Flexibility is critical for athletes and non-athletes alike. It allows people to move freely and easily in their everyday life and can also help prevent injury or aggravated conditions during physical activities. One of the best methods to maximize flexibility is through stretching. However, research suggests that not all stretching techniques are created equal. Proprioceptive neuromuscular facilitation, or P.N.F., stretching is depends on reflexes to produce deeper stretches which increase flexibility.
What is P.N.F. stretching?
Proprioceptive neuromuscular facilitation (PNF) is a more complex form of endurance training which involves both the stretching and contraction of the muscle group being targeted. PNF stretching was initially developed as a form of rehabilitation, and to that effect, it’s very effective. It’s also great for targeting specific muscle groups, and also, while it helps increase flexibility, it also enhances muscle power.
As stated by the International PNF Association, P.N.F. stretching was developed by Dr. Herman Kabat in the 1940’s as a means to take care of neuromuscular ailments, including polio and multiple sclerosis. Proprioceptive neuromuscular facilitation techniques have since gained recognition with healthcare professionals, such as chiropractors, physical therapists and other fitness professionals. Based on research from the University of Queensland, PNF stretching may be the best stretching procedure for increasing range of motion.
How Does Proprioceptive Neuromuscular Facilitation Function?
While there are multiple PNF stretching techniques, all of these rely on extending a muscle to its own limitation. Doing so causes the inverse myotatic reflex, a protective reflex that calms the muscle to prevent injury. P.N.F. induces the brain to think “I do not need that muscle to rip” and sends a message to let the muscle relax a bit more than it would normally.
You know the feeling when you stretch a muscle? It feels great when you stretch it until you move nearer to the end of its range of movement and it starts to feel extremely tight and even painful. It’s similar to a flexible band that does not want to stretch any farther.This is known as the myotatic reflex, which is the human body’s natural method of protecting your muscles from stretching too far. It is possible to conquer this to an extent by gradually extending and exhaling to decrease tension in the muscle.
However, proprioceptive neuromuscular facilitation, or PNF, stretching tricks your nervous system into relaxing the myotatic reflex, enabling your muscles to extend further than what’s attainable using a conventional style of stretching. All PNF stretching requires is that you stretch a muscle and then forcefully contract that muscle before stretching it again. As you proceed into the stretch after the contraction, you will be able to stretch farther that you did earlier. This permits you to create more length in the muscle and receives a much greater flexibility benefit from the stretch. P.N.F. stretching consists of several techniques which can help achieve the same effect as described above.
Hold-Relax Stretch
This type of PNF stretch relies on the concept of autogenic inhibition. By stretching the muscle and after using an isometric contraction of the muscle, it’s possible to decrease the activity (or tone) of the muscle and deceive the myotatic reflex to permit for a more significant stretch. To perform this technique, stretch a muscle as far as you can, remember, it shouldn’t be painful, and then hold the stretch for 10 seconds. Next, contract that muscle as forcefully as possible against an immovable object. Hold this for 5 minutes. Now move into a stretch, using a partner’s assistance if needed, which ought to be deeper than what you attained before. Repeat the stretch-contraction order three times for each muscle.
Contract-Relax, Antagonist-Contract Stretch
Your system is wired so that two muscles cannot shorten at precisely the exact same time, otherwise they’d fight against one another, and you would not be able to move. So when you consciously contract a muscle, your nervous system automatically sends an indication to the opposing muscle, or antagonist, that it ought to relax so that your joint can proceed. This is called reciprocal inhibition. This variant of PNF benefits from reciprocal inhibition. It resembles the hold-relax stretch but entails a forceful contraction of the opposing muscle to the one being extended in order to move deeper into the stretch.
To perform this technique, stretch a muscle as far as you can, again, remember it shouldn’t be painful, and hold the stretch for 10 seconds. Next, contract that muscle as aggressively as you can against an immovable object, such as your partner’s chest. Hold this for 5 seconds. Now use the opposing muscle to pull yourself back to the stretch. Again for the hamstring stretch, this would be your hip flexors. Your partner won’t have to supply as much assistance as the hold-relax stretch technique, but can give an excess drive and will help you maintain the stretch if needed. Repeat the sequence three times for each muscle.
Contract-Relax Stretch
Finally, the third type of PNF stretch closely resembles the hold-relax stretch but rather entails contracting the muscle through an active assortment of motion. To perform this technique for a hamstring stretch, for instance, you’d extend the muscle for 10 seconds and slowly lower your leg into a table. Now increase your leg back around 90 degrees and also have a partner move you into the next stretch.
Dr. Alex Jimenez’s Insight
Proprioceptive Neuromuscular Facilitation, or PNF, is a rehabilitation stretching technique used to help increase flexibility as well as improve muscle elasticity. P.N.F. has been demonstrated to have a positive effect on active and passive range of motion because it can increase the length of the muscle and neuromuscular efficiency. Stretching has long been seen as beneficial to enhance performance and decrease risk of injury during physical activities. Proprioceptive neuromuscular facilitation stretching can also improve function and range of motion following an injury. Proper protocol should be followed when performing PNF stretching to attain and maintain the benefits of these techniques.
A Word of Caution Regarding PNF Stretching
Certain precautions need to be taken when performing proprioceptive neuromuscular facilitation, or PNF, stretches because they can place additional amounts of stress, pressure and/or tension on the targeted muscle group, which can boost the risk of soft tissue injury. To help reduce this risk, it’s important to incorporate a conditioning stage before a maximum, or extreme effort is utilized.
Additionally, before undertaking any form of stretching it is extremely important that a comprehensive warm up is completed. Warming up prior to stretching does a variety of valuable things, but mainly its objective is to prepare the body and mind for more strenuous physical activities. Among the ways it accomplishes this is by helping to increase the body’s core temperature whilst also increasing the body’s muscle dimensions. This is imperative to ensure the maximum benefit is obtained from your stretching. The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Curated by Dr. Alex Jimenez
Additional Topics: Sciatica
Sciatica is medically referred to as a collection of symptoms, rather than a single injury and/or condition. Symptoms of sciatic nerve pain, or sciatica, can vary in frequency and intensity, however, it is most commonly described as a sudden, sharp (knife-like) or electrical pain that radiates from the low back down the buttocks, hips, thighs and legs into the foot. Other symptoms of sciatica may include, tingling or burning sensations, numbness and weakness along the length of the sciatic nerve. Sciatica most frequently affects individuals between the ages of 30 and 50 years. It may often develop as a result of the degeneration of the spine due to age, however, the compression and irritation of the sciatic nerve caused by a bulging or herniated disc, among other spinal health issues, may also cause sciatic nerve pain.
Food:�Genes that determine illness are triggered by what we put into our bodies, literally what we eat. Our cells are literally created out of the foods we put into our bodies. Like most people do, we are likely eating nutrient-poor foods that create damaged dysfunctional cells. When we learn to eat foods that nourish the body, our cells repair themselves, and the new cells created will be optimal functioning cells.
Unhealthy foods create chronic inflammation, which is destructive to the body. Inflammation is normally the body�s healthy response to injury or infection. However, when inflammation becomes chronic, from constant assault on the gut by consuming the wrong foods, inflammation becomes the cause of destructive diseases, i.e. Lupus, Rheumatoid Arthritis, Colitis and other inflammatory diseases.
Disclosure
Terry Wahls, MD disclosed no relevant financial relationships with any commercial interest.
The two routes by which diet can influence our health:
(A) the metabolism of our cells and
(B) the population of our gut microbiota.
Paolo Riccio, and Rocco Rossano ASN Neuro
2015;7:1759091414568185
Copyright � by SAGE Publications Inc, or the American Society for Neurochemistry, unless otherwise noted.
Manuscript content on this site is licensed under Creative Commons Licenses.
1. Review of MS patient survival on a Swank low saturated fat diet. Nutrition. 2003 Feb;19(2):161-2. Review.
2. Effect of low saturated fat diet in early and late cases of multiple sclerosis. Lancet. 1990 Jul 7;336(8706):37-9.
3. Multiple sclerosis: twenty years on low fat diet. Arch Neurol. 1970 Nov;23(5):460-74
Low-Fat, Plant-Based Diet In Multiple Sclerosis: A Randomized
Controlled Trial
This was a randomized-controlled, assessor- blinded, one-year long study
1. Voitk AJ, Echave V, Feller JH, et, al: Experience with elemental diet in the treatment of inflammatory bowel disease. Is this primary therapy? Arch Surg, 1973;107: 329-333.
2. Tim LO, Odes HS, Duys PJ, et al. The use of an elemental diet in gastrointestinal diseases. S Afr Med J,1976;50: 1752-1756
3. Zoli G, Care? M, Parazza M et al, A randomized controlled study comparing elemental diet and steroid treatment in Crohn’s disease. Aliment
Pharmacol Ther. 1997 Aug;11(4):735-40.
4. Zachos M, Tondeur M, Griffiths AM. Enteral nutritional therapy for induction of remission in Crohn�s disease. Cochrane Database Syst Rev, 2007
January 24;(1)
5. Podas T, Nightingale JM, Oldham R, et al, Is rheumatoid arthritis a disease that starts in the intestine? A pilot study comparing an elemental diet with
oral prednisolone. Postgrad Med J. 2007 Feb;83(976):128-31
6. Podas T, Nightingale JM, Oldham R, et al, Is rheumatoid arthritis a disease that starts in the intestine? A pilot study comparing an elemental diet with
oral prednisolone. Postgrad Med J. 2007 Feb;83(976):128-31
Exclusion Diets
Eliminated specific protein sources � RA Sx ?
Raw vegan, vegan and gluten free vegan
Systematic review of 14 RCTs
Dietary benefits uncertain
Small studies with risk of bias
1. Kjeldsen-Kragh J, Haugen M, Borchgrevink CF, Laerum E, Eek M, Mowinkel P, Hovi K, F�rre O. Controlled trial of fasting and one-year vegetarian diet in rheumatoid arthritis. Lancet. 1991 Oct 12;338(8772):899-902.
