, quick, and permanent and can make individuals feel like failures for losing and regaining weight.

Honor Hunger

Hunger is a normal, biological process. The body requires adequate amounts of energy and carbohydrates to function properly. Ignoring these cues and hunger can lead to cravings, overeating, and binges. Learning to honor hunger cues sets the stage for rebuilding trust with food. A food scale can help determine proper portions.

Make Friends With Food

Allow yourself unconditional permission to eat what you want. This means including all foods without labeling them as good or bad. Once an individual tells themself they can’t have a certain food, they can feel deprived, and intense cravings can build that often lead to overeating, binges, and extreme food guilt.

Get the Food Police Out Of Your Head

Learn to say no to self-induced thoughts of good or bad based on what is being eaten or how many calories are involved. Diets often say eating too many calories or enjoying a cookie is bad. These rules and restrictions can lower self-esteem and cause feelings of guilt. Removing negative food thoughts, guilt, and other rules is critical to intuitive eating.

Respect The Body’s Fullness

Listen for body cues that say you are full. This means your body is no longer hungry and should stop eating. Enjoy the flavors, stay aware of satiety signals throughout meals, and always be aware of your fullness level.

Satisfaction Factor

Learn to find joy and satisfaction in the eating experience. Eating what they want in an inviting environment promotes happiness and satisfaction, and a positive eating experience has been shown to promote satisfaction with even less food.

Honor Feelings Without Using Food

Don’t fix problems with food. Learn healthy ways to cope with emotions like stress, anxiety, anger, or boredom without turning to food. Feeding emotional hunger only makes feelings worse and adds guilt to the mix.

Respect Your Body

Body size and shape are unique for each person. Acceptance is an important part of self-respect and love. Instead of being critical, embrace individual genetic blueprints.
Being unrealistic and critical about one’s body makes it difficult to reject the diet mentality.

Exercise

Exercise doesn’t have to be intense or extreme to be effective. Individuals should focus on how good it feels to be active and moving their bodies rather than how many calories are burned during the workout sessions. Feeling great and motivated about exercise is easy when there is increased energy, better sleep, and improved quality of life.

Honor Health

Individuals don’t have to be perfect eaters. Infrequently eating a certain snack or meal won’t make you gain weight or cause health problems.
It’s what is eaten consistently over time that matters. Making food choices that taste good and nourish the body is what counts.

Weight Loss Benefits

Intuitive eating is not designed for weight loss. It aims to improve an individual’s relationship with food, including building healthier food behaviors and not focusing on the weight scale. However, learning to be an intuitive eater can help individuals lose weight by allowing the body to break the diet cycle and settle into its natural set point weight range.

Overall Health Benefits

Intuitive eating has been shown to have both physical and emotional health benefits that include:

Higher levels of contentment and satisfaction
Reduced stress
Increased self-esteem
Better body image outlook
Improved cholesterol levels
Improved metabolism
Lower rates of emotional and disordered eating

In a 24-study review that examined the psychosocial effect intuitive eating had on adult women was associated with the following positive results (Bruce, L. J., and Ricciardelli, L. A. 2016)

Decreased eating disorders
Improved positive outlook on body image
Higher emotional functioning

Another study compared restrictive diets and intuitive eating among men and women. The study found that intuitive eating uniquely and consistently presented lower levels of disordered eating and body image concerns. (Linardon, J., & Mitchell, S. 2017) Participants using intuitive eating expressed high levels of body appreciation, and researchers suggested promoting the practice within public health approaches to eating disorder prevention. The study also supported intuitive eating by promoting body acceptance and removing unhealthy thinking about food and eating.

