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Complex Regional Pain Syndrome Explained and Treated

Complex Regional Pain Syndrome Explained and Treated

Individuals dealing with chronic pain following a minor injury, surgery, or trauma could be experiencing complex regional pain syndrome. What are the symptoms, diagnosis, and treatments available?

Complex Regional Pain Syndrome Explained and Treated

Complex Regional Pain Syndrome

Reflex sympathetic dystrophy syndrome (RSDS), more commonly known as complex regional pain syndrome (CRPS), is a chronic pain condition where a person experiences severe, persistent pain in a limb, usually following an injury, that is significantly more profound than from the initial trauma. It is considered a neuroinflammatory disorder in which the body’s response to injury is dysregulated. The condition is characterized by severe burning pain, often in an arm or leg, that can occur following a minor injury, surgery, or trauma. It is associated with abnormal changes in skin temperature, swelling, and sensitivity to touch, usually affecting the affected area’s nerves, skin, muscles, blood vessels, and bones. Other names it is known by include:

  • Causalgia
  • Shoulder-Hand Syndrome
  • Sudeck’s Atrophy

Causes

CRPS is a chronic pain condition believed to result from dysfunction in the central or peripheral nervous systems (National Institute of Neurological Disorders and Stroke, 2017). It involves irritation and abnormal excitation of nervous tissue, leading to abnormal impulses along nerves that affect blood vessels and skin. Animal studies indicate that norepinephrine, a catecholamine released from sympathetic nerves, acquires the ability to activate pain pathways after tissue or nerve injury, resulting in CRPS. Another theory is that CRPS, which follows an injury, is caused by triggering an immune response and continuous inflammation symptoms (swelling, redness, warmth). (Goh E. L., Chidambaram S., & Ma, D. 2017) It is believed to have multiple causes producing similar symptoms.

Triggers

There can be numerous triggers, including:

Symptoms

CRPS usually affects one of the extremities (arm, leg, hand, or foot). The primary symptom is intense, continuous pain. (National Institute of Neurological Disorders and Stroke, 2017) Other symptoms can include

  • Burning pain
  • Swelling
  • Increased skin sensitivity
  • Extreme sensitivity to touch, often causing significant disability in the affected limb.
  • Stiffness and swelling in affected joints
  • Skin color changes – blotchy, purple, pale, red.
  • Skin temperature changes – warmer or cooler than the opposing extremity.
  • Skin texture changes – shiny, thin, sweaty.
  • Changes in nail and hair growth patterns.
  • Pain can spread, for example, from the finger to the entire arm and the opposite extremity or from the left to the right arm.
  • Emotional stress can cause symptoms to worsen.

Some experts suggest three stages during which progressive changes occur in the affected area’s skin, muscles, joints, ligaments, and bones (Harvard Health Publishing, 2023). However, further research is needed.

Stages

Stage One

  • Lasts 1 to 3 months
  • Severe, burning pain
  • Muscle spasm
  • Joint stiffness
  • Rapid hair growth
  • Skin color and temperature changes (Stanford Medicine, 2025)

Stage Two

  • Lasts from 3 to 6 months
  • Pain becomes more intense
  • Swelling
  • Decreased hair growth
  • Nails are cracked, brittle, grooved, spotty
  • Softened bones
  • Stiff joints
  • Weak muscle tone

Stage Three

  • Pain is continuous
  • Muscle atrophy
  • Severely limited mobility
  • Irreversible changes to skin and bone
  • Contractions of muscles and tendons – limbs may be twisted

Diagnosis

  • A patient’s clinical history – signs and symptoms are the major factor in diagnosis.
  • The diagnosis is difficult because many symptoms overlap with other conditions. (Goh E. L., Chidambaram S., & Ma, D. 2017)
  • There is no specific blood test or other diagnostic tests.
  • X-rays may show osteoporosis, and nuclear bone scans may show characteristic uptake patterns that help diagnose.

Treatments

Treatment focuses on relieving painful symptoms and can include: (Goh E. L., Chidambaram S., & Ma, D. 2017)

  • Physical therapy and exercise
  • Psychotherapy to alleviate stress, anxiety, and depression
  • Sympathetic nerve blocks
  • Surgery
  • Spinal cord stimulation
  • Intrathecal drug pumps

Medications

These can include:

  • Topical analgesics
  • Anti-seizure drugs
  • Antidepressants
  • Corticosteroids
  • Opioids

It is estimated that there are 50,000 new cases every year in the United States. (Tajerian M., & Clark J. D. 2016)

Injury Medical Chiropractic & Functional Medicine Clinic

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.


The Root Causes of Pain


References

National Institute of Neurological Disorders and Stroke. (2017). Complex regional pain syndrome fact sheet. Retrieved from www.ninds.nih.gov/sites/default/files/migrate-documents/CRPS_FactSheet-E_508C.pdf

Goh, E. L., Chidambaram, S., & Ma, D. (2017). Complex regional pain syndrome: a recent update. Burns & Trauma, 5, 2. doi.org/10.1186/s41038-016-0066-4

Bruehl S. (2015). Complex regional pain syndrome. BMJ (Clinical research ed.), 351, h2730. doi.org/10.1136/bmj.h2730

Harvard Health Publishing. (2023). Complex Regional Pain Syndrome (CRPS). www.health.harvard.edu/a_to_z/complex-regional-pain-syndrome-crps-a-to-z

Stanford Medicine. (2025). Complex Regional Pain Syndrome (CRPS). med.stanford.edu/pain/about/chronic-pain/crps.html

Tajerian, M., & Clark, J. D. (2016). New Concepts in Complex Regional Pain Syndrome. Hand Clinics, 32(1), 41–49. doi.org/10.1016/j.hcl.2015.08.003

Nutritional Yeast and Its Nutritional Benefits

Nutritional Yeast and Its Nutritional Benefits

Can incorporating nutritional yeast be an option for individuals seeking a healthy vegan and vegetarian cheese substitute?