2. Kjeldsen-Kragh J, Haugen M, Borchgrevink CF, F�rre Vegetarian diet for patients with rheumatoid arthritis–status: two years after introduction of the diet. Clin Rheumatol. 1994 Sep;13(3):475-82
3. McDougall J, Bruce B, Spiller G, et al, Effects of a very low-fat, vegan diet in subjects with rheumatoid arthritis. J Altern Complement Med. 2002 Feb;8(1):71-5
4. Hafstro?m I, Ringertz B, Spa?ngberg A, et. al, A vegan diet free of gluten improves the signs and symptoms of rheumatoid arthritis: the effects on arthritis correlate with a reduction in antibodies to food antigens. Rheumatology (Oxford). 2001 Oct;40(10):1175-9.
5. Hagen KB, Byfuglien MG, Falzon L, et, al. Dietary interventions for rheumatoid arthritis. Cochrane Database Syst Rev. 2009 Jan 21;(1):
6. Smedslund G, Byfuglien MG, Olsen SU, et. al, Effectiveness and safety of dietary interventions for rheumatoid arthritis: a systematic review of
randomized controlled trials. J Am Diet Assoc. 2010 May;110(5):727-35
Exclusion Diets
Atopic dermatitis improved n=20
UC � fewer symptoms n=18
Crohn�s food sensitivities identified in half n=42
Antibody cross-reactivity between myelin oligodendrocyte glycoprotein and the milk protein butyrophilin in MS – Inducing antibodies reacting with myelin oligodendrocyte glycoprotein (MOG) and Cerebellar peptides
Liquid cow milk (not cheese) and MS prevalence was highly correlated (rho = 0.836) across 27 countries and 29 populations.
�By eliminating lectins, which adversely influence both enterocyte and lymphocyte structure and function, it is proposed that the peripheral antigenic stimulus (both pathogenic and dietary) will be reduced and thereby result in a diminution of disease symptoms in certain patients with RA.�
1. Lindeberg, S., Jo?nsson, T., Granfeldt, Y. et al. Diabetologia (2007) 50: 1795. doi:10.1007/s00125-007-0716-y
2. O?sterdahl M, Kocturk T, Koochek A, Wa?ndell PE. Effects of a short-term intervention with a paleolithic diet in healthy volunteers. European Journal of
Clinical Nutrition. 2007;62(5):682�685. doi:10.1038/sj.ejcn.1602790.
3. Jo?nsson T, Granfeldt Y, Ahre?n B, et al. Beneficial effects of a Paleolithic diet on cardiovascular risk factors in type 2 diabetes: a randomized cross-over pilot study. Cardiovascular Diabetology. 2009;8:35. doi:10.1186/1475-2840-8-35.
4. Frassetto LA, Schloetter M, Mietus-Synder M, Morris RC, Sebastian A. Metabolic and physiologic improvements from consuming a paleolithic, hunter- gatherer type diet. European Journal of Clinical Nutrition. 2009;63(8):947�955. doi:10.1038/ejcn.2009.4.
5. Halberg N, Henriksen M, So?derhamn N, et. al, Effect of intermittent fasting and refeeding on insulin action in healthy men. J Appl Physiol (1985). 2005 Dec;99(6):2128-36.
6. Ryberg M, Sandberg S, Mellberg C, et al. A Palaeolithic-type diet causes strong tissue-specific effects on ectopic fat deposition in obese postmenopausal women. Journal of Internal Medicine. 2013;274(1):67�76. doi:10.1111/joim.12048.
7. Ruiz-Nu?n?ez B, Dijck-Brouwer DAJ, Muskiet FAJ. The relation of saturated fatty acids with low-grade inflammation and cardiovascular disease. The Journal of Nutritional Biochemistry. January 2016. doi:10.1016/j.jnutbio.2015.12.007.
8. Otten J, Stomby A, Waling M, et al. Benefits of a Paleolithic diet with and without supervised exercise on fat mass, insulin sensitivity, and glycemic control: A randomized controlled trial in individuals with type 2 diabetes. Diabetes/Metabolism Research and Reviews. January 2016. doi:10.1002/dmrr.2828.
9. Konijeti GG1, Kim N, Lewis JD, Groven S, Chandrasekaran A. Efficacy of the Autoimmune Protocol Diet for Inflammatory Bowel Disease. Inflamm Bowel Dis. 2017 Aug 29. doi: 10.1097/MIB.0000000000001221.
10. Spreadbury I. Comparison with ancestral diets suggests dense acellular carbohydrates promote an inflammatory microbiota, and may be the primary dietary cause of leptin resistance and obesity. Diabetes Metab Syndr Obes. 2012;5:175-89.
11. Eaton SB, Konner MJ, Cordain L. Diet-dependent acid load, Paleolithic nutrition, and evolutionary health promotion. Am J Clin Nutr. 2010;91:295-7. Andersson A, et al. Whole?grain foods do not affect insulin sensitivity or markers of lipid peroxidation and inflammation in healthy, moderately overweight subjects. J Nutr.2007 Jun;137(6):1401?7.
12. Tighe P, et al. Effect of increased consumption of whole ? grain foods on blood pressure and other cardiovascular risk markers in healthy middle?aged persons: a randomized controlled trial. Am J Clin Nutr. 2010 Oct;92(4):733?40.
13. Brownlee IA, et al. Markers of cardiovascular risk are not changed by increased whole?grain intake: the WHOLEheart study, a randomised, controlled dietary intervention. Br J Nutr. 2010 Jul;104(1):125?34.
14. Masters RC, et al. Whole and refined grain intakes are related to inflammatory protein concentrations in human plasma. J Nutr. 2010 Mar;140(3):587?94.
15. Katcher HI, et al. The effects of a whole grain-enriched hypocaloric diet on cardiovascular disease risk factors in men and women with metabolic syndrome. Am J Clin Nutr. 2008 Jan;87(1):79?90.
Nutrient Triage
Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triage.
Fruit and vegetable consumption and mortality from all causes, cardiovascular disease, and cancer: systematic review and dose response meta-analysis of prospective cohort studies.
16 studies – 833,234 participants
Risk Of All Cause Mortality Associated With Servings/Day Of Fruit & Vegetables
Dose-Response Relation Between Fruit & Vegetable Consumption & Risk Of All Cause Mortality
BMJ. 2014; 349: g4490.
1. Neuroprotective Effect of Brassica oleracea Sprouts Crude Juice in a Cellular Model of Alzheimer’s Disease. Med Cell Longev.2015;2015:781938
2. Learning and memory promoting effects of crude garlic extract. Indian J Exp Biol.2013 Dec;51(12):1094-100.
3. Enhancement of the neuroprotective activity of Hericium erinaceus mycelium co-cultivated with Allium sativum extract. Arch Physiol Biochem.2015 Feb;121(1):19-25.
4. Mori K, Obara Y, Hirota M, Azumi Y, Kinugasa S, Inatomi S, Nakahata N. Nerve growth factor-inducing activity of Hericium erinaceus in 1321N1 human astrocytoma cells. Biol Pharm Bull. 2008 Sep;31(9):1727-32.
5. Lee DH, Kim HW. Innate immunity induced by fungal ?-glucans via dectin-1 signaling pathway. Int J Med Mushrooms. 2014;16(1):1-16.
6. Akramiene D, Kondrotas A, Didziapetriene J, Kevelaitis E Effects of beta-glucans on the immune system. Medicina (Kaunas).2007;43(8):597-606.
7. Lai PL, Naidu M,Sabaratnam V,Wong K, DaviP, Kuppusamy UR, Abdullah N, Malek SN. Neurotrophic properties of the Lion’s mane medicinal mushroom, Hericium erinaceus (Higher Basidiomycetes) from Malaysia Int J Med Mushrooms.2013;15(6):539-54.
8. Phan CW, David P, Naidu M, Wong KH, Sabaratnam V. Therapeutic potential of culinary-medicinal mushrooms for the management of neurodegenerative diseases: diversity, metabolite, and mechanism. Crit Rev Biotechnol.2015;35(3):355-68.
9. Scientifica (Cairo).2016;2016:3109254.
10. Berry antioxidants: small fruits providing large benefits. J Sci Food Agric.2014 Mar 30;94(5):825-33
11. Dietary and plant polyphenols exert neuroprotective effects and improve cognitive function in cerebral ischemia. Recent Pat Food Nutr Ag. 2013 Aug;5(2):128-43.
12. The impact of fruit flavonoids on memory and cognition. Br J Nutr.2010 Oct;104 Suppl 3:S40-7. d
13. Grape juice, berries, and walnuts affect brain aging and behavior. J Nutr. 2009 Sep;139(9):1813S-7S.
14. Fruit polyphenolics and brain aging: nutritional interventions targeting age-related neuronal and behavioral deficits. Ann N Y Acad Sci.2002 Apr;959:128-32.
15. Reversing the deleterious effects of aging on neuronal communication and behavior: beneficial properties of fruit polyphenolic compounds. Am J Clin Nutr.2005 Jan;81(1 Suppl):313S-316S.
16. Krikorian R, Shidler MD, Nash TA, Kalt W, Vinqvist-Tymchuk MR, Shukitt-Hale B, Joseph JA. Blueberry supplementation improves memory in older adults. J Agric Food Chem.2010 Apr 14;58(7):3996-4000.
17. Funding for the studies was provided by the US Highbush Blueberry Council, the National Institute on Aging, and Wild Blueberries of North America. Dr. Krikorian has disclosed no relevant financial relationships.
18. Lobo GP Amengual J, Baus D, Shivdasani RA Genetics and diet regulate vitamin A production via the homeobox transcription factor ISX. J Biol Chem.2013 Mar 29;288(13):9017-27
?-carotene Is Not Retinol (Vitamin A)
?-Carotene is converted to vitamin A in the intestine by the enzyme ?-carotene-15,15′- monoxygenase (BCMO1) to support vision, reproduction, immune function, and cell differentiation.
