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MET Treatment Strategies To Reduce Pelvic Pain

MET Treatment Strategies To Reduce Pelvic Pain

For individuals with pelvic pain, how does MET treatment strategies reduce muscle weakness in the hips region?

Introduction

The pelvis’s main job is to ensure that the person’s body weight is distributed evenly for everyday movement within the upper and lower body. At the same time, the core muscles, ligaments, and joints surround the skeletal structure of the pelvis, which provides normal function while protecting the vital organ systems within the pelvic region. When normal or traumatic factors start to affect the body’s pelvic area, many individuals will often mistake the pain for low back pain, and the core muscles surrounding the pelvic bone can become weak and lead to pelvic pain. At the same time, normal factors like improper posture can cause anterior pelvic tilt and develop into other musculoskeletal disorders with overlapping risk profiles. When pelvic pain affects the lower extremities, it can also lead to reproductive issues that can cause even more stress to the individual. Luckily, many people opt for non-surgical treatments to reduce pelvic pain and its associated musculoskeletal condition by strengthening the weakened core muscles and reducing muscle weakness. Today’s article examines how referred pain symptoms affect the pelvis and how non-surgical treatments like MET therapy can reduce muscle weakness correlating with pelvic pain. Additionally, we communicate with certified medical providers who incorporate our patient’s information to reduce muscle weakness associated with pelvic pain. We also inform them that MET therapy can help mitigate the referred pain-like symptoms related to pelvic pain. We encourage our patients to ask amazing educational questions for our associated medical providers about their pelvic pain. Dr. Jimenez, D.C., incorporates this information as an educational service. Disclaimer

 

Referred Pain Symptoms Affecting The Pelvis

Have you noticed that you are taking more frequent trips to the bathroom and that your bladder still feels full? Do you experience muscle stiffness within your lower back or pelvic region from excessive sitting at your desk during work? Or do you notice that you are experiencing weak core muscles affecting your workout routine? These scenarios are associated with pelvic pain and can cause issues within the lower body extremities, affecting the person’s performance when doing normal activities. Pelvic pain is a multifactorial musculoskeletal disorder that can affect the corresponding body systems to induce referred pain. (Grinberg, Sela, & Nissanholtz-Gannot, 2020) Pelvic pain can cause referred pain to the gastrointestinal, pelvic musculoskeletal, and nervous systems, which then causes anatomic malfunction to the pelvic floor muscles. Pelvic pain can easily be mistaken for low back pain since the lumbar spine creates stressors for the muscles surrounding the pelvis.

 

 

When the pelvis is affected by mechanical stressors associated with the lumbar spine, it can cause pelvic dysfunction and causes the individual to be unbalanced when in motion. At the same time, the pelvic muscle structures will be overworked, leading to hip and joint destabilization, causing them to be weak. (Lee et al., 2016) When the pelvic muscle structures begin to destabilize, it can lead to sciatic nerve entrapment to the lower extremities, which leads to overlapping risk profiles for musculoskeletal disorders. When the surrounding pelvic muscles begin to entrap the pelvic nerve roots causing radiating pain down the legs. (Kale et al., 2021) However, there are ways to reduce referred pain affecting the pelvic region and restore muscle strength.

 


Sciatica, Causes, Symptoms, & Tips- Video

Since pelvic pain is a multifactorial musculoskeletal disorder that can lead to the development of referred pain to the lower body extremities, many individuals often think it is low back pain or sciatica. Referred pain is when pain affects a body location instead of where the source originated. Not treated immediately causes nerve entrapment, muscle weakness, and chronic pain within the reproductive and urinary organs. Many individuals seek non-surgical treatments to alleviate the pain and restore muscle strength to the body’s pelvic region. Non-surgical treatments like MET(muscle energy techniques) can help restore muscle strength to the pelvis through soft tissue stretching. Pain specialists specializing in MET therapy, like chiropractors and massage therapists, use hands-on maneuvers to relax, elongate, stretch, and massage the affected tight muscles and reduce any tender points that may have developed over time. (Grinberg et al., 2019) MET therapy can help stretch the pelvic stabilizing muscles. It can be combined with physical therapy and chiropractic care to realign the body and reduce nerve entrapment caused by pelvic pain. Check out the video above to learn more about the causes of sciatica and how non-surgical treatments may be the answer to alleviate pain.


MET Treatment Strategies For Pelvic Pain

MET therapy can reduce the effects of pelvic pain by including soft tissue manipulation methods to use controlled isometric and isotonic contraction to improve the normal physiologic function of the surrounding pelvic muscles and decrease pain and help stabilize the alternating structures within the pelvic region. (Sarkar, Goyal, & Samuel, 2021) MET therapy can also encourage self-regulating influences to reduce pain within the pelvic area, resulting in a greater range of motion. (Chaitow, 2009)

 

MET Treatment Reducing Muscle Weakness

MET therapy can also be part of a personalized health plan that can help restore muscle strength in the core and stabilize muscle within the pelvis. The positive effects of the combination of MET therapy and exercise, it can be more effective in reducing pain while improving physical function. (Hu et al., 2020) This allows the pelvis to realign itself and help stretch the shortened muscles. MET therapy can help restore low extremity function and improve a person’s quality of life. (Danazumi et al., 2021) MET therapy is an excellent way to stretch out tired muscles and restore pelvic function, as it can make individuals more mindful of their bodies while reducing the chances of pelvic pain associated with musculoskeletal disorders reoccurring again in the lower extremities.

