Can individuals with rheumatoid arthritis incorporate various exercises to reduce joint pain and inflammation in their hands and feet?
Introduction
The joints in the human help provide function, mobility, and flexibility to the upper and lower extremities. The joints are part of the musculoskeletal system and have an outstanding relationship with the muscles, ligaments, and soft tissues that give the body structure and support that lets the individual move around and protects the important organs to function normally. However, when a person is dealing with injuries or illnesses that affect the body’s musculoskeletal function, it can cause pain to the individual. One of the symptoms that often correlate in the joints is chronic inflammation, leading to the development of an autoimmune disease known as rheumatoid arthritis. Today’s article looks at how rheumatoid arthritis affects the joints in the musculoskeletal system and how various exercises can help manage and reduce the symptoms associated with rheumatoid arthritis. We discuss with certified associated medical providers who consolidate our patients’ information to assess rheumatoid arthritis and its associated pain symptoms affecting the joints. We also inform and guide patients while asking their associated medical provider intricate questions to integrate various exercises into their personalized treatment plan to manage the pain correlated with rheumatoid arthritis. Dr. Jimenez, D.C., includes this information as an academic service. Disclaimer.
How RA Affects The Joints
Do you feel pain and tenderness in your joints affecting your daily routine? Do you experience stiffness first thing in the morning, and it goes away throughout the day? Or do you feel fatigued throughout the day, even after a good night’s sleep? Many individuals with these symptoms could be dealing with early development of rheumatoid arthritis in their joints. Now, rheumatoid arthritis is a chronic inflammatory autoimmune disorder that affects the body’s joints but is more prominent on the hands, wrists, and feet. The symptoms of rheumatoid arthritis can develop early or slowly depending on the environmental factors contributing to the development. Since rheumatoid arthritis is categorized as a systemic autoimmune disease, genetic and environmental risk factors that can contribute to rheumatoid arthritis development can trigger overlapping risk profiles on the joints. (Jang et al., 2022) When a person is dealing with the symptoms of rheumatoid arthritis, one of the key pain symptoms that can affect the joints drastically is inflammation. Inflammation is associated with rheumatoid arthritis; it is reflected by joint pain, leading to swelling and subsequent destruction of the cartilage and bone. (Scherer et al., 2020) This causes many individuals to be in constant pain and prevents them from doing any activities.
Additionally, when a few joints are being affected by rheumatoid arthritis in the early stages, some of the symptoms include:
Fatigue
Flu-like symptoms
Swollen & tender joints
Stiffness
However, when rheumatoid arthritis reaches the later stages in the joints, the autoantigens that are specific to rheumatoid arthritis can lead to a self-perpetuating chronic inflammatory state on the joints, thus causing an expansion on the periarticular bone at the cartilage-bone junction, leading to bone erosion and cartilage degradation. (Lin et al., 2020) Luckily, there are therapeutic options to reduce the pain and inflammatory effects of rheumatoid arthritis and help manage the symptoms that are affecting the joints.
Arthritis Explained- Video
How Various Exercises Can Help With RA
When it comes to reducing the inflammatory effects of rheumatoid arthritis, many individuals can seek out therapeutic options to restore mobility, function, and flexibility. Many individuals can incorporate various physical activities to relieve stress on the inflamed tissues while slowing the progression of rheumatoid arthritis. (Radu & Bungau, 2021) When people with rheumatoid arthritis incorporate various physical activities, they can include a healthy diet and nutrition to suppress pro-inflammatory effects associated with rheumatoid arthritis, help provide symptomatic improvement, and restore bodily function to the joints. (Gioia et al., 2020)
When people with rheumatoid arthritis start exercising as part of their personalized treatment, it can have beneficial properties as they can help with the following:
Reduce joint pain & stiffness
Improve muscle strength around the joints
Enhance physical function
Boost mental health
Reduces inflammation
Increase energy levels
The main priority of incorporating exercises to reduce rheumatoid arthritis is choosing gentle exercises on the person’s joints while providing enough movement to keep the body flexible and strong. Below are some exercises to reduce rheumatoid arthritis.
Range of Motion Exercises
Range of motion exercises can help maintain normal joint function by improving flexibility and reducing stiffness for individuals with rheumatoid arthritis. Some examples include:
Finger Bends: Gently bend your fingers into a fist and straighten them. Repeat several times.
Wrist Stretch: Extend your arm with the palm facing down. Gently use your other hand to press the extended hand down and back for a stretch.
Shoulder Rolls: Roll the shoulders in a forward circular motion, then reverse the direction.
Strength Training Exercises
Strength training can help build the surrounding muscles around the joints. This allows many individuals with rheumatoid arthritis to provide better support and reduce stress on the joints. Some examples include:
Resistance Bands: Use resistance bands to perform bicep curls, leg extensions, and chest presses.
Light Weights: Incorporate light dumbbells to perform exercises like shoulder presses, tricep extensions, and squats.
Bodyweight Exercises: Engage in wall push-ups, seated leg lifts, and modified planks.
Water-Based Exercises
Water-based exercises provide resistance without impact on the joints, making it ideal for those with rheumatoid arthritis. The water helps cushion the joints by easing the stiffness, building strength, and helping relax sore muscles. Some examples of water-based exercises include:
Water Aerobics: Join a water aerobics class that offers structured routines in a supportive environment.
Aqua Jogging: Use a buoyancy belt to jog in the pool’s deep end.
Swimming: Perform laps or engage in gentle exercises like the backstroke or breaststroke.