Considerable variability in BCMO1 exists and can effect individual vitamin A status
Nutritional Adequacy (%RDA) US Diet Vs. Study Diet
Multimodal Intervention Improves Quality Of Life
Mood & Cognition
In the setting of progressive MS Improved thinking ability and reduced anxiety and reduced depression
Average daily servings of the study diet recommended (vegetables/fruits) and excluded (gluten/dairy/eggs) foods p < 0.01 difference from baseline to 12 months
Average Scores On The Mood Measures At Each Study Visit
Average Scores On The DKEFS & WAIS Sub-Scales At Each Study Visit.
Relapsing Remitting MS
Reduce Fatigue
?Mental & Physical QoL 16% (> 5 points)
Improved Motor Function
A Simplified Model Of FMD?Mediated Effects On Glucocorticoid, Immune Suppression & Oligodendrocyte Regeneration & Differentiation In MS
N=60 6 Month Human Clinical Trial
FMD 100 ml broth, 1 T flax oil tid, 200 � 350 Kcal, Plus enema as needed 7 days Mediterranean diet
Ketogenic(KD) 160gmfatm<100gPro,<50g CHO
Usual diet
Change at 3 month of (k) overall quality of life, (l) change in health, (m) physical health composite, and (n) mental health composite. The dotted line represents a threshold that is thought to be clinically important
The Two Routes By Which Diet Can Influence Our Health:
(A) the metabolism of our cells and
(B) the population of our gut microbiota.
Paolo Riccio, and Rocco Rossano ASN Neuro
2015;7:1759091414568185
Copyright � by SAGE Publications Inc, or the American Society for Neurochemistry, unless otherwise
noted. Manuscript content on this site is licensed under Creative Commons Licenses.
Gut Brain Immune Axis
Gut microbiota influence the brain and immune system balance
Diet influences the microbiome strongly
Exercise, sleep, stress level also important
Changes in the colon mucosa every early in the disease process
The composition of gut microbiota is influenced by multiple factors, such as diet and host genotype. Within the gut, ecological processes such as selection and evolution take place. The use of antibiotics reduces the numbers and diversity of gut microbiota.
Higher quality diet (food), stress reduction, movement � are relatively safe with large favorable benefits for all cause mortality
3 month trial of a grain free, dairy free, sugar free vegetable rich (or gluten free vegetarian) diet is relatively safe with potential for many favorable benefits
Specially certified healthcare professionals utilize the active release techniques, A.R.T., to diagnose and treat soft tissue injuries created by scar tissue. This manual, hands on treatment divides adhesions which limit normal range of motion causing strain and painful symptoms.
What is Active Release Technique (ART)?
Active Release Techniques (ART) is a guide treatment administered by trained healthcare practitioners to particular soft tissue structures of the human body. The ART soft tissue control process relies on scientific proof that muscles, nerves, blood vessels, and connective tissue develop adhesions inside and between them as a result of various injuries that include: acute, or sudden injury, cumulative, or chronic injury, and pressure because of poor posture. These adhesions cause the motion of joints or muscles to be altered, leading to a vast array of signs and symptoms, including fatigue, pain and reduced range of movement, as well as tingling sensations and numbness.
What is the History of A.R.T.?
Michael Leahy, D.C., now practicing in Colorado Springs, Colorado, began developing A.R.T. in 1984. Prior to practicing chiropractic care, Dr. Leahy was an aeronautical engineer with the US Air Force. This technology background enabled Dr. Leahy to strategize soft tissue injuries in a new perspective, turning into the active release technique. Dr. Leahy is now widely considered a top rated soft tissue authority in the United States and the entire world.
What is ART Treatment Like?
After a diagnosis has been achieved according to a medical history and evaluation, treatment can be rendered by the appropriate healthcare professional with experience and certification in the active release technique, ART. Since soft tissue injuries made by scar tissue cannot be detected by a machine, for instance, X-ray or MRI, or by any orthopedic tests, A.R.T. is itself a diagnostic tool. The healthcare practitioner can determine where the adhesions are and also how intense the soft tissue injury is, only by touch.
ART is usually performed using direct contact from the doctor to the patient’s skin. The practitioner will locate the area to be worked on and either have the individual actively move a body part or they will passively move the body part for the individual.
The active release technique (ART) is a hands on treatment in which muscle, fascia, ligament, tendon, nerve, or capsule is held with pressure and tension on the tissue involved (not the skin) in a shortened position, while the arrangement is lengthened through a full, comfortable range of active movement and force is maintained throughout the movement. There is no skin tension or slipping on the epidermis.
Active release technique differs from massage in the use of movement of the limb, or spine under pressure and tension, along with the attention to anatomical detail and potential nerve entrapments in the area. Instead of treating a general region, an active release technique healthcare provider uses their hands to feel damaged or abnormal tissues in muscle, fascia, tendons, ligaments or nerves. Abnormalities present as having a different feel and affect the motion and operation in which a patient can perform.
The qualified and experienced healthcare professional’s contact, coupled with the motion of the patient, allows the adhesions to separate. The therapy protocols, currently amounting to over 500 specific moves, are unique to ART or active release techniques. They allow healthcare practitioners to identify and correct the specific health issues which are impacting each patient.
Active release techniques, or ART, goes right after the adhesion in order to break up the scar tissues producing the painful symptoms and malfunction. Considering these sites are extremely sensitive to begin with, A.R.T. might cause some discomfort described by many patients as a “good hurt”. However, pressure or tension is never applied beyond the patient’s tolerance.
How Long Does ART Treatment Last?
Each individual’s active release technique differs. On average, between 2 to 6 visits, each lasting about 15 to 30 minutes, are needed for correction of soft tissue problems. Factors that affect this range include the intensity of the health issue, the individual’s willingness to take part in their treatment and the patient’s overall health status. Patients need to have an active part in their recovery to help lower the chances of reoccurrence. This may entail strengthening a certain tissue or altering certain physical activities.
ART is considered one of the best and most successful treatments for soft tissue injuries. However, like any other therapy, ART can not fix everything. If significant improvement isn’t seen throughout the course of treatment, other treatments options will be considered to fully resolve the patients injuries or conditions. Healthcare professionals generally will not encourage ongoing sessions if no improvement is observed within a specific number of visits.
Who Can Benefit from A.R.T.?
Anybody who is in pain due to a soft tissue injury can benefit from the active release technique. ART is utilized in a clinical setting on professional and olympic athletes, office workers, laborers, housewives, young athletes, in addition to many others. These individuals all have in common their altered movement patterns, but their mechanism or trigger often differs. A.R.T. effectively heals muscles, tendons and ligaments throughout the body that are very congested with scar tissue by freeing up their ability to function and thereby decreasing pain and other painful symptoms.
Active release techniques can also be effective in treating plantar nerve entrapments in which a nerve is entangled by scar tissue and has pressure or tension exerted during specific positions or movements. Through a healthcare provider’s extensive training, they’re taught where the nerves are likely entrapped and how best to reduce the adhesions. This provides individuals who suffer from sciatica, carpal tunnel syndrome and other peripheral nerve entrapments a fast and effortless solution for their complaints. Palliative therapies such as ART ought to be researched before a person has decided they cannot be properly treated due to their current health and wellness. If it is a soft tissue structure that is causing your pain, it could most likely be fixed.
How Does ART Help?
Active release technique promotes faster healing, recovery of normal tissue function, and may also prevent future injuries. For the athlete, it is going to make it possible for them to train better and more frequently. For the employee, it can keep them injury free, if used as a preventative therapy.
Abnormal tissue, or scar tissue, can go unnoticed by an athlete as well as for the office employee and it may manifest into an injury. Symptoms of damaged tissue include tightening and shortening of the muscle. What was once simple could become a chore, for instance, stiffer golf swing rotation, or fighting to reach your seatbelt. A reduction of mobility, limited range of motion, poor biomechanics, overcompensation along other body parts, and loss of strength could all be identified and adjusted with ART. Many times, a patient will not understand why scar tissue is building up until it is too late. No apparent injury is necessary for this to happen.
Possibly an IT band pain can be traced back to some dysfunctional hip. Tingling sensations or numbness in the hand may be from constant insult to the nerve from poor computer desk setup along with the shoulder, neck, forearm posture causing the nerve to be entrapped up the arm or neck; it doesn’t even have to develop in your hand.
How Does ART Improve Performance?
Performance of almost any activity, such as golfing, typing, walking or running could be improved considerably with the active release technique, or ART, by restoring proper muscle function and motion to permit the entire body to perform at its most efficient level. Adhesions create drag and tension which requires additional energy and effort to accomplish a desired movement. Reaction times may also be enhanced as muscle function is improved.
Who Can Provide Active Release Technique?
Only certified healthcare professionals in active release techniques, such as chiropractors or physical therapists, can efficiently render treatment. Regrettably, there are a number of people who claim they provide ART but don’t really get the true training needed to provide safe and efficient therapy. It’s essential to find a qualified and experienced healthcare practitioner in A.R.T..
Dr. Alex Jimenez’s Insight
Active release technique is a type of soft tissue therapy which helps relieve tight muscles and nerve trigger points, tremendously reducing joint stress and muscular pains. Relieving muscle stiffness and trigger points can make a big difference towards improving overall health and wellness. Furthermore, the active release technique, or A.R.T., can help turn on muscles which may have been turned off due to trauma from an injury or an aggravated condition. ART is primarily used to treat health issues which affect muscles, fascia, tendons, ligaments and even nerves, which contribute to the formation of scar tissue, strains and sprains as well as pain and inflammation.
The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Curated by Dr. Alex Jimenez
Additional Topics: Sciatica
Sciatica is medically referred to as a collection of symptoms, rather than a single injury and/or condition. Symptoms of sciatic nerve pain, or sciatica, can vary in frequency and intensity, however, it is most commonly described as a sudden, sharp (knife-like) or electrical pain that radiates from the low back down the buttocks, hips, thighs and legs into the foot. Other symptoms of sciatica may include, tingling or burning sensations, numbness and weakness along the length of the sciatic nerve. Sciatica most frequently affects individuals between the ages of 30 and 50 years. It may often develop as a result of the degeneration of the spine due to age, however, the compression and irritation of the sciatic nerve caused by a bulging or herniated disc, among other spinal health issues, may also cause sciatic nerve pain.