Nutritional Yeast and Its Nutritional Benefits

Nutritional Yeast

Nutritional yeast is a deactivated form of Saccharomyces cerevisiae yeast, commonly known as baker’s or brewer’s yeast. It’s popular in vegan and vegetarian cooking for its savory, cheesy flavor and nutritional benefits. Nutritional yeast is harvested, rinsed, and heat-dried to deactivate it, removing its leavening properties. This means it doesn’t cause food to rise but adds flavor and vital nutrients.

Nutrition

Nutritional yeast nutrition information is for 16 grams or around 1.5 tablespoons. (U.S. Department of Agriculture, 2019)

  • Calories – 60
  • Fat – 0.5 grams
  • Sodium – 30 milligrams
  • Carbohydrates – 5 grams
  • Fiber – 3 grams
  • Sugars – 0 grams
  • Protein – 8 grams
  • Thiamin – vitamin B1 – 10 milligrams
  • Riboflavin – vitamin B2 – 10 milligrams
  • Vitamin B6 – 12 milligrams
  • Vitamin B12 – 24 micrograms

Carbohydrates

  • Around 1.5 tablespoons contains 5 grams of carbohydrates, including 3 grams of fiber.
  • Yeast provides an especially beneficial form of soluble fiber known as beta-glucan, with unique health benefits. (Bashir K. M. I., & Choi J. S. 2017)

Fats

  • Most brands are naturally fat-free.

Protein

  • It provides all essential amino acids with 8 grams per 1.5 tablespoons.

Vitamins and Minerals

Most nutritional yeast products are fortified with added B vitamins. Most provide 600% or more B vitamins per 16 grams and 1,000% of the daily value for vitamin B12, depending on the brand. It also has:

  • Calcium
  • Thiamin
  • Iron
  • Potassium

Nutritional Yeast Health Benefits

Health benefits include:

Reduces Risk of Anemia

Iron is typically the first nutrient to come to mind. However, inadequate folate or vitamin B12 also causes anemia. A common treatment for a vitamin B12 deficiency is injections, but large doses consumed can also be effective. (National Institutes of Health, Office of Dietary Supplements, 2024) Individuals who follow a plant-based or vegan diet often have limited sources of vitamin B12. Most brands of nutritional yeast are fortified with B12, providing more than 500% of the daily value per serving. Because B12 is water-soluble, it won’t cause toxicity when consumed in high doses and can serve as a key source of this essential nutrient.

Supports Heart Health

Nutritional yeast contains beta-glucan, a carbohydrate found in the cell walls of plants, bacteria, and fungi. Higher intakes lead to favorable cardiovascular outcomes, including lowering bad cholesterol and increasing good cholesterol. (Bashir K. M. I., & Choi J. S. 2017) In addition, most brands contain potassium, which reduces blood pressure.

Promote Healthy Immune System Function

More research is needed, but several studies have shown how yeast-derived beta-glucan can strengthen the immune system. (Stier H., Ebbeskotte V., & Gruenwald J. 2014) These benefits are attributed to beta glucan’s bacterial fermentation in the intestines. Beta-glucan may also stimulate the activity of crucial immune system cells, like macrophages.

Prevents Constipation

Fiber is essential. The recommended fiber intake is at least 25 to 35 grams daily. Unfortunately, many do not get enough. Nutritional yeast contributes 3 grams of fiber per 16 grams. Fiber regulates bowel movements by pulling water into the colon and adding bulk and softness to stool. (University of Michigan, 2008)
Using nutritional yeast can help reach an adequate fiber intake.

Diabetes Management

Getting enough fiber helps prevent blood sugar fluctuations. Low-fiber diets have been shown to increase the risk of diabetes in various populations. (Harvard T.H. Chan, School of Public Health, 2022) Fiber slows digestion and increases satiety, controlling hunger and the glycemic response. Fiber is beneficial for preventing diabetes and helping those with diabetes maintain good numbers.

Allergies

  • Individuals who suspect a yeast or mold allergy see an allergist for a full evaluation.
  • Yeast overgrowth is another possible condition that is unrelated to yeast allergies.
  • Yeast overgrowth can occur in compromised immune systems or following antibiotic treatment.
  • Because yeast is present in many foods, anyone with a true yeast allergy may have to avoid several food items, including baked goods, fermented alcoholic beverages, marmite/vegemite, sourdough bread, and certain multivitamins. (Cunningham E. 2013)

Adverse Effects

Nutritional yeast is inactive and unlikely to cause negative effects. However, for individuals who suffer from irritable bowel syndrome (IBS) or migraines, yeast may be a trigger. (UMass Medical School Center for Applied Nutrition, 2020)

Varieties

  • Nutritional yeast may be sold as granules, powder, or flakes. (UMass Medical School Center for Applied Nutrition, 2020)
  • Check the label to see if the product is fortified with added vitamins and minerals or has added sodium.
  • Nutritional yeast is a dry food product available year-round in supermarkets or sold in a bulk food bin.

Storage, Safety, and Use

Although nutritional yeast is a dry product, it will stay in the refrigerator longer after it has been opened. Store it in an airtight container, and be mindful of the expiration date on the label.

It can be added to savory dishes such as pasta, roasted meats, vegetables, and salads. Ways to use include:

  • On scrambled eggs.
  • On top of garlic bread.
  • Popcorn seasoning.
  • Add to soups.
  • In pasta dishes, as a substitute for parmesan cheese.
  • An alternative to cheese sauce.

Injury Medical Chiropractic and Functional Medicine Clinic

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop highly effective treatment plans through an integrated approach for each patient and restore health and function to the body through nutrition and wellness, functional medicine, acupuncture, Electroacupuncture, and integrated medicine protocols. We focus on what works for you to relieve pain, restore function, prevent injury, and mitigate issues through adjustments that help the body realign itself. The clinic can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.


