Dr. Alex Jimenez, D.C., presents how hypertension affects the human body and some causes that can increase hypertension in many individuals in this 2-part series. We refer our patients to certified medical providers who provide multiple available treatments for many individuals suffering from hypertension associated with the cardiovascular and immune systems affecting the body. We encourage each of our patients by mentioning them to associated medical providers based on their analysis appropriately. We understand that education is a delightful way when asking our providers questions at the patient’s request and understanding. Dr. Jimenez, D.C., only makes use of this information as an educational service. Disclaimer
How To Look For Hypertension
Dr. Alex Jimenez, D.C., presents: Let’s go back to the decision tree so you can begin to think about how you will apply the go-to-it model in functional medicine to hypertension and how you will start better assessing somebody with hypertension rather than telling them that their blood pressure is elevated. Is the body influenced by inflammation, oxidative stress, or immune response? Is it affecting endothelial function or vascular smooth muscle from those three categories of reactions, inflammation, oxidative stress, or immune response? Do we choose a diuretic calcium channel blocker or an ACE inhibitor? And so to do that, it’s really important in our gather section. Taking the medical history and the timeline of their hypertension, you get a clue about the organ damage to the questionnaires. You’re looking at their anthropometrics.
This includes the following questions:
What are the inflammatory markers?
What are the biomarkers and clinical indicators?
Those are outlined through the clinical decision tree. And already just doing that, you’re going to expand and fine-tune your lens on what you might see in your hypertensive patient. Let’s add to the timeline when does hypertension begin? The timeframe of hypertension begins actually in prenatally. It’s important to ask your patient if they were early or large educational age. Was their mother stressed? Were they born early or premature? Was there nutritional stress in their pregnancy? If they know that, you can have two people with the same kidney size, but the person who didn’t have enough protein during pregnancy can have up to 40% less glomeruli. Knowing that will change how you adjust the medication decades later if you know they possibly have 40% less glomeruli.
The Timeline For Blood Pressure
Dr. Alex Jimenez, D.C., presents: So it’s important to take the timeline of their blood pressure. Then it’s also important to recognize what is happening when we begin to organize and collect data through the biomarkers; the basic biomarkers will give you clues about whether they have issues with insulin lipids, whether they have problems with vascular reactivity, autonomic nervous system balance, imbalance, coagulation, or immune toxin effects. So this is a reasonable thing to print off because, in your hypertensive patient, this is through just the biomarkers you can begin to get a clue as to what areas of dysfunction affect inflammation, oxidative stress, and immune response and how these biomarkers reflect that information for you. This is very reasonable to have in front of you to help change your thoughts about hypertension and also enables you to refine some of the characteristics of the person on the other side of your stethoscope in a more personalized, precise way.
But let’s start at the very beginning. Does your patient have high blood pressure? We know that depending on the end organ effects of their comorbidities, you may run someone a slightly higher blood pressure if you have a profusion issue in the brain and the kidneys or the heart, but some guidelines are there. Our 2017 American Heart Association guidelines for blood pressure categories are listed here. They’ve waxed and waned back and forth over the last couple of decades, but this is very clear. Having elevated blood pressure, anything above 120, really shifted how many people we start seeing or considering addressing the root causes of their blood pressure. So we will come back to this, especially in the case to help us look at how we categorize people with blood pressure issues.
The Criteria To Mesure Blood Pressure
Dr. Alex Jimenez, D.C., presents: What is the first step? It’s how do you have the blood pressure taken in your patient? Do they monitor it at home? Do they bring those numbers to you? How do you monitor blood pressure in your clinic? How do you get accurate readings in your clinic? Here are the criteria to accurately measure blood pressure and the questions to consider whether you’re doing all these.
Do you ask your patient whether they’ve had caffeine in the last hour?
Whether they’ve smoked in the previous hour?
Were they exposed to smoke in the last hour?
Is the place where you’re taking blood pressure warm and quiet?
Are they sitting with their back supported in a chair with their feet on the ground?
Do you use the roll-around side table to rest your arm at the heart level?
Are they sitting at the exam table with their feet dangling, and a nurse aide elevates their arm and puts in their axillary fold to hold their arm there?
Are their feet on the ground?
Have they sat there for five minutes?
Have they exercised in the previous 30 minutes?
You may have systolic blood pressure if everything is in the criteria. Here’s the challenge. There are 10 to 15 millimeters of mercury higher when it comes to sitting and taking blood pressure. What about the cuff size? We know last century; most adults had an upper arm circumference of fewer than 33 centimeters. Over 61% of people now have an upper arm circumference greater than 33 centimeters. So the size of the cuff is different for around 60% of your adult patients, depending on your population. So you have to use a large cuff. So take a look at how blood pressure is collected in your office. Let’s say the blood pressure is elevated in your patients; then we have to ask, is it normal? Great.