Low back pain occurs due to a variety of causes, which is why it is often poorly diagnosed and treated. As there are many mechanisms by which lower back pain happens, such as trauma, overuse from weight lifting for example, and repetitive motion, it’s important to mention that this article will only focus on sciatic nerve pain, or sciatica.
Sciatica refers to pain and other symptoms which radiate or travel down the leg, associated with numbness, tingling or burning sensations, and weakness in one or both lower extremities. Many patients complain of sharp, intense pain and discomfort when sitting and driving, affecting their capacity to bear weight properly when one has to walk or move. Their pain can shoot down the length of the sciatic nerve, into the buttocks, down the back of the leg, into the calf, and lastly, into the ankle and foot. The sciatic nerve, which is the longest nerve in the body, can become compressed or entrapped by certain muscles leading to sciatica.
Based on the location of this impingement, the individual will present with a variety of symptoms. If the health issue is diagnosed to originate in the low back, then the problem normally occurs around the hole in which the nerve exits the spine, resulting in symptoms surrounding the entire lower extremity. If the health issue is correctly diagnosed to originate from the buttocks, it most often includes the piriformis muscle because the sciatic nerve travels beneath it as it makes its way down the length of the leg. The source of this type of sciatica may involve different muscles just below the piriformis, otherwise known as a group of muscles called the hip rotators.
If the health issue is not in the lower back, or buttocks, then the problem is very likely to have occurred in the hamstrings, primarily at one of the muscles where the plantar nerve divides the hamstrings at the back of the thigh. The sciatic nerve may also manifest symptoms when compressed in the calf, however, these symptoms will often only be reported below the knee.
ART and PNF Treatment for Sciatic Nerve Pain
In regards to treatment, sciatica can be worked out by performing active release techniques, or ART, through the release of the entire nerve where it is being compressed. The objective when using ART for sciatic nerve pain would be to maneuver the nerve while trapping the muscle(s) in their own position. The nerve is then pulled from beneath the muscle. Also, using rehabilitation exercises through specific stretches and strengthening exercises of the muscle groups involved may allow for faster healing alongside chiropractic care to boost the communication between the spine and the positioning of the nerve entrapment/compression.
One of the most common stretching methods for sciatica is PNF or proprioceptive neuromuscular facilitation. PNF is a sort of stretch that produces a rebound relaxation of the muscle. PNF is a more advanced kind of flexibility training that involves both the contraction and stretching of the muscle group being targeted. PNF is a stretching technique utilized to increase range of motion and flexibility. PNF increases range of motion by increasing the length of the muscle and increasing neuromuscular efficiency. PNF stretching has been found to increase ROM in trained, as well as untrained, individuals. Effects can last 90 minutes or more after the stretching has been completed. PNF stretching was initially created as a form of rehabilitation, and to that effect, it is very effective. It’s also excellent for targeting specific muscle groups as well as increasing flexibility and enhancing muscle power and strength.
Four theoretical physiological mechanisms for increasing range of motion were identified using PNF stretching: autogenic inhibition, reciprocal inhibition, stress relaxation, and the gate control theory.�Autogenic Inhibition is what occurs in a contracted or stretched muscle in the form of a decrease in the excitability because of inhibitory signals sent from the same muscle.�Reciprocal inhibition is what occurs in the TM when the opposing muscle is contracted voluntarily in the form of decreased neural activity. It occurs when an opposing muscle is contracted in order to maximize its contraction force, and it relaxes.�Stress relaxation is what occurs when the musculotendinous unit (MTU), which involves the muscles and the connected tendons, is under a constant stress.�The gate control theory is what occurs when two kinds of stimuli, such as pain and pressure, activate their respective receptors at the same time.
How to Perform a PNF Stretch
The practice of doing a PNF stretch involves the next steps. The muscle group to be stretched is first placed so that the muscles are stretched and under pressure. The individual then contracts the muscle, using a band for 5 to 6 seconds while a partner, or immovable object, applies sufficient resistance to inhibit motion. Please be aware, the effort of contraction ought to be relevant to the individual’s amount of conditioning. The contracted muscle group is then relaxed and a controlled stretch is used for approximately 20 to 30 seconds. The muscle band is then allowed 30 seconds to recover and the process is repeated 2 to 4 more times.
Information differs marginally regarding time recommendations for PNF stretching, determined by which healthcare professional you’re speaking to. Although there are conflicting responses to the question of how long should a patient contract the specific muscle group for and how long should they rest for between each stretch, it’s been found through a study of research and patient experience, that the above timing recommendations offer the most advantages from proprioceptive neuromuscular facilitation stretching.
Furthermore, certain precautions will need to be taken when performing PNF stretches because they may put additional stress on the targeted muscle group, which can boost the possibility of soft tissue injury. To reduce this risk, it’s essential for the patient to include a conditioning phase before a maximum, or intense effort is utilized.
About the Active Release Technique or ART
The active release technique, or ART, is among the newest treatments in the world of chiropractic. ART is used to target muscle, nerve, and tendon problems. It is also used to treat blood vessel problems. Quite a few studies have been conducted and these have generated positive results which reveal that ART is really an effective treatment method. A lot of individuals nowadays try ART since so many are experiencing muscle problems.
Oftentimes, individuals, particularly the older ones, wake up and they feel that their body is quite hard to move. There are also those who start to feel their range of motion getting more and more limited with time. A number of the most common body parts that suffer from limited selection of motion include the neck, the arms, and the back. For many individuals, there is also restricted range of motion. There are numerous factors that cause restricted range of movement. The active release technique can be used to improve limited mobility as well as improve sciatica symptoms associated with a variety of health issues.
How ART Affects Limited Range of Motion
ART therapists initial assess the muscles that they are supposed to take care of. They check the texture, the stiffness, and needless to say, their freedom. Since the groundwork is conducted, the therapists would then attempt to elongate the muscles so as to break the adhesions. The stretching is usually conducted with the management of vein in consideration. Also, the practitioner would need to ask the patient to move the affected body parts in ways prescribed by the practitioner. So essentially, ART is a joint-venture. Practitioner and patients work together in order to generate great medical outcomes.
Dr. Alex Jimenez’s Insight
The active release techniques, or ART, and the proprioceptive neuromuscular facilitator, or PNF, stretches are therapeutic procedures commonly utilized for the common practice of releasing tension in the soft tissues as well as increasing the range of motion of the human body. Although a variety of treatment options are available to help treat sciatica, ART and PNF can be used by qualified and experienced healthcare professionals to safely and effectively improve and manage sciatic nerve pain. Moreover, alternative treatment options, such as chiropractic care, and strengthening exercises can also be used in combination with these therapeutic methods to help speed up the recovery process.
The Future of ART and PNF
It’s important to remember that both ART and PNF should only be run by accredited practitioners. Healthcare professionals are not just expected to find basic instruction and permit but they are also expected to have attended numerous workshops and seminars about the subject. In some countries, credential tests even must be passed. In addition, it ought to be noted that ART and PNF must be conducted on muscle stiffness not due to blunt trauma. The condition should also not involve inflammation.
There are many healthcare professionals who focus on ART and PNF. A few of these include chiropractors, physical therapists, massage therapists, medical physicians, and even athlete trainers. The active release technique and the proprioceptive neuromuscular facilitation stretches helps people do things that they used to do. It helps them become more efficient at work as well as be practical in their daily lives. Due to the health benefits of ART and PNF, more and more people from the medical and therapeutic world are learning how to concentrate on it. The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Curated by Dr. Alex Jimenez
Additional Topics: Sciatica
Sciatica is medically referred to as a collection of symptoms, rather than a single injury and/or condition. Symptoms of sciatic nerve pain, or sciatica, can vary in frequency and intensity, however, it is most commonly described as a sudden, sharp (knife-like) or electrical pain that radiates from the low back down the buttocks, hips, thighs and legs into the foot. Other symptoms of sciatica may include, tingling or burning sensations, numbness and weakness along the length of the sciatic nerve. Sciatica most frequently affects individuals between the ages of 30 and 50 years. It may often develop as a result of the degeneration of the spine due to age, however, the compression and irritation of the sciatic nerve caused by a bulging or herniated disc, among other spinal health issues, may also cause sciatic nerve pain.
It has been compared to the worst possible type of pain anyone can imagine. Other people say it’s even worse than labor because the pain doesn’t seem to have an end to it. These are some of the most common descriptions of sciatica, where a severe case of this excruciating nerve pain can bring anyone to their knees. That’s why lots of patients don’t simply say they have sciatica, they’re victims of its symptoms.
Sciatic nerve pain, or sciatica, is associated with many well-known symptoms, however, is sciatica really that common? What type of treatments are available to help alleviate sciatic nerve pain?And does a person’s everyday activities play a part in whether they will develop sciatica in the first place? Dwight Tyndall, MD, FAAOS answers several of the most commonly asked questions patients need to know regarding their sciatica.�Dr. Tyndall is a pioneer in the area of outpatient spine surgery, however, he is also a strong proponent of non-surgical treatment methods, including chiropractic care, to manage back pain and sciatica. Dr. Tyndall shares his perspectives on sciatic nerve pain and discusses what may indicate a need for surgery in severe cases of sciatica.
What is Sciatica?
According to Dr. Tyndall, sciatica is both a spinal disorder and a catch-all term for a group of symptoms. Sciatic nerve pain, best referred to as sciatica, is a spinal condition characterized by nerve pain which radiates down the length of the sciatic nerve. The sciatic nerve is the largest nerve in the entire human body, and it’s made up of spinal nerves from the vertebrae level L4 in the lumbar spine down to the vertebrae level S1 in the sacrum. Anything which impacts those nerves can lead to sciatica. Moreover, sciatica’s symptoms may be grouped under the medical term dysesthesia, meaning any sort of abnormal sensation. Most patients describe sciatica as an odd feeling radiating out of their lower back into their buttocks and down to their thigh and calf, often radiating as far down into the foot.
What are the Symptoms of Sciatica?