Learning About Food Substitutions


References

U.S. Department of Agriculture. FoodData Central. (2019). Nutritional yeast. Retrieved from fdc.nal.usda.gov/food-details/1744022/nutrients

Bashir, K. M. I., & Choi, J. S. (2017). Clinical and Physiological Perspectives of β-Glucans: The Past, Present, and Future. International journal of molecular sciences, 18(9), 1906. doi.org/10.3390/ijms18091906

National Institutes of Health, Office of Dietary Supplements. (2024). Vitamin B12: Fact sheet for health professionals. Retrieved from ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional/

Stier, H., Ebbeskotte, V., & Gruenwald, J. (2014). Immune-modulatory effects of dietary Yeast Beta-1,3/1,6-D-glucan. Nutrition journal, 13, 38. doi.org/10.1186/1475-2891-13-38

University of Michigan. (2008). Bowel function anatomy. medicine.umich.edu/sites/default/files/content/downloads/bowel-function.pdf

Harvard T.H. Chan, School of Public Health. (2022). Fiber. nutritionsource.hsph.harvard.edu/carbohydrates/fiber/

Cunningham E. (2013). Is there a diet for “yeast allergy”? Journal of the Academy of Nutrition and Dietetics, 113(3), 484. doi.org/10.1016/j.jand.2013.01.013

UMass Medical School Center for Applied Nutrition. Chan, U., School, M., & Nutrition, C. F. A. (2020). Nutritional yeast: Nourishing or no-go? UM. www.umassmed.edu/nutrition/blog/blog-posts/2020/2/nutritional-yeast–nourishing-or-no-go/

Available Resources for Developmental Disorders & Learning Disabilities

Available Resources for Developmental Disorders & Learning Disabilities

Explore the connection between developmental disorders and learning disabilities and their impact on education and social skills.

Introduction To Developmental Disorders

When talking about disabilities, whether from health conditions or diseases, many healthcare professionals have to think about two languages crucial to the individual they are assessing. One is person-first language, and the other is identity language. In person-first language, it pertains to how a person places more importance on the individual and their uniqueness. This involves individuals young and old with ADHD or Down syndrome. This is compared to the identity-first language, which often highlights the disorder or disease more than the individual (e.g., autistic child). The goal that many healthcare professionals aim for when treating individuals with disabilities or developmental disorders is to use respectful terminology to reduce social stigma, prejudice, and discrimination.

Many young individuals have their cognitive and social skills evaluated when entering and progressing through school. These evaluations sometimes indicate that a young individual or children might need special assistance with either language or learning to interact with others. Evaluation and diagnosis are the first steps in providing many people with the tools and resources needed to function. However, there are also significant social implications regarding diagnosis and labeling. Many healthcare providers must consider that anyone, young or old, can be misdiagnosed. Once the person receives the diagnosis label, the individual and whoever is in the person’s life have to interpret the person’s actions through that label. For instance, if a child has been misdiagnosed as having a learning disability, it can influence the child’s self-concept. It may be due to difficulties in school that cause children to have trouble at their academic level. This self-fulfilling prophecy causes them to act this way, causing people to predict what will happen come true. Healthcare professionals must pay attention to the power of labels and apply them accurately when assessing patients.

It is also important to consider that people’s difficulties can change over time. An example would be a child who has problems in school that may improve later or grow up to be an adult where these problems are no longer relevant. That person, however, will still have a label for having a learning disability. Even though it is fairly common for children and young individuals to have abnormal behaviors, healthcare providers should recognize that the distinction between abnormal/atypical and normal/typical behavior is not always clear. When evaluating learning disabilities, misdiagnosis may be more of a concern.
When it comes to the diagnosis of developmental disabilities, it is required that a pediatrician, psychologist, psychiatrist, or other accredited professional should assess a child for a developmental disability, as there are many factors to consider. Many common behaviors in children, like temper tantrums, being overly active, being shy, etc., might be misinterpreted as a behavioral disorder like ADHD (attention-deficit/hyperactivity disorder). Therefore, trained professionals use multiple assessments or questionnaires completed by the parent(s) and teacher(s) in conjunction with in-person observations and case history before diagnosing.

 

Autism Spectrum Disorders

As a common developmental disorder, autism spectrum disorder (ASD) can affect various areas of development, such as communication and behavior, in many individuals. The spectrum is wide and varies from person to person. In the United States, it is estimated that about 1 out of every 36 children or individuals has been diagnosed with autism, covering a wide variety of abilities and symptom expression between high and low functioning. ASD is characterized by age-inappropriate, impaired social communication and may have a complex interaction between genetics, epigenetic, and environmental factors associated with cerebral dysfunction. (Mukherjee, 2017) When it comes to social skills and communication, ASD can impact a person’s language skills as it can become difficult. A person within the autism spectrum may respond to a question by repeating the question, may not respond appropriately, or may not communicate in response at all. Some symptoms for an individual within the autism spectrum may be sensitivity to touch, sound, or visual stimulation. Individuals with autism often view the world differently and learn in unique ways while preferring routines and can become upset when routines are altered. For example, moving furniture or changing the daily schedule can be very upsetting.

 

There is no single known cause of autism, though research has indicated a possible genetic link. This could be due to the intricate neurobiological mechanisms that correlate with the immune system and neuroinflammation, causing atypical functional connectivity and neurotransmitter alterations. (Rajabi et al., 2024) Luckily, there are holistic approaches to reducing autism symptoms to help improve a person’s quality of life within the spectrum.