Tips For Exercising With RA
It is important to remember that when exercising with rheumatoid arthritis, it is important to always start with a gentle warm-up and always end with a cool down to prepare the muscles and joints when beginning to exercise. Another thing to remember is to stay consistent and modify when needed. This allows many individuals to listen to their bodies and modify exercises to avoid pain and discomfort. Incorporating exercises is highly effective in reducing rheumatoid arthritis activity as it can help enhance the body’s immune function and help manage the inflammatory response associated with rheumatoid arthritis. (Li & Wang, 2022)
References
Gioia, C., Lucchino, B., Tarsitano, M. G., Iannuccelli, C., & Di Franco, M. (2020). Dietary Habits and Nutrition in Rheumatoid Arthritis: Can Diet Influence Disease Development and Clinical Manifestations? Nutrients, 12(5). doi.org/10.3390/nu12051456
Jang, S., Kwon, E. J., & Lee, J. J. (2022). Rheumatoid Arthritis: Pathogenic Roles of Diverse Immune Cells. Int J Mol Sci, 23(2). doi.org/10.3390/ijms23020905
Li, Z., & Wang, X. Q. (2022). Clinical effect and biological mechanism of exercise for rheumatoid arthritis: A mini review. Front Immunol, 13, 1089621. doi.org/10.3389/fimmu.2022.1089621
Lin, Y. J., Anzaghe, M., & Schulke, S. (2020). Update on the Pathomechanism, Diagnosis, and Treatment Options for Rheumatoid Arthritis. Cells, 9(4). doi.org/10.3390/cells9040880
Radu, A. F., & Bungau, S. G. (2021). Management of Rheumatoid Arthritis: An Overview. Cells, 10(11). doi.org/10.3390/cells10112857
Scherer, H. U., Haupl, T., & Burmester, G. R. (2020). The etiology of rheumatoid arthritis. J Autoimmun, 110, 102400. doi.org/10.1016/j.jaut.2019.102400
For individuals living with chronic pain and various diseases like Parkinson’s, arthritis, and diabetes, can water aerobics be beneficial?
Water Aerobics
Water aerobics are low-impact exercises performed commonly in swimming pools. It is a great way to exercise for a full-body, low-impact workout without overworking the body’s joints and muscles. Other names used include:
Aquafitness
Aqua aerobics
Aquarobics
Many types can be tailored to individual needs, injuries, and/or conditions. The exercises have various health benefits, especially for those who cannot perform higher-impact movements.
Individuals participating in water aerobics will need a bathing suit, towel, goggles, and a swim cap to protect their eyes or hair from chlorinated water. Individuals do not need other special equipment while exercising as the water acts as extra resistance. Foam dumbbells or paddles can be used to increase resistance. Other optional equipment includes: (Plunge San Diego, 2024) (Harvard Health Publishing Harvard Medical School, 2023)
Kickboards
Wrist and ankle weights
Water-jogging belts
Swim bar
Pool Exercises
There are many types of pool exercises to help reach health and fitness goals. They include:
Water Walking
The basic act of walking in water is a great way to get a full-body workout.
Start by standing in waist-deep water with the feet planted on the bottom of the pool.
Lengthen the spine by bringing the shoulders up and back and aligning the shoulders with the hips and knees.
Once in a good starting position, walk through the water, putting pressure on the heel first and then the toes, just like walking out of the water, while swinging the arms back and forth through the water.
This exercise can be done for five to 10 minutes.
The muscles that will get the most attention are the arms, core, and the lower body.
Arm Lifts
Stand up to the shoulders in water.
With the palms facing up, draw the elbows into the torso while lifting the forearms in front of the body up to the water’s surface.
Once at the surface, rotate the palms to face down and slowly move the forearms back down to the sides.
For more resistance, this exercise can also be done using foam dumbbells.
Repeat the action 10–15 times for one to three sets.
The muscles targeted are the core and the arm muscles.
Jumping Jacks
Water resistance makes jumping jacks in the water much more difficult than on land.
To perform, start by standing in chest-level water with your feet together and your arms straight down the sides.
Once in position, begin by simultaneously swinging the legs out to the side and arms over the head before returning to the starting position.
Muscles targeted include the entire body and cardiovascular system.
Add wrist or ankle weights for more resistance and to make the exercise more challenging.
High-Knee-Lift Extensions
High-knee-lift extensions are performed while standing in water that is waist deep.
To do the exercise, engage the core and lift one leg in a bent position until it is level with the water’s surface.
Hold the position for a few seconds, then extend the leg out in front and hold again.
After the hold period, move the leg back down through the water to the starting position while keeping it straight and flexing the foot.
Repeat on both legs for two to three sets of 15 reps per leg.
Use weights on the ankles to increase resistance.
The muscles targeted include the core, glutes, and lower body.
Risks
While exercising in water, individuals may not notice how much they sweat. This can make it seem like the workout is not as hard and can lead to dehydration. Individuals should always hydrate before and after a pool workout. Individuals who cannot swim well should avoid exercises that do not require a flotation device. Sometimes pools are heated, so choosing one 90 degrees F or below is recommended so the body doesn’t get overheated while exercising.
Stop Pool Exercises Immediately
Performing pool exercises can often seem easier than they are, leading to overworking. Stop exercising immediately if you feel:
Pain in any area of the body
Shortness of breath
Nauseated
Faint
Dizzy
Pressure in the upper body or chest
Other Health Conditions That Benefit
Water aerobics is recommended for most individuals, completely healthy or with a chronic disease. Those with chronic disease have been shown to benefit from the low-impact exercise. (Faíl, L. B. et al., 2022) One study looked at individuals with various health conditions, with the results showing that the following conditions saw improvements after 12 weeks of regular water exercise (Faíl, L. B. et al., 2022)
Diabetes
Arthritis
Fibromyalgia
Bone diseases
High blood pressure
Coronary artery disease
Stroke
Multiple sclerosis (MS)
Parkinson’s disease
While the benefits of water aerobics have been studied and proven effective, individuals should be cleared by a medical professional before starting any new exercise regimen. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution 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 normal. Our providers create personalized care plans for each patient. 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.