 


References

Chaitow, L. (2009). Ligaments and positional release techniques? J Bodyw Mov Ther, 13(2), 115-116. doi.org/10.1016/j.jbmt.2009.01.001

 

Danazumi, M. S., Yakasai, A. M., Ibrahim, A. A., Shehu, U. T., & Ibrahim, S. U. (2021). Effect of integrated neuromuscular inhibition technique compared with positional release technique in the management of piriformis syndrome. J Osteopath Med, 121(8), 693-703. doi.org/10.1515/jom-2020-0327

 

Grinberg, K., Sela, Y., & Nissanholtz-Gannot, R. (2020). New Insights about Chronic Pelvic Pain Syndrome (CPPS). Int J Environ Res Public Health, 17(9). doi.org/10.3390/ijerph17093005

 

Grinberg, K., Weissman-Fogel, I., Lowenstein, L., Abramov, L., & Granot, M. (2019). How Does Myofascial Physical Therapy Attenuate Pain in Chronic Pelvic Pain Syndrome? Pain Res Manag, 2019, 6091257. doi.org/10.1155/2019/6091257

 

Hu, X., Ma, M., Zhao, X., Sun, W., Liu, Y., Zheng, Z., & Xu, L. (2020). Effects of exercise therapy for pregnancy-related low back pain and pelvic pain: A protocol for systematic review and meta-analysis. Medicine (Baltimore), 99(3), e17318. doi.org/10.1097/MD.0000000000017318

 

Kale, A., Basol, G., Topcu, A. C., Gundogdu, E. C., Usta, T., & Demirhan, R. (2021). Intrapelvic Nerve Entrapment Syndrome Caused by a Variation of the Intrapelvic Piriformis Muscle and Abnormal Varicose Vessels: A Case Report. Int Neurourol J, 25(2), 177-180. doi.org/10.5213/inj.2040232.116

 

Lee, D. W., Lim, C. H., Han, J. Y., & Kim, W. M. (2016). Chronic pelvic pain arising from dysfunctional stabilizing muscles of the hip joint and pelvis. The Korean Journal of Pain, 29(4), 274-276. doi.org/10.3344/kjp.2016.29.4.274

 

Sarkar, M., Goyal, M., & Samuel, A. J. (2021). Comparing the Effectiveness of the Muscle Energy Technique and Kinesiotaping in Mechanical Sacroiliac Joint Dysfunction: A Non-blinded, Two-Group, Pretest-Posttest Randomized Clinical Trial Protocol. Asian Spine Journal, 15(1), 54-63. doi.org/10.31616/asj.2019.0300

Disclaimer

Bananas and Stomach Pain

Bananas and Stomach Pain

Should individuals with existing gastrointestinal problems eat bananas?

Bananas and Stomach Pain

Bananas

  • Bananas can be easy to digest and are often recommended for nausea and diarrhea, however, not everyone can tolerate them. (MedlinePlus. 2021)
  • Bananas are high in fructose, sorbitol, and soluble fiber, which makes them a common trigger for gastrointestinal problems.
  • Additionally, individuals not used to eating a high-fiber diet may find it helpful to gradually increase fiber and drink more water to alleviate unpleasant symptoms.
  • If there is a suspicion of intolerance, IBS, or malabsorption, it is recommended to speak with a healthcare provider for an evaluation.
  • Bananas can make the stomach hurt due to:
  • Irritable bowel syndrome (IBS)
  • Cramping
  • Gas
  • Bloating
  • Other gastrointestinal (GI) problems.
  • Individuals can experience stomach discomfort if there is a fructose intolerance or a rare banana allergy.

Stomach Pain

  • Bananas are used to replenish potassium and other essential nutrients lost from vomiting or diarrhea.
  • Some individuals can experience bloating and gas after eating them.
  • One reason is because of their soluble fiber content.
  • Soluble fiber dissolves in water and is more readily fermented in the colon than insoluble fiber.
  • This can lead to gas and bloating. (Jackson Siegelbaum Gastroenterology. 2018)
  • Bananas also contain sorbitol – a naturally occurring sugar that acts as a laxative and can cause gas, bloating, and diarrhea when consumed in large amounts. (U.S. Food and Drug Administration. 2023)

Irritable Bowel Syndrome – IBS

  • Bananas can be a common trigger food for individuals with IBS.
  • This is because as bananas break down in the stomach, they can generate excess gas. (Bernadette Capili, et al., 2016)
  • Bananas are also high in fructose/simple sugar especially when they have overripened.
  • Individuals who have IBS are advised to avoid bananas because they can trigger many of the same side effects as undigested lactose/sugar in milk. (Johns Hopkins Medicine. 2023)
  • Ripe bananas are considered to be high in FODMAPSfermentable oligosaccharides, disaccharides, monosaccharides, and polyols.
  • Individuals following a low FODMAP diet to manage IBS may want to avoid or limit consumption.
  • Unripe bananas are considered to be low-FODMAP food. (Monash University. 2019)

Allergy

  • Banana allergies are rare and affect less than 1.2% of the global population.
  • Many individuals with a banana allergy are also allergic to pollen or latex because of similar protein structures. (Dayıoğlu A, et al., 2020)
  • An individual with a banana allergy may experience wheezing, narrowing of the throat, or hives within minutes of eating.
  • They can also experience nausea, abdominal pain, vomiting, and diarrhea. (Family Medicine Austin. 2021)

Fructose Intolerance

  • An individual with fructose intolerance has difficulty digesting fructose.
  • Individuals with this intolerance should restrict or limit fructose. (UW School of Medicine and Public Health. 2019)
  • Fructose malabsorption is when the body cannot digest or absorb fructose correctly. This causes bloating gas and abdominal discomfort.
  • Hereditary fructose intolerance is very rare. It happens when the liver cannot assist in the breakdown of fructose.
  • This condition often causes more severe symptoms and requires additional treatment besides removing fructose from an individual’s diet. (UW School of Medicine and Public Health. 2019)
  • Most can tolerate small amounts of fructose found in fruits like bananas.
  • There is often more difficulty tolerating large fructose amounts found in honey and high fructose corn syrup. (UW School of Medicine and Public Health. 2019)