 

Holistic Treatments For Individuals Within The Autism Spectrum

When it comes to holistic treatment approaches for individuals with autism, they can vary for the individual while not affecting their sensory issues. Physical activities and motor skill training can help their mobility and improve movement performance. (Shahane et al., 2024) Additionally, individuals within the autism spectrum could be dealing with abnormal sensitivity and gastrointestinal difficulties that can cause numerous pain-like symptoms in the body. Incorporating and allowing autistic individuals to try out anti-inflammatory foods and prebiotics can help improve the symptoms associated with ASD while reducing the inflammatory effects on their bodies. (Sivamaruthi et al., 2020)

 

What Are Learning Disabilities?

When a person, both young and old, has an intellectual disability or an intellectual development disability, they could have significant impairment in intellectual and adaptive functioning. This, in turn, generally results in an IQ (intelligence quotient) under 70, which is two standards below the median. This causes deficits within two or more adaptive behaviors that affect everyday general living, causing them to learn slowly in all areas of learning. This is known as learning disabilities.

A learning disability (LD) is a specific impairment of academic learning that interferes with a particular aspect of schoolwork and significantly reduces a person’s educational performance. It can be shown as a major discrepancy between a person’s ability and some achievement features, causing them to be delayed in various academic areas. Many people often confuse the difference between a learning problem and a learning disability, as a learning problem stems from physical, sensory, or motor handicaps or generalized intellectual impairment.

 

Dyslexia

Dyslexia, one of the most prevalent learning impairments, is characterized by difficulties with reading; fundamentally, many dyslexics struggle to learn how to decode and spell words and to be fluent via phonological representation. In 2020, Snowling et al. This is due to a number of anatomical alterations in the brain that impair the brain’s capacity to integrate data from various RSNs (resting state networks), hence decreasing its neuroplasticity. (Munzer and others, 2020) Reading experts are used in several therapies to assist address the patient’s troublesome regions.

 

Dysgraphia

One writing impairment that is often linked to dyslexia is dysgraphia. The word is often used to refer to all abnormalities of written language. Phonological dysgraphia and orthographic dysgraphia are the two forms of dysgraphia. When someone has phonological dysgraphia, they are unable to write words using their phonemes. Conversely, those with orthographic dysgraphia are able to spell words that are spelled consistently but not sporadically. When writing with a pen or pencil, some people with dysgraphia may have problems controlling their movements and producing letters.

 

Dyscalculia

A kind of math-related handicap known as dyscalculia is characterized by challenges with learning math-related concepts (including amount, place value, and time), remembering math-related information, and comprehending how problems are structured on paper. This, in turn, leads to a lot of people in school having bad experiences and consistently failing at math assignments, which breeds failure anxiety and lowers self-esteem. In 2019, Haberstroh and Schulte-Korne When working with numbers, this leads to problems with working memory. The smaller and less active parietal lobes may be the cause of this, which would explain the unusual patterns of mathematical cognitive performance. Dowker (2024)

 


Optimizing Your Wellness-Video


Attention-Deficit/Hyperactivity Disorder (ADHD)

A person with attention-deficit/hyperactivity disorder (ADHD) struggles with both cognitive and physical skills. Smaller brain structures may lead to patterns of impulsive, hyperactive, and inattentive behavior, which can alter neurotransmitters and disrupt regular brain function. (The Brain and ADHD, 2017)

The following are some indications of inattention:
Task difficulty and avoidance
Not heeding directions
Organizing poorly
Being easily distracted and not paying enough attention to details
Ignorance.

Excessive movements are a hallmark of hyperactivity in ADHD, including:
Uneasy
Having difficulties staying still
When not acceptable, running and climbing on objects
blurring out answers
Waiting problems
disturbing and encroaching on other people’s space.

Adults or children who are energetic often come across as noisy. They have social and intellectual difficulties as a result of this throughout their lives. Those with ADHD are more likely to get bad grades, perform poorly on standardized tests, be expelled more often, and drop out of school during the academic year than their peers without ADHD.

 

Causes of ADHD

Numerous twin and family studies suggest that heredity is a major factor in the development of ADHD. According to several studies, gender, exposure to environmental variables, and the diagnosis of an ADHD subtype may all function as modifiers of the development of ADHD. (Gizer and others, 2009) The modulation of the neurotransmitter dopamine is believed to be one of the particular genes implicated in ADHD. Brain imaging studies have shown anomalies in the frontal lobes, a part of the brain where dopamine is abundant, in people with ADHD. When undertaking mental activities, those with ADHD will have decreased frontal brain activity since the frontal lobe regulates behavior. Thus, part of the hyperactive, uncontrollable behavior associated with ADHD may be explained by anomalies in this area.

It has been suggested that some environmental elements, such as sugar and artificial coloring, might make people more hyperactive. For this reason, many individuals choose to cut them in order to lessen the symptoms of ADHD. However, a number of research have compared the effects of cigarette smoke exposure on the development of severe ADHD symptoms in the fetus. (Linnet and others, 2003)

 

 

ADHD Treatment

The most popular therapy for ADHD is stimulant medication, while non-surgical therapies and lifestyle modifications may also help lessen symptoms. Although many people believe that using stimulant medicine is contradictory, it may assist persons with ADHD concentrate by activating the undeveloped prefrontal and frontal lobes of the brain. Consequently, this aids in managing the adverse impacts of ADHD.

Cognitive and motor functions may be enhanced by physical exercise and non-pharmaceutical therapies. Jansen & Ziereis (2015) Simultaneously, cognitive behavioral therapy is a popular non-surgical treatment that may assist individuals in being conscious of their thinking patterns and changing them from negative to positive. As part of their treatment approach, many medical experts might combine CBT with medication. It is most advantageous because the drug facilitates behavior change more rapidly, which speeds up the learning process for long-term behavioral changes via cognitive behavioral therapy. People with developmental disorders and learning impairments may have a personalized treatment plan to enhance their quality of life on their path toward health and wellness by implementing minor adjustments and employing a variety of therapy choices.