The Different Types Of Hypertension
Dr. Alex Jimenez, D.C., presents: Is it elevated because of white-coat hypertension? Do they have normal blood pressure, elevated outside the clinic, or masked hypertension? Or do they just have sustained hypertension which is a challenge? We’ll talk about that. So when you interpret, it is also important to consider ambulatory blood pressure monitoring. So if you have somebody who’s hypertensive and don’t know whether the blood pressure goes down and you’re trying to figure out whether they have sustained hypertension, you can use 24-hour blood pressure monitoring. The mean daytime blood pressure above 130 over 80 is hypertensive the mean nighttime blood pressure above 110 over 65 is hypertensive. So why is this important? The average blood pressure dips to around 15% at night because of the issue with blood pressure dipping. Failure to have blood pressure drop while you sleep at night could develop problems that can affect a person throughout the day.
If your patient sleeps at night, it should drop about 15% when they sleep. If they have non-dipping blood pressure, it is associated with comorbidities. What are some of those comorbidities in non-dipping blood pressure? Some of the conditions correlated with non-dipping blood pressure include:
Congestive Heart Disease
Cardiovascular Disease
Cerebrovascular Disease
Congestive Heart Failure
Chronic Renal Failure
Silent Cerebral Infractions
Co-morbidities Associated With Non-Blood Pressure
Dr. Alex Jimenez, D.C., presents: These are the comorbidities associated with non-blood pressure. All of us agree that elevated blood pressure is not necessarily good in all those conditions. So when you look at different people groups or other comorbidities, non-dipping blood pressure is most commonly associated with sodium-sensitive folks, people who have renal insufficiency, people who have diabetes, people who have left ventricular hypertrophy, people who have refractory hypertension or autonomic nervous system dysfunction and finally, sleep apnea. So, non-dipping blood pressure increases your association with subclinical cardiac damage. Okay, Reverse dipping means you are more hypertensive at night and is more ascent associated than during the day is more related to hemorrhagic stroke. And if you have somebody with nocturnal hypertension, you have to start thinking about things like the carotid arteries and increased carotid, internal medial thickness. You start thinking about left ventricular hypertrophy and may see it on EKG. Here’s what we know about nocturnal hypertension. Nocturnal hypertension is a nighttime blood pressure greater than 120 over 70. It is associated with greater predictability of cardiovascular morbidity and mortality.
If you have nocturnal hypertension, it increases your risk of mortality from cardiovascular disease by 29 to 38%. We must know what’s happening at night when we sleep, right? Well, what’s another refinement? Another refinement is recognizing that resting blood pressure is controlled by your renin-angiotensin system. Waking blood pressure is controlled by your sympathetic nervous system. So let’s talk about how their renal angiotensin system drives their nighttime hypertension, and you think about what medication they’re taking. You might change the medication dosing to nighttime. Well, studies have shown that if you have nighttime hypertension and are a non-dipper, it’s best to take your ACE inhibitors, ARBs, calcium channel blockers, and certain beta blockers at night before bed. But it makes sense that you wouldn’t move your diuretics to nighttime, or you will have a disruptive sleep.
Addressing Daytime & Nighttime Blood Pressure
Dr. Alex Jimenez, D.C., presents: So if we don’t address daytime and nighttime blood pressure, we have to consider the effect of blood pressure load. What is your average daytime blood pressure and your moderate sleeping blood pressure is. We know that blood pressure load in young adults is hypertensive only about 9% of the time. So meaning the systolic load is about 9% versus in the elderly, about 80% of the blood pressure load is systolic. And so when you have a higher systolic load, you have more complications and end-organ damage. So what we’re talking about is helping identify your patient with hypertension; what is their timeline? What is their phenotype? Are they only hypertensive during the day, or they’re hypertensive at night also? We have to look at what helps balance that.
Here’s the other point, only about 3.5% of people with hypertension do it have a genetic cause. Only 3.5% of people their genes cause hypertension. The power is at the bottom of the matrix and recognizing these patterns, right? So you look at exercise, sleep, diet, stress, and relationships. So we know that these four autonomic balances help determine blood pressure. We will examine the renal angiotensin system, plasma volume where they hold onto too much fluid, secondary salt load, and endothelial dysfunction. Abnormalities in any of these can lead to hypertension. We’ve been talking about another one that can lead to hypertension: the link between insulin resistance and hypertension.
This diagrammatically gives you an idea of the physiologic interactions between insulin resistance and hypertension. It affects increasing sympathetic tone and increasing renal-angiotensin system balance. So let’s spend a few minutes on the renin-angiotensin system pathway angiotensinogen down to angiotensin two. We take advantage of these enzymes by giving inhibitors to angiotensin-converting enzymes in our hypertensives patients. Elevated angiotensin two leads to cardiovascular hypertrophy, leads to sympathetic phase constriction, increased blood volume, sodium fluid, retention, and aldosterone release. Can you inquire about your patient biomarkers? Can you ask whether they have elevated renin levels?