Prevent GI Symptoms

  • If experiencing gas, bloating, or abdominal discomfort after eating bananas, consider limiting the portion size.
  • For example, instead of eating one or more bananas a day, try eating half of a banana to see if symptoms resolve.
  • Alternatively, if there is a belief that there is fructose malabsorption, try temporarily removing all high-fructose foods.
  • If the body begins to feel better, slowly add foods that contain fructose.
  • This can help you pinpoint the foods that are causing the problem. (UW School of Medicine and Public Health. 2019)
  • If you’re eating bananas that are too green or unripe, you may also experience stomach discomfort.
  • Unripened bananas contain high amounts of resistant starch. In large quantities, this can cause mild symptoms like gas and bloating. (Jennifer M Erickson, et al., 2018)
  • Resistant starch ferments slowly, so it usually does not cause as much gas as other fiber types. (The Johns Hopkins Guide to Diabetes. 2020)
  • Ripe or cooked bananas have less starch and more simple sugars, making them easier to digest. (University of Hawaii. 2006)
  • Drinking more water and gradually increasing fiber intake can also reduce GI side effects. (The Johns Hopkins Guide to Diabetes. 2020)

Gut Dysfunction


References

MedlinePlus. Bananas and nausea.

Jackson Siegelbaum Gastroenterology. Colon gas and flatus prevention.

U.S. Food and Drug Administration. Sorbitol.

Capili, B., Anastasi, J. K., & Chang, M. (2016). Addressing the Role of Food in Irritable Bowel Syndrome Symptom Management. The journal for nurse practitioners: JNP, 12(5), 324–329. doi.org/10.1016/j.nurpra.2015.12.007

Johns Hopkins Medicine. 5 foods to avoid if you have IBS.

Monash University. Bananas re-tested.

Dayıoğlu A, Akgiray S, Nacaroğlu HT, Bahçeci Erdem S. The clinical spectrum of reactions due to banana allergy. BMB. 2020;5(2):60-63. doi: 10.4274/BMB.galenos.2020.04.013

Family Medicine Austin. Banana allergy.

UW School of Medicine and Public Health. Fructose-restricted diet.

Erickson, J. M., Carlson, J. L., Stewart, M. L., & Slavin, J. L. (2018). The Fermentability of Novel Type-4 Resistant Starches in In Vitro System. Foods (Basel, Switzerland), 7(2), 18. doi.org/10.3390/foods7020018

The Johns Hopkins Guide to Diabetes. What is resistant starch?

The University of Hawaii. Cooking banana.

Incorporating Decompression To Alleviate Discogenic Low Back Pain

Incorporating Decompression To Alleviate Discogenic Low Back Pain

In individuals with discogenic low back pain, how does incorporating decompression reduce muscle strain in the back?

Introduction

When it comes to low back pain, many people often complain that the surrounding muscles will ache constantly, and there is no relief from their primary doctors. Muscle strain associated with low back pain is one of the pain-like symptoms that many individuals experience when normal or traumatic factors start to cause issues in the lower back region of the body. When people begin to make constant repetitive motions correlating with normal daily activities like heavy lifting objects, poor posture, or stepping wrong, it can cause micro-tears to the surrounding muscles and the spinal discs in the lumbar region. When the spinal discs degenerate over time and have been under constant pressure, it can aggravate the surrounding nerve roots causing pain-like problems to the surrounding muscles, ligaments, and tissues, leading to musculoskeletal disorders corresponding with discogenic low back pain. Pain affecting the lower back can lead to a life of disability and make a person feel miserable. To that point, many individuals will seek non-surgical treatment to reduce discogenic pain associated with the low back and can find the relief they have sought. Today’s article examines how discogenic low back pain causes low back pain and how non-surgical treatments like decompression reduce discogenic low back pain and restore muscle strength. Additionally, we communicate with certified medical providers who incorporate our patient’s information to reduce muscle strain correlating with discogenic low back pain. We also inform them that decompression can help mitigate the pain-like symptoms associated with degenerated discs affecting the lower back region. We encourage our patients to ask amazing questions while looking for education from our associated medical providers about their low back issues. Dr. Jimenez, D.C., incorporates this information as an educational service. Disclaimer

 

Discogenic Low Back Pain Causing Muscle Strain

 

 

Do you often experience a pinched nerve or muscle strain in your lower back that hurts when standing? Do you feel symptoms of muscle spasms in your lower back or behind your legs? Or do you and your loved ones feel numbness or tingling sensations in your back, legs, and feet after sitting down excessively? These pain-like issues are associated with discogenic low back pain, which can lead to the development of disability in many people. Discogenic low back pain is developed when the intervertebral (spinal) disc degenerates over time and can contribute to disability. (Mohd Isa et al., 2022) When there are structural changes to the spinal disc that causes the degeneration to progress, it can lead to dysfunction and instability in the lumbar spine. The spinal discs in the spine have the primary job of absorbing the unwanted pressure load that the body is experiencing. Over time though, the spinal disc can degenerate and crack under pressure, leading to discogenic low back pain. Discogenic low back pain can lead to increased pain in the lower back region’s paraspinal muscles and muscle atrophy, inflammation, and muscle strain in the lower back muscles and lumbar spinal discs. (Huang et al., 2022) When the spinal disc is under constant pressure, the inflammatory cytokines can induce nerve ingrowth, structural and biomechanical changes, and a release of pain factors to contribute to the effects of discogenic low back pain. (Lyu et al., 2021) When people are dealing with discogenic low back pain associated with muscle strain, it can make them miss out on their daily activities.

 


From Injury To Recovery With Chiropractic-Video

 

When many individuals are experiencing discogenic low back pain, it can be difficult for pain specialists and doctors to identify the underlying source of pain since it is a multifactorial musculoskeletal disorder. (Fujii et al., 2019) However, numerous ways exist to reduce the pain and allow the individual to return to their daily routines. Non-surgical treatments are an excellent way to minimize the pain-like symptoms associated with discogenic low back pain. Treatments like decompression therapy and chiropractic care can create a happy experience for many individuals dealing with discogenic low back pain as it is safe, cost-effective, and gentle on the spine. Decompression can help reduce the pain in the posterior segment of the lumbar spine while relaxing the surrounding muscles and ligaments and pulling the affected disc back to its original position. (Choi et al., 2022) This creates negative pressure on the spinal column and increases disc height on the spine, which allows the fluids and nutrients to flood back into the spine and rehydrate the disc. Decompression therapy can also be combined with chiropractic care, as the spine can be manipulated mechanically or manually to allow the body to realign itself. This, in turn, promotes the body’s natural healing properties to work its magic and provide relief. The video explains how these treatments can positively impact many suffering individuals and help them regain their health.