Pereira Neiva, H., Brandão Faíl, L., Izquierdo, M., Marques, M. C., & Marinho, D. A. (2018). The effect of 12 weeks of water-aerobics on health status and physical fitness: An ecological approach. PloS one, 13(5), e0198319. doi.org/10.1371/journal.pone.0198319
Faíl, L. B., Marinho, D. A., Marques, E. A., Costa, M. J., Santos, C. C., Marques, M. C., Izquierdo, M., & Neiva, H. P. (2022). Benefits of aquatic exercise in adults with and without chronic disease-A systematic review with meta-analysis. Scandinavian journal of medicine & science in sports, 32(3), 465–486. doi.org/10.1111/sms.14112
Can using a self-care traction device help and be a cost-effective method of providing cervical relief at home for individuals who have neck pain?
Neck Pain Traction Device
Neck Pain Traction Device: Individuals with neck or arm pain caused by neck/cervical radiculopathy may benefit from physical therapy to manage their condition. (Alshami, A. M., and Bamhair, D. A. 2021) Physical therapy can improve neck mobility, restore function, and decrease pain.
Traction
A physical therapist may use various treatments and modalities to treat the individual’s condition. Cervical traction is one treatment to help relieve neck pain and can help:
There are different neck traction techniques. The therapist may use a mechanical traction device that requires the individual to strap their head and neck to a machine that gently pulls the neck, providing relief. (Romeo, A. et al., 2018) The physical therapist may also use manual traction with their hands to help the process. This type allows the therapist to easily adjust the amount of traction force and the direction of the pull on the neck. (Romeo, A. et al., 2018)
Home Traction Devices
Cervical traction that works for individuals at the clinic may also benefit from using a traction device at home to maintain their gains. Over-the-door cervical traction may be an effective, safe, and simple way to administer neck traction in the comfort of one’s home to help decrease pain. (Fritz, J. M. et al., 2014) Medical supply stores and pharmacies carry over-the-door traction devices, which can also be found online. If finding an over-the-door traction unit is difficult, the therapy clinic can help order one from a medical supplier.
Setting Up The Device
Before using a neck pain traction device, consult a physical therapist or doctor to ensure neck traction is safe and on usage. Over-the-door traction units may be built differently but comprise the main parts:
A hook-and-pulley apparatus that hangs over the door.
A nylon cord that’s fed through the pulley.
A weight that could be a water bag that hangs on the end of the cord to provide traction force.
A harness to wear on your head.
The traction unit must be hung over a door secured to the top and closed.
It is recommended that the door be a closet door so no one will open it while using the device.
If a closet door is not available, be sure to lock the door so that no one can open it while attached to the device.
A small hook with a pulley attached to it hangs on the door.
The harness attaches to the end of the nylon cord opposite the weighted water bag.
The harness goes on the head, and the chin strap should fit snugly under the chin and be secured by the hook-and-loop fasteners.
The two straps on either side of your head should be hooked to the end of the nylon cord, which is fed through the pulley system.
After strapping on the head harness, fill the water bag using the markings on the bag to indicate its weight and hang it on one end of the cord.
Fill the bag until the water reaches the desired mark, usually 8–15 pounds.
After filling the water bag, sit in a chair facing the door and hang the bag on the other end of the cord not attached to the head harness.
Do not drop the bag; this could cause a sudden forceful traction motion on your neck.
How Long to Use
Individuals should generally use the traction device for about 15 to 20 minutes each session and can perform several sessions per day. (American Physical Therapy Association. 2020) While using the over-the-door traction device, there should be a gentle pulling sensation in the neck, relieving the neck pain, and if there is arm pain or tingling, it should also decrease. Traction does not replace neck exercises or postural correction in treating neck pain. Be sure to follow the therapist’s prescribed exercises. Active engagement is essential to treating and preventing neck pain from returning. If the pain increases while using the traction device, stop using it and consult a physical therapist or doctor. Ask a physical therapist or other neuromusculoskeletal medical professional if self-care traction is appropriate for specific conditions.
Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution that helps individuals return to normal. Our providers create personalized care plans for each patient, including Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine principles through an integrated approach to treat injuries and chronic pain syndromes to improve ability through flexibility, mobility, and agility programs to relieve pain. If other treatment is needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments.
Neck Injuries
References
Alshami, A. M., & Bamhair, D. A. (2021). Effect of manual therapy with exercise in patients with chronic cervical radiculopathy: a randomized clinical trial. Trials, 22(1), 716. doi.org/10.1186/s13063-021-05690-y
Madson, T. J., & Hollman, J. H. (2017). Cervical Traction for Managing Neck Pain: A Survey of Physical Therapists in the United States. The Journal of orthopaedic and sports physical therapy, 47(3), 200–208. doi.org/10.2519/jospt.2017.6914
Romeo, A., Vanti, C., Boldrini, V., Ruggeri, M., Guccione, A. A., Pillastrini, P., & Bertozzi, L. (2018). Cervical Radiculopathy: Effectiveness of Adding Traction to Physical Therapy-A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Physical therapy, 98(4), 231–242. doi.org/10.1093/physth/pzy001
Fritz, J. M., Thackeray, A., Brennan, G. P., & Childs, J. D. (2014). Exercise only, exercise with mechanical traction, or exercise with over-door traction for patients with cervical radiculopathy, with or without consideration of status on a previously described subgrouping rule: a randomized clinical trial. The Journal of orthopaedic and sports physical therapy, 44(2), 45–57. doi.org/10.2519/jospt.2014.5065
Can athletic individuals with ACL injuries find relief through non-surgical treatments to restore knee mobility?