Look For The Signs
Dr. Alex Jimenez, D.C., presents: Well, you can. You can check plasma renin activity and aldosterone levels. It’s important to do this if your patient is hypertensive and has never been on medication because this is where nitrous oxide is so important. This is where your endothelial nitric oxide synthase is present. This is where you have sheer and hemodynamic stress. This is where dietary intake of arginine or the environment that affects nitric oxide plays such a role in the health of this layer of endothelia. If you lay it all together somehow, miraculously, or at least in your mind’s eye, it’ll cover six tennis courts in the average adult. It’s a huge surface area. And the things that cause endothelial dysfunction are not new news to people in functional medicine. Increased oxidative stress and inflammation are two things we mentioned that play an effect.
And then, look at some of these other components, your ADMA being elevated and correlated with insulin resistance. It all begins to form together in a matrix that interacts. So you look at one comorbidity in cardiometabolic syndrome, and it affects another comorbidity. You suddenly see the interrelation between them or hyperhomocysteinemia, which is a one-carbon metabolism marker, meaning you’re looking at the adequacy of folate, b12, b6, riboflavin, and that activity of your one-carbon metabolism. So let’s look at some of these emerging risk markers to improve and track in patients with hypertension. Let’s reanalyze ADMA again. ADMA stands for asymmetric dimethyl arginine. Asymmetric, dimethyl arginine is a biomarker of endothelial dysfunction. That molecule inhibits nitric oxide synthase while impairing endothelial function, and in all of the comorbidities associated with cardiometabolic syndrome, ADMA can be elevated.
Conclusion
So, as a quick review, L-arginine is converted to nitric oxide via nitric oxide synthase, and nitric oxide adequacy leads to vasodilation. ADMA blocks this conversion. And if your ADMA levels are elevated and your nitric oxide levels are low, then you have decreased nitric oxide platelet aggregation increases in LDL oxidation. So many things reduce nitric oxide or are associated with lower nitric oxide levels, sleep apnea, low dietary arginine, protein, zinc insufficiency, and smoking.
Unhealthy posture and slouching incorrectly position the body unnaturally, adding chronic strain on the muscles and ligaments. For example, when sitting or standing at a workstation, individuals start to relax by slumping forward because it feels comfortable; however, they don’t realize that their shoulders are hunching over, and their neck is in an awkward forward position. For every inch the head moves forward, its weight on the neck and upper back muscles increases by 10 pounds. Individuals that stay in this position for a long time often experience neck soreness, tension in the shoulder muscles, and low back discomfort. Chiropractic care, massage, and decompression therapy can realign the spine to its natural position and train individuals to maintain a healthy posture.
Slouching
Posture is the body’s position in space, the relationship of the body’s parts, head, torso, and limbs to each other. Maintaining the natural lumbar curve in the low back is essential to preventing posture-related discomfort symptoms. This natural curve works as a shock absorber, helping to distribute weight along the length of the spine. The most common causes for slouching posture are:
Repetitive motions or tasks can cause physical and mental fatigue, causing individuals to relax their core muscles.
Combined with the repetitiveness, individuals also begin implementing unhealthy movements because it makes the job easier.
Often individuals want to finish their work tasks, and even though they can feel their muscles and body stiffening and tightening up, they continue to work through the discomfort and don’t take a quick break to move around and stretch.
Stressful situations can cause muscle tension.
Carrying heavy bags, purses, backpacks, etc.
Weight fluctuation.
Pregnancy.
Spine
Muscles move the skeletal system and provide resistance against movement.
The musculoskeletal system comprises soft tissue structures that provide active and passive spinal stabilization.
The spine has natural curves to distribute weight/loads evenly.
The cervical and lumbar spine have a lordosis or forward curve.
The thoracic spine and sacrum have a kyphosis or backward curve.
They help to mitigate the forces exerted on passive stabilizing structures like the ligaments, joint capsules, and intervertebral discs.
A prolonged seated or standing position fatigues the muscles that stabilize the spine from the forces of gravity and body weight. When the tired muscles no longer provide stability, the spine must rely on the passive structures of the musculoskeletal system for support. Without the support, the spine gradually loses its natural cervical and lumbar curves and becomes more kyphotic or slouched. Slouching can provide relaxation and relief to the fatigued muscles; however, repetitive or prolonged stress to the passive structures can result in discomfort and injury to those tissues. This is how nerve compression, ligament inflammation, and disc herniations start.
Symptoms of Unhealthy Posture
Head that leans forward or backward.