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

Eating Smart To Feel Better

References

Linardon, J., & Mitchell, S. (2017). Rigid dietary control, flexible dietary control, and intuitive eating: Evidence for their differential relationship to disordered eating and body image concerns. Eating behaviors, 26, 16–22. doi.org/10.1016/j.eatbeh.2017.01.008

Bruce, L. J., & Ricciardelli, L. A. (2016). A systematic review of the psychosocial correlates of intuitive eating among adult women. Appetite, 96, 454–472. doi.org/10.1016/j.appet.2015.10.012

Swimmer’s Shoulder: How to Recover and Prevent Future Injuries

Dr. Alex Jimenez

Female warming up on pool edge — Female warming up for swimming. Stamding on pool edge and warming up hands and shoulders

Competitive swimmers, recreational, and swimming enthusiasts who experience pinching and sharp shoulder pain while swimming may suffer from shoulder impingement. Can understanding symptoms can help healthcare providers develop an effective treatment program?

Table of Contents

Swimmer’s Shoulder

Swimmer’s shoulder, medically known as rotator cuff impingement syndrome, is a common injury among swimmers. It can limit swimming ability and normal arm use for functional tasks. It is caused by persistent and abnormal rubbing and pinching of the structures in the shoulder, causing pain and irritation of the shoulder’s rotator cuff tendons and the bursa. The injury affects 40% to 90% of swimmers at some point. (Wanivenhaus F. et al., 2012) Self-care treatment involves rest, anti-inflammatory medication, and exercise to restore normal shoulder mobility. Most cases resolve within a few months, but physical therapy may be needed along with continued exercises and stretches to maintain pain relief.

Anatomy

The shoulder is a complex joint with extreme mobility. It is comprised of three bones:

The scapula or shoulder blade.
The clavicle or collar bone.
The humerus or upper arm bone.

These three bones combine at various places to make up the joint. Several muscles attach to and move the joint. (Kadi R. et al., 2017) The rotator cuff is one group of four muscles deep in the shoulder surrounding the joint. When lifting the arm, these muscles contract to hold the ball in the joint’s socket, allowing the arm to be raised in a fluid and smooth motion. Several ligaments hold the shoulder joint together and connect the various bones of the shoulder, giving the joint stability when moving. (Kadi R. et al., 2017)

Symptoms

Common symptoms include: (Wanivenhaus F. et al., 2012)

Swelling in the front or top of the shoulder
Difficulty reaching up overhead
Shoulder pain
Shoulder pain when bearing weight through the arm.
Symptoms tend to be worse during or immediately after swimming.

This is due to the position of the arms and upper extremities while swimming. (Wanivenhaus F. et al., 2012) Reaching overhead and turning the hand inward can cause the rotator cuff tendons or shoulder bursa to become pinched underneath the acromion process of the shoulder blade, similar to the motion that occurs during the crawl or freestyle stroke. When pinching/impingement occurs, the tendons or bursa can become inflamed, leading to pain and difficulty with normal arm use. (Struyf F. et al., 2017) The condition may also occur due to the laxity of the shoulder ligaments. (Wanivenhaus F. et al., 2012) It is theorized that the ligaments in swimmers become stretched and lax, leading to shoulder joint instability. This can cause the shoulder joint to become loose and compress the shoulder structures.

Diagnosis

A clinical examination can diagnose cases of swimmer’s shoulder. (Wanivenhaus F. et al., 2012) The exam can include:

Palpation
Strength test
Specialized tests

One shoulder test that is often used is called Neer’s test. A physician elevates the arm overhead to the maximum degree during this examination. If this results in pain, the rotator cuff tendons may be compressed, and the test is positive. Individuals may begin treatment after the examination, but a doctor may also refer them for diagnostic testing. An X-ray may be taken to examine the bone structures, and an MRI may be used to examine the soft tissue structures, such as the rotator cuff tendons and the bursa.