 


Injury Medical & Functional Medicine Clinic

We associate with certified medical providers who understand the importance of the various effects of developmental disorders and learning disabilities affecting the body. While asking important questions to our associated medical providers, we advise patients to implement small changes to their daily routine to reduce the symptoms affecting their bodies. Dr. Alex Jimenez, D.C., envisions this information as an academic service. Disclaimer.


References

ADHD & The Brain. (2017).  American Academy of Child & Adolescent Psychiatry. www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/ADHD_and_the_Brain-121.aspx

Dowker, A. (2024). Developmental Dyscalculia in Relation to Individual Differences in Mathematical Abilities. Children (Basel), 11(6). doi.org/10.3390/children11060623

Gizer, I. R., Ficks, C., & Waldman, I. D. (2009). Candidate gene studies of ADHD: a meta-analytic review. Hum Genet, 126(1), 51-90. doi.org/10.1007/s00439-009-0694-x

Haberstroh, S., & Schulte-Korne, G. (2019). The Diagnosis and Treatment of Dyscalculia. Dtsch Arztebl Int, 116(7), 107-114. doi.org/10.3238/arztebl.2019.0107

Linnet, K. M., Dalsgaard, S., Obel, C., Wisborg, K., Henriksen, T. B., Rodriguez, A., Kotimaa, A., Moilanen, I., Thomsen, P. H., Olsen, J., & Jarvelin, M. R. (2003). Maternal lifestyle factors in pregnancy risk of attention deficit hyperactivity disorder and associated behaviors: review of the current evidence. Am J Psychiatry, 160(6), 1028-1040. doi.org/10.1176/appi.ajp.160.6.1028

Mukherjee, S. B. (2017). Autism Spectrum Disorders – Diagnosis and Management. Indian J Pediatr, 84(4), 307-314. doi.org/10.1007/s12098-016-2272-2

Munzer, T., Hussain, K., & Soares, N. (2020). Dyslexia: neurobiology, clinical features, evaluation and management. Transl Pediatr, 9(Suppl 1), S36-S45. doi.org/10.21037/tp.2019.09.07

Rajabi, P., Noori, A. S., & Sargolzaei, J. (2024). Autism spectrum disorder and various mechanisms behind it. Pharmacol Biochem Behav, 245, 173887. doi.org/10.1016/j.pbb.2024.173887

Shahane, V., Kilyk, A., & Srinivasan, S. M. (2024). Effects of physical activity and exercise-based interventions in young adults with autism spectrum disorder: A systematic review. Autism, 28(2), 276-300. doi.org/10.1177/13623613231169058

Sivamaruthi, B. S., Suganthy, N., Kesika, P., & Chaiyasut, C. (2020). The Role of Microbiome, Dietary Supplements, and Probiotics in Autism Spectrum Disorder. Int J Environ Res Public Health, 17(8). doi.org/10.3390/ijerph17082647

Snowling, M. J., Hulme, C., & Nation, K. (2020). Defining and understanding dyslexia: past, present and future. Oxf Rev Educ, 46(4), 501-513. doi.org/10.1080/03054985.2020.1765756

Ziereis, S., & Jansen, P. (2015). Effects of physical activity on executive function and motor performance in children with ADHD. Res Dev Disabil, 38, 181-191. doi.org/10.1016/j.ridd.2014.12.005

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Greenstick Fracture in Children: Causes and Care

Greenstick Fracture in Children: Causes and Care

Broken bones are common injuries. Because children’s bones grow rapidly, they have increased flexibility. When injuries, specifically fractures, occur, they do not always break cleanly across the bone or into pieces. What type of fracture is this, and how are they treated?

Greenstick Fracture in Children: Causes and Care

Greenstick Fracture

A greenstick fracture is a partial break in a bone that occurs when a bone bends and cracks instead of breaking into separate pieces. (Wolfe J. A. et al., 2019) The term is based on a young green branch that bends and splinters but does not break into pieces when bent. Only one side of the bone is broken, while the other side gets bent. Many children experience at least one fracture during their growing years. This is one of multiple fracture types seen in children. They can happen in adults but are uncommon.

Causes

Greenstick fractures mostly occur in infants or toddlers, sometimes in children during their early adolescent and pre-adolescent years. They are partial-thickness fractures (a break in a bone that doesn’t completely break it) characterized by a break on one side and a bend on the other. Buckle fractures and bow fractures are different types of partial-thickness fractures. Greenstick fractures commonly occur:

  • In children under 10 years old
  • Occurs when a child reaches out to break a fall
  • During motor vehicle collisions
  • Sports
  • Direct impacts
  • Non-accidental trauma

It is more common in long bones, including:

  • Radius
  • Ulna
  • Humerus
  • Fibula
  • Tibia
  • Clavicle

The fracture pattern often indicates a limb’s bending or contortion.

Symptoms

Greenstick fracture symptoms can include:(Atanelov Z, & Bentley T.P. 2025)

  • Localized swelling
  • Localized bruising
  • Pain
  • Deformity, such as the affected body part looking crooked or out of alignment.

Treatment

If the bone is not significantly bent out of alignment, a splint or cast may be all that is necessary to treat the break. If the bone is visibly out of alignment, it must be manually straightened before the limb is put into a cast. If the break is severe, surgery may be required. Fortunately, a growing skeleton can remodel bone, so fractured bones can often realign themselves over time with minimal intervention. Healing depends on various factors, including:

  • Age of the child
  • The severity of the break
  • Location of the break

The younger the child is, the faster the recovery will be. (Pountos I., Clegg J., & Siddiqui A. 2010)

Sometimes, the fracture must be bent back and repositioned in a fracture reduction procedure. An anesthetic may be used as the doctor manually realigns the bone into the correct position. After the reduction, a cast or splint will stabilize the bone and maintain proper alignment. Depending on how quickly the bone heals, a cast may be necessary for a few weeks, months, or longer, depending on the patient and/or underlying conditions.