Headaches.
Jaw pain.
Poor circulation.
Rounded shoulders.
A decline in breathing efficiency.
Muscle fatigue – Certain muscles can change in length, becoming short and tense or long and weak.
The advantages of practicing healthy posture include the following:
Prevents abnormal wear on the joints.
Lessens stress on the ligaments.
Prevents muscle strain and fatigue.
Prevents the spine from becoming misaligned.
Prevents back aches and soreness.
Reduces the risk of chronic diseases or conditions.
Helps maintain fitness and overall health.
Chiropractic Realignment
Our approach starts by correcting the physical problems caused by slouching, which involves chiropractic adjustments, therapeutic massage, and non-surgical decompression therapy. The objective is to fix the root cause to ensure that the treatment lasts and maintains neuromusculoskeletal health.
Examination
The initial assessment looks at an individual’s posture and a physical evaluation to identify the root cause.
When muscles become weak, over or underused, or suffer injury, others tighten or tense up.
A chiropractor looks at how an individual stands from behind and from the sides, noting issues like uneven shoulders, arched back, twisted pelvis, or other symmetry issues.
Treatment
Massage will increase circulation and reduce tension.
Muscle release and relaxation for any overactive muscles.
A chiropractor will perform slow joint movements.
Targeted stretches and strength exercises will correct imbalances, maintain flexibility, and strengthen the core muscles.
Postural training will help individuals learn to use proper body mechanics and to listen to their bodies.
Impact of Stress
References
Defloor, T, and M H Grypdonck. “Sitting posture and prevention of pressure ulcers.” Applied nursing research: ANR vol. 12,3 (1999): 136-42. doi:10.1016/s0897-1897(99)80045-7
Fortner, Miles O et al. “Treating ‘slouchy’ (hyperkyphosis) posture with chiropractic biophysics®: a case report utilizing a multimodal mirror image® rehabilitation program.” Journal of physical therapy science vol. 29,8 (2017): 1475-1480. doi:10.1589/jpts.29.1475
Katzman, Wendy B et al. “Age-related hyperkyphosis: its causes, consequences, and management.” The Journal of orthopedic and sports physical therapy vol. 40,6 (2010): 352-60. doi:10.2519/jospt.2010.3099
Korakakis, Vasileios, et al. “Physiotherapist perceptions of optimal sitting and standing posture.” Musculoskeletal science & practice vol. 39 (2019): 24-31. doi:10.1016/j.msksp.2018.11.004
Snijders, Chris J et al. “Effects of slouching and muscle contraction on the strain of the iliolumbar ligament.” Manual therapy vol. 13,4 (2008): 325-33. doi:10.1016/j.math.2007.03.001
Yoong, Nicole Kah Mun et al. “Commercial Postural Devices: A Review.” Sensors (Basel, Switzerland) vol. 19,23 5128. 23 Nov. 2019, doi:10.3390/s19235128
Dr. Alex Jimenez, D.C., presents how anti-inflammatory phytochemicals can reduce inflammation and treat other chronic conditions that inflammation is correlated with. We dive into what medicines can trigger inflammatory cytokines and some treatments that work together to reduce chronic inflammation. We refer our patients to certified medical providers incorporating multiple therapies for many individuals suffering from chronic inflammation and its correlating symptoms affecting the body. We encourage each of our patients by mentioning them to associated medical providers based on their analysis appropriately. We understand that education is a delightful way when asking our providers questions at the patient’s request and understanding. Dr. Jimenez, D.C., only makes use of this information as an educational service. Disclaimer
How Medications Associate With Inflammation
Dr. Alex Jimenez, D.C., presents: When it comes to a person’s health and wellness, it is important to know that when you are introducing them to potential antigenic medication, that person’s immune system is already imbalanced and much more likely to make abnormal immune responses, which then can lead to inflammatory effects in the body’s system. You see them mostly with chimeric human marine antibodies, which are the ones that make antibodies for the immune system, to that point, will elicit a much higher immune response. When this happens, it becomes a challenge to long-term pharmacotherapy. So when people go to their doctors for a prescription, about 20-30% of medication prescriptions are never filled because, most of the time, the prescription will never fill them in the drugstore, which can cascade into various issues.
And when people follow their prescription, sometimes they’ll take it for a little while, and after six months, they stop taking it. So the drop in prescriptions taken for longer than six months is quite low. In the last article, we discussed NSAIDs, DMARDs, and biologics, and we will touch base with acetaminophen. Acetaminophen is another one that’s just really widely used, and it’s because it’s put into all of these different cold and flu, and pain products. They sneak it into many other medications; you must read the labels. This is because some people metabolize acetaminophen quickly, which can become toxic. This can lead to individuals getting random headaches throughout the day and causes their glutathiones to be used promptly. So when looking for cold and flu medicine, it is best to look at the labels for acetaminophen because it doesn’t have anti-inflammatory responses since it is used for pain control.