Treatment

Appropriate treatment of swimmer’s shoulder involves managing pain and inflammation in your shoulder and improving the way your shoulder moves so you avoid pinching structures inside the joint. (Wanivenhaus F. et al., 2012) There are various treatments available and can include:

Rest
Physical therapy
Acupuncture
Non-surgical decompression
Targeted exercises and stretches
Medications
Injections
Surgery for serious cases

Physical Therapy

A physical therapist can treat shoulder impingement. They can assess the condition and prescribe treatments and exercises to improve mobility and strength. (Cleveland Clinic, 2023) They may use various treatment modalities to decrease pain and improve circulation to facilitate and expedite healing. Physical therapy treatments can include:

Ice
Heat
Trigger point release
Joint mobilizations
Stabilization
Stretching
Exercise
Electrical stimulation
Ultrasound
Taping

Medication

Medication may include over-the-counter anti-inflammatory medicine to help decrease pain and inflammation. A physician may prescribe stronger medication to manage inflammation if the condition is severe. While taking medication, the shoulder will need rest, so avoiding swimming or other shoulder movements for a week or two may be necessary.

Injections

Cortisone is a powerful anti-inflammatory medicine. Individuals may benefit from cortisone injections into their shoulders. (Wanivenhaus F. et al., 2012) When injected, cortisone decreases pain, reduces swelling in the rotator cuff and bursa, and improves shoulder mobility.

Surgery

If symptoms are persistent and fail to be alleviated with conservative treatments, surgery may be recommended. An arthroscopic procedure called subacromial decompression may be performed. (Cleveland Clinic, 2023) This type of surgery is done with small incisions, inserting a camera, and tiny tools. During this procedure, inflamed tissue and bone spurs are removed from the underside of the acromion process of the shoulder blade, allowing more space to the shoulder joint. Post-surgery, individuals can gradually return to swimming and all other activities in about eight weeks.

Recovery

Most episodes last about eight to ten weeks, and severe cases last up to three months. (Struyf F. et al., 2017) Often, the symptoms slowly resolve with rest and gentle stretching. As symptoms improve, individuals can slowly return to normal activity and swimming. However, performing prescribed exercises two to three times a week may be necessary to maintain shoulder strength and mobility and help prevent future episodes of shoulder impingement. Individuals experiencing any of these symptoms should visit their physician for an accurate diagnosis of their condition to begin proper treatment. Discuss goals with a healthcare professional and physical therapist.

Sports Injuries Rehabilitation

References

Wanivenhaus, F., Fox, A. J., Chaudhury, S., & Rodeo, S. A. (2012). Epidemiology of injuries and prevention strategies in competitive swimmers. Sports health, 4(3), 246–251. doi.org/10.1177/1941738112442132

Kadi, R., Milants, A., & Shahabpour, M. (2017). Shoulder Anatomy and Normal Variants. Journal of the Belgian Society of Radiology, 101(Suppl 2), 3. doi.org/10.5334/jbr-btr.1467

Struyf, F., Tate, A., Kuppens, K., Feijen, S., & Michener, L. A. (2017). Musculoskeletal dysfunctions associated with swimmers’ shoulder. British journal of sports medicine, 51(10), 775–780. doi.org/10.1136/bjsports-2016-096847

Cleveland Clinic. (2023). Swimmer’s shoulder. my.clevelandclinic.org/health/diseases/17535-swimmers-shoulder

Knee Strengthening Exercises for Joint Health and Pain Relief

Dr. Alex Jimenez

Woman doctor examining male patient leg in clinic — African American man sitting on massage table in doctor office while female physiotherapist checking male leg injury

Can incorporating stretches and exercises help relieve pain and provide more support for individuals with knee pain?

Table of Contents

Knee Strengthening

The knee is the largest joint connecting the shin and thigh bones. Its cartilage, muscles, ligaments, and nerves all play a role in maintaining the joint’s health and movement. Individuals of all ages can experience knee pain, but it is more common in those with labor-intensive jobs, arthritis, and athletes. A healthcare provider will prescribe targeted stretches and exercises for individuals with pain, inflammation, or a health disorder that affects the strength of their knees to relieve knee pain while strengthening the muscles around the joint. Knee stretches and exercises are great for those with sore knees and knee pain or stiffness, but they can also be used as preventative medicine.