Healing

  • Healing involves specialized cells that gradually rebuild and fine-tune the new bone.
  • The average time for a greenstick fracture to heal completely may take four weeks.

Injury Medical Chiropractic & Functional Medicine Clinic

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.


Building a Stronger Body


References

Wolfe, J. A., Wolfe, H., Banaag, A., Tintle, S., & Perez Koehlmoos, T. (2019). Early Pediatric Fractures in a Universally Insured Population within the United States. BMC pediatrics, 19(1), 343. doi.org/10.1186/s12887-019-1725-y

Atanelov, Z., & Bentley, T. P. (2025). Greenstick Fracture. In StatPearls. www.ncbi.nlm.nih.gov/pubmed/30020651

Pountos, I., Clegg, J., & Siddiqui, A. (2010). Diagnosis and treatment of greenstick and torus fractures of the distal radius in children: a prospective randomised single-blind study. Journal of children’s orthopaedics, 4(4), 321–326. doi.org/10.1007/s11832-010-0269-3

Pectoralis Minor and Its Role in Posture Improvement

Pectoralis Minor and Its Role in Posture Improvement

For individuals dealing with posture problems causing neck, back, and shoulder pain, can pectoralis minor stretches designed to work these areas be a part of physical therapy or as regular exercises at home?

Pectoralis Minor and Its Role in Posture Improvement

Pectoralis Minor Muscle Stretches

The pectoralis minor is a small, triangular muscle situated deep to the pectoralis major in the anterior chest wall. It originates from the margins of the third to fifth ribs adjacent to the costochondral junction and connects to the coracoid process of the scapula. The pectoralis minor helps with posture, mobility, and shoulder stability and aids breathing. Muscle tightness can cause pain in the chest, shoulder, and neck and a restricted range of motion. Strain and injuries can occur during activities involving overhead movements or forceful pushing. Pectoralis minor stretches are designed to work these muscles that span the ribs and connect to the shoulder to help improve posture and relieve pain and chest weakness. They can help reduce muscle tightness and other conditions like thoracic outlet syndrome. (Kaur U. et al., 2023) (Wagner E. R. et al., 2023) Talk with a healthcare provider Before starting any exercise or stretching program.

Corner Pectoralis Stretch

A corner pec stretch is similar to a wall push-up, except the emphasis is on staying in a position that lengthens the chest muscles. It’s important to move the whole body as a unit and not bend.

  • Stand facing a corner with a relaxed, upright posture.
  • Place your feet so they are parallel, and bend your knees slightly.
  • Stay as relaxed as possible during the movement to protect your joints.
  • Keep your gaze forward.
  • Place your forearms and palms over the walls where two walls connect at a right angle.
  • With your elbows bent to 90 degrees, move forward into the corner of the wall until you feel a comfortable stretch in the pectorals.
  • Keep the hips straight.
  • Hold the position for up to 30 seconds.
  • Return to starting position.
  • If you need a deeper stretch, move the arm position up or down. (University of North Carolina School of Medicine, 2020)

Doorway Stretch

The doorway stretch is similar to the corner stretch. It works the pectoralis major and the minor muscles and helps with mobility. To perform: (Maryland Pain & Wellness Center, 2025)

  • Stand in a doorway with your feet placed together.
  • Place the palms and forearms on either side of the doorway.
  • Your elbows should be even with your shoulders and bend at a 90-degree angle.
  • Keep your back straight.
  • Take a step forward, leaning into the doorway.
  • You should feel the stretch in the muscle.
  • Repeat the stretch with the other foot.

Exercise and ergonomic changes to your chair or desk height can help improve posture and relieve muscle tightness. (Kaur U. et al., 2023)

T Stretch

The T stretch stretches the front of the chest and is done on the floor, typically with a foam roller placed directly under the spine. To perform: (OrthoCarolina, N.D.)

  • Lie down on your back with the foam roller aligned to the spine.
  • Make sure your head and tailbone are supported.
  • Open your arms straight out like a T.
  • Hold the position while stretching.

Y Stretch

The Y stretch is similar to the T stretch; both reduce chest muscle tightness and discomfort. To perform: (OrthoCarolina, N.D.)

  • Use the same foam roll position, lying on your back with the head and tailbone supported and aligned.
  • Stretch the arms out above your head, placing them into the shape of a Y.
  • Allow the chest muscles that connect to the arms to relax.

Studies have examined how quickly a prone scapular retraction can help stretch the back and shoulders. Results suggest the exercises must be performed longer before the pectoralis minor is lengthened to improve symptoms. (Dye J., Allyn M., & Frank C. 2024) However, further research is needed.

Health Conditions

Pectoralis minor stretches may be part of a personalized therapy program to improve mobility, posture, and/or breathing and sleep quality with health conditions that include:

Stretching and strengthening exercises can help improve their flexibility and function. Exercises can improve strength and function by standing or lying down, depending on the stretch.

Injury Medical Chiropractic and Functional Medicine Clinic

The pectoralis minor muscles are often overlooked in clinical examinations but can contribute to musculoskeletal pain and dysfunction. A healthcare provider can teach about stretches, how they can help, and whether they are safe for the individual’s injury and/or condition. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to build optimal health and wellness solutions. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. The clinic can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.