How Acetaminophen Affects the Immune System
Dr. Alex Jimenez, D.C., presents: So even though we do not know how exactly how the analgesic effects work when people take cold and flu medicines, however, we do know that when people take a ubiquitous amount of acetaminophen, it could increase the pain threshold by inhibiting nitric oxide pathways in the body through mediation through the receptors for NMDA and substance P. We still don’t have a great handle on that, but that’s how it works. So, these drugs can be quite useful in the short term, but long-term use has serious side effects.
When looking for medications, it is important to read the labels that have a black box warning, which is the highest warning that the FDA issues for any potential overlapping risk profiles that the FDA issues. This can include severe liver injuries or serious possible allergic reactions that can develop into chronic inflammation of the muscles and joints. Now there are ways to reduce inflammation and prevent the body from being in more pain by slowly introducing anti-inflammatory botanicals and phytochemicals to detoxify the medication causing these complications.
Some individuals may not realize that constant medication for various pains and issues affecting the body can mask other problems involving the body’s systems. This can include:
Endocrine system
Cardiovascular system
Gastrointestinal system
Reproductive system
When these systems have been affected by medications, they can develop inflammatory markers in the vital organs and cause lead to visceral-somatic dysfunction in the body. When pain medications target pain localized in one location, but the issue is in a different area, this is known as referred pain. Referred pain is where the pain is in one muscle group location but is felt in another area of the body. When the organs are involved, it can cause inflammatory symptoms in the system. To that point, this causes the immune system to be induced into autoimmunity.
How The Immune System Is Induced Into Autoimmunity
Dr. Alex Jimenez, D.C., presents: When the immune system has been induced with autoimmunity, the corticosteroids can develop side effects that can be long termed and delay the healing process. Some of the physical symptoms that are visible with autoimmunity include:
Muscle weakness
Diabetes
High blood pressure
Thin bones
Delay wound healing
Flare-ups
Rheumatoid arthritis
Mood changes
When dealing with these inflammatory symptoms associated with pain, there are fundamental functional treatment approaches that can reduce the inflammatory cytokines causing joint and muscle pain.
Treatments To Target Inflammation
Dr. Alex Jimenez, D.C., presents: Some of the treatments that target inflammation include the following:
Slowly incorporating healthy lifestyle choices into a person’s daily lifestyle can reduce the effects of inflammatory cytokines affecting the vital organs, muscles, and joints. It is important to know that incorporating antioxidants, phytonutrients, and anti-inflammatory supplements can reduce residual symptoms in the body. All these treatments are some of the foundations that can address these inflammatory triggers and help reduce muscle and joint pain associated with inflammation.
Anti-Inflammatory Vitamins & Supplements
Dr. Alex Jimenez, D.C., presents: Another important note about these treatments is that vitamins and supplements can combine to help treat inflammatory effects that are causing issues in the body. These anti-inflammatory botanicals and phytochemical agents can not only act on the different pathways in the body but also have different mechanisms similar to healthy nutritional foods. Incorporating anti-inflammatory botanicals and phytochemical agents into the body will help modulate the inflammatory cascades and provide multiple synergistic activities to the body.
These agents down-regulate the inflammatory pathways caused by NF-kappaB. They can act as modulators that dissociate the cytokines from causing more issues like oxidative stress or infections triggering inflammation. However, we need inflammation to heal the body from wounds and infections. We mustn’t want the cytokines too high to cause inflammatory effects. So incorporating anti-inflammatory botanicals and phytochemicals provides a much safer option to the body and can be used in many chronic inflammatory conditions.
Conclusion
Since many botanicals and phytochemicals have anti-inflammatory properties, it can be difficult to find a good amount that the body needs to reduce chronic inflammation. Since many cultures and places have used many nutritional plants and herbs for years worldwide, it can be exhausting. Some of the botanical supplements include:
Zinc
Green tea extract
Capsaicin
S-adenosylmethionine
Ginger
To summarize how it is important to know which supplements have anti-inflammatory properties, doing research and incorporating small changes into a daily lifestyle can provide amazing results and allow the individual to be pain-free and have good health when combining botanicals and phytonutrients.
The iliopsoas muscle is a primary hip flexor that assists in the femur’s external rotation and maintains the hip joint’s strength and integrity. It also helps to stabilize the lumbar spine and pelvis. Athletes often overuse these muscles with all the sprinting, jumping, kicking, and changing directions when running, causing strains and/or tears. Repetitive hip flexion can result in chronic degenerative tendon changes. Chiropractic care and physical therapy can assist in the early phases of healing, safely transitioning to rehabilitation, and returning to physical activities.