Exercise Benefits

Doing knee-strengthening exercises can significantly improve joint health. The benefits associated with exercises include (Zeng C. Y. et al., 2021)

Reduced pain, stiffness, and joint dysfunction.
Reduced inflammation.
Improved mobility.
Improved strength.
Cartilage degeneration prevention.
Bone loss prevention.

Leg Lifts

Leg lifts are done by lying on the back with one leg bent and the other fully extended. To perform the exercise: (American Academy of Orthopaedic Surgeons, 2009)

Raise the extended leg, keeping it straight.
Hold for three to five seconds once the leg is elevated roughly one foot off the floor.
Lay it back down to rest.
Repeat the exercise 20 times for each leg.

What To Avoid

When performing the single-leg lift, there are certain things to avoid as they can lead to other issues or injuries. This includes: (American Academy of Orthopaedic Surgeons, 2009)

Arching the back
Flexing the neck
Moving too quickly through the motion.
Using momentum instead of the muscles.

To know the exercise is being performed correctly, individuals should feel it in the front of their thighs.

Hamstring Stretch on a Bench

If a weight bench is available, doing hamstring stretches can help strengthen the knee. To perform this stretch:

Sit straight on the bench, with one leg straight out and the other planted on the floor.
With the knee straight, hinge over from the hips, keeping a straight, neutral spine.
Slowly push the chest towards the leg straight out on the bench. Hold for 15 to 30 seconds.

This exercise helps with overall strength, stamina, and balance. (Kothawale S. Rao K. 2018) (Wang H. et al., 2016)

What To Avoid

Avoid curving the spine to get closer to the thigh during the stretch. The key is not how far you can bend down but getting a deep stretch. Individuals not yet flexible enough to go all the way down should bend until comfortable but can still feel the stretch in their hamstrings. With practice and time, flexibility will improve. This stretch should be felt in the hamstrings.

Step Exercises

Step exercises, or step-ups, involve using a platform at least 6 inches high. To perform the exercise:

Put one foot onto the platform and use that leg to lift the other foot off the floor.
Hold the position with the foot hanging loosely for 3 to 5 seconds, then place the foot back on the floor.
Repeat each motion 20 times on each leg. (American Academy of Orthopaedic Surgeons, 2009)

What To Avoid

Avoid locking the knees when stepping up on the platform. Locking the knees switches off the muscles that need strengthening (American Academy of Orthopaedic Surgeons, 2009). Step exercises work out various areas of the leg. Individuals should feel this exercise in the thigh, hip, and buttocks.

Post-Exercise Stretching

Post-exercise stretching is vital in physical rehabilitation and strengthening. Stretching after exercise, individuals can (Afonso J. Clemente. et al., 2021)

Relieve and reduce soreness.
Expedite recovery times.
Increase range of motion.
Strengthen the knees more quickly and effectively.

Post-exercise stretches for knee pain and weakness can include:

Quadricep Stretch

This stretch targets the quad muscles located in the thighs. To perform this stretch:

Stand with the feet planted flat on the floor, spaced the same width as the shoulders.
Bending the left knee, grab the foot with the left hand and pull the heel toward the buttocks.
Hold for 5 to 10 seconds.
Repeat on both sides.

What to Avoid

There is no need to pull the heel too far into the buttocks. The goal is to feel a deep stretch. Pushing it too far can lead to injury. (Lee J. H. et al., 2021)

Toe Touches

Toe touches will help stretch calve muscles and hamstrings. To perform this stretch:

Sit on the floor with the legs straight out in front.
Bend the body over the legs at the hips, reaching for the toes in front while maintaining a straight back.
Relax the shoulders and keep them away from the ears.
Once touching the toes, hold the stretch for 15 seconds.

What To Avoid

Individuals who cannot yet touch their toes should perform the same steps and reach only as far as is comfortably possible. Over time, flexibility will improve. (Lee J. H. et al., 2021)

Injury Medical Chiropractic Clinic

These are examples of exercises and stretches that a physical therapy and chiropractic team may prescribe. Each case is different and requires reviewing individual medical history and physical examination to determine the proper treatment program. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop a personalized treatment program through an integrated approach to treating injuries and chronic pain syndromes, improving flexibility, mobility, and agility to relieve pain and help individuals return to normal activities. If other treatments are needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments.