Doorway Stretching Routine


References

Kaur, U., Shrestha, D., Hussain, M. A., Dalal, P., Kalita, M., Sharma, V., & Sharma, S. (2023). Prompt Impact of Muscle Energy Technique on Pectoralis Muscle Tightness in Computer Users: A Quasi-Experimental Study. Journal of Lifestyle Medicine, 13(2), 123–128. doi.org/10.15280/jlm.2023.13.2.123

Wagner, E. R., Gottschalk, M. B., Ahmed, A. S., Graf, A. R., & Karzon, A. L. (2023). Novel Diagnostic and Treatment Techniques for Neurogenic Thoracic Outlet Syndrome. Techniques in hand & upper extremity surgery, 27(2), 100–114. doi.org/10.1097/BTH.0000000000000419

University of North Carolina School of Medicine. (2020). Upper Body Stretching. www.med.unc.edu/htcenter/wp-content/uploads/sites/711/2020/04/Upper-Body-Stretching.pdf

Maryland Pain & Wellness Center. (2025). Stretches to Help with Strained Chest Muscles. Maryland Pain & Wellness Center Restoring Hope, Rebuilding Lives. www.marylandpainandwellnesscenter.com/blog/stretches-to-help-with-strained-chest muscles#:~:text=With%20your%20knees%20bent%20and,assist%20in%20deepening%20the%20stretch.

OrthoCarolina. (N.D.). Stretching Guide to Ease Tight Muscles. www.orthocarolina.com/storage/wysiwyg/stretching_guide_1.pdf

Dye, J., Allyn, M., & Frank, C. (2024). Is there an immediate effect on pectoralis minor length after performing a prone scapular retraction exercise using typical sets and repetitions in pain-free participants? Journal of bodywork and movement therapies, 40, 1014–1019. doi.org/10.1016/j.jbmt.2024.07.026

Chankavee, N., Amatachaya, S., Hunsawong, T., Thaweewannakij, T., & Mato, L. (2023). Effects of modified long stick exercise on hyperkyphosis, muscle imbalance, and balance control in elderly community-dwelling women with hyperkyphosis. Journal of back and musculoskeletal rehabilitation, 36(5), 1151–1162. doi.org/10.3233/BMR-220350

Liao, Y. X., Saiken, A., Chang, X., Guo, Y. F., Tan, Z., Deng, F., Meng, Q. L., Zhen, H., Li, Y. M., & Fang, B. M. (2025). Associations of fat, bone, and muscle indices with disease severity in patients with obstructive sleep apnea-hypopnea syndrome. Sleep & breathing = Schlaf & Atmung, 29(1), 82. doi.org/10.1007/s11325-024-03241-8

Thongchote, K., Chinwaro, U., & Lapmanee, S. (2024). Effects of scapulothoracic exercises on chest mobility, respiratory muscle strength, and pulmonary function in male COPD patients with forward shoulder posture: A randomized controlled trial. F1000Research, 11, 1284. doi.org/10.12688/f1000research.126832.2

Dates: A Nutrient-Packed Superfood for Health

Dates: A Nutrient-Packed Superfood for Health

Can adding dates to one’s diet be nutritious and provide various health benefits for individuals looking for a naturally sweet snack?

Dates: A Nutrient-Packed Superfood for Health

Dates

Dates are a type of dried fruit from the date palm tree. Dates are a healthy source of fiber, calcium, magnesium, potassium, niacin, folate, vitamin A, beta-carotene, lutein, and selenium. They can be a healthier alternative to refined sugar because they have a low glycemic index and do not cause a rapid spike in blood sugar levels. They are a rich source of nutrients, including:

  • Fiber: High in fiber, which promotes good digestion and helps keep you feeling full.
  • Potassium: This is essential for heart health and muscle function.
  • Magnesium: supports bone health and energy production.
  • Antioxidants: which protect the body from damage caused by free radicals.
  • Vitamins: a good source of vitamins B6, K, and A.

Consuming them in moderation is recommended, especially for individuals who are trying to lose weight or have diabetes. They are high in sugar, so individuals need to be mindful to avoid or limit additional sources of sugar. Nutritionists and dieticians recommend a modest dose of two large or three small dates, which is around 50 grams and provides half the sugar and calories.

Benefits

Lower Cholesterol

Research has shown that eating dates may also help lower cholesterol and triglyceride levels. However, further research is needed as the current evidence is still inconclusive. (Mirghani H. O. 2024) A recent meta-analysis also showed no significant effect on LDL cholesterol but reduced total cholesterol in individuals with type 2 diabetes.

Help Regulate Blood Sugar

Pitted dates generally don’t contain added sugars but can still contain a significant amount of natural sugars in sucrose, glucose, or fructose. Although their high sugar level may prevent individuals from eating dates as a healthy snack, a key difference between dates and sugary drinks, snacks, or other processed foods is that they contain high levels of fiber. Because of the fiber, which slows glucose absorption in the bloodstream, they also have a low glycemic index, which causes a smaller spike in blood sugar levels. (Mirghani H. O. 2021) Using dates as a sweetener can also be a healthier alternative to refined sugar and can be used in recipes to replace sugar. However, portion control is important.

Support Gut Health

Since dates are high in fiber, they can help the gastrointestinal tract but should be eaten in moderation as part of a balanced, healthy diet. However, they are recommended to be eaten with other fiber-rich foods, specifically those with lower sugar, that includes:

  • Leafy greens
  • Non-starchy vegetables
  • Whole grains
  • Legumes
  • Nuts
  • Seeds

Adding these foods to a diet can also benefit the microbiome. Dates and other fruits can improve the ratio of beneficial gut microbiota. (Eid N. et al., 2015) Eating too many dates could also cause diarrhea, but eating a few daily can help constipation.

Alternatives

  • Other dried fruits, such as prunes, figs, and apricots, are alternatives, but fresh fruits are an even better choice as they are much lower in calories.

Injury Medical Chiropractic and Functional Medicine Clinic

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop highly effective treatment plans through an integrated approach for each patient and restore health and function to the body through nutrition and wellness, functional medicine, acupuncture, Electroacupuncture, and integrated medicine protocols. We focus on what works for you to relieve pain, restore function, prevent injury, and mitigate issues through adjustments that help the body realign itself. The clinic can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.