Introduction
The body’s lower extremities help the individuals to be mobile but also help stabilize the body’s upper weight. From the hips to the feet, many people are on their feet and using every muscle group to allow functionality. Athletic individuals use their lower extremities to do various physical activities and are susceptible to injuries. An ACL injury is one of the most common and feared injuries that can impact an athletic person’s performance. These types of injuries affect the knees of the individual and can make a person feel miserable. However, numerous surgical and non-surgical treatments can help the recovery process of an ACL injury while helping the individual restore their motion to their lower extremities. Today’s article looks at what an ACL injury is, how it affects the knees, and how non-surgical treatments can help restore knee mobility from ACL injuries. We discuss with certified associated medical providers who consolidate our patients’ information to assess ACL injuries affecting their mobility. We also inform and guide patients while asking their associated medical provider intricate questions to integrate and provide them with numerous non-surgical treatments to be incorporated into their personalized treatment plan. Dr. Jimenez, D.C., includes this information as an academic service. Disclaimer.
What Is An ACL Injury?
Do you feel aches or pains around your knees after a long exercise regime? Do you feel or hear a loud popping sensation in your knees? Or do you experience pain and swelling affecting your ability to be mobile? Many of these pain-like scenarios are correlated with ACL injuries, that is amongst the most common and feared injuries for athletic individuals and non-athletic individuals. However, we must look at the ACL itself to better understand ACL injuries. The ACL (anterior cruciate ligament) plays an important role as it helps with knee joint stabilization, prevents excessive forward movements from the tibia (shin bone), and limits rotational knee movements. (Yoo & Marappa-Ganeshan, 2024) This ligament is one of the most injured structures affecting athletic performance. ACL injuries and tears can lead to many individuals having knee instability and an increased risk of future knee osteoarthritis. (Atik, 2024) This is because ACL injuries typically occur during physical activities involving sudden stops, jumps, or directional impacts to the knees.
How Does It Affect The Knees?
So, how do ACL injuries affect the knees of the individual? As stated earlier, the ACL is a crucial ligament that stabilizes the knee joint during movement. When that ligament is injured, it can cause pain-like symptoms like:
Pain
Limited range of motion
Knee instability
Altered biomechanics
This causes many people to have reduced physical activity levels, which can become a great economic burden to their daily routine. (Wang et al., 2020) When dealing with ACL injuries, it can also affect the meniscus in the knees as cartilage erosion often accelerates and can potentially lead to early osteoarthritis, which correlates with ACL injuries. (Key et al., 2022) However, when a person is dealing with ACL injuries, there are numerous treatments to reduce the pain-like symptoms caused by ACL injuries and help restore knee mobility.
Overcoming An ACL Injury-Video
Non-Surgical Treatments For ACL Injuries
When finding the right treatment for ACL injuries, many individuals can incorporate non-surgical treatments as part of their customized treatment plan. Non-surgical treatments can vary and may be suitable for individuals with partial ACL tears and knee instability and who have been involved in low-impact sports. When athletic individuals are dealing with ACL injuries, by incorporating non-surgical treatments, they can address the impairments, achieve functional stability, and safely return to their physical activities while improving the neuromuscular system to achieve functional knee stability. (Diermeier et al., 2020) Non-surgical treatments can positively impact many individuals by relieving the overlapping pain-like issues affecting the knees and the severity of ACL injuries.
Chiropractic Care
Chiropractic care is one of the many non-surgical treatments that can benefit individuals dealing with ACL injuries. Chiropractic care incorporates mechanical and manual manipulation to diagnose and treat any musculoskeletal issues associated with ACL injuries and emphasizes the body’s natural ability to heal itself. For many athletic and non-athletic individuals with ACL injuries, chiropractic care can offer several benefits:
Pain management
Enhancing mobility and flexibility
Improving balance
Strengthening supporting muscles
Chiropractic care can help individuals by stretching and strengthening weak muscles and soft tissues that can help break down scar tissues that may have surrounded the knee while improving blood flow to the injured area. Chiropractors can also incorporate specific rehabilitation exercises and physical therapy for the individual, focusing on strength, flexibility, and stability in the knees and surrounding muscles.
Physical Therapy
Another form of non-surgical treatment is through physical therapy. Physical therapy can help many individuals with ACL injuries through strength training, balance, and range of motion exercises that are catered to strengthen the surrounding muscles and help maintain the knee’s stability, flexibility, and mobility. Stretching exercises like Pilates and Tai Chi are favorable for ACL rehabilitation as they are important for functional outcomes and ACL stability. (Giummarra et al., 2022) Additionally, many individuals can utilize a functional knee brace to provide additional support to the knees when doing any physical therapy, as they can help stabilize the knee and prevent unwanted movements that could exacerbate the ACL injury. While ACL injuries are serious, non-surgical treatments offer viable alternatives for many athletes. Individuals can effectively manage their injuries and lead active, fulfilling lives by focusing on physical therapy, utilizing supportive braces, and adopting lifestyle modifications.