Knee Pain Rehabilitation

References

Zeng, C. Y., Zhang, Z. R., Tang, Z. M., & Hua, F. Z. (2021). Benefits and Mechanisms of Exercise Training for Knee Osteoarthritis. Frontiers in physiology, 12, 794062. doi.org/10.3389/fphys.2021.794062

American Academy of Orthopaedic Surgeons. OrthoInfo. (2009). Knee exercises. orthoinfo.aaos.org/en/staying-healthy/knee-exercises/

Kothawale S. and Rao K. (2018). Effectiveness of positional release technique versus active release technique on hamstrings tightness. Int J Physiother Res., 6(1), 2619-2622. doi.org/https://dx.doi.org/10.16965/ijpr.2017.265

Wang, H., Ji, Z., Jiang, G., Liu, W., & Jiao, X. (2016). Correlation among proprioception, muscle strength, and balance. Journal of physical therapy science, 28(12), 3468–3472. doi.org/10.1589/jpts.28.3468

Afonso, J., Clemente, F. M., Nakamura, F. Y., Morouço, P., Sarmento, H., Inman, R. A., & Ramirez-Campillo, R. (2021). The Effectiveness of Post-exercise Stretching in Short-Term and Delayed Recovery of Strength, Range of Motion and Delayed Onset Muscle Soreness: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Frontiers in physiology, 12, 677581. doi.org/10.3389/fphys.2021.677581

Lee, J. H., Jang, K. M., Kim, E., Rhim, H. C., & Kim, H. D. (2021). Effects of Static and Dynamic Stretching With Strengthening Exercises in Patients With Patellofemoral Pain Who Have Inflexible Hamstrings: A Randomized Controlled Trial. Sports health, 13(1), 49–56. doi.org/10.1177/1941738120932911

Understanding Hip Tendonitis: Causes, Symptoms, and Treatment

Dr. Alex Jimenez

Full length shot of a female physician working with a senior male patient.

Can understanding the causes and symptoms of potential hip tendonitis help healthcare providers diagnose and treat the condition for individuals experiencing pain in the front of the hip with restricted hip flexibility that worsens during movement?

Table of Contents

Hip Tendonitis

Hip tendonitis is inflammation of the iliopsoas tendon. It is most commonly caused by overuse of the hip flexors without adequate rest for recovery. The condition can occur when the hip muscles overpower the tendons attached to the hip bone, causing inflammation and irritation. This can lead to pain, tenderness, and mild swelling near the hip joint. Hip tendonitis can be diagnosed with a physical examination, and treatment can include:

Rest
Ice
NSAIDs
Stretching
Physical therapy
Chronic cases may require a cortisone injection into the iliopsoas tendon to decrease inflammation.
Surgical release of the iliopsoas tendon may be recommended to decrease tightness and pain.

There is a high prognosis for a full recovery.

Tendonitis

Inflammation in a muscle’s tendon leads to pain and tenderness that worsens the more the muscle is used. An overuse injury means the tendon becomes repeatedly stressed through repetitive muscle contractions, causing muscle and tendon fibers to micro-tear. If not enough rest is allowed for the micro-tears to heal, a chronic cycle of pain and inflammation develops within the affected tendon. Other tendons that are prone to developing the condition include:

The tendon of the wrist extensors/tennis elbow.
The tendon of the wrist flexors/golfer’s elbow.
The Achilles’ tendon/Achilles tendonitis.
The patellar tendon/jumper’s knee.
The tendons of the thumb/De Quervain’s tenosynovitis.

Bursitis

Bursae are small fluid-filled sacs that help cushion and decrease friction around joints.
Because the iliopsoas tendon overlays bursae, inflammation of the tendon can also cause bursitis or inflammation of the bursae surrounding the tendon.
Tendonitis and bursitis can and often occur together due to overlapping symptoms.