Personalized Medicine and Wellness


References

Mirghani H. O. (2024). Effect of dates on blood glucose and lipid profile among patients with type 2 diabetes. World journal of diabetes, 15(6), 1079–1085. doi.org/10.4239/wjd.v15.i6.1079

Mirghani H. O. (2021). Dates fruits effects on blood glucose among patients with diabetes mellitus: A review and meta-analysis. Pakistan journal of medical sciences, 37(4), 1230–1236. doi.org/10.12669/pjms.37.4.4112

Eid, N., Osmanova, H., Natchez, C., Walton, G., Costabile, A., Gibson, G., Rowland, I., & Spencer, J. P. (2015). Impact of palm date consumption on microbiota growth and large intestinal health: a randomised, controlled, cross-over, human intervention study. The British journal of nutrition, 114(8), 1226–1236. doi.org/10.1017/S0007114515002780

Hula hoop for Core Strength and Fitness

Hula hoop for Core Strength and Fitness

Can hula hooping be an option for individuals and athletes needing an effective, light, fun workout?

Hula hoop for Core Strength and Fitness

Hula Hoop Workout

A hula hoop workout is a low-impact exercise that involves spinning a hula hoop around your body. It can help improve balance, core strength, and aerobic fitness. Hula hooping is a great aerobic exercise that raises the heart rate and engages the whole body. Exercises can be done with a weighted or non-weighted hula hoop. A standard hoop will increase heart rate after about three minutes. A weighted hula hoop can target and build important core and lower body muscles, including the hamstrings, calves, quadriceps, and glutes. Lifting the weighted hula hoop also works the upper body muscles, giving the all-over body workout.

Weighted Hula Hoop

A weighted hula hoop can offer several health benefits.

Burns Calories

According to a research study, hula hooping can burn an average of 200 calories during a 30-minute workout. Researchers found that hooping is comparable in calories burned to boot camp-style fitness classes, kickboxing, and step aerobics. The average heart rate of the study participants was 151 beats per minute, equal to 84% of the age-predicted heart rate maximum. This can result in improved cardiovascular health and muscle conditioning. (American Council on Exercise, 2011)

Helps Build Muscle Mass

A study found that hula hooping increased trunk muscle mass and decreased waist circumference more than walking alone. Participants hula hooped an average of 12.8 minutes daily and walked almost 10,000 steps daily. The results showed more benefits to the core with hula hooping. The body fat percentage in the core region decreased significantly with hula hooping compared to walking. (Lahelma M. et al., 2019)

Lowers LDL Cholesterol

  • In the same study, researchers found that hula hooping can reduce LDL cholesterol more than walking. The results demonstrated an LDL-lowering effect similar to what resistance training does for cholesterol levels. Hula hooping for 13 minutes daily could benefit anyone with elevated cholesterol levels. (Lahelma M. et al., 2019)

Fun Workout

  • Weighted hula hooping can help individuals get out of a workout rut if they’re bored with a routine. It is recommended as either a warmup or a full workout.

Allows for Multitasking

  • If time to work out is limited, you can multitask using a hula hoop, easily add it to an exercise routine, and get moving while speaking on the phone, during breaks, or watching TV.

Benefits

  • Core strength: The exercise requires core strength to keep the hoop spinning.
  • Balance: Helps improve balance.
  • Aerobic fitness: Hooping can be used as a primary cardio routine.
  • Weight loss: Hooping can help burn calories and contribute to weight loss.

Hula Hoop Workout

  • Stand with a straight spine and feet shoulder-width apart.
  • Draw your abdomen in to engage your core.
  • Place the hoop around your waist, just above your hips.
  • Hold the hoop with both hands and toss it to one side.
  • Keep your back straight and move forward and back as fast as you can.
  • Pulse your hips and feet in a rocking motion.
  • Keep your arms out to the side or above your head.
  • Be mindful of posture, which will help you hoop better.

Weighted Workout

A full-weighted hula hoop workout. Start with a warmup for 5 minutes with a light jog or running in place. Then, perform three sets of the following:

Minute 1

  • 50 seconds of a hula hoop halo with the right arm – swinging the hoop around your arm
  • 10 seconds of rest

Minute 2

  • 50 seconds of a hula hoop halo with the left arm
  • 10 seconds of rest

Minute 3

  • 50 seconds around the waist, hula hooping
  • 10 seconds of rest

Minute 4

  • 50 seconds of hula hoop squats, keeping the hoop around the legs and not dropping it
  • 10 seconds of rest

Minute 5

  • 50 seconds of hula hoop sit-ups, keeping the hoop around your legs and not dropping it
  • 10 seconds of rest

Minute 6

  • 0 seconds of hula jumping front to back, keeping the hoop around your legs and not dropping it
  • 10 seconds of rest

How long you hula hoop each day is a matter of personal preference. To gain cardiovascular benefits, it is recommended that adults engage in at least 150 minutes per week of moderate-intensity aerobic activity. Spreading out the exercise throughout the week is preferable. (American Heart Association, 2024)

Injury Medical Chiropractic and Functional Medicine Clinic

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to build optimal health and wellness solutions. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. The clinic can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.


Can Core Exercises Help With Back Pain?


References

American Council on Exercise. (2011). ACE-sponsored research: Hooping—Effective workout or child’s play? www.acefitness.org/certifiednewsarticle/1094/ace-sponsored-research-hooping-effective-workout-or-child-s-play/

Lahelma, M., Sädevirta, S., Lallukka-Brück, S., Sevastianova, K., Mustelin, L., Gylling, H., Rockette-Wagner, B., Kriska, A. M., & Yki-Järvinen, H. (2019). Effects of Weighted Hula-Hooping Compared to Walking on Abdominal Fat, Trunk Muscularity, and Metabolic Parameters in Overweight Subjects: A Randomized Controlled Study. Obesity facts, 12(4), 385–396. doi.org/10.1159/000500572

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