References
Atik, O. S. (2024). The risk factors for second anterior cruciate ligament (ACL) tear after ACL reconstruction. Jt Dis Relat Surg, 35(2), 255-256. doi.org/10.52312/jdrs.2024.57920
Diermeier, T., Rothrauff, B. B., Engebretsen, L., Lynch, A. D., Ayeni, O. R., Paterno, M. V., Xerogeanes, J. W., Fu, F. H., Karlsson, J., Musahl, V., Svantesson, E., Hamrin Senorski, E., Rauer, T., Meredith, S. J., & Panther Symposium, A. C. L. T. C. G. (2020). Treatment after anterior cruciate ligament injury: Panther Symposium ACL Treatment Consensus Group. Knee Surg Sports Traumatol Arthrosc, 28(8), 2390-2402. doi.org/10.1007/s00167-020-06012-6
Giummarra, M., Vocale, L., & King, M. (2022). Efficacy of non-surgical management and functional outcomes of partial ACL tears. A systematic review of randomised trials. BMC Musculoskelet Disord, 23(1), 332. doi.org/10.1186/s12891-022-05278-w
Key, S., Baygin, M., Demir, S., Dogan, S., & Tuncer, T. (2022). Meniscal Tear and ACL Injury Detection Model Based on AlexNet and Iterative ReliefF. J Digit Imaging, 35(2), 200-212. doi.org/10.1007/s10278-022-00581-3
Wang, L. J., Zeng, N., Yan, Z. P., Li, J. T., & Ni, G. X. (2020). Post-traumatic osteoarthritis following ACL injury. Arthritis Res Ther, 22(1), 57. doi.org/10.1186/s13075-020-02156-5
Yoo, H., & Marappa-Ganeshan, R. (2024). Anatomy, Bony Pelvis and Lower Limb, Knee Anterior Cruciate Ligament. In StatPearls. www.ncbi.nlm.nih.gov/pubmed/32644659
Can knowing the difference between butter and margarine help Individuals looking to improve cholesterol levels?
Butter and Margarine
Individuals watching their cholesterol levels and switching from butter to margarine may have heard that it may be worse for heart health. What research has to say about the healthiest spread and the butter and margarine debate?
History
Butter was shown to be associated with an increased risk of heart disease because of its saturated fat content when margarine was developed as a substitute. Margarine is made from plant-based oils like canola, palm fruit, and soybeans. Nutritionists and researchers saw it as a healthier alternative. It is lower in saturated fat and has no cholesterol but contains high levels of trans fats, which raise unhealthy LDL cholesterol levels and lower healthy HDL cholesterol levels. (Ginter, E., and Simko, V. 2016)
Margarine Trans Fat and Butter Saturated Fat
Most of margarine’s unsaturated fats undergo hydrogenation, creating harmful trans fats. Trans fat raises unhealthy LDL cholesterol levels more than saturated fat. The trans-fatty acids solidify and maintain margarine consistency at room temperature. Stick margarines, the hardest type, contain the most trans fats and are still sold despite what is known about the damage they can do. (Brouwer, I. A. et al., 2010) Clinical studies showed these trans fats are associated with a 28% increased risk of death from heart disease and a 34% increased risk of death. (de Souza, R. J. et al., 2015)
Margarine Types
Some softer and liquid margarine products contain less trans fat than stick versions. They are low in saturated fat and high in unsaturated fat. Individuals can determine how much trans fat the margarine has by its softness. Those that are more solid at room temperature contain more trans fats than those in a tub, which are softer. However, some soft options can contain trans fats. If the label has partially hydrogenated oil, it’s recommended to avoid it. (Garsetti, M. et al., 2016) Some newer margarines are enriched with plant sterols, which block cholesterol absorption and help lower LDL levels. These are healthy choices if trying to lower LDL. (Ras, R. T. et al., 2014)
Butter
Butter is primarily made up of saturated fat and cholesterol and comes in a stick and spread. One tablespoon of butter contains around 30 milligrams of cholesterol and 7 grams of saturated fat. The maximum amount allowed daily is 200 milligrams and 10 milligrams, respectively. Both types of fat are linked to rising cholesterol levels and the risk of heart disease. Butter from grass-fed cows is higher in omega-3 fatty acids, essential for heart health, making it far more nutritional than the more widely used butter from conventionally-fed cows. (Hebeisen, D. F. et al., 1993)
Other Options
Butter or margarine are not the healthiest options. Olive, avocado, and other vegetable-based spreads are the most heart-healthy options. (Yubero-Serrano, E. M. et al., 2019) Use avocado oil as a cooking oil when sautéing or roasting vegetables. Consider substituting applesauce, nut butters, or squash purees in baked goods. Look for soft versions of margarine as a bread spread that contain plant sterols and no hydrogenated oils.
Injury Medical Chiropractic and Functional Medicine Clinic uses an integrated approach to create personalized care plans for each patient to restore health and function to the body through Nutrition and Wellness, Functional Medicine, Acupuncture, Electro-Acupuncture, 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.
Enhancing Health Together: Multidisciplinary Evaluation and Treatment
References
Ginter, E., & Simko, V. (2016). New data on harmful effects of trans-fatty acids. Bratislavske lekarske listy, 117(5), 251–253. doi.org/10.4149/bll_2016_048
Brouwer, I. A., Wanders, A. J., & Katan, M. B. (2010). Effect of animal and industrial trans fatty acids on HDL and LDL cholesterol levels in humans–a quantitative review. PloS one, 5(3), e9434. doi.org/10.1371/journal.pone.0009434
de Souza, R. J., Mente, A., Maroleanu, A., Cozma, A. I., Ha, V., Kishibe, T., Uleryk, E., Budylowski, P., Schünemann, H., Beyene, J., & Anand, S. S. (2015). Intake of saturated and trans unsaturated fatty acids and risk of all cause mortality, cardiovascular disease, and type 2 diabetes: systematic review and meta-analysis of observational studies. BMJ (Clinical research ed.), 351, h3978. doi.org/10.1136/bmj.h3978
Garsetti, M., Balentine, D. A., Zock, P. L., Blom, W. A., & Wanders, A. J. (2016). Fat composition of vegetable oil spreads and margarines in the USA in 2013: a national marketplace analysis. International journal of food sciences and nutrition, 67(4), 372–382. doi.org/10.3109/09637486.2016.1161012
Ras, R. T., Geleijnse, J. M., & Trautwein, E. A. (2014). LDL-cholesterol-lowering effect of plant sterols and stanols across different dose ranges: a meta-analysis of randomised controlled studies. The British journal of nutrition, 112(2), 214–219. doi.org/10.1017/S0007114514000750
Hebeisen, D. F., Hoeflin, F., Reusch, H. P., Junker, E., & Lauterburg, B. H. (1993). Increased concentrations of omega-3 fatty acids in milk and platelet rich plasma of grass-fed cows. International journal for vitamin and nutrition research. Internationale Zeitschrift fur Vitamin- und Ernahrungsforschung. Journal international de vitaminologie et de nutrition, 63(3), 229–233.