Causes

The iliopsoas originates in the pelvis and vertebrae of the lower spine and attaches to the top of the femur or thigh bone. It allows the hip joint movement that brings the leg closer to the front of the body, like lifting the leg to step up or jump. It also helps keep the torso stable when standing with one or both feet on the ground and rising from a lying position. Hip tendonitis most often results from physical activities that require repeated leg lifting when stepping, running, kicking, or jumping. This can include:

Running
Dancing
Gymnastics
Martial arts
Cycling
Playing soccer

Iliopsoas tendonitis can also occur after hip arthroscopy, a minimally invasive surgical procedure to repair structures inside the hip joint because of altered joint movement and muscle activation patterns after surgery. (Adib F. et al., 2018)

Symptoms

The primary symptoms of hip tendonitis include a soreness or deep ache in the front of the hip that worsens after physical activity and limits the range of motion because of the pain. Other symptoms include:

Tenderness to touch in the front of the hip.
The pain can feel like a dull ache.
Stiffness may also be present.
Hip flexor tightness.
Altered posture, with the pelvis rotated forward and an exaggerated curve in the lower back.
Lower back pain.
Discomfort after prolonged sitting.
Altered walking pattern characterized by shortened steps.

Diagnosis

Hip tendonitis is diagnosed through a physical examination and medical history reviews of individual symptoms.
Individuals may also have an X-ray of their hip performed to examine the joint alignment and determine if a fracture or arthritis is present.

Treatment

Initial treatment involves rest from physical activities, applying ice, and gentle stretching.
Nonsteroidal anti-inflammatory drugs/NSAIDs can ease pain and swelling, decrease inflammation, and reduce muscle spasms.
If chronic pain persists, individuals may receive a cortisone injection into their iliopsoas tendon. (Zhu Z. et al., 2020)
A personalized physical therapy program focusing on hip flexor stretching and strengthening, as well as strengthening the glutes and core, will help expedite an optimal recovery.

Surgery

For cases that do not improve after three months of treatment, surgery to lengthen the iliopsoas tendon, a procedure known as a tenotomy, may be performed. It involves making a small cut into a portion of the tendon, allowing the tendon to increase in length while decreasing tension as it heals back together. A tenotomy temporarily reduces the strength of the iliopsoas; however, this weakness usually resolves within three to six months after surgery. (Anderson C. N. 2016)

Chiropractic Care

Chiropractic care can be an effective treatment because it can help restore proper alignment and motion in the hip, reduce inflammation, and improve muscle and joint function. Treatments may include:

Spinal adjustments to realign the spine and other joints, reducing pressure on nerves and inflammation.
Non-surgical decompression
Manual therapy – massage, trigger point therapy, or spinal manipulation.
Acupuncture
Graston technique
Rehabilitative exercises like stretching, strengthening, and range of motion exercises.

Tendonitis generally has an excellent prognosis for full recovery as long as thorough rest from activities is taken to allow the inflamed tendon to heal. The postsurgical prognosis is positive for chronic and severe cases of iliopsoas tendonitis that require surgery.

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop a customized treatment program through an integrated approach to treating injuries and chronic pain syndromes, improving flexibility, mobility, and agility to relieve pain and help individuals return to normal activities. If other treatments are needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments.

Inflammation and Integrative Medicine

References

Adib, F., Johnson, A. J., Hennrikus, W. L., Nasreddine, A., Kocher, M., & Yen, Y. M. (2018). Iliopsoas tendonitis after hip arthroscopy: prevalence, risk factors and treatment algorithm. Journal of hip preservation surgery, 5(4), 362–369. doi.org/10.1093/jhps/hny049

Zhu, Z., Zhang, J., Sheng, J., Zhang, C., & Xie, Z. (2020). Low Back Pain Caused by Iliopsoas Tendinopathy Treated with Ultrasound-Guided Local Injection of Anesthetic and Steroid: A Retrospective Study. Journal of pain research, 13, 3023–3029. doi.org/10.2147/JPR.S281880

Anderson C. N. (2016). Iliopsoas: Pathology, Diagnosis, and Treatment. Clinics in sports medicine, 35(3), 419–433. doi.org/10.1016/j.csm.2016.02.009

Understanding the Gluteus Maximus: Functions and Importance

Dr. Alex Jimenez

Man professional doctor osteopath fixing and stretching mans back with hands during exersicing at rehabilitation theapy in manual therapy clinic, top view. Chiropractor during work.