Dr. Tyndall explains that sciatica’s hallmark symptom include pain in the low back or buttocks which radiates down one or both legs. Signs and symptoms which shouldn’t be ignored include pain which doesn’t respond to non-surgical treatment options and/or pain which greatly restricts an individuals activity level and quality of life. Some red flags which may signal the need for surgical interventions associated with sciatic nerve pain include: reduced motor function in one part of the leg, usually a drop foot at which the patient can’t lift thei foot off the ground, weakness in one or both legs and bladder or bowel changes.
Is Sciatica the Same as Lumbar Radiculopathy?
“Most people see sciatica to be more severe than lumbar radiculopathy, but radiculopathy, which comes from the Latin radix significance origin, is a condition that affects the nerve during its origin as it exits the spinal cord. Sciatica and lumbar radiculopathy can be brought on by a pinched nerve from the spinal column due to a disc herniation or stenosis, but kidney problems or a sinus issue, like endometriosis, may also pose sciatica-like symptoms,” states Dr. Dwight Tyndall.
Who’s at Risk of Developing Sciatica?
“By my clinical experience, men and women have exactly the same identical risk of developing sciatica. Obesity also doesn’t play a role, either. Concerning age classes, however, sciatica has been estimated to peak during the ages of 30 and 40, and the risk usually declines as people begin reach their 50’s,” added Dr. Tyndall.
How Common is Sciatica?
As mentioned by Dr. Dwight Tyndall, sciatica and low back pain frequently occur together, but sciatica is much less common. While 80 percent of individuals experience low back pain at any point in their lives, just 2 to 3 percent will actually develop sciatica.
When Should a Person with Sciatica See a Healthcare Professional?
According to Dr. Tyndall, an individual with symptoms of sciatic nerve pain will need to see a healthcare professional if their pain is not reacting to over-the-counter (OTC) medications, or if these create weakness in the leg. Also, a person ought to see a doctor if their pain is so severe that their well-being is affected. Should the sciatica include bladder or bowel changes, the individual must seek immediate medical attention for their health issues. Furthermore, it’s important for a person with sciatica to seek the help of a healthcare professional to rule out any possible underlying causes which may be responsible for their symptoms.
What Type of Healthcare Professional Can Help Treat Sciatica?
According to Dr. Tyndall, any healthcare professional qualified and experienced in spine health issues, such as a chiropractor, can help diagnose, treat and even prevent sciatica. A doctor of chiropractic, or chiropractor, is a healthcare professional who utilizes spinal adjustments and manual manipulations, among other non-invasive treatment methods, to help correct any spinal misalignments, or subluxations, which may be causing sciatic nerve pain. A chiropractor may also recommend a series of stretches and exercises, as well as lifestyle modifications, to help speed up the patient’s recovery process. Chiropractic care is often the preferred alternative treatment option to help alleviate sciatica without the need for drugs and/or medications or surgery. However, if a patient is experiencing any of the red flag symptoms mentioned above, it may be necessary to visit a spine surgeon in order to discuss the treatment options. Always make sure to consider surgical interventions as a final alternative if your sciatica doesn’t respond to non-surgical treatment methods.
What are the Causes of Sciatica?
“There are many external factors, but among the greatest is your occupation. Someone who operates in a manual labor industry, like construction, has a higher likelihood of developing sciatica since they put more wear and tear on their back. Tiger Woods is an example of this. He acquired sciatica because his career as a golfer placed significant stress on his spine. There is a genetic element as well, as a few young men and women who do not operate in a strenuous job develop sciatica, however, the genetic tie is not clearly defined. Lastly, pregnancy may also result in sciatica. As the infant develops, it can put pressure on the lumbar spine, pelvis, and sciatic nerve. However, delivering the infant is usually enough to eliminate sciatica caused by pregnancy,” says Dr. Tyndall.
How Often is Sciatica Likely to Re-Occur?
“This question isn’t easy to answer because many factors contribute to whether a person will develop sciatica more than once. Sciatica is likely to re-occur if the spinal disc that led to sciatica the very first time is severely damaged. The more damaged the disk, the more likely it is to re-herniate and lead to sciatica again. Also, if the patient continues to work in a high-physical stress environment, the risk of re-ocurrence increases.
How is Sciatica Diagnosed?
“The physical examination is essential to a sciatica diagnosis. The straight-leg raise test is the traditional diagnostic tool during a physical examination. In this test, a patient be asked to lift up their leg when lying down. If that induces pain down their leg, the patient could have sciatica. Other physical tests healthcare professionals frequently utilize are knee extension tests, where the patient expands their knee to a straight position, like a straight-leg lift. Additionally, healthcare professionals will as patients to walk on their tip toes or on their heel to measure their potency. Other healthcare professionals will also observe how strong they are going down stairs or simply walking. Many doctors can determine a sciatica analysis from a physical examination, but if imaging studies are needed to learn more, the physician may recommend a magnetic resonance imaging (MRI) scan.
What Treatments are Effective for Sciatica?
As mentioned before by Dr. Dwight Tyndall, there is a variety of treatment options available to help alleviate the symptoms of sciatica. Approximately 80 percent of patients will improve with non-surgical treatment options. Several OTC medications, such as NSAIDs (eg, ibuprofen), are also effective in the management of sciatic nerve pain. If the sciatica does not subside, the doctor may prescribe a low-dose steroid pack (to be obtained over one week). If this doesn’t manage the sciatic nerve pain, then the patient may receive an epidural steroid injection (you will first need an MRI to pin-point the injection region).
Other non-surgical treatment options which are commonly utilized to help alleviate the symptoms of sciatica, include, acupuncture, chiropractic care and physical therapy, and needless to say, time normally works wonders such as pain. Chiropractic care is the most commonly used alternative treatment option for the treatment of sciatica. Chiropractic care focuses on the diagnosis, treatment and prevention of a variety of injuries and/or conditions associated with the musculoskeletal and nervous system. Through spinal adjustments and manual manipulations, a doctor of chiropractic, or chiropractor, can help reduce unnecessary pressure in the structures surrounding the spine, improving strength, mobility and flexibility. Chiropractic care and physical therapy alike, can also help improve a patient’s overall health and wellness, aside from improving their sciatica, through physical activities and nutritional advice.
Is Surgery Ever Necessary to Treat Sciatica?
“It may certainly be so, however, the good thing is that the vast majority of people with sciatica don’t need surgery. And, your doctor may ask you to explore non-surgical treatment options, however, your tolerance for pain is the real predictor as to when you have to consider another option for treatment. Surgery may be necessary if symptoms worsen despite trying non-surgical alternatives, if you have weakness in your leg, or if you experience bladder and/or bowel changes,” explained Dr. Dwight Tyndall.
“The surgical procedure to treat sciatica is also called a lumbar microdiscectomy. It is a normal procedure with very positive individual outcomes when used accordingly. A lumbar microdiscectomy is similar to a traditional lumbar discectomy. Technological advances, like the advent of surgical microscopes, allow surgeons to create smaller incisions that are minimally traumatic to the body and result in a much quicker recovery for the patient”, added Dr. Tyndall.
Can Surgery be Performed in an Outpatient Setting?
“Yes, lumbar microdiscectomy can surely be carried out in an outpatient setting. Many patients like the cozy environment and are able to go home the exact same day of operation,” concluded�Dwight Tyndall, MD, FAAOS.
Is Sciatica Preventable?
As thoroughly explained by Dr. Dwight Tyndall, sciatica can be preventable if the individual doesn’t put significant and repeated stress in their back, which will reduce the chance of damaging or injuring a nerve. Nonetheless, in the present society, through our tasks and daily stresses of modern life, it’s difficult to accomplish that. Fortunately, with the abundance of treatment choices available, people can get relief from sciatic nerve pain with the appropriate healthcare professional’s help.
Dr. Alex Jimenez’s Insight
Many people will experience symptoms of low back pain at least once throughout their lifetime, however, only a few individuals will develop true sciatica symptoms. Sciatica is medically referred to as a collection of symptoms, rather than a single condition, and it’s generally characterized by pain and discomfort, followed by tingling or burning sensations and numbness along the length of the sciatic nerve. The sciatic nerve is the largest nerve in the human body and it travels from the lower back down the buttocks and thighs into the legs and feet. Sciatic nerve pain, or sciatica, has become a common health issue for many people, therefore, its important to be educated regarding this prevalent complaint in order to follow up with the most appropriate treatment.
The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Curated by Dr. Alex Jimenez
Additional Topics: Sciatica
Sciatica is medically referred to as a collection of symptoms, rather than a single injury and/or condition. Symptoms of sciatic nerve pain, or sciatica, can vary in frequency and intensity, however, it is most commonly described as a sudden, sharp (knife-like) or electrical pain that radiates from the low back down the buttocks, hips, thighs and legs into the foot. Other symptoms of sciatica may include, tingling or burning sensations, numbness and weakness along the length of the sciatic nerve. Sciatica most frequently affects individuals between the ages of 30 and 50 years. It may often develop as a result of the degeneration of the spine due to age, however, the compression and irritation of the sciatic nerve caused by a bulging or herniated disc, among other spinal health issues, may also cause sciatic nerve pain.
Autoimmunity is the reaction of cells (lymphocytes) or antibodies�of the immune system along with the body�s own tissues leading to certain pathology. Autoimmunity can produce various conditions, which depend upon the target of the attack.�While intrinsic factors, which include age, sex, and genetics contribute to autoimmunity, it is believed that extrinsic factors such as drugs, chemicals, microbes, and/or the environment can trigger the initiation of autoimmune responses.
Autoimmune Disease & Environmental Toxicants
Educational Objectives
Review air pollution, cigarette smoking, and citrullination as models for the genesis of autoimmune disease
Explore the role of general cell stressors in autoimmune disease
Discuss the impact of lung and gut barrier disruption by environmental toxins and food additives in autoimmune disease
Utilize the Functional Medicine ATM model to illustrate the various mechanisms by which toxicants could contribute to the pathophysiology of autoimmune disease.
�Mild forms of the autoimmune response probably occur naturally in most people. But, for people with a predisposition to autoimmunity, environmental factors, such as toxic chemicals, drugs, bacteria or viruses, may trigger a full?fledged response.�
�NOVEL CRYSTAL BALL: One day Y?shaped molecules called autoantibodies in a patient�s blood may tell doctors whether a patient is �brewing� certain diseases and may even indicate roughly how soon the individual will begin to feel symptoms.�
Autoimmune Disease: �Delayed Gratification�
Scientific American, March, 2007
Many autoimmune diseases do not develop spontaneously, but instead evolve through an extended germination period before they become clinically evident…
Well over 10 million people test positive for ANA, years before they have any symptoms.
This implies the presence of additional environmental factors that dampen or amplify the process over time.
Arbuckle MR, et al, N Engl J Med. 2003 Oct 16;349(16):1526?33.
Elevated Levels Of Antibodies Against Xenobiotics In A Subgroup Of Healthy Subjects
Vojdani, A, Kharrazian, D, Mukherjee, PS
Some environmental chemicals, acting as haptens, can bind to a high? molecular?weight carrier protein such as human serum albumin (HSA), causing the immune system to misidentify self?tissue as an invader and launch an immune response against it, leading to autoimmunity
The levels of specific antibodies against 12 different chemicals bound to HSA were measured by ELISA in serum from 400 blood donors.
10% (IgG) and 17% (IgM) of tested individuals showed significant antibody elevation against aflatoxin?HSA adduct.
The percentage of elevation against the other 11 chemicals ranged from 8% to 22% (IgG) and 13% to 18% (IgM).
Detection of antibodies against various protein adducts may indicate chronic exposure to these chemical haptens in about 20% of the tested individuals
J Appl Toxicol. 2015 Apr; 35(4): 383�397.
Could Environmental Toxins Be A Key Missing Link That Pushes The Immune System Over The Brink To Permanently Lose Control Of Its Tolerance To Self?Antigens?
(A Corollary Question: Does The Persistent Presence Of Autoantibodies Or Autoreactive T Cells Imply An Inevitable Progression To Full?Blown Autoimmune Disease?)
Rheumatoid Arthritis: Swan neck deformity from chronic synovitis
Anti?Cyclic Citrullinated Peptide Antibody
Current method is 96% specific for RA
Elevated titers detected >10 years before onset of clinical disease
Sensitivity (likelihood of positive test) increases from 50% at Dx to >75% over course of disease
Likely involved in pathogenesis
Citrullinated Ags are highly expressed in inflamed joints
Citrulline is formed by posttranslational modification of arginine residues by peptidyl arginine deiminases (PADs)
PADs are upregulated by inflammation, injury, and toxicants
Inflammation and injury thus increases citrullination of multiple synovial proteins
Multiple HLA?DR variants (shared epitope) associated with RA preferentially display citrullinated Ags on MHCII � activating citrulline?specific autoreactive T cells
Smoking increases risk of +anti?CCP when coupled with HLR?DR shared epitope
Floris van Gaalen et al. J Immunol 2005;175:5575-5580
Autoimmunity To Specific Citrullinated Proteins Gives The First Clues To The Etiology Of Rheumatoid Arthritis
Four citrullinated whole protein antigens, fibrinogen, vimentin, collagen type II, and alpha?enolase, are now well established, with others awaiting further characterization All four proteins are expressed in the joint, and there is evidence that antibodies to citrullinated fibrinogen and collagen type II mediate inflammation by the formation of immune complexes Antibodies to citrullinated proteins are associated with HLA ‘shared epitope’ alleles
Porphyromonas gingivalis, pathogenic bacteria that is a major cause of periodontal disease, expresses endogenous citrullinated proteins
Thus, both smoking and Porphyromonas gingivalis are attractive etiological agents for further investigation into the gene/environment/autoimmunity triad of RA.
Wegner N, Lundberg K, Kinloch A, et al, Immunol Rev. 2010 Jan;233(1):34?54
�More than 20,000 physicians, after Luckies had been furnished them for tests, basing their opinions on their smoking experience, stated that Luckies are less irritating than other cigarettes.�
Mad Men?
Holy Smokes!!
Cigarette Smoking Has Been Strongly Linked To Numerous Autoimmune Diseases
Cigarette Smoking & Autoimmune Disease: What Can We Learn From Epidemiology?
Rheumatoid arthritis and cigarette smoking:
Risk is highest in men: OR up to 4.4 X
Smoking increases risk of seropositive RA 2.4X in women
Smoking intensity and duration both greatly increase risk
Smoking increases severity of symptoms
Increased risk remains for 20 yrs after cessation
�Cigarette smoking is the most conclusively established environmental risk factor for RA�
Smoking & Air Pollution As Pro?Inflammatory Triggers For The Development Of Rheumatoid Arthritis.
Smoking initiates chronic inflammatory events in the lungs.
These, in turn, promote the release of the enzymes, peptidylarginine deiminases 2 and 4 from smoke?activated, resident and infiltrating pulmonary phagocytes.
Peptidylarginine deiminases mediate conversion of various endogenous proteins to putative citrullinated autoantigens.
In genetically susceptible individuals, these autoantigens trigger the production of autoantibodies to anti?citrullinated peptide, an event which precedes the development of RA.
Anderson R, Meyer PW, Ally MM, Tikly M, Nicotine Tob Res. 2016 Jul;18(7):1556?65
Floris van Gaalen et al. J Immunol 2005;175:5575-5580
Cigarette Smoking & Autoimmune Disease: What Can We Learn From Epidemiology?
Systemic lupus erythematosis
Highest risk in current smokers
Current smokers have higher levels of anti?dsDNA Ab
Multiple sclerosis
Increased risk of MS in both current & past smokers
Risk increases with intensity of smoking (more cigarettes per day)
Increased severity of MS in current smokers
Cirtrullination of myelin?basic protein ?? antigenic
Graves� hyperthyroidism
Smoking is esp. strong risk factor for opthalmopathy
Industrial Air Emissions & Proximity To Major Industrial Emitters, Are Associated With Anti?Citrullinated Protein Antibodies.
Randomly sampled 1586 subjects out of 20,000 population from Quebec, Canada
After adjusting for age, sex, smoking, and ethnicity, found
Positive association between anti?CCPA and annual industrial PM 2.5 and sulfur dioxide emissions (i.e. living closer to emitters increases anti?CCPA)
Negative association between anti?CCPA and to a major industrial emitter of both PM 2.5 and SO2 (living further away from emitters decreases anti?CCPA)
�These analyses suggest that exposure to industrial emissions of air pollutants is related to ACCPA positivity.�
Bernatsky S, Smargiassi A, Joseph L, et al, Environ Res. 2017 Aug;157:60?63
Air Pollution As A Determinant of Rheumatoid Arthritis
The induction by air pollution of an inflammatory environment with high citrullination levels in the lung may induce iBALT formation, thereby causing a transition toward a more specific immune response via the production of anti?citrullinated peptide antibodies.
Air pollution not only triggers innate immune responses at the molecular level, increasing the levels of proinflammatory cytokines and reactive oxygen species, but is also involved in adaptive immune responses.
Thus, via the aryl hydrocarbon receptor (AHR), diesel exhaust particles can trigger a T?cell switch to the Th17 profile.
Sigaux J, et al Joint Bone Spine. 2018 Mar 7. pii: S1297?319X(18)30043?5
The Aryl Hydrocarbon Receptor Links TH17?Cell? Mediated Autoimmunity To Environmental Toxins
The aryl hydrocarbon receptor (AhR) is a ligand?dependent transcription factor that mediates a range of critical cellular events in response to halogenated aromatic hydrocarbons and non?halogenated polycyclic aromatic hydrocarbons such as dioxin (TCDD)
In a murine model of multiple sclerosis, which is mediated by Th17 cells, activation of cells using the AhR exacerbated disease, whereas mice deficient in the AhR had attenuated autoimmune disease.
This paper thus links activation of Th17 cells with environmental toxins, suggesting a plausible hypothesis for the increase in such diseases with industrialization.
Veldhoen, M., Hirota, K., Westendorf, A.M, et al Nature. 2008 May 1;453(7191):106?9
J Inflamm (Lond). 2015; 12: 48.
Does Rheumatoid Arthritis (& Other Autoimmune Diseases) Start In The Gut, Or In The Lungs?
Gomez?Mejiba SE, Zhai Z, Akram H, et al. Inhalation of Environmental Stressors & Chronic Inflammation: Autoimmunity and Neurodegeneration.
Mutation research. 2009;674(1?2):62?72.
Citrullination & Autoimmunity
Environmental exposure to cigarette smoke and nanomaterials of air pollution may be able to induce citrullination in lung cells prior to any detectable onset of inflammatory responses, suggesting that protein citrullination could be considered as a sign of early cellular damage
Citrullination has been reported to be a process present in a wide range of inflammatory tissues. Indeed, citrullinated proteins have been detected also in other inflammatory arthritides and in inflammatory conditions other than arthritides (multiple sclerosis, polymyositis, inflammatory bowel disease and chronic tonsillitis)
Histone hypercitrullination can activate neutrophil extracellular traps (NETS)� high inflammatory
These data support the hypothesis that rather than being a disease?dependent process, citrullination is an inflammatory?dependent condition that plays a central role in autoimmune diseases.
Valesini G, Shoenfeld Y, et al Autoimmun Rev. 2015 Jun;14(6):490?7 Wang S,
Wang Y.Biochim Biophys Acta. 2013 Oct;1829(10):1126?35
Air Pollution In Autoimmune Rheumatic Diseases: A Review
Environmental factors contribute to the onset of autoimmune diseases, especially smoking and occupational exposure to silica dust in rheumatoid arthritis and systemic lupus erythematosus
Scleroderma may be triggered by the inhalation of chemical solvents, herbicides and silica dust.
Primary vasculitis associated with anti?neutrophil cytoplasmic antibody (ANCA) may be triggered by silica exposure
Air pollution is one of the environmental factors involved in systemic inflammation and autoimmunity
Farhat SC, et al, Autoimmun Rev. 2011 Nov;11(1):14?21
Silica, Silicosis & Autoimmunity
Exposure to respirable crystalline silica (<10 ?m in size) occurs most often in occupational settings � the �dusty� trades
Epidemiological studies link occupational exposure to crystalline silica dust with systemic lupus erythematosus, systemic sclerosis, and rheumatoid arthritis
Findings from human and animal model studies are consistent with an autoimmune pathogenesis that begins with activation of the innate immune system leading to proinflammatory cytokine production (NLRP3 inflammasome), pulmonary inflammation leading to activation of adaptive immunity, breaking of tolerance, and autoantibodies and tissue damage
Pollard KM, Front Immunol. 2016; 7: 97.
Asbestos = Magnesium Silicate
Assessment Of Autoimmune Responses Associated With Asbestos Exposure In Libby, Montana, USA
The population in Libby, Montana, provides a unique opportunity for study because of both occupational and environmental exposures that have occurred as a result of the mining of asbestos?contaminated vermiculite near the community
Libby serum samples showed significantly higher frequency of positive ANA and ENA tests, increased mean fluorescence intensity and titers of the ANAs, and higher serum IgA, compared with Missoula serum samples
The results support the hypothesis that asbestos exposure is associated with autoimmune responses and suggests that a relationship exists between those responses and asbestos?related disease processes.
Pfau JC, et al Environ Health Perspect, 2005, Vol 113: 25-30
Air Pollution, Oxidative Stress & Exacerbation Of Autoimmune Diseases
Particulate matter present in air pollution can induce oxidative stress and cell death, both by apoptosis and necrosis of human cells leading to aggravation of chronic inflammation, i.e. the tissue damaging reaction observed in autoimmune diseases.
Therefore, identification of strong inducers of oxidative stress among components of PM seems to be crucial for their neutralization and elimination from the ambient environment.
It seems likely that PM 2.5 may exacerbate the onset of the SLE because they were attributed to a significant increase of the level of anti?dsDNA antibodies, and the presence of the renal casts in SLE patients
Exposure to ozone, sulphates, and other pollutants present in the air has been associated with type 1 diabetes in children
MS occurrence and hospitalization was associated with exposure to air pollutants such as PM10, SO2, NO2, and NOx
In addition to tobacco smoke and silica, pollution emissions from road traffic may be an environmental factor responsible for exacerbation of RA
Gawda, A, et al, Central European Journal of Immunology 2017; 42(3)
What Do Environmental Pollutants, Toxins, Infections & Unhealthy Diets Have In Common?
Increase inflammation and additional free radical production,
Which damages tissues (bystander effect), disrupts barriers, and/or modifies DNA…
Creating �foreign?like� tissues that break immune tolerance (eg anti?nuclear antibodies)
Cell Stressors
Macario, A. J.L. et al. N Engl J Med 2005;353:1489-1501
Damage Associated Molecular Patterns
Molecular structures that activate immunologic receptors
Released with cellular injury and/or necrosis after exposure to cellular stressors
DNA fragments
Mitochondria
Misfolded proteins
Advanced glycation end products have similar biological effects
Initiate and perpetuate inflammatory response (esp NLRP3 inflammasome)
Ojcius D, Sai?d?Sadier N. Alarmins, inflammasomes and immunity. Biomedical Journal. 2012;35(6):437.
Vakrakou AG, Boiu S, Ziakas PD, et al, Systemic activation of NLRP3 inflammasome in patients with severe primary Sjo?gren’s syndrome fueled by inflammagenic DNA accumulations.
J Autoimmun. 2018 Mar 15. pii: S0896?8411(17)30789?8.
Environmental Xenobiotic Exposure & Autoimmunity
We argue that localized tissue damage and chronic inflammation elicited by xenobiotic exposure leads to the release of self?antigens and damage?associated molecular patterns …
As well as the appearance of ectopic lymphoid structures and secondary lymphoid hypertrophy,
Which provide a milieu for the production of auto-reactive B and T cells that contribute to the development and persistence of autoimmunity in predisposed individuals.
Pollard KM, Christy JM, Cauvi DM, Kono DH, Current Opinion in Toxicology, Volume 10, August 2018, Pages 15?22
The Functional Medicine Paradigm (Slightly Modified)
Immune disruption = increased susceptibility to triggers
Overload in hepatic detoxification pathways
Effect on triggers:
Synergistic action (immunotoxicant)
Adjuvant: chemical modification of self?antigen to make it appear foreign or immunogenic (neoantigens)
Enhanced apoptosis: danger/damage signals (DAMPs)
Effect on mediators:
Amplified inflammatory pathways
Increased oxidative stress
Disruption of pro?resolution counter?regulatory mechanisms
Functional Toxicology
Changes In Intestinal Tight Junction Permeability Associated With Industrial Food Additives Explain The Rising Incidence Of Autoimmune Disease
The incidence of autoimmune diseases and food additive consumption are both increasing in parallel
Dysfunction of intestinal tight junctions is common in multiple autoimmune diseases
Commonly used industrial food additives including glucose, salt, solvents, emulsifiers, gluten, microbial transglutaminase, and nanoparticles increase intestinal tight junction leakage.
Intestinal entry of foreign antigen activates the autoimmune cascade
Lerner A, Matthias T. Autoimmunity Reviews 14 (2015) 479�489
Autoimmunity Reviews 14 (2015) 479�489
Autoimmune Disease: �Two?Hit� Signal Theory
Barrier disruption allows immune system to be repeatedly exposed to a combination of an autoantigen & an �adjuvant� [Adjuvants can be toxicants, microbes, foods]
This triggers a genetically predisposed immune system to react to the autoantigen as a non?self �stranger�
�Danger� signals released at the site of clearance of dead cells amplify the process; shaping the features & severity of the resulting autoimmune disease
Persistent �Stranger + Danger� = loss of tolerance
Based on this model, strategies aimed at preventing the accumulation of dying cells lowering the adjuvant (toxic) load may be beneficial for the prevention & treatment of autoimmune disease
Anaya JM, Ramirez?Santana C, Alzate MA, Molano?Gonzalez N, Rojas?Villarraga A, The Autoimmune Ecology., Front Immunol. 2016 Apr 26;7:139
Oxidatively Modified Autoantigens In Autoimmune Diseases
Oxidative modification of proteins has been shown to elicit antibodies in a variety of diseases, including SLE, diabetes mellitus & RA.
Oxidatively modified DNA & LDL occur in SLE, a disease in which premature atherosclerosis is a serious problem. AGE pentosidine & AGE?modified IgG have been shown to correlate with RA disease activity.
In the face of overwhelming evidence for the involvement of oxidative damage in autoimmunity, the administration of antioxidants is a viable untried alternative for preventing or ameliorating autoimmune disease…�
Kurien BT, Hensley K, Bachmann M, Scofield RH., Free Rad Biol & Med, 2006, Vol 41: 549-556
Oxidative Stress In The Pathology & Treatment Of Systemic Lupus Erythematosus.
Oxidative stress is increased in SLE, and it contributes to immune system dysregulation, abnormal activation and processing of cell? death signals, autoantibody production and fatal comorbidities.
Oxidative modification of self antigens triggers autoimmunity, and the degree of such modification of serum proteins shows striking correlation with disease activity and organ damage in SLE.
Reactive oxygen intermediates (ROI) mostly originate from mitochondria, and T cells from patients with SLE exhibit mitochondrial dysfunction
In T cells from patients with SLE and animal models of the disease, glutathione, the main intracellular antioxidant, is depleted and serine/threonine?protein kinase mTOR undergoes redox?dependent activation.
In turn, reversal of glutathione depletion by application of its amino acid precursor, N?acetylcysteine, improves disease activity in lupus? prone mice; pilot studies in patients with SLE have yielded positive results that warrant further research.
Antioxidant therapy might also be useful in ameliorating damage caused by other treatments.
Oxidative stress (OS) plays an important role in the pathogenesis of a variety of autoimmune diseases (ADs) and many environmental agents participate in this process.
Environmental agents, including trichloroethylene (TCE), silica, pristane (TMPD in mineral oil), mercury, and smoke, are known to induce an autoimmune response, potentially through OS?mediated mechanisms.
Antioxidants can attenuate SLE disease activity by down regulating NLRP3 inflammasome activation and activating Nrf2 signaling.
Khan MF, Wang G. Curr Opin Toxicol. 2018 Feb;7:22?27.
Metals & Minerals Associated With Autoimmune Diseases
Heavy metals
Mercury
Cadmium
Lead
Gold
Minerals & Metalloids
Silica (crystalline silicon dioxide)
Asbestos (chrysotile = magnesium silicate)
Arsenic
Lithium
Iodine
Bigazzi PE., Metals and kidney autoimmunity. Environ Health Perspect. 1999 Oct;107 Suppl 5:753?65
Biologic Markers in Immunotoxicology National Research Council (US) Subcommittee on Immunotoxicology. Washington (DC): National Academies Press (US); 1992.
Anaya JM, et al, The Autoimmune Ecology., Front Immunol. 2016 Apr 26;7:139
Messages To Take Home
Autoimmune and autoinflammatory diseases are steadily increasing in our society
The rise in exposure to environmental pollutants and other toxins is increasing the total body burden of xenobiotics
A central theme in the development of autoimmune diseases is the loss of immune tolerance
Immune tolerance can be broken by disruption of barriers (skin, lung, gut, brain) and/or immune dysregulation
Numerous xenobiotics have been shown to disrupt healthy barriers and dysregulate immune responses
Xenobiotics may play a central role in the initiation and perpetuation of autoimmune disease
Explosion Of Autoimmune Diseases: The Mosaic Of Old & Novel Factors
Modern life and exposures to novel chemical and xenobiotic compounds may lead to the development of new complexes of symptoms that do not necessarily belong to one of the well?known autoimmune diseases
As physicians and scientists, we must continue to study novel pathogenic mechanisms and susceptible alleles to help us identify new therapeutic venues.
Agmon?Levin N, Lian Z, Shoenfeld Y. Cell Mol Immunol. 2011 May; 8(3): 189�192.