Yubero-Serrano, E. M., Lopez-Moreno, J., Gomez-Delgado, F., & Lopez-Miranda, J. (2019). Extra virgin olive oil: More than a healthy fat. European journal of clinical nutrition, 72(Suppl 1), 8–17. doi.org/10.1038/s41430-018-0304-x
Can understanding the location of the funny bone and how pain can be managed after injury help expedite recovery and prevention for individuals who have hit their funny bone?
Elbow Funny Bone Nerve Injury
Behind the elbow is an area known as the “funny bone,” where the ulnar nerve has less tissue and bone protection. This is where part of the ulnar nerve passes around the back of the elbow. Because less tissue and bone protect the nerve in this area, taking a hit like bumping into something can cause an electric shock-like pain and a tingling sensation down the arm and to the outside fingers typical of an irritated nerve. Most injuries to the funny bone resolve quickly, and the pain disappears after a few seconds or minutes, but sometimes, an ulnar nerve injury can lead to more persistent symptoms.
Anatomy
The funny bone is not a bone but the ulnar nerve. The nerve runs down the arm, passing around the back of the elbow. (Dimitrova, A. et al., 2019) Because the ulnar nerve is on top of the elbow and there is very little fatty cushion, lightly bumping this spot can cause pain and tingling sensations down the forearm. Three bones comprise the junction of the elbow that include:
Humerus – arm bone
Ulna and radius – forearm bones
The humerus has a groove that protects and holds the ulnar nerve as it passes behind the joint. This is where the nerve can be injured or irritated when the nerve is hit or pinched against the end of the bone, causing the funny bone pain.
Electrical Pain Sensation
When hitting the ulnar nerve or funny bone where the ulnar nerve provides sensation, pain, and electrical/tingling sensations are experienced from the forearm to the outside fingers. This part of the arm and hand is called the ulnar nerve distribution. (American Academy of Orthopaedic Surgeons. 2024) The ulnar nerve provides sensation into most of the pinky finger and about half of the ring finger. Other nerves, including the median and radial nerve, supply sensation to the rest of the hand.
Treatment
Usually, a sharp jolt to the elbow quickly resolves. Some recommendations to help symptoms improve faster include:
Shaking the forearm and hand out.
Straightening out and bending the elbow to stretch the nerve.
Decreasing mobility of the elbow.
Applying ice to the area.
Taking anti-inflammatory medications.
Treating Long-Lasting Pain
In rare circumstances, injuries to the ulnar nerve can cause more persistent symptoms, a condition known as cubital tunnel syndrome. Cubital tunnel syndrome can happen after an injury or from elbow overuse. Individuals with cubital tunnel syndrome may benefit from wearing a splint at night. Standard-sized splints can be ordered online, but most are fabricated by an occupational or hand therapist. If symptoms become more long-lasting, surgery may be recommended to relieve pressure and tension on the ulnar nerve (American Academy of Orthopaedic Surgeons, 2024). The procedure decompresses the nerve by relieving any tight constrictions around it and releasing them. In severe cases, the nerve is repositioned to an area that doesn’t place as much pressure on the nerve, known as an ulnar nerve transposition.
Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution that helps individuals return to normal. Our providers create personalized care plans for each patient, including Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine principles through an integrated approach to treat injuries and chronic pain syndromes to improve ability through flexibility, mobility, and agility programs to relieve pain. If other treatment is needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments.
Chiropractic Treatment For Carpal Tunnel Syndrome
References
Dimitrova, A., Murchison, C., & Oken, B. (2019). Local effects of acupuncture on the median and ulnar nerves in patients with carpal tunnel syndrome: a pilot mechanistic study protocol. Trials, 20(1), 8. doi.org/10.1186/s13063-018-3094-5
How can healthcare professionals recognize and establish protocols for individuals who are being trafficked and provide a safe place?
Introduction
Today, we will look at part two of this series, which is about recognizing trafficking in a clinical setting. Today’s article in this two-part series of recognizing trafficking helps inform many healthcare professionals to understand the roles and protocols for identifying trafficking that is affecting their patients and help provide a safe, positive space for them. We discuss with certified associated medical providers who consolidate our patients’ information to assess and identify trafficking in the clinic while taking the proper protocols to ensure patient safety. We also inform and guide patients while asking their associated medical provider intricate questions to integrate and provide them with a safe and positive space. Dr. Jimenez, D.C., includes this information as an academic service. Disclaimer.
Health Care Professional’s Role in Identifying Trafficking
Even though they may come across victims of human trafficking and have the chance to step in, many healthcare professionals believe they lack the knowledge and self-assurance needed to recognize these victims and offer them the kind of aid they need. As an illustration:
Just 37% of social workers and medical professionals surveyed again had any training in recognizing and supporting victims of human trafficking (Beck et al., 2015).
It is extremely hard for processors to identify and aid victims because traffickers move their victims around a lot and employ various strategies to evade discovery. Frequently, it could be your final interaction with the victim (Macy & Graham, 2012).
There can be a companion who comes across as very domineering, who won’t let the patient spend time alone with you, or who insists on filling out paperwork or talking on the patient’s behalf.
It’s possible that neither the victim nor their friend will have identification or insurance paperwork and will just pay in cash.
The victim or their companion may refuse to answer questions.
The victim may decline additional testing and follow-up care.
The victim may have physical injuries, sexually transmitted diseases, and signs of psychosocial stress.
The victim may not know the city and state that they are in.
The victim may appear fearful when asked questions or in the presence of their companion.
The victim may exhibit feelings of shame, guilt, helplessness, or humiliation.
You may notice inconsistencies in basic information, such as age, name, address, work history, or information regarding living status and daily activities.
If the patient does not speak English, where are they from, and how did they arrive?
If the patient is a minor, who and where is the guardian?
The victim may have unusual tattoos to indicate that they are the “property” of their trafficker.
Recognizing the Signs of Trafficking
You can more easily spot possible victims and offer the right help if you are aware of the typical warning indicators of human trafficking. The following are typical signs that someone is being trafficked. Naturally, not all victims or forms of trafficking will exhibit all of the indicators. Work and Living Conditions (National Human Trafficking Hotline, n.d.):
The victim may not be able to come and go on their own or leave their current home or work situation.
Human trafficking victims are often minors who are forced to engage in commercial sex acts.
The individual may work in the commercial sex industry and be under the control of a pimp or manager.
The victim may be required to work unusual or excessively long hours.
The victim may receive little, if any, pay or may only receive tips.
The victim may be subjected to unusual or extreme restrictions at work or may not be allowed to take breaks.
The victim may owe a large debt to their “employer.”
The victim may have been lured to their current work or living situation through false promises about the nature of their work or living environment.
The victim’s home or work location may have unusually high security, such as opaque or boarded-up windows, bars on windows, high fences, and security cameras.
The victim may be required to live at their work location.
The victim may experience various signs of abuse at the hands of their employer.
The victim may not be paid directly. Instead, the money is directed to the supervisor or manager, who deducts a large percentage for living expenses and other debts.
The victim may be forced to meet unreasonable daily quotas.
The victim may be forced to work in unsafe work environments without the proper safety equipment.
Chiropractic Care for Healing After Trauma-Video
Best Practice Guidelines for Interviewing Trafficking Individuals
As a healthcare provider, you must continuously weigh the different courses of action at every interview process step. To establish trust and ensure safety, practitioners must, above all, put aside preconceived notions and assumptions about the victims and their behavior (Hodge, 2014; DeBoise, 2014; Hemmings, Jakobowitz, & Abas, 2016). Zimmerman and Watts (2003) suggest that the World Health Organization has produced rules for every phase of the interview process, which include the following recommendations:
It’s critical to keep in mind that every trafficking scenario and survivor is distinct, making it crucial to pay attention to and accept each person’s account.
It could take some time for victims to open up and be willing to talk about their experiences because it can be hard for them to build rapport and trust.
You should take precautions to protect both you and the victim because you should anticipate that the victim is at risk of psychological, bodily, social, and legal harm.
To prevent further upsetting the victim, you should consider the risks and advantages before beginning the interview process, as it can be a traumatic experience in itself.
While you should direct victims to available resources when necessary, you should avoid making unfulfilled promises or pledges.
The amount of time it takes for victims of human trafficking to be prepared to embrace change might vary greatly. Some victims can be eager to look for new possibilities and to improve their circumstances. Some people can be less likely to accept assistance because they haven’t developed enough trust issues or because they fear retaliation from their trafficker.
Depending on the situation, many service providers or interpreters must be present during the interview. Everyone taking part in the interview process ought to be reasonably knowledgeable about human trafficking, including how traffickers manipulate their victims and how to interact with them in a way that respects their cultural differences. To maintain anonymity and ensure the victim can communicate freely and honestly, you should refrain from using interpreters who are acquainted with the victim or who live in the same neighborhood.
Having an emergency safety plan in place is crucial to shielding the victim from harm—both from others and self-harm.
Consent must always be obtained voluntarily for all interventions, including interviews. For many victims who have never known autonomy or self-determination, this may be a foreign idea.
Avoid using legal or technical jargon.
Furthermore, it’s critical to remember that trauma survivors may suffer after treatment can have a lasting effect on all facets of their lives, making psychological, emotional, and physical safety a top priority. It is reasonable to presume that the person provides the most accurate account of their experience at that time. A person’s guarded, defensive, and belligerent behavior may be only their coping mechanism for their trauma. (V. Greenbaum, 2017)
How to Report Known or Suspected Trafficking
The best way to report suspected trafficking is by calling the National Human Trafficking Hotline or texting the number 711 if the patient responds affirmatively to the evaluation questions if your findings imply that they might be victims of human trafficking. Additionally, you can text 233733. Basic details about the case will be requested from you, such as (National Human Trafficking Hotline, n.d.):
the location of the suspected trafficking
the name of the alleged trafficker, if possible
your city and state
how you learned about the hotline
Health care providers who know or believe that a youngster is being abused, neglected, or abandoned should report their concerns to law enforcement or the relevant child welfare agency right away, as they are required reporters under child abuse and neglect statutes. You can report abuse online or by calling the Department of Children and Families Abuse Hotline in the state you are residing in.
Documenting Physical Findings
Physical findings should be meticulously and precisely recorded using written descriptions, freehand sketches that have been identified and annotated, and digital or film photos with the patient’s consent. Regarding photography, the picture should show the patient’s face and the lesion or injury measured using a coin, ruler, or other common object. The photo should include a piece of paper bearing the date the picture was taken. More photos can capture up close shots of every pertinent lesion or injury. Serial follow-up photos over seven to ten days can be used to record the healing or advancement of ecchymoses and other injury-related symptoms. A statement identifying the photographer and attesting to the accuracy and integrity of the images ought to be incorporated into the chart. Before any photos are taken, consent for the photographic documentation should be sought and recorded. Patients should be aware of their rights, which include the ability to decline all photographic documentation or limit it to a limited number of specified locations.
In addition to providing essential medical care, the healthcare professional should work to establish an environment where each patient feels respected, comfortable, cared for, validated, and empowered to reveal if they so choose. If the patient does not feel “ready” to demonstrate in the clinical environment, disclosure may happen later. As a result, for at-risk patients, every single clinical interaction should be seen as a step toward their eventual safety.
Laws & Policies for Human Trafficking
The United States has enacted a variety of laws and policies designed to prevent human trafficking, punish the perpetrators, and protect the survivors. One of these laws and policies is the Trafficking Victims Protection Act law or the TVPA (U.S. Congress).
This is the centerpiece of federal human trafficking legislation. The act focuses on three primary areas:
The TVPA seeks to prevent human trafficking through increased training and awareness.
The act seeks to protect trafficking victims by providing them access to services using federal funds similar to other refugees.
The act establishes trafficking and related crimes as federal offenses subject to stiff penalties.
One way that the legislation protects victims of human trafficking is that it absolves them of consequences for engaging in criminal activities that arise from their trafficking experience, such as entering the nation using fraudulent documents or working without the proper authorization. In addition, families of trafficking victims are qualified for T visas, which let them stay in the nation to support federal law enforcement in their pursuit of the offenders. After three years, victims can then apply to become permanent residents. Depending on the specific circumstances, many individuals may be entitled to assistance and benefits, such as access to the Witness Security Program and reparations. In addition, individuals between 16 and 24 could qualify for the Job Corp program and work permits.
Others criticize the TVPA. Usually, the onus is on the victim to prove their innocence or compulsion first. Second, the act emphasizes sex trafficking more than other types of human trafficking, which ignores how intricate human trafficking is. Only victims and survivors of “severe” types of trafficking who are prepared to cooperate with the investigation and prosecution of their offenders are eligible for the services provided under the act. This ignores the severity of the abuse the victims endured and the degree of mistrust and terror they might harbor toward both the abuser and others in positions of power.
Preventing Trafficking Through Awareness, Interventions, & Resources
In the shadows, human trafficking flourishes. We eradicate the shadows where human traffickers lurk by increasing public and health practitioner awareness of the problem (Hodge, 2008; Gozdziak & MacDonnell, 2007). For instance, putting up signs and pamphlets on human trafficking can not only help to enhance public awareness but also boost the chance that victims may come forward on their own. Brochures and posters are free from the Campaign to Rescue and Restore Victims of Trafficking.
When assisting victims of human trafficking, practitioners and service providers need to be able to engage with a variety of governmental, legal, medical, and social service organizations and institutions. Generally speaking, there are three main categories into which the care and services that a victim falls (Dell et al., 2019; Johnson, 2012; Oram & Domoney, 2018):
Immediate Services
Services Related to Recovery
Services About Reintegration
Resources for Providers
The National Human Trafficking Resource Center’s referral database can be consulted by providers looking to connect with local programs that assist victims of human trafficking or who need assistance for a victim or survivor. Many healthcare providers can check out the website to provide helpful resources in their local area.
Conclusion
Any human trafficking violates fundamental rights. Since human trafficking has many underlying roots, eradicating the issue would need different approaches on various fronts. When it comes to addressing racism, poverty, oppression, prejudice, and other factors that lead to human trafficking, healthcare professionals need to be dedicated to facing this issue both within their patient population and in partnership with colleagues from different disciplines. Physicians, social workers, counselors, and other health care professionals are required by their code of ethics to lead in addressing power abuses and advancing social justice. Practitioners can accomplish this, among other things, by teaching others and themselves about the intricate dynamics and international scope of human trafficking.
References
Beck, M. E., Lineer, M. M., Melzer-Lange, M., Simpson, P., Nugent, M., & Rabbitt, A. (2015). Medical providers’ understanding of sex trafficking and their experience with at-risk patients. Pediatrics, 135(4), e895-902. doi.org/10.1542/peds.2014-2814
DeBoise, C. (2014). Human Trafficking and Sex Work: Foundational Social-Work Principles. Meridians: Feminism, Race, Transnationalism, 12(1), 227–233. muse.jhu.edu/article/541879/pdf
Dell, N. A., Maynard, B. R., Born, K. R., Wagner, E., Atkins, B., & House, W. (2019). Helping Survivors of Human Trafficking: A Systematic Review of Exit and Postexit Interventions. Trauma Violence Abuse, 20(2), 183-196. doi.org/10.1177/1524838017692553
Gozdziak, E., & MacDonnell, M. (2013, March 4). Closing the Gaps: the Need to Improve Identification and Services to Child Victims of Trafficking by School of Foreign Service – Georgetown University – Issuu. Issuu.com. issuu.com/georgetownsfs/docs/gozdziak-closing-the-gaps
Greenbaum, V. J. (2017). Child sex trafficking in the United States: Challenges for the healthcare provider. PLoS Med, 14(11), e1002439. doi.org/10.1371/journal.pmed.1002439
Hemmings, S., Jakobowitz, S., Abas, M., Bick, D., Howard, L. M., Stanley, N., Zimmerman, C., & Oram, S. (2016). Responding to the health needs of survivors of human trafficking: a systematic review. BMC Health Serv Res, 16, 320. doi.org/10.1186/s12913-016-1538-8
Hodge, D. R. (2008). Sexual trafficking in the United States: a domestic problem with transnational dimensions. Soc Work, 53(2), 143-152. doi.org/10.1093/sw/53.2.143
Macy, R. J., & Graham, L. M. (2012). Identifying domestic and international sex-trafficking victims during human service provision. Trauma Violence Abuse, 13(2), 59-76. doi.org/10.1177/1524838012440340
Oram, S. (2021). Responding to the mental health needs of trafficked women. European Psychiatry, 64(S1), S12-S12. doi.org/10.1192/j.eurpsy.2021.55
Zimmerman, C., & Watts, C. (2003). Ethical and safety recommendations for intervention research on violence against women. Www.who.int. www.who.int/publications/i/item/9789241510189
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The traction unit must be hung over a door secured to the top and closed.