Individuals dealing with pain in the buttocks can make life difficult to sit, walk, or perform simple, everyday tasks. Can understanding the anatomy, location, and function of the gluteus maximus muscle help in muscle rehabilitation and avoid potential injuries?

Table of Contents

Gluteus Maximus

The gluteus maximus is the largest human body muscle responsible for hip extension, external rotation, adduction, and abduction, as well as the ability to stand upright. The primary muscle extends laterally and keeps the body upright by supporting the bony pelvis and trunk. (Neto W. K. et al., 2020) When the gluteus maximus is strained, injured, or weak, it can lead to pain and inflammation.

Common symptoms can include:

Stiffness in the buttock
Discomfort while sitting
Difficulty standing up from sitting
Difficulty bending over
Pain when walking, especially upstairs or on a hill
Pain in the lower back and/or tailbone

Anatomy and Structure

The muscles that comprise the glutes are the gluteus maximus, gluteus medius, and gluteus minimus. The gluteus medius runs underneath the gluteus maximus, and the gluteus minimus is underneath the gluteus medius.

The gluteus maximus is one of the strongest muscles. Fibers from the muscle connect to different body parts, including the femur/thighbone and the iliotibial band, which comprises connective tissue that runs up the thigh. The superior gluteal artery transports blood from the heart to the glutes.

Nerve Supply

The inferior gluteal nerve, part of the sacral plexus branch, innervates the maximus muscle. The sacral plexus nerves support motor and sensory function in the thighs, lower legs, feet, and pelvis. The sciatic nerve runs under the gluteus maximus, from the lower back down to the leg, and is often the cause of nerve pain in and around the area. (Carro L. P. et al., 2016) The main nerve of the perineum is the pudendal nerve, which runs under the gluteus maximus muscle.

Location

The gluteus maximus muscle defines the buttocks. It can be called a superficial muscle, sometimes referred to muscles that help provide shape. The origin of the gluteus maximus connects to the sacrum, the ilium, or the large upper part of the hip bone, the thoracolumbar fascia tissue, and the sacrotuberous ligaments attached to the posterior superior iliac spine. The gluteus maximus has a 45-degree angle from the pelvis to the buttocks and then inserts at the gluteal tuberosity of the femur and the iliotibial tract.

Variations

Sometimes, a duplicate muscle may originate from the gluteus maximus muscle in rare cases. However, it is more common that the gluteus maximus muscle fibers may be inserted into different body parts than where they are typically inserted. (Taylor, V. G., Geoffrey & Reeves, Rustin. 2015) This can cause a condition called greater trochanteric pain syndrome or GTPS. Inflammation of the gluteus medius, minimum tendons, and bursa inflammation can also cause GTPS. Individuals with GTPS will have tenderness or a pulsing feeling on the outer side of the hip and thigh when lying on the side, along with other symptoms.

Function

The gluteus maximus extends and externally rotates the hip joint, stabilizing the body. It is highly engaged during running and hiking activities. Regular walking does not typically target gluteus maximus strength training. However, the gluteus maximus promotes balance when walking and other activities by helping keep the pelvis and posture upright.

Conditions

The most common condition associated with the gluteus maximus is muscle strain, and deep gluteus maximus syndrome is another condition that can cause pain and involves the muscles.