Decompression Reducing Discogenic Low Back Pain

Decompression therapy allows the individuals to be strapped into a traction machine in a supine position and gently pulls the spine to enable the affected disc to return to the spine and lay off the pressure on the aggravating nerve root that is causing muscle strain. This causes the intervertebral disc space to change through negative pressure, which allows the height to increase in the intervertebral height without stimulating the surrounding fibers around the disc. (Oh et al., 2019) This allows the facet joints in the spine to be realigned, allowing them to be in their moveable location back to the spine to alleviate pain, thus restoring normal posture and activating body functions. When individuals incorporate decompression therapy consecutively, it can minimize the pain caused by discogenic low back pain and allows the individual to have a personalized plan to ensure the pain doesn’t return. (Macario et al., 2008)

 

Restoring Muscle Strength In The Low Back

Decompression therapy allows the affected muscle to be stretched gently, which can be strengthened through other treatments like physical therapy. This can effectively reduce discogenic low back pain associated with the affected discs and positively influence spinal mobility and muscle strength. (Wang et al., 2022) Even though degeneration in the spinal disc is a natural process, it is important to be mindful of the body to prevent pain-like symptoms from occurring and causing issues to the back. Decompression therapy can positively influence many individuals looking to regain their health and reduce the pain they are experiencing from discogenic low back pain so they can return to their daily activities.

 


References

Choi, E., Gil, H. Y., Ju, J., Han, W. K., Nahm, F. S., & Lee, P. B. (2022). Effect of Nonsurgical Spinal Decompression on Intensity of Pain and Herniated Disc Volume in Subacute Lumbar Herniated Disc. International Journal of Clinical Practice, 2022, 6343837. doi.org/10.1155/2022/6343837

 

Fujii, K., Yamazaki, M., Kang, J. D., Risbud, M. V., Cho, S. K., Qureshi, S. A., Hecht, A. C., & Iatridis, J. C. (2019). Discogenic Back Pain: Literature Review of Definition, Diagnosis, and Treatment. JBMR Plus, 3(5), e10180. doi.org/10.1002/jbm4.10180

 

Huang, Y., Wang, L., Luo, B., Yang, K., Zeng, X., Chen, J., Zhang, Z., Li, Y., Cheng, X., & He, B. (2022). Associations of Lumber Disc Degeneration With Paraspinal Muscles Myosteatosis in Discogenic Low Back Pain. Front Endocrinol (Lausanne), 13, 891088. doi.org/10.3389/fendo.2022.891088

 

Lyu, F. J., Cui, H., Pan, H., Mc Cheung, K., Cao, X., Iatridis, J. C., & Zheng, Z. (2021). Painful intervertebral disc degeneration and inflammation: from laboratory evidence to clinical interventions. Bone Res, 9(1), 7. doi.org/10.1038/s41413-020-00125-x

 

Macario, A., Richmond, C., Auster, M., & Pergolizzi, J. V. (2008). Treatment of 94 outpatients with chronic discogenic low back pain with the DRX9000: a retrospective chart review. Pain Pract, 8(1), 11-17. doi.org/10.1111/j.1533-2500.2007.00167.x

 

Mohd Isa, I. L., Teoh, S. L., Mohd Nor, N. H., & Mokhtar, S. A. (2022). Discogenic Low Back Pain: Anatomy, Pathophysiology and Treatments of Intervertebral Disc Degeneration. Int J Mol Sci, 24(1). doi.org/10.3390/ijms24010208

 

Oh, H., Choi, S., Lee, S., Choi, J., & Lee, K. (2019). Effects of the flexion-distraction technique and drop technique on straight leg raising angle and intervertebral disc height of patients with an intervertebral disc herniation. Journal of Physical Therapy Science, 31(8), 666-669. doi.org/10.1589/jpts.31.666

 

Wang, W., Long, F., Wu, X., Li, S., & Lin, J. (2022). Clinical Efficacy of Mechanical Traction as Physical Therapy for Lumbar Disc Herniation: A Meta-Analysis. Comput Math Methods Med, 2022, 5670303. doi.org/10.1155/2022/5670303

 

Disclaimer

Throwing Sports Strength Training

Throwing Sports Strength Training

Can weight and strength training increase speed and power in athletes that participate in throwing sports?

Throwing Sports Strength Training

Throwing Sports

Top-throwing athletes have amazing arm speed. To succeed in throwing sports athletes need to be able to generate quick explosive power. This means the ability to propel the arm forward with substantial velocity for maximum object delivery like a baseball, javelin, hammer throw, shot put, discus, etc. Combined with sports technique training, throwing strength and power can be increased by training with weights. Here is a three-phase training plan to improve throwing performance.

Full Body

  • The arm provides only one part of the delivery process.
  • The legs, core, shoulders, and general flexibility need to work cooperatively to exert maximum thrust and achieve maximum object speed.
  • The natural ability to throw fast with power is largely determined by an individual’s muscle type, joint structure, and biomechanics. (Alexander E Weber, et al., 2014)

Preparation

  • Preparation should provide all-around muscle and strength conditioning for early pre-season conditioning.
  • Athletes will be doing throwing training as well, so fieldwork will need to be able to fit in.
  • It is recommended not to do weight training prior to throwing practice.
  • Do the session on a separate day if possible.

Frequency

  • 2 to 3 sessions per week

Type

Exercises

  • Warm-up
  • Squat or leg press
  • Bench-press or chest press
  • Deadlift
  • Crunch
  • Seated cable row
  • Triceps pushdown
  • Lat pulldown
  • 3 sets of 12
  • Cool-down

Rest

  • Between sets 60 to 90 seconds.

Weight Training

  • This stage will focus more on the development of strength and power. (Nikolaos Zaras, et al., 2013)
  • This leads to the start of competition and tournament play.

Frequency

  • 2 to 3 sessions per week

Type

  • Strength and power – 60% to 70% for one-rep max/1RM
  • The one-repetition maximum test, known as a one-rep max or 1RM, is used to find out the heaviest weight you can lift once.
  • When designing a resistance training program, individuals use different percentages of their 1RM, depending on whether they’re lifting to improve muscular strength, endurance, hypertrophy, or power. (Dong-Il Seo, et al., 2012)

Exercises

  • 5 sets of 6
  • Romanian deadlift
  • Incline bench press (Akihiro Sakamoto, et al., 2018)
  • Hang clean press
  • Single-leg squats
  • Back squat
  • Lat pulldown
  • Pull-ups
  • Combo crunches

Rest

  • Between sets 2 to 3 minutes

Competition

  • This stage focuses on maintaining strength and power. (Nikolaos Zaras, et al., 2013)
  • Throwing practice and competition are the priorities.
  • Before competition begins, take a 7- to 10-day break from heavyweight sessions while maintaining throwing workouts.
  • Weight training during competition should provide maintenance.

Frequency

  • 1 to 2 sessions per week

Type

  • Power – lighter loads and faster execution than in the preparation stage.

Exercises

  • 3 sets of 10
  • Rapid movement, 40% to 60% of 1RM.
  • Squats
  • Power hang clean and press
  • Romanian deadlift
  • Lat pulldown
  • Incline bench press
  • Crunches

Rest

  • Between sets 1 to 2 minutes.

Training Tips

  • Athletes have individual needs, so a general program like this needs modification based on age, sex, goals, skills, competitions, etc.
  • A certified strength and conditioning coach or trainer could help develop a fitness plan that can be adjusted as the athlete progresses.
  • Be sure to warm up prior to weight training and cool down afterward.
  • Don’t try to train through injuries or try to progress too fast – it is recommended not to throw or do weights when treating or recovering from an injury. (Terrance A Sgroi, John M Zajac. 2018)
  • Focus on the fundamentals and practice proper form.
  • Take a few weeks off at the end of the season to recover after hard training and competition.

Body Transformation


References

Weber, A. E., Kontaxis, A., O’Brien, S. J., & Bedi, A. (2014). The biomechanics of throwing: simplified and cogent. Sports medicine and arthroscopy review, 22(2), 72–79. doi.org/10.1097/JSA.0000000000000019

American College of Sports Medicine (2009). American College of Sports Medicine position stand. Progression models in resistance training for healthy adults. Medicine and science in sports and exercise, 41(3), 687–708. doi.org/10.1249/MSS.0b013e3181915670

Zaras, N., Spengos, K., Methenitis, S., Papadopoulos, C., Karampatsos, G., Georgiadis, G., Stasinaki, A., Manta, P., & Terzis, G. (2013). Effects of Strength vs. Ballistic-Power Training on Throwing Performance. Journal of sports science & medicine, 12(1), 130–137.

Seo, D. I., Kim, E., Fahs, C. A., Rossow, L., Young, K., Ferguson, S. L., Thiebaud, R., Sherk, V. D., Loenneke, J. P., Kim, D., Lee, M. K., Choi, K. H., Bemben, D. A., Bemben, M. G., & So, W. Y. (2012). Reliability of the one-repetition maximum test based on muscle group and gender. Journal of sports science & medicine, 11(2), 221–225.

Sakamoto, A., Kuroda, A., Sinclair, P. J., Naito, H., & Sakuma, K. (2018). The effectiveness of bench press training with or without throws on strength and shot put distance of competitive university athletes. European journal of applied physiology, 118(9), 1821–1830. doi.org/10.1007/s00421-018-3917-9

Sgroi, T. A., & Zajac, J. M. (2018). Return to Throwing after Shoulder or Elbow Injury. Current reviews in musculoskeletal medicine, 11(1), 12–18. doi.org/10.1007/s12178-018-9454-7

Cisgender: What It Means

Cisgender: What It Means

Cisgender has nothing to do with an individual’s sexual orientation. Therefore how do sex and gender differ and where does cisgender fall within the spectrum of gender identities?

Cisgender: What It Means

Cisgender

Cisgender is a segment of the larger spectrum of gender identities. Also referred to as “cis,” it describes an individual whose gender identity corresponds to the sex they were assigned at birth. Therefore if an individual assigned sex at birth is female and identifies as a girl or a woman they are a cisgender woman.

  • The term describes how a person sees themselves and helps others communicate more accurately and respectfully.
  • Although many individuals may identify as cisgender, a cisgender person is not typical nor has qualities or characteristics that inherently differentiate them from a person of other gender identities.
  • Cisgender women commonly use the pronouns she and her.
  • A common mistake is using the term cis-gendered.
  • The proper usage of the term is cisgender.

Sex and Gender Differences

  • The terms sex and gender are often used interchangeably, however, they are not the same.
  • Sex is a biological and physiological designation based on an individual’s sex chromosomes and sexual organs.
  • It refers to an individual’s sex chromosomes and the characteristics assigned by those chromosomes. (Janine Austin Clayton, Cara Tannenbaum. 2016)
  • This includes an individual’s genitals and sex organs.
  • It also encompasses secondary characteristics – like body size, bone structure, breast size, and facial hair – that are regarded as female or male.

Differences

Gender is a social construct that refers to roles and behaviors that society assigns as being masculine or feminine. The construct infers behaviors that are accepted or appropriate based on how an individual behaves, speaks, dresses, sits, etc.

  • Gender titles include sir, ma’am, mister, or miss.
  • Pronouns include him, she, he, and her.
  • Roles include actress, actor, prince, and princess.
  • Many of these suggest a power hierarchy of who has it and who does not.
  • Cisgender women often fall victim to these dynamics.

Sex

  • Refers to an individual’s chromosomes and the way that their genes are expressed.
  • Typically described in terms of male and female characteristics or the sex assigned at birth.

Gender

  • A social construct.
  • Refers to the social roles, behaviors, and expectations considered and/or deemed appropriate for men and women.
  • Historically defined as masculine and feminine, however, definitions can change as society changes.

Gender Identities Glossary

Today, gender is viewed as a spectrum where an individual might identify as one gender, more than one gender, or no gender. The definitions are often subtle and can often overlap, co-exist, and/or change. Gender identities include:

Cisgender

  • An individual whose gender identity matches their assigned sex at birth.

Transgender

  • An individual whose gender identity does not align with their assigned sex at birth.

Non-binary

  • An individual who feels their gender identity cannot be defined.

Demigender

  • An individual who experiences a partial, but not full/complete connection to a particular gender.

Agender

  • An individual who feels neither male nor female.

Genderqueer

  • Similar to non-binary but infers refusal of societal expectations.

Gender-neutral

  • Non-binary similarities but focuses on abandoning gender labels.

Gender fluid

  • An individual who experiences multiple genders or shifts between genders.

Polygender

  • An individual who experiences or expresses more than one gender.

Pangender

  • An individual who identifies with all genders.

Third gender

  • Third gender is a concept in which individuals are categorized, either by themselves or by society, as neither male nor female, not transitioning.
  • They are a different gender altogether.

Twin gender

  • A Native American term describing someone who is male and female or of two spirits simultaneously.

Cis Woman Identity

The terms cis woman or cis female are used to describe individuals who were assigned female at birth and identify as a woman or female. For cisgender woman, this means their gender identity aligns with their primary sex organs and secondary sex traits that include:

  • Higher pitch voice.
  • Wider pelvis.
  • Broadening of hips.
  • Breast development

It can also involve cisnormativity – a concept that everyone identifies as the gender they were assigned at birth. This could inform how a cis woman is expected to dress and act. An even more extreme concept is gender essentialism – this is the belief that gender differences are rooted purely in biology and cannot be changed. However, even cisnormativity beauty standards can influence the perceptions of transgender women that end up reinforcing gender stereotypes. (Monteiro D, Poulakis M. 2019)

Cisgender Privilege

Cisgender privilege is the concept that individuals who are cisgender receive added benefits compared to individuals who don’t conform to the gender binary norm. This includes cisgender women and men. Privilege happens when a cisgender individual assumes they are the norm and consciously or unconsciously takes action against those who are outside the definition of masculine and feminine. Examples of cisgender privilege include:

  • Not being denied work and social opportunities because of not fitting into the boy’s or girl’s club.
  • Not having to have sexual orientation questioned.
  • Not being denied healthcare due to provider discomfort.
  • Not fearing that civil rights or legal protections will be taken.
  • Not worrying about being bullied.
  • Not having to worry about attracting questioning looks in public.
  • Not being challenged or questioned about the clothes being worn.
  • Not being demeaned or mocked because of pronoun use.

Gender Identity and Sexual Orientation

  • Gender identity and sexual orientation are not the same. (Carla Moleiro, Nuno Pinto. 2015)
  • Gender identity and sexual orientation are not the same.
  • A cisgender individual can be heterosexual, homosexual, bisexual, or asexual and so can a transgender individual.
  • Being cisgender has no correlation to an individual’s sexual orientation.

Chiropractic Care After Accidents and Injuries


References

Clayton, J. A., & Tannenbaum, C. (2016). Reporting Sex, Gender, or Both in Clinical Research? JAMA, 316(18), 1863–1864. doi.org/10.1001/jama.2016.16405

Monteiro, Delmira and Poulakis, Mixalis (2019) “Effects of Cisnormative Beauty Standards on Transgender Women’s Perceptions and Expressions of Beauty,” Midwest Social Sciences Journal: Vol. 22: Iss. 1, Article 10. DOI: doi.org/10.22543/2766-0796.1009 Available at: scholar.valpo.edu/mssj/vol22/iss1/10

Moleiro, C., & Pinto, N. (2015). Sexual orientation and gender identity: review of concepts, controversies and their relation to psychopathology classification systems. Frontiers in Psychology, 6, 1511. doi.org/10.3389/fpsyg.2015.01511

The Effects Of Vertebral Decompression On Intradiscal Pressure

The Effects Of Vertebral Decompression On Intradiscal Pressure

Can the effects of vertebral decompression relieve individuals with herniated discs and reduce intradiscal pressure on the spine?

Introduction

The spine’s main job is to maintain the vertical pressure of the body without feeling pain or discomfort, especially when a person is in motion. The spinal discs are between the spinal joints, which are shock absorbers when pressure is implemented when a person is carrying a heavy object. The spinal column also has the spinal cord and nerve roots that are spread out from each section and have nerve root signals to be transmitted back and forth from the muscles to the brain to carry out its function. However, as the body ages, so does the spine, as many individuals are constantly adding unwanted pressure on their spines by doing normal factors and developing musculoskeletal disorders. At the same time, the spinal discs are also being affected as the unwanted pressure compresses them constantly, causing them to crack and herniate out of their position. To that point, the herniated disc aggravates the spinal nerve roots, leading to pain-like symptoms affecting the upper and lower body extremities. When this happens, many people will begin to experience musculoskeletal pain and cause overlapping risk profiles that cause their bodies to be misaligned. However, non-surgical treatments can be implemented as part of a daily routine for individuals dealing with herniated discs to reduce intradiscal pressure off the affected muscles in the upper and lower body extremities and restore functionality to the body. Today’s article focuses on why herniated disc affects many people and how vertebral traction can reduce intradiscal pressure off the spine while relieving the musculoskeletal system. Additionally, we work hand-in-hand with certified medical providers who incorporate our patient’s information to reduce intradiscal stress correlating with herniated discs. We also inform them that vertebral traction therapy (spinal decompression) can help mitigate the pain-like symptoms associated with herniated discs and provide relief to the body. We encourage our patients to ask profound questions while seeking education from our associated medical providers about their pain-like issues. Dr. Alex Jimenez, D.C., incorporates this information as an educational service. Disclaimer

 

Why Does Herniated Disc Affect People?

Have you or your loved ones been dealing with muscle aches or strains in their back, neck, or shoulders after carrying/lifting a heavy object? Do you feel a numbing or tingling sensation in your hands, legs, or feet after a long day after work? Or have you been constantly dealing with muscle and joint stiffness after a long workday? At some point in their lives, everyone has dealt with pain affecting their upper and lower extremities, leading to herniated discs in the spine’s upper, middle, or lower portions. As stated earlier, the body and the spine age naturally, leading to the development of herniated discs in the spine. Disc herniation occurs when the nucleus pulposus (inner disc layer) starts to break through the weaker annulus fibrosus (outer disc layer) and compress the surrounding nerve root, leading to an overlapping risk profile to the upper and lower body portions. (Ge et al., 2019) Disc herniation is developed when the spine goes through a natural degeneration, which causes them to be more susceptible to microtears. When individuals start to do normal activities like lifting or carrying heavy objects, it can enhance the progression further, leading to musculoskeletal disorders. Additionally, the spinal degeneration associated with disc herniation can cause inflammatory responses when the protruding disc is compressing the nerve roots, which then causes symptoms of pain and numbness to the upper and lower extremities. (Cunha et al., 2018)

 

Why do herniated discs cause inflammatory responses to the compressed nerve roots that cause pain-like symptoms to the upper and lower body extremities? Well, when many individuals are experiencing pain associated with herniated discs, they believe they are dealing with upper or lower pain, depending on where the herniated disc is located. This causes referred pain symptoms where the pain is being perceived in one location than the site where the pain is originating. Coincidentally, when individuals are doing repetitive motions associated with herniated discs can cause the adjacent nerve root to be compressed, which then causes the surrounding muscles, ligaments, and soft tissues to be in pain. (Blamoutier, 2019) Pain developing from herniated discs can reduce a person’s quality of life and make them miss out on important life events.

 


Disc Herniation Overview-Video

Many factors associated with a herniated disc can lead to its development and range from mild to severe depending on where the disc is herniated. Since the spine and spinal disc do degenerate over time naturally, it can cause the disc to crack and dehydrate. This leads to restricted movement, the development of neck, back, and shoulder pain, a decrease in muscle strength in the extremities, and numbness. (Jin et al., 2023) These are some results when herniated discs are not being treated right away. Luckily there are non-surgical treatments to alleviate the pain-like symptoms associated with herniated discs and help reduce intradiscal pressure in the spine while restoring spinal mobility and muscle strength. Spinal decompression, chiropractic care, massage therapy, and physical therapy are some non-surgical treatments that can help alleviate herniated discs and its associated symptoms. Non-surgical treatments can help pull the herniated disc off the compressed nerve root through manual and mechanical manipulation and return it to its original position. Additionally, non-surgical treatments can be part of a daily health and wellness routine combined with other therapies to reduce pain-like symptoms associated with herniated discs and help restore the spine’s mobility. The video above explains the causes, factors, and symptoms associated with herniated discs and how these treatments can alleviate the pain.


The Effects Of Vertebral Traction On Disc Herniation

Non-surgical treatments like vertebral decompression can provide a positive outlook when reducing the effects of herniated discs. Vertical or spinal decompression can help reduce the underlying problem associated with herniated discs by relieving the pain and intradiscal pressure off the vital structures of the spine. (Ramos & Martin, 1994) Additionally, vertebral decompression uses gentle traction to relieve nerve pain associated with herniated discs. It helps reduce the compression force on the affected spinal discs, reducing nerve compression by expanding the disc height in the spine. (Wang et al., 2022)

 

 

Spinal Decompression Reducing Intradiscal Pressure

With spinal decompression being incorporated to reduce the effects of herniated discs, individuals are strapped into a traction machine in a supine position. They will feel a mechanical pull to their spines as the herniated disc returns to its original position and the height of the spinal disc increases. (Oh et al., 2019) This allows the negative pressure from the traction to increase the body’s blood flow for the nutrients and fluids to rehydrate the discs while allowing the body’s natural healing process to kick into full gear. (Choi et al., 2022) After a few consecutive sessions with spinal decompression, many individuals will notice that the pain in their neck, back, and shoulders has decreased and that they can return to their daily activities. Spinal decompression allows the individual to regain their health and well-being while also reminding them to be more mindful of what certain factors can cause the pain to return to the spine. By being more aware of what is affecting a person’s body, they have the tools to continue their health and wellness journey.

 


References

Blamoutier, A. (2019). Nerve root compression by lumbar disc herniation: A french discovery? Orthop Traumatol Surg Res, 105(2), 335-338. doi.org/10.1016/j.otsr.2018.10.025

 

Choi, E., Gil, H. Y., Ju, J., Han, W. K., Nahm, F. S., & Lee, P. B. (2022). Effect of Nonsurgical Spinal Decompression on Intensity of Pain and Herniated Disc Volume in Subacute Lumbar Herniated Disc. International Journal of Clinical Practice, 2022, 6343837. doi.org/10.1155/2022/6343837

 

Cunha, C., Silva, A. J., Pereira, P., Vaz, R., Goncalves, R. M., & Barbosa, M. A. (2018). The inflammatory response in the regression of lumbar disc herniation. Arthritis Res Ther, 20(1), 251. doi.org/10.1186/s13075-018-1743-4

 

Ge, C. Y., Hao, D. J., Yan, L., Shan, L. Q., Zhao, Q. P., He, B. R., & Hui, H. (2019). Intradural Lumbar Disc Herniation: A Case Report and Literature Review. Clin Interv Aging, 14, 2295-2299. doi.org/10.2147/CIA.S228717

 

Jin, Y. Z., Zhao, B., Zhao, X. F., Lu, X. D., Fan, Z. F., Wang, C. J., Qi, D. T., Wang, X. N., Zhou, R. T., & Zhao, Y. B. (2023). Lumbar Intradural Disc Herniation Caused by Injury: A Case Report and Literature Review. Orthopaedic Surgery, 15(6), 1694-1701. doi.org/10.1111/os.13723

 

Oh, H., Choi, S., Lee, S., Choi, J., & Lee, K. (2019). Effects of the flexion-distraction technique and drop technique on straight leg raising angle and intervertebral disc height of patients with an intervertebral disc herniation. Journal of Physical Therapy Science, 31(8), 666-669. doi.org/10.1589/jpts.31.666

 

Ramos, G., & Martin, W. (1994). Effects of vertebral axial decompression on intradiscal pressure. J Neurosurg, 81(3), 350-353. doi.org/10.3171/jns.1994.81.3.0350

 

Wang, W., Long, F., Wu, X., Li, S., & Lin, J. (2022). Clinical Efficacy of Mechanical Traction as Physical Therapy for Lumbar Disc Herniation: A Meta-Analysis. Comput Math Methods Med, 2022, 5670303. doi.org/10.1155/2022/5670303

 

Disclaimer

What Makes A Healthy Life?

What Makes A Healthy Life?

While a healthy, sustainable lifestyle for one individual may not be the best option for another, can experts point out signs of a healthy life?

What Makes A Healthy Life?

Healthy Life

Being or living a healthy life is a phrase that can be confusing. Researchers examine some major areas of concern with constant imagery like social media’s role in shaping what behaviors people consider important to reach a physical fitness/health goal. These behaviors prioritize physical appearance and are often linked with negative psychological effects and worsening physical health outcomes. (Binder A, et al., 2021) Studies routinely show that someone’s body shape is not a good indicator of how healthy they really are. (Uhlmann LR, et al., 2018)

Living a healthy life is a multi-faceted endeavor that requires maintaining a balance. New research has shown that “adhering to both quality diet and sufficient physical activity is important for optimally reducing the risk of mortality from all causes, CVD and PDAR cancers.” (Ding D, et al., 2022) Individuals do not need to make extreme changes to these areas of their lifestyle. Studies show that making small adjustments, little by little, prepares the individual to develop long-term sustainable habits. (Adhikari P, Gollub E. 2021)

Nutritional Health

Too much salt, sugar, and saturated fat increases the risk of diseases like diabetes, heart disease, and stroke. (National Institutes of Health, 2017) It can be easy to overlook balanced nutrition and it is not all about what should be restricted and avoided. It is about making sure the body gets the proper amount of nutrient-rich foods essential to overall health. Examples include:

  • Deficiency of nutrients like magnesium, calcium, and vitamins A, C, D, E, and K are with sleep problems. (Ikonte CJ, et al., 2019)
  • Not acquiring enough protein can lead to slowed metabolism and weight gain. (Pezeshki A, et al., 2016)
  • Healthy fats are essential to protect against heart disease and can help maintain high energy levels. (Gammone MA, et al., 2018)
  • Research has found that depression and nutrition are linked.
  • Incorporating a diet like the Mediterranean has been associated with a reduced risk of depression symptoms. (Oddo VM, et al., 2022)

Physical Activity

Regular physical activity helps with weight management, reduces the risk of chronic diseases, maintains healthy bones and joints, and contributes to positive mental health and mood.

  • The Centers for Disease Control and Prevention estimates around 60 percent of the population does not get enough daily physical activity. (Surgeon General Report, CDC. 1999)
  • According to the research, individuals don’t exercise for consistent reasons that include: not having enough time, no access to resources, and being too tired to work out. (Yen Sin Koh, et al., 2022)
  • Studies show that going on a brisk 10-minute daily walk can extend lifespan. (Pedro F Saint-Maurice, et al., 2022)
  • Increasing the heart rate for only 12 minutes a day can protect the cardiovascular system. (Matthew Nayor, et al., 2020)

Signs

A few signs that an individual is healthy.

Stable Energy Levels

  • Having energy throughout the day is a sign you’re getting high-quality sleep.
  • Energy levels can also offer clues on nutritional intake, particularly of fats, carbohydrates, and proteins. (Yohannes Adama Melaku, et al., 2019)
  • The right combination of macronutrients can be different for everyone, especially depending on factors like age, job, medical history, and physical activity.
  • Paying attention to energy levels at different times of the day can help guide fitness and health goals.

Can Handle Stress Healthily

  • Stress is a part of life.
  • Research says it can even be beneficial when it is approached in a healthy way. (Jeremy P Jamieson, et al., 2021)
  • One sign that the mind and body are dealing with stress well is the ability to set boundaries.
  • Setting boundaries shows recognition and priority for their needs.
  • This could be boundaries for respect of thoughts and ideas, physical space, emotional needs, the time spent on certain things, sex life, and material possessions.

Fresh Breath

  • The mouth can show what is going on as far as the health of the body.
  • Poor oral hygiene can lead to a buildup of bacteria that can spread throughout the respiratory and digestive tracts.
  • Chronic bad breath is a common sign of poor oral health.
  • Studies suggest that increased bacteria entering the body can lower immune system response and increase the development of general health problems. (NIH. 2018)

Time to Change

Signs that the mind and body are not healthy include:

  • Always sick or feel as if you’re coming down with something.
  • The stomach is constantly feeling like it is bloated, backed up, or dealing with acid reflux or indigestion.
  • Digestion problems caused by stress.
  • Minor physical activities cause major fatigue.
  • Increased irritability
  • Difficulty falling asleep, staying asleep, and insomnia. (Filippo Vernia, et al., 2021)

The human body, organs, and tissues are complex structures, