Back problems and discomfort symptoms are a common ailment that many types of healthcare providers diagnose and treat it. Can knowing a little about what each back pain specialist does and what they have to offer help in choosing a provider?
Back Pain Specialists
Nowadays individuals have options for treating back pain. Primary healthcare providers, general practitioners, pediatricians, and emergency room workers are usually the first to examine the injury or problem. If they are unable to properly diagnose or treat the injury, they will refer the individual to a specialist. Specialists include:
Osteopaths
Chiropractors
Orthopedists
Rheumatologists
Neurologists
Neurosurgeons.
They specialize in chronic conditions and diseases like arthritis or problems like herniated discs. Complementary and alternative providers treat individuals solely or with help from a care team. They look at the whole body and focus on improving overall function.
Family and General Practitioners
When neck or back pain begins a regular doctor that’s usually a family or general practitioner/GP or primary care provider PCP is a recommended place to start. They will:
Order diagnostic tests.
Recommend exercises and stretches.
Prescribe medication.
Refer the patient to a physical therapist or other back pain specialist.
However, studies suggest general providers can be uninformed and slow to adopt new back treatments. (Paul B. Bishop, Peter C. Wing. 2006) It is recommended to research possible treatment options, ask a lot of questions during an appointment, and ask or request a referral to a specialist.
Pediatricians
Pediatricians diagnose and treat children. They cover a wide range of issues including back problems and injuries. As with a general practitioner or primary care provider, a child’s pediatrician is the place to start. Depending on the child’s needs, they’ll refer them to the proper specialist.
Emergency Healthcare Providers
When there is serious neck or back trauma, individuals need to go to the emergency room. Trauma can include automobile collisions, sports accidents, work accidents, and/or personal home accidents. Someone with a possible spinal injury should not be moved. (W Yisheng, et al., 2007) Go to the ER if there is back pain with loss of bowel or bladder control, or the legs become progressively weaker. These are symptoms of an emergency condition known as cauda equina syndrome. (American Association of Neurological Surgeons. 2023)
Orthopedists
Orthopedists and orthopedic surgeons treat the musculoskeletal system, which includes:
Muscles
Bones
Joints
Connective tissues
Cartilage
Common orthopedic issues include:
Repetitive stress injuries
Sports injuries
Bursitis
Tendonitis
Ruptured discs
Nerve impingement
Scoliosis
Osteoporosis
Osteoarthritis
Orthopedics can overlap with other specialties. As orthopedists and rheumatologists both treat arthritis and orthopedic surgeons and neurosurgeons do some of the same procedures that include spinal fusions and discectomies.
Rheumatologists
A rheumatologist treats autoimmune, inflammatory, and musculoskeletal conditions that can include different types of arthritis, lupus, and Sjogren’s syndrome. A primary care provider may refer a patient to a rheumatologist if they have symptoms that include:
Sacroiliitis – inflammation of the sacroiliac joint at the base of the spine.
Axial spondylosis – a form of spinal arthritis.
Axial spondylosis – spinal arthritis that causes the bones to fuse together.
Rheumatologists can also treat spinal stenosis or advanced osteoarthritis as they overlap with orthopedists.
Neurologists
A neurologist specializes in the function of the nervous system. They treat disorders of the brain, spinal cord, and nerves that include:
Parkinson’s disease
Multiple sclerosis
Alzheimer’s disease
Chronic back or neck pain
They are experts in the origins of pain. (David Borsook. 2012) However, a neurologist does not perform spine surgery.
Neurosurgeons
A neurosurgeon specializes in nervous system surgical procedures that include the brain, spine, and spinal cord. However, neurosurgeons do not provide overall treatment for back pain because they are usually the last to be seen after exhausting all other treatment options.
Osteopaths
An osteopath is a licensed physician who practices medicine using conventional treatments and osteopathic manipulative medicine. They have the same education as an MD plus 500 hours of musculoskeletal system studies. (National Library of Medicine. 2022) They take the same exams and are licensed as an MD. Many osteopaths are primary care providers. For back pain, they will focus on:
Posture rehabilitation and training.
Stretching
Therapeutic massage
Spinal manipulation
The goal is to relieve pain and muscle tension, increase mobility, and improve musculoskeletal function.
Physiatrists
Physiatrists are holistic providers that focus on physical function. They can be thought of as a primary care provider plus a physical therapist. These back pain specialists provide rehabilitation for various types of conditions and injuries including:
Back pain
Sports injuries
Stroke
Often they will coordinate a team of specialists to develop a targeted treatment plan.
Chiropractor
Chiropractic is a hands-on alternative medicine. The goal is to restore neuromusculoskeletal function by realigning the spine to its proper form. They do this with spinal manipulations, non-surgical mechanical decompression, traction, and massage techniques. (Michael Schneider, et al., 2016)
The purpose of most chiropractic adjustments is to relax and retrain tight muscles and increase flexibility.
Chiropractic helps to relieve stiff muscles and restore range of motion.
Individuals may not be referred to a chiropractor if they:
Have loose-joints
Have connective tissue problems or conditions.
Have osteoporosis/thinning bones
All types of back pain specialists provide various forms of therapy that may be able to help.
Spinal Decompression in Depth
References
Bishop, P. B., & Wing, P. C. (2006). Knowledge transfer in family physicians managing patients with acute low back pain: a prospective randomized control trial. The spine journal : official journal of the North American Spine Society, 6(3), 282–288. doi.org/10.1016/j.spinee.2005.10.008
Yisheng, W., Fuying, Z., Limin, W., Junwei, L., Guofu, P., & Weidong, W. (2007). First aid and treatment for cervical spinal cord injury with fracture and dislocation. Indian journal of orthopaedics, 41(4), 300–304. doi.org/10.4103/0019-5413.36991
Schneider, M., Murphy, D., & Hartvigsen, J. (2016). Spine Care as a Framework for the Chiropractic Identity. Journal of chiropractic humanities, 23(1), 14–21. doi.org/10.1016/j.echu.2016.09.004
Individuals that experience nerve pain in the foot could be caused by a number of different conditions, can recognizing the most common causes help in developing an effective treatment plan?
Nerve Pain In The Foot
These sensations can feel like a burning, shooting, electrical, or stabbing pain and can happen while in motion or at rest. It can occur on the top of the foot or through the arch. The area closest to the nerve may be sensitive to the touch. A number of different conditions can cause nerve pain in the foot, including:
Morton’s neuroma
Pinched nerve
Tarsal tunnel syndrome
Diabetic peripheral neuropathy
Herniated disc
Morton’s Neuroma
Morton’s neuroma involves the nerve that runs between the third and fourth toes, but can sometimes occur between the second and third toes becoming thicker. Typical symptoms include a burning or shooting pain in the area, usually while walking. (Nikolaos Gougoulias, et al., 2019) Another common symptom is the sensation of pressure beneath the toes like the sock is bunched up underneath. Treatments can include:
Arch supports
Cortisone injections to decrease swelling
Footwear modifications – can include lifts, orthotics combined with metatarsal pads, and rocker soles, to provide cushion where needed.
Things that increase the risk of developing the condition include:
Regularly wearing high-heels – the condition occurs more frequently in women.
Shoes that are too tight.
Participating in high-impact sports like running.
Having flat feet, high arches, bunions, or hammertoes.
Pinched Nerve
A pinched nerve can feel like shooting or burning pain. Nerve entrapment can occur in various regions of the foot or the area on top of the foot may feel sensitive. Causes can be caused by: (Basavaraj Chari, Eugene McNally. 2018)
Trauma that causes swelling.
Blunt impact.
Tight shoes.
Treatment can include:
Massage
Physical therapy
Rest
Footwear modifications
Anti-inflammatories.
Things that increase the risk of developing a pinched nerve in the foot include:
Poor-fitting footwear.
Repetitive stress injury.
Trauma to the foot.
Obesity.
Rheumatoid arthritis.
Tarsal Tunnel Syndrome
Another type of nerve entrapment is tarsal tunnel syndrome. Tarsal tunnel syndrome is “anything that produces compression on the posterior tibial nerve.” (American College of Foot and Ankle Surgeons. 2019) The tibial nerve is located near the heel. Symptoms include numbness and foot cramps, burning, tingling, or shooting sensations that often radiate from the instep/arch. Both can worsen while the foot is at rest, like when sitting or sleeping. Treatment can consist of:
Placing padding in the shoe where the foot is being compressed to relieve the pain.
Custom foot orthotics.
Cortisone shots or other anti-inflammatory treatments.
Surgery may be necessary to release the nerve.
Conditions that compress the tibial nerve and can lead to tarsal tunnel syndrome include:
Flat feet
Fallen arches
Ankle sprain
Diabetes
Arthritis
Varicose veins
Bone spurs
Diabetic Peripheral Neuropathy
Long-term high blood sugar/glucose associated with diabetes can lead to a form of nerve damage known as peripheral neuropathy. (Centers for Disease Control and Prevention. 2022) Neuropathy pain feels like burning or shooting pain, or the sensation of walking on bubble wrap that usually shows up overnight. The pain can come and go as well as a gradual loss of feeling in the feet that begins in the toes and moves up the foot. It’s estimated that around half of individuals with diabetes will eventually develop neuropathy. (Eva L. Feldman, et al., 2019) Treatments can include:
Physical therapy massage to increase circulation.
Topical treatments with capsaicin.
Vitamin B.
Blood sugar management.
Alpha lipoic acid.
Medication.
Individuals with diabetes have an increased risk of developing peripheral neuropathy if:
Blood sugar is not well-controlled.
Diabetes has been present for many years.
Kidney disease.
Smoke.
Overweight or obese.
Herniated Disc
Nerve pain in the foot can be caused by spinal issues. A herniated disc in the lower back can irritate and compress the nerves, causing pain that radiates down the leg and foot. Additional symptoms usually include muscle weakness in the legs and/or numbness and tingling. Most herniated discs don’t require surgery and get better with conservative treatment. (Wai Weng Yoon, Jonathan Koch. 2021) If symptoms don’t improve or worsen, a healthcare provider may recommend surgery. Herniated discs are most common in young and middle-aged adults. Increased chances of developing a herniated disc can come from:
Degenerative changes in the spine from normal age wear and tear.
Physically demanding job.
Lifting incorrectly.
Overweight or obese.
Genetic predisposition – family history of herniated discs.
Spinal Stenosis
Spinal stenosis occurs when the spaces in the spine begin to narrow, creating pressure on the spinal cord and nerve roots. It is usually caused by wear and tear on the spine as the body ages. Stenosis in the lower back can cause burning pain in the buttocks and leg. As it progresses pain can radiate into the feet along with numbness and tingling. Conservative treatment consists of physical therapy exercises and non-steroidal anti-inflammatory medications/NSAIDs. (Jon Lurie, Christy Tomkins-Lane. 2016) Cortisone injections can be beneficial and if the condition worsens, surgery may be an option. Risk factors include:
Physical trauma – after surgery or an automobile or sports accident.
Certain cancer, antiviral medications, or antibiotics.
Complex regional pain syndrome.
Tumors that irritate and/or compress a nerve.
Liver or kidney disease.
Infectious diseases – Lyme disease complications or viral infections.
Nerve pain in the foot is definitely a reason to see a healthcare provider. Early diagnosis can help prevent symptom progression and future problems. Once the cause of the pain has been identified, the healthcare team can work together to develop a personalized treatment plan to release compressed nerves and restore mobility and function. See a healthcare provider right away if the pain and symptoms worsen, or if there are difficulties standing or walking.
Chiropractic After Accidents and Injuries
References
Gougoulias, N., Lampridis, V., & Sakellariou, A. (2019). Morton’s interdigital neuroma: instructional review. EFORT open reviews, 4(1), 14–24. doi.org/10.1302/2058-5241.4.180025
Chari, B., & McNally, E. (2018). Nerve Entrapment in Ankle and Foot: Ultrasound Imaging. Seminars in musculoskeletal radiology, 22(3), 354–363. doi.org/10.1055/s-0038-1648252
Feldman, E. L., Callaghan, B. C., Pop-Busui, R., Zochodne, D. W., Wright, D. E., Bennett, D. L., Bril, V., Russell, J. W., & Viswanathan, V. (2019). Diabetic neuropathy. Nature reviews. Disease primers, 5(1), 42. doi.org/10.1038/s41572-019-0097-9
Yoon, W. W., & Koch, J. (2021). Herniated discs: when is surgery necessary?. EFORT open reviews, 6(6), 526–530. doi.org/10.1302/2058-5241.6.210020
Lurie, J., & Tomkins-Lane, C. (2016). Management of lumbar spinal stenosis. BMJ (Clinical research ed.), 352, h6234. doi.org/10.1136/bmj.h6234
Staff, N. P., & Windebank, A. J. (2014). Peripheral neuropathy due to vitamin deficiency, toxins, and medications. Continuum (Minneapolis, Minn.), 20(5 Peripheral Nervous System Disorders), 1293–1306. doi.org/10.1212/01.CON.0000455880.06675.5a
Nowadays, individuals trying to avoid surgery have more therapy options. Can regenerative medicine help treat neuromusculoskeletal injuries?
Regenerative Medicine
Regenerative medicine utilizes the body’s raw cells and is used in cancer treatment and to reduce the risk of infections. (American Cancer Society. 2020) Researchers are looking for other ways to use these cells in medical therapies.
What are These Cells
Stem cells are unspecialized cells that can develop into any cell and in certain cases renew themselves an unlimited number of times. (National Institutes of Health. 2016)
Regenerative cell therapy uses these cells as a treatment for a disease or condition.
Regenerative cells are given to individuals to replace cells that have been destroyed or have died.
In the case of cancer, they may be used to help the body regain the ability to produce regenerative cells after treatment. (American Cancer Society. 2020)
For individuals with multiple myeloma and certain types of leukemia, regenerative cell therapy is used to eliminate cancer cells.
The therapy is called graft-versus-tumor effect/GvT, where a donor’s white blood cells/WBCs are used to eliminate the cancerous tumor. (American Cancer Society. 2020)
What They Can Treat
This is a new treatment that is still going through research. The Food and Drug Administration has only approved it for certain cancers and conditions that affect the blood and immune system. (Centers for Disease Control and Prevention. 2019) Regenerative cell therapy is FDA-approved to treat: (National Cancer Institute. 2015)
Leukemia
Lymphoma
Multiple myeloma
Neuroblastoma
It is also used to decrease the risk of infection after regenerative cell transplantation in individuals with blood cancers. (U.S. Food & Drug Administration. 2023)
Researchers are studying how these cells can treat other conditions. Clinical trials are analyzing how to use the therapy for neurodegenerative diseases like:
During regenerative cell therapy, the cells are given through an intravenous line. The three places where blood-forming cells can be obtained are bone marrow, the umbilical cord, and blood. Transplants can include: (American Cancer Society. 2020)
Autologous
The cells are taken from the individual who will be receiving the therapy.
Allogeneic
The cells are donated by another individual.
Syngeneic
The cells come from an identical twin, if there is one.
Safety
The therapy has shown to provide benefits but there are risks.
One risk is known as graft-versus-host disease – GVHD.
It occurs in one-third to half of allogeneic recipients.
This is where the body does not recognize the donor’s white blood cells and attacks them causing problems and symptoms throughout the body.
To treat GVHD medications are given to suppress the immune system to stop attacking the donor cells. (American Cancer Society. 2020)
The future of regenerative cell therapy is promising. Research is ongoing to find out how these cells can treat conditions and find new ways to treat and cure diseases.
Regenerative medicine has been researched for over twenty years for conditions like macular degeneration, glaucoma, stroke, and Alzheimer’s disease. (National Institutes of Health. 2022) This therapy is a new medical treatment that could be used in future therapies as part of a multidisciplinary approach to neuromusculoskeletal injuries and conditions.
For individuals with a broken collarbone, can conservative treatment help in the rehabilitation process?
Broken Collarbone
Broken collarbones are very common orthopedic injuries that can occur in any age group. Also known as the clavicle, it is the bone over the top of the chest, between the breastbone/sternum and the shoulder blade/scapula. The clavicle can be easily seen because only skin covers a large part of the bone. Clavicle fractures are extremely common, and account for 2% – 5% of all fractures. (Radiopaedia. 2023) Broken collarbones occur in:
Babies – usually during birth.
Children and adolescents – because the clavicle does not fully develop until the late teens.
Athletes – because of the risks of being hit or falling.
Through various types of accidents and falls.
The majority of broken collarbones can be treated with nonsurgical treatments, usually, with a sling to let the bone heal and physical therapy and rehabilitation.
Sometimes, when clavicle fractures are significantly shifted out of alignment, surgical treatment may be recommended.
There are treatment options that should be discussed with an orthopedic surgeon, physical therapist, and/or a chiropractor.
A broken collarbone is not more serious than other broken bones.
Once the broken bone heals, most individuals have a full range of motion and can return to the activities before the fracture. (Johns Hopkins Medicine. 2023)
Types
Broken clavicle injuries are separated into three types depending on the location of the fracture. (Radiopaedia. 2023)
Mid-Shaft Clavicle Fractures
These occur in the central area which can be a simple crack, separation, and/or fractured into many pieces.
Multiple breaks – segmental fractures.
Significant displacement – separation.
Shortened length of the bone.
Distal Clavicle Fractures
These happen close to the end of the collarbone at the shoulder joint.
This part of the shoulder is called the acromioclavicular/AC joint.
Distal clavicle fractures can have similar treatment options as an AC joint injury.
Medial Clavicle Fractures
These are less common and often related to injury to the sternoclavicular joint.
The sternoclavicular joint supports the shoulder and is the only joint that connects the arm to the body.
Growth plate fractures of the clavicle can be seen into the late teens and early 20s.
The bruising can extend down to the chest and armpit.
Numbness and tingling down the arm.
Deformity of the collarbone.
In addition to swelling, some individuals may have a bump in the place where the fracture occurred.
It can take several months for this bump to fully heal, but this is normal.
If the bump appears inflamed or irritated, inform a healthcare provider.
Clavicular Swelling
When the sternoclavicular joint swells up or gets bigger, it is referred to as clavicular swelling.
It is commonly caused by trauma, disease, or an infection that affects the fluid found in the joints. (John Edwin, et al., 2018)
Diagnosis
At the healthcare clinic or emergency room, an X-ray will be obtained to assess for the specific type of fracture.
They will perform an examination to ensure the nerves and blood vessels surrounding the broken collarbone are unsevered.
The nerves and vessels are rarely injured, but in severe cases, these injuries can occur.
Treatment
Treatment is accomplished either by allowing the bone to heal or by surgical procedures to restore the proper alignment. Some common treatments for broken bones are not used for clavicle fractures.
For example, casting a broken collarbone is not done.
In addition, resetting the bone or a closed reduction is not done because there is no way to hold the broken bone in proper alignment without surgery.
If surgery is an option the healthcare provider looks at the following factors: (UpToDate. 2023)
Location of Fracture and Degree of Displacement
Nondisplaced or minimally displaced fractures are usually managed without surgery.
Age
Younger individuals have an increased ability to recover from fractures without surgery.
Shortening of the Fracture Fragment
Displaced fractures can heal, but when there is a pronounced shortening of the collarbone, surgery is probably necessary.
Other Injuries
Individuals with head injuries or multiple fractures can be treated without surgery.
Patient Expectations
When the injury involves an athlete, heavy job occupation, or the arm is the dominant extremity, there can be more reason for surgery.
Dominant Arm
When fractures occur in the dominant arm, the effects are more likely to be noticeable.
The majority of these fractures can be managed without surgery, but there are situations where surgery can produce better results.
Supports for Non-surgical Treatment
A sling or figure-8 clavicle brace.
The figure-8 brace has not been shown to affect fracture alignment, and many individuals generally find a sling more comfortable. (UpToDate. 2023)
Broken collarbones should heal within 6–12 weeks in adults
3–6 weeks in children
Younger patients are usually back to full activities before 12 weeks.
The pain usually subsides within a few weeks. (UpToDate. 2023)
Immobilization is rarely needed beyond a few weeks, and with a doctor’s clearance light activity and gentle motion rehabilitation usually begins.
Edwin, J., Ahmed, S., Verma, S., Tytherleigh-Strong, G., Karuppaiah, K., & Sinha, J. (2018). Swellings of the sternoclavicular joint: review of traumatic and non-traumatic pathologies. EFORT open reviews, 3(8), 471–484. doi.org/10.1302/2058-5241.3.170078
For individuals with aches and pains throughout their body, can a foot detox help bring relief?
Foot Detox
A foot detox involves soaking the feet in an ionic bath to help remove toxins from the body. They can also be performed using acupressure, scrubs, foot masks, and pads. Combined with eliminating toxins, detox is also believed to help enhance blood circulation and provide body pain and discomfort relief. However, current evidence is limited and there has been no evidence to support that toxins can be released from the feet using an ionic bath. However, they have been found to provide other benefits, which include:
Relaxation
Lower stress levels
Enhanced skin health and hydration.
Reduced inflammation in individuals with skin disorders.
Foot detoxes are considered generally safe, but individuals are recommended to speak to their healthcare provider.
Potential Benefits
The potential health benefits include:
Reduces inflammation and swelling.
Improves stress levels and mood.
Can help with weight management.
Can help with heart health and increased blood circulation.
However, most reports surrounding the benefits of foot detox are not proven by research investigating whether the health claims are scientifically accurate. One study in 2012 found that foot detoxes did not produce the intended results and could not help remove toxins from the body. (Deborah A. Kennedy, et al., 2012) Other research surrounding foot baths and massages showed that they could help reduce symptoms of mood disorders like schizophrenia because of the relaxing effect they produce. (Kazuko Kito, Keiko Suzuki. 2016)
Ways Toxins are Removed From the Body
Toxins are filtered out of the body in a variety of ways. Breathing out expels carbon dioxide from the body. Another way is through the body’s natural processes. The body has organs and other systems to filter out and release toxins.
Specific organs, such as the liver, kidneys, and lymph nodes, filter and remove harmful and unneeded substances. (UW Integrative Health. 2021)
The health claims surrounding toxin removal through the feet are currently insubstantial because no evidence supports the effectiveness and the anecdotal evidence is not based on science.
Foot detoxes can be an enjoyable experience that can help relieve sore feet, relax the body, and offer relief for certain foot ailments. They could be an excellent addition to a self-care routine. Some of the most commonly used natural foot detoxes include the following.
Epsom Salt Foot Bath
Combining Epsom salts with warm water and soaking the feet for 20–30 minutes can help promote relaxation.
Apple cider vinegar foot baths are made by diluting 1 cup of vinegar in warm water and soaking the feet for 20–30 minutes.
There is limited research available to confirm the health claims.
The studies that have been done have found the reverse effect, that bathing the feet in apple cider vinegar and water can irritate the skin. (Lydia A Luu, et al., 2021)
Baking Soda and Sea Salt
Sea salt combined with baking soda dissolved in a bath and soak the feet for up to 30 minutes. While research is limited, some evidence supports the health benefits associated with sea salt that include: (Ehrhardt Proksch, et al., 2005)
Reduces inflammation in skin conditions, like atopic dermatitis.
Foot baths should be avoided for the following:
There are open sores on the feet that could be irritated by salt and other foot bath ingredients.
Individuals with a pacemaker or any electrical body implant.
Pregnant women.
Consult a healthcare provider before trying any new health protocols.
Foot Orthotics Benefits
References
Kennedy, D. A., Cooley, K., Einarson, T. R., & Seely, D. (2012). Objective assessment of an ionic footbath (IonCleanse): testing its ability to remove potentially toxic elements from the body. Journal of environmental and public health, 2012, 258968. doi.org/10.1155/2012/258968
Kito, K., & Suzuki, K. (2016). Research on the Effect of the Foot Bath and Foot Massage on Residual Schizophrenia Patients. Archives of psychiatric nursing, 30(3), 375–381. doi.org/10.1016/j.apnu.2016.01.002
UW Integrative Health. Improving your health by removing toxins from your body.
Akyuz Ozdemir, F., & Can, G. (2021). The effect of warm salt water foot bath on the management of chemotherapy-induced fatigue. European journal of oncology nursing: the official journal of European Oncology Nursing Society, 52, 101954. doi.org/10.1016/j.ejon.2021.101954
Vakilinia, S. R., Vaghasloo, M. A., Aliasl, F., Mohammadbeigi, A., Bitarafan, B., Etripoor, G., & Asghari, M. (2020). Evaluation of the efficacy of warm salt water foot-bath on patients with painful diabetic peripheral neuropathy: A randomized clinical trial. Complementary therapies in medicine, 49, 102325. doi.org/10.1016/j.ctim.2020.102325
Luu, L. A., Flowers, R. H., Gao, Y., Wu, M., Gasperino, S., Kellams, A. L., Preston, D. C., Zlotoff, B. J., Wisniewski, J. A., & Zeichner, S. L. (2021). Apple cider vinegar soaks do not alter the skin bacterial microbiome in atopic dermatitis. PloS one, 16(6), e0252272. doi.org/10.1371/journal.pone.0252272
Proksch, E., Nissen, H. P., Bremgartner, M., & Urquhart, C. (2005). Bathing in a magnesium-rich Dead Sea salt solution improves skin barrier function, enhances skin hydration, and reduces inflammation in atopic dry skin. International journal of dermatology, 44(2), 151–157. doi.org/10.1111/j.1365-4632.2005.02079.x
Kanwar A. J. (2018). Skin barrier function. The Indian Journal of Medical Research, 147(1), 117–118. doi.org/10.4103/0971-5916.232013
For individuals with stomach issues, can maintaining gut flora balance promote and improve gut health?
Gut Flora Balance
Maintaining gut flora balance is part of optimal digestive health. Gut microbiota, gut microbiome, or gut flora, are the microorganisms, including bacteria, archaea, fungi, and viruses that live in the digestive tract. The type and amount of bacteria present depend on their location in the body which could be the small intestine and colon. This is the storage housing for waste/stool, and the colon comprises hundreds of different types of bacteria, which have specific jobs and functions.
Unhealthy Flora
The more common pathogens are bacteria that can cause illness if left unchecked, including germs like streptococcus/strep throat or E. coli/urinary tract infections and diarrhea. Other common germs found in the colon include: (Elizabeth Thursby, Nathalie Juge. 2017)
Clostridioides Difficile
C. diff overgrowth can cause watery foul-smelling stools daily, and abdominal pain and tenderness.
Enterococcus Faecalis
Enterococcus faecalis is a cause of post-surgical abdominal and urinary tract infections.
Escherichia Coli
E. coli is the most common cause of diarrhea in adults.
This bacteria is present in almost every healthy adult’s colon.
Klebsiella
Klebsiella overgrowth is associated with a Western diet that consists of various meat and animal products.
Bacteroides
Bacteroide overgrowth is associated with colitis, which causes painful inflammation of the colon.
Healthy Flora
Healthy bacteria like Bifidobacteria and Lactobacillus, help maintain gut flora balance and keep the unhealthy bacteria in check. Without healthy flora, the entire colon can become overrun by bad flora, which can result in symptoms like diarrhea and/or illness. (Yu-Jie Zhang, et al., 2015) These protective, microscopic germs have important functions that include:
Assisting with vitamin synthesis – vitamins B and K in the small intestine.
Increases immune system function.
Maintaining regular bowel movements.
Maintaining a clean colon naturally without the need for colon cleansers.
Destroying the unhealthy bacteria.
Preventing unhealthy bacteria overgrowth.
Breaking up gas bubbles from food fermentation.
Bacterial Dismantling
Whether labeled as healthy bacteria or unhealthy, they are both single-celled organisms that can be destroyed quite easily. Sometimes, it is necessary, like when having to take antibiotics to kill a strep throat infection. However, the antibiotics also kill the beneficial bacteria, which can lead to compounding problems that can include: (Mi Young Yoon, Sang Sun Yoon. 2018)
Bowel irregularity – diarrhea and constipation.
Yeast overgrowth – can cause itching, burning around the anus and lead to vaginal and oral yeast infections.
Dysbiosis – the technical name for a lack of healthy bacteria or a bacterial imbalance.
Complications for individuals suffering from irritable bowel syndrome.
There are different ways to destroy bacteria including.
Prolonged diarrhea – can flush out the bad and good bacteria.
Stress
Completing a bowel prep, like those required for a colonoscopy.
Diagnosing Gut Flora Issues
Many times, problems with gut flora will correct themselves, and no action is required. However, individuals facing chronic bowel problems, like colitis or inflammatory bowel disease, may require medical intervention of their colon’s bacteria.
Comprehensive Digestive Stool Analysis/CDSA is a stool test that checks what type and amount of bacteria are present, nutrient absorption rates/digestion speed, and how well food is digested.
If there is a significant difference in the proportion of unhealthy versus beneficial bacteria, a healthcare provider may suggest taking a probiotic or a live microbial supplement to help repopulate and maintain gut flora balance.
Gut Dysfunction
References
Thursby, E., & Juge, N. (2017). Introduction to the human gut microbiota. The Biochemical journal, 474(11), 1823–1836. doi.org/10.1042/BCJ20160510
Zhang, Y. J., Li, S., Gan, R. Y., Zhou, T., Xu, D. P., & Li, H. B. (2015). Impacts of gut bacteria on human health and diseases. International journal of molecular sciences, 16(4), 7493–7519. doi.org/10.3390/ijms16047493
Yoon, M. Y., & Yoon, S. S. (2018). Disruption of the Gut Ecosystem by Antibiotics. Yonsei medical journal, 59(1), 4–12. doi.org/10.3349/ymj.2018.59.1.4
Quigley E. M. (2013). Gut bacteria in health and disease. Gastroenterology & hepatology, 9(9), 560–569.
Tennis requires strength, power, and endurance. Can combining tennis weight training into a player’s fitness regimen that is broken up into phases achieve optimal results?
Tennis Weight Training
In professional sports that utilize weight lifting, the training is often broken up into seasonal phases. (Daniel S Lorenz, Michael P Reiman, John C Walker. 2010) Each phase consists of specific objectives that contribute to and build upon the previous phase. This is known as periodization. Tennis is played year-round indoors and outdoors. This is an example of a tennis weight training program to build up strength.
Pre-Season
In the early pre-season, players prepare to rebuild their strength after a break.
The emphasis is on building functional strength and some muscle.
Late Pre-Season
In late pre-season, players workout to get ready for the start of the season.
Here, the emphasis is on building maximum power.
In Season
In season, regular practice, play, and competition get underway and players are in top condition.
In this phase, strength and power maintenance is the focus.
Season Break
This is when players need to relax for a while.
However, players need to keep active if they want to maintain some level of fitness.
The emphasis is on rest and recovery with the maintenance of light activity, like cross-training and light gym workouts.
Research has shown that taking a break from serious strength training does help the body recover and rebuild. (Daniel Lorenz, Scot Morrison. 2015)
This is a three-phase all-around program.
The first phase concentrates on building basic strength and muscle
The second phase on power delivery.
Players who play year-round can continue with the power program once they build the basics.
Players who take a break for longer than six weeks should start again with the strength program.
Pre-Season – Phase One
Strength and Muscle
The focus is on lifting heavy weights, but not going full force to begin training the nervous system to work with the muscle fibers.
Some muscle building or hypertrophy/building muscle size will happen during strength development.
Strength is the foundation for the power development phase.
Exercises:
Duration: 6-8 weeks
Workout Days: 2-3, with at least one day, however, two are recommended between sessions.
Reps: 8-10
Sets: 2-4
Rest between sets: 1-2 minutes
Barbell squat, dumbbell squat, or sled hack squat
Romanian deadlift
Dumbbell bent-over row
Dumbbell triceps extension or machine pushdown
Cable wood chop
Lat pulldown to the front with a wide grip
Reverse crunch
Things to Remember
Use the Proper Weight
Adjust the weight so that the last reps are heavy but don’t cause a complete failure.
Balance the Lower Half
The posterior chain of the hips, the gluteals/buttocks, the upper legs, and the abdominals are of equal importance and require equal attention. (Eline Md De Ridder, et al., 2013)
Squats and deadlifts build strength and power in this region.
Follow Proper Form
For upper body exercises like the dumbbell press, lat pulldown, and wood chops the proper form needs to be followed.
Keep the forearms in a vertical plane with the upper arms.
Do not extend excessively at the bottom of the movement.
Remember to protect the vulnerable shoulder joint.
Listen to The Body
Strength training is physically and mentally challenging.
Individuals who are not able to recover from a session with only one rest day are recommended to move the program to two sessions per week.
Muscle soreness or delayed onset muscle soreness – DOMS – is normal, however, joint pain is not.
Monitor arm and shoulder reactions during this phase.
Stop if any joint pain or discomfort is felt.
Late Pre-Season – In-Season – Phase Two
Power
Power is the ability to move the heaviest loads in the shortest time and is the combination of strength and speed. In this phase, the player builds on the strength developed in phase one with tennis weight training that will increase the ability to move a load at high velocity.
Power training requires lifting weights at high velocity and with explosiveness.
The body needs to rest adequately between repetitions and sets so that each movement is done as fast as possible.
The number of sets can be less than phase one because there is no point in training at this level when the body is fatigued.
Exercises
Duration: Ongoing
Days per week: 2
Reps: 8 to 10
Sets: 2-4
Rest between repetitions: 10 to 15 seconds
Rest between sets: at least 1 minute or until recovered
Barbell or dumbbell hang clean
Cable push-pull
Cable wood chop
One arm cable raises
Medicine ball push press
Medicine ball standing twist with a partner or alone – 6×15 repetitions fast and recover between sets.
Reminders When Preparing For the Season
Recovery Time
In power training, it’s important that the body has relatively recovered for each repetition and set so that the individual can maximize the movement.
The weights should not be as heavy and the rest periods sufficient.
Push When Possible
Rest is important, at the same time, the player needs to push through reasonably heavy loads to develop power against significant resistance.
When doing medicine ball twists, do a full set at maximum, then sufficiently rest before the next one.
If doing the medicine ball exercises alone, use a lighter ball and keep the ball in your hands while twisting.
In Season – Phase Three
When the season begins training does not stop in order to help maintain strength and power.
Strength and Power Maintenance
Alternate phase one and phase two for a total of two sessions each week.
Every fifth week, skip weight training to achieve optimal recovery.
Key Points
Things to keep in mind during the season.
Avoid Overscheduling
Avoid strength training on the same day when practicing on the court.
If the weight training has to be both on the same day, try to separate the workouts into morning and afternoon sessions.
Plan Time
Rest completely from strength training one week out of every six.
Light gym work is fine.
During the season, use intuition when it comes to working out at the gym.
Individuals with limited time, stick to court skills training instead of tennis weight training.
Off Season
If there is an off-season, this is the time for emotional and physical decompression and full-body recovery.
For several weeks, forget about weight training and do other things.
Stay fit and active with cross-training or other physical activities but keep it light to prevent injuries.
It is recommended to consult a coach, trainer, sports chiropractor, and/or physical therapist to develop a program specific to an individual’s needs, fitness goals, and access to resources.
Spine Injuries In Sports
References
Lorenz, D. S., Reiman, M. P., & Walker, J. C. (2010). Periodization: current review and suggested implementation for athletic rehabilitation. Sports health, 2(6), 509–518. doi.org/10.1177/1941738110375910
Lorenz, D., & Morrison, S. (2015). CURRENT CONCEPTS IN PERIODIZATION OF STRENGTH AND CONDITIONING FOR THE SPORTS PHYSICAL THERAPIST. International journal of sports physical therapy, 10(6), 734–747.
De Ridder, E. M., Van Oosterwijck, J. O., Vleeming, A., Vanderstraeten, G. G., & Danneels, L. A. (2013). Posterior muscle chain activity during various extension exercises: an observational study. BMC musculoskeletal disorders, 14, 204. doi.org/10.1186/1471-2474-14-204
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