Muscle Strain

A muscle strain can result from stretching and working the muscle too much that it becomes overstretched or tears. (Falótico G. G. et al., 2015) This can happen from not warming up or cooling down properly, repetitive use injury, and over-exercising. Alternatively, not exercising and not utilizing your gluteus maximus can weaken it, leading to lower back pain, hip pain, and stability and posture issues. (Jeong U. C. et al., 2015)

Deep Gluteus Maximus Syndrome

This syndrome causes pain in the buttocks when the sciatic nerve becomes entrapped. (Martin, H. D. et al., 2015) The location of the pain can help healthcare providers determine where the nerve is trapped. Those with deep gluteus maximus syndrome may experience various types of discomfort, including (Martin, H. D. et al., 2015)

Numbness and tingling in the leg
Pain when sitting
Pain when walking
Pain that radiates down the back and hips and into the thigh

To diagnose the condition, a healthcare provider may perform a physical examination and various tests to rule out other conditions that can cause similar symptoms.

Treatment and Rehabilitation

If there is pain in the buttocks and/or lower extremities, it’s important to consult a primary doctor, chiropractor, or physical therapist. They will evaluate the strength of the gluteus muscles to diagnose any strain or weakness. From there, they will develop a personalized treatment plan to help heal the injury, strengthen the muscles, and restore function. Treatment will include stretches once the strain is rested and improves.

Recommendations can include taking a few days off to rest the muscle or, at the very least, stop performing the work or activity that caused the strain.
Ice and over-the-counter medication like ibuprofen can help reduce inflammation.
For weak gluteus maximus, a physical therapist will strengthen and retrain the muscle with a tailored program of exercises. (Jeong U. C. et al., 2015)
Treatment for deep gluteus maximus syndrome may include conservative treatment, such as chiropractic decompression and realignment, physical therapy, medications for pain and inflammation, and injections.
If conservative treatments do not relieve the pain, a primary healthcare provider may recommend surgery. (Martin, H. D. et al., 2015)

Working with a chiropractic physical therapy team can help individuals return to normal function and expedite healing. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop a customized treatment program through an integrated approach to treating injuries and chronic pain syndromes, improving flexibility, mobility, and agility to relieve pain and help individuals return to normal activities. If other treatments are needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments.

The Science of Motion and Chiropractic Care

References

Neto, W. K., Soares, E. G., Vieira, T. L., Aguiar, R., Chola, T. A., Sampaio, V. L., & Gama, E. F. (2020). Gluteus Maximus Activation during Common Strength and Hypertrophy Exercises: A Systematic Review. Journal of sports science & medicine, 19(1), 195–203.

Carro, L. P., Hernando, M. F., Cerezal, L., Navarro, I. S., Fernandez, A. A., & Castillo, A. O. (2016). Deep gluteal space problems: piriformis syndrome, ischiofemoral impingement and sciatic nerve release. Muscles, ligaments and tendons journal, 6(3), 384–396. doi.org/10.11138/mltj/2016.6.3.384

Taylor, Victor & Guttmann, Geoffrey & Reeves, Rustin. (2015). A variant accessory muscle of the gluteus maximus. International Journal of Anatomical Variations. 8. 10-11.

Falótico, G. G., Torquato, D. F., Roim, T. C., Takata, E. T., de Castro Pochini, A., & Ejnisman, B. (2015). Gluteal pain in athletes: how should it be investigated and treated?. Revista brasileira de ortopedia, 50(4), 462–468. doi.org/10.1016/j.rboe.2015.07.002

Jeong, U. C., Sim, J. H., Kim, C. Y., Hwang-Bo, G., & Nam, C. W. (2015). The effects of gluteus muscle strengthening exercise and lumbar stabilization exercise on lumbar muscle strength and balance in chronic low back pain patients. Journal of physical therapy science, 27(12), 3813–3816. doi.org/10.1589/jpts.27.3813

Martin, H. D., Reddy, M., & Gómez-Hoyos, J. (2015). Deep gluteal syndrome. Journal of hip preservation surgery, 2(2), 99–107. doi.org/10.1093/jhps/hnv029