IFM Annual International Conference Hollywood, Florida May, 2018
Robert Rountree, MD
Robert Rountree, MD is a speaker, consultant, and advisory board member for Thorne and Balchem. He is also a clinical trial board member for Thorne Research.
Active release therapy, more specifically referred to as the active release technique, is a patented system designed by Dr. P. Michael Leahy which focuses on the treatment of developed scar tissue in damaged muscles all across the human body. When Dr. Leahy first developed the technique about two decades ago, he realized that the damage in the complex soft tissues of the muscles might perhaps be able to be sensed as well as addressed directly through movement in the form of specialized techniques. With its proven ability to cure pain, its own acronym, ART, provides the active release therapy with some ironical link to being a true art form in chiropractic care.
When athletes overwork their muscles from playing sports or even through just everyday activities, many individuals don’t understand how scar tissue can develop on our muscles in the first place. The scar issue forms in order to help heal damaged muscles, however, it can ultimately create painful symptoms which may last long after these have healed. Scar tissue most commonly develops as a result of pulled muscles or muscle tears, or even from a lack of oxygen, called hypoxia.
As the scar tissue builds in the damaged or injured muscles, if the individual does not maintain a proper level of mobility in the affected area, it can progressively cause muscles to become stiff or tight and weak, eventually leading to health issues such as tendonitis or nerve problems. This explains why some people with pain or limited range of motion, often will need to visit a healthcare professional immediately. Fortunately, many doctors are certified to treat these type of problems using active release therapy.
Using the Active Release Technique to Relieve Pain
Together with providing tension to the targeted sore muscle and utilizing specific body motions, the painful symptoms associated with scar tissue improves through active release therapy. As of now, there are approximately 500 different active release techniques designed to alleviate the tightness or stiffness and weakness in all of the body’s soft tissues, from the muscles to the nerves. Many of these movements are particularly chosen for each individual based on the specific muscle issue and location.
Active release techniques can also be helpful for small traumatic injuries caused by accumulative trauma or repetitive strain. More specifically, ART functions to break up fibrous tissues called adhesions. These adhesions result from a tear onto a tendon, ligament or muscle. Adhesions commonly develop in different ways, including from trauma as a result of acute injury or from repetitive motion injury caused by overuse, most commonly from sports injuries. It may also be a result of poor posture which has been aggravated by continuous pressure in addition to tension produced in the soft tissues for extended amounts of time.
Such adhesions, when left untreated, can also limit blood flow as well as shorten muscles, causing the well-known symptoms. Worsened symptoms can also result in pain, discomfort or weakness and at times numbness, most notably when scar tissue applies pressure on the nerves. When adhesions occur, the patient will surely complain of distress much more due to the simple fact that they will not be able to engage in the physical activities they were used to performing in before.
The active release technique, or ART,� works by implementing a couple of movements and motions on the affected muscle, tendon or fascia. In comparison to other soft tissue therapies, it’s said to achieve better end results. Primarily, ART aims to help improve the symptoms of the damaged or injured area by applying pressure and force on it. From there, the individual will be tasked to perform a technique which will help release the tension from the treatment. This can essentially improve motion for the treated region.
The combination of this tension out of the active release technique and that of the movement of muscles and its soft tissues will loosen and break up the adhesions. Because of this, there’ll be lesser pain felt on the injured region. This technique works well with active strengthening in addition to biomechanics training. The combination of these therapies will make patients feel improved body awareness, strength, flexibility and mobility even after a few ART sessions.
How Different is ART from Traditional Soft Tissue Treatments?
When compared with traditional manners of soft tissue therapy, ART boasts of a very comprehensive strategy. The active release technique is performed by certified healthcare practitioners who’ve underwent a very rigorous training procedure. Healthcare professionals must participate in sit-in classes and they must also have hands-on testing. Their certificate doesn’t stop after they pass the 90 percent mark on the hands on test though. They’ll also have to maintain their ART certification by getting annual recertification. This may work by honing the healthcare professional’s abilities and at the exact time, this will boil to the benefit of patients undergoing the therapy.
How Successful is ART as a Treatment?
Current research has demonstrated how effective the procedure is when it comes to treating hamstring pain and dysfunction in addition to hip pain, turf toe and lymph nodes. While the efficacy of ART has been demonstrated along these areas, several studies are still being made to check into its potential for treating disorders for other body components.
Using the Active Release Technique for Sciatica
Sciatica is an issue which affects a large number of people. It is essentially a pain syndrome, characterized by a collection of common symptoms which are caused when the sciatic nerve, the largest and most important nerve supplying the lower spine and the lower extremities, is compressed by the small muscles in the pelvis. The piriformis muscle is the one most implicated in the compression of the sciatic nerve, particularly because it moves through this muscle when emerging from the pelvis and entering the lower limbs. The active release technique, or ART, may be used in the treatment of sciatica brought on by piriformis syndrome.
Pathophysiology of Sciatica
When sciatica is caused by the compression of the sciatic nerve by the piriformis muscle, the latter generally goes into a spasm for an extended period of time, leading to the compression of this fundamental nerve. The spasm may result in a compromise in the blood supply to the muscle itself as well as the nerve, which will further complicate the issue. Nerve communications are important in order for the human body to maintain its outmost efficiency. Sciatica often can also be caused by disc injuries and herniations, as generally is a differential diagnosis to piriformis syndrome. Specific orthopedic tests can help, doctors of chiropractic, or chiropractors, evaluate the source of the patient’s sciatica prior to commencing any type treatment.
Consequences of Sciatic Nerve Pain
There are a number of effects that could arise as a result of sciatica. Reduction in overall body ranges of movement can be anticipated, accompanied by searing or sharp pain that can be excruciating. This can make it very difficult for an individual’s quality of life, especially when carrying out daily tasks like going to school and work, might become impossible due to the seriousness of the health issue. When the issue isn’t treated on time, it might cause permanent damage to the sciatic nerve.
Conventional Treatments for Sciatic Nerve Pain
There are a range of conventional treatments that may be utilized based on the intensity of the sciatic nerve pain, or sciatica. One of these is an injection of a drug/medication that can relax the muscle so that it stops compressing the nerve. Additionally, it has been proven that drugs and/or medications, such as steroids, may also have an impact on reducing the pain and impairment related to the symptoms. When the pharmacological methods don’t result in any progress, surgical ones can be attempted. The most usual of these is a surgery to release the nerve from the muscle by cutting away a portion of it. Although these have been listed as conventional treatments which may be used to treat sciatica, alternative treatment options and secondary opinions should be considered before considering surgical interventions. Only when no other treatment has demonstrated any improvements, should surgery be considered by a patient.
The Role of Active Release Techniques for Sciatica
The active release technique, or ART, is a form of therapy that focuses on the manipulation of soft tissues, including nerves, fascia and muscles, so as to achieve relief of painful symptoms, in this case for sciatica. For sciatic nerve pain, ART is utilized to reduce spasm and remove adhesions of the muscle that may be entrapping the sciatic nerve. Since the adhesions are removed through specific manual methods, the nerve can slide under the soft tissues, and sciatica symptoms can solve relatively quickly. There are a range of things that a patient can do in order to increase the efficacy of the active release technique. Early start to treatment assists in long-term resolution of sciatica symptoms.
Dr. Alex Jimenez’s Insight
The active release technique, also known as active release therapy or ART, is a soft tissue treatment based on a series of movement and motion techniques utilized to relieve pain and discomfort as well as promote the healing of muscles, joints and nerves, among other soft tissues. When performed by a certified healthcare professional, including a chiropractor, ART can help break down adhesions which may have developed following scar tissue formation after a damaged or injured muscle has healed. The active release technique has become one of the most common therapy for soft tissue treatment.
ART therapy is usually provided by skilled therapists like chiropractors, who have to keep their accreditation through continuing education on a yearly suface. This treatment is a specialized procedure that needs quite a bit of expertise and skill so as to work and supply rapid results. The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Curated by Dr. Alex Jimenez
Additional Topics: Sciatica
Sciatica is medically referred to as a collection of symptoms, rather than a single injury and/or condition. Symptoms of sciatic nerve pain, or sciatica, can vary in frequency and intensity, however, it is most commonly described as a sudden, sharp (knife-like) or electrical pain that radiates from the low back down the buttocks, hips, thighs and legs into the foot. Other symptoms of sciatica may include, tingling or burning sensations, numbness and weakness along the length of the sciatic nerve. Sciatica most frequently affects individuals between the ages of 30 and 50 years. It may often develop as a result of the degeneration of the spine due to age, however, the compression and irritation of the sciatic nerve caused by a bulging or herniated disc, among other spinal health issues, may also cause sciatic nerve pain.
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Nat Rev Rheumatol. 2017 Jun;13(6):348-358.
Paolo Riccio, and Rocco Rossano ASN Neuro
BMJ. 2014; 349: g4490.
Reduce Fatigue
The composition of gut microbiota is influenced by multiple factors, such as diet and host genotype. Within the gut, ecological processes such as selection and evolution take place. The use of antibiotics reduces the numbers and diversity of gut microbiota.
Arbuckle MR, et al, N Engl J Med. 2003 Oct 16;349(16):1526?33.
Floris van Gaalen et al. J Immunol 2005;175:5575-5580
J Inflamm (Lond). 2015; 12: 48.
Gomez?Mejiba SE, Zhai Z, Akram H, et al. Inhalation of Environmental Stressors & Chronic Inflammation: Autoimmunity and Neurodegeneration.
Macario, A. J.L. et al. N Engl J Med 2005;353:1489-1501
Autoimmunity Reviews 14 (2015) 479�489
Anaya JM, Ramirez?Santana C, Alzate MA, Molano?Gonzalez N, Rojas?Villarraga A, The Autoimmune Ecology., Front Immunol. 2016 Apr 26;7:139
Bannerjee, B.D., Toxicology Letters, 1999, Vol 107: 21-31
Garza, A, Drug?Induced Autoimmune Diseases. Pharmacy Times 1?20?16
Anaya JM, et al, The Autoimmune Ecology., Front Immunol. 2016 Apr 26;7:139
IFM Annual International Conference Hollywood, Florida May, 2018