Iliopsoas Muscle
The hip flexors are the group of muscles, including the iliac and psoas major muscles/iliopsoas and the rectus femoris/quadriceps. One of the largest and thickest muscles in the body, the psoas, extends from the lumbar vertebrae, crosses in front of each hip, and attaches to the inside top of the thigh bone. The muscle works by flexing the hip joint and lifting the upper leg towards the body. These fibers can tear if tension is more than the muscle can bear. An iliopsoas strain occurs when one or more of these hip flexor muscles become overly stretched or begin to tear.
Injury
The injury can occur from sports or everyday physical activities. This leads to inflammation, pain, and scar tissue formation. An iliopsoas injury is commonly caused by sudden movements, including sprinting, kicking, and changing direction fast while running. Individuals participating in any sports, especially cycling, running, dance, tennis, martial arts, and soccer, are more likely to experience this injury. Other contributing factors include:
Muscle tightness
Joint stiffness
Muscle weakness
Inadequate core stability
Not warming up correctly
Improper biomechanics
Decreased fitness and conditioning
Individuals will feel a sudden stinging pain or pulling sensation, usually on the front of the hip, groin, or abdominal area. Other symptoms include:
Healing and recovery depend on the severity of the injury. A minor iliopsoas muscle injury can take around three weeks to recover fully. More serious strains and tears take six to eight weeks before returning to activity, as the tissue needs time to repair before starting rehabilitation.
Chiropractic Rehabilitation and Recovery
The first steps when dealing with this injury should be P.R.I.C.E. protection, rest, ice, compression, and elevation. It is important to rest and seek treatment immediately; if left untreated, the condition could worsen, lead to a chronic condition, and require surgery. A chiropractic treatment and rehabilitation plan will consist of the following:
Soft tissue massage
Joint mobilization
A chiropractor may recommend crutches to keep the weight off the hip.
A brace can help compress and stabilize the hip flexor to expedite healing.
A flexibility and strengthening program will be implemented to target the muscles around the hip.
Core strengthening exercises will improve the stability of the pelvis area to prevent any further overuse problems.
Wearing compression clothing could also be recommended, as the clothing helps maintain muscle temperature.
Labral Tear
References
Dydyk AM, Sapra A. Psoas Syndrome. [Updated 2022 Oct 24]. In: StatPearls [Internet]. Treasure Island (F.L.): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK551701/
Lifshitz, Liran BPt, MSc, PT; Bar Sela, Shlomo BPt MPE; Gal, Noga BPt, MSc; Martin, RobRoy PhD, PT; Fleitman Klar, Michal BPt. Iliopsoas the Hidden Muscle: Anatomy, Diagnosis, and Treatment. Current Sports Medicine Reports 19(6):p 235-243, June 2020. | DOI: 10.1249/JSR.0000000000000723
Rauseo, Carla. “THE REHABILITATION OF A RUNNER WITH ILIOPSOAS TENDINOPATHY USING AN ECCENTRIC-BIASED EXERCISE-A CASE REPORT.” International journal of sports physical therapy vol. 12,7 (2017): 1150-1162. doi:10.26603/ijspt20171150
Rubio, Manolo, et al. “Spontaneous Iliopsoas Tendon Tear: A Rare Cause of Hip Pain in the Elderly.” Geriatric orthopedic surgery & rehabilitation vol. 7,1 (2016): 30-2. doi:10.1177/2151458515627309
It is a common scenario, whether sitting or standing when we need to bend down or forward, and suddenly there is a sharp sting on one side of the low back. The sensation can cause the knees to buckle. So we stand up slowly to assess the condition and realize it is almost impossible to stand completely straight and even harder to bend forward. So we sit back down to try and relieve the pressure. It helps a little, but the injury has caused the back muscles to spasm and get tighter and tighter. When we try to get up, there can be one big or several mild to severe electrical shock sensations traveling through the back. A severely over-rotated vertebrae could be the cause and require chiropractic care, massage, and/or decompression therapy.
Over Rotated Vertebrae
The spinal column is made of 26 interconnected vertebrae. When in motion, each vertebra moves, and as the torso rotates, the spine must rotate as well. The spine can move in several ways, including:
Bending
Rounding forward.
Extending or arching backward.
Twisting
Tilting sideways uses some of the same muscles when twisting.
Although the spine can move in various directions, there are limits to how far it can and should go. For example, when bending forward to lift an object, an individual can unknowingly over-extend and over-rotate vertebrae. This is where the risk of injury increases. A rotational injury of the spine occurs when the torso turns too far, and the spinal cord can’t handle it. This can stretch the ligaments in the spine to the point of snapping, causing the facet joints to dislocate. Ligament strains and facet dislocations are two of the most common rotational spine injuries.
Complications
An over-rotated vertebrae injury can also lead to complications that include.
Chronic Pain
Spinal nerve damage can lead to chronic pain conditions.
Mobility Problems
Mobility problems are common following an injury of the spine.
This comes from damage to the nerves that innervate the legs, causing weakness and coordination problems.
Pressure Ulcers
Numbness following a spine injury can cause individuals not to notice pressure ulcers developing.
These can lead to infections and could require hospitalization.
Individuals accumulate tension and/or weakness in the oblique abdominal muscles and other trunk muscles that can lead to chronic tightness and weakness, affecting movement and decreasing the range of motion.
Chiropractic Treatment Plan
Depending on the time and severity of the injury, a personalized treatment plan may consist of the following:
Chiropractic mobilization to release the spasms and reset the spine.
Rest
Facet Syndrome Treatment
References
Janssen, Michiel M A, et al. “Pre-existent vertebral rotation in the human spine is influenced by body position.” The European spine journal: official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society vol. 19,10 (2010): 1728-34. doi:10.1007/s00586-010-1400-3
Kruger, Erwin A et al. “Comprehensive management of pressure ulcers in spinal cord injury: current concepts and future trends.” The Journal of spinal cord medicine vol. 36,6 (2013): 572-85. doi:10.1179/2045772313Y.0000000093
Passias, Peter G et al. “Segmental lumbar rotation in patients with discogenic low back pain during functional weight-bearing activities.” The Journal of bone and joint surgery. American volume vol. 93,1 (2011): 29-37. doi:10.2106/JBJS.I.01348
Shan, X., Ning, X., Chen, Z. et al. Low back pain development response to sustained trunk axial twisting. Eur Spine J 22, 1972–1978 (2013). https://doi.org/10.1007/s00586-013-2784-7
Trail mix is a favorite snack for many individuals. A typical mix combines granola, dried fruits, nuts, seeds, cereals, and pretzels. The mix was originally developed as a portable snack/meal for hikers that was lightweight, could be stored in a backpack, and provided plenty of protein and energy. Prepackaged trail mix is available at many grocery stores and online retailers. It’s an excellent choice for traveling or going on a road trip because of its energy and nutritional content. However, not all types are considered equal in terms of nutrition. Some can consist of ingredients loaded with sugar and salt. Added consumption could cause weight gain and contribute to conditions like heart disease, type 2 diabetes, and liver problems. Here we look at choosing healthy mixes.
Trail Mix
The nutritional power comes from the high amounts of fiber and antioxidants.
Benefits
Protein and Healthy Fats
Protein is essential for tissue repair, immune health, and muscle development.
Nuts and seeds make up the largest portion.
A healthy source of protein, allowing individuals to snack on the go and not become hungry.
One of the greatest benefits of eating these is that they are full of heart-healthy fats.
These healthy fats help decrease unhealthy LDL cholesterol levels and reduce inflammation.
Fiber
The fiber in the seeds and granola helps keep the gut healthy and regular.
It also helps control appetite, aids in digestion, and keeps the body fuller longer.
Energy
Dried fruits and granola consist of healthy sugars.
Healthy sugars help stabilize blood sugar levels, providing the body with a consistent energy source.
Antioxidants, Vitamins, and Minerals
Dried fruit maintains a majority of its nutritional value.
The nuts and seeds are also packed with nutrients and antioxidants.
Choosing Healthy
Check the nutrition label and avoid varieties high in added sugar or sodium.
Look for products containing nutrient-dense ingredients like nuts, seeds, dried fruits, and limited amounts of candy or chocolate chips, if any.
Healthy ingredients include almonds, pumpkin seeds, cashews, sunflower seeds, dried fruit, popcorn, and dark chocolate.
Making trail mix at home allows control of its contents and maximizes its potential health benefits.
It is important to keep an eye on portion control.
A recommended serving is about a fourth of a cup.
Nutritionist
Nutritional consultation can improve an individual’s quality of life, health, and well-being. A nutritionist can help individuals with precision or personalized nutrition that focuses on the individual. Nutritionists can create meal plans for their clients and provide education and knowledge on appropriate food choices.
Potassium
References
Devitt, A A et al. “Appetitive and Dietary Effects of Consuming an Energy-Dense Food (Peanuts) with or between Meals by Snackers and Nonsnackers.” Journal of nutrition and metabolism vol. 2011 (2011): 928352. doi:10.1155/2011/928352
Grillo, Andrea et al. “Sodium Intake and Hypertension.” Nutrients vol. 11,9 1970. 21 Aug. 2019, doi:10.3390/nu11091970
Mehlhose, Clara, et al. “PACE Labels on Healthy and Unhealthy Snack Products in a Laboratory Shopping Setting: Perception, Visual Attention, and Product Choice.” Foods (Basel, Switzerland) vol. 10,4 904. 20 Apr. 2021, doi:10.3390/foods10040904
Vreman, Rick A et al. “Health and economic benefits of reducing sugar intake in the USA, including effects via non-alcoholic fatty liver disease: a microsimulation model.” BMJ open vol. 7,8 e013543. 3 Aug. 2017, doi:10.1136/bmjopen-2016-013543
Chiropractic care has a powerful therapeutic effect on the body’s systems. This includes the nervous, muscular, skeletal, and lymphatic. The lymphatic system is a part of the immune system. It circulates lymph, a fluid comprised of white blood cells that support the immune system, proteins, and fats. The lymphatic system collects toxins, moves waste, and protects the body from foreign invaders. Together with the immune system, the lymphatic system keeps the body balanced. However, imbalances occur due to misalignments, subluxations, compressed nerves, chronic conditions, and injuries. Chiropractic care, massage, and decompression therapy can help mobilize stuck or misaligned joints, reduce muscular tension, alleviate nerve inflammation and discomfort, and restore optimal function.
Spinal Lymphatic Detox
Lymphatic System
The lymphatic system is a network throughout the body. The system drains lymph fluid from the blood vessels into the tissues and empties it back into the bloodstream through the lymph nodes. The main functions of the system include the following:
Regulates fluid levels in the body.
Activates when bacteria or viruses enter.
Manages and removes cancer cells or cell byproducts that could result in disease or disorders.
Absorbs some of the fats from the intestine.
The lymph nodes and other structures like the spleenand thymushouse specialized white blood cells called lymphocytes. These are ready to go and can rapidly multiply and release antibodies when bacteria, viruses, and other stimuli, enter the body.
Fluid Balance
The blood in the vessels is under constant pressure. Nutrients, fluids, and certain cells need to circulate throughout the body to supply the tissues and maintain the system’s defense. The lymphatic system:
Removes all fluids and contents that leak into the tissues.
Eliminates waste products formed in the tissues.
Eliminates bacteria that enter through the skin.
The digestive and respiratory systems are lined with lymphatic tissue because the systems are exposed. The most important sites are the tonsils, the intestinal region, and the appendix. Lymph nodes are the filters. Viruses and cancer cells get trapped and destroyed in the lymph nodes. More lymphocytes are produced when an infection is present, which is why the nodes experience swelling. When the lymphatic system does not drain fluids from the tissues properly, the tissues swell and can cause symptoms of discomfort. If the swelling is only for a short period, it is called edema. If it lasts more than three months, it is called lymphoedema.
Symptoms of Unhealthy Circulation
Unhealthy circulation can include the following symptoms:
Fatigue
Concentration problems
Cold hands or feet
Swelling
Muscle cramps
Numbness
Tingling
Stinging
Throbbing
Development of ulcers on the feet, ankles, and legs.
Chiropractic Care
A chiropractic spinal lymphatic detoxtreatment releases stagnant fluid collected in the joints, muscles, and tissues. A personalized treatment plan will consist of massage therapy to increase circulation, release and relax the muscles and nerves, chiropractic to realign the body, decompression to open the spine, stretching techniques to improve flexibility, and nutritional guidance to support optimal circulation. The benefits include:
Discomfort and pain relief.
Stress and anxiety relief.
Balanced and realigned body.
Relaxed muscles.
Helps with allergy symptoms.
Detoxes bacteria along the spine.
Lymphatic Anatomy
References
Dmochowski, Jacek P et al. “Computational Modeling of Deep Tissue Heating by an Automatic Thermal Massage Bed: Predicting the Effects on Circulation.” Frontiers in medical technology vol. 4 925554. 14 Jun. 2022, doi:10.3389/fmedt.2022.925554
Majewski-Schrage, Tricia, and Kelli Snyder. “The Effectiveness of Manual Lymphatic Drainage in Patients With Orthopedic Injuries.” Journal of sport rehabilitation vol. 25,1 (2016): 91-7. doi:10.1123/jsr.2014-0222
Mihara, Makoto et al. “Combined conservative treatment and lymphatic venous anastomosis for severe lower limb lymphedema with recurrent cellulitis.” Annals of vascular surgery vol. 29,6 (2015): 1318.e11-5. doi:10.1016/j.avsg.2015.01.037
Mortimer, Peter S, and Stanley G Rockson. “New developments in clinical aspects of lymphatic disease.” The Journal of clinical investigation vol. 124,3 (2014): 915-21. doi:10.1172/JCI71608
Weerapong, Pornratshanee et al. “The mechanisms of massage and effects on performance, muscle recovery and injury prevention.” Sports medicine (Auckland, N.Z.) vol. 35,3 (2005): 235-56. doi:10.2165/00007256-200535030-00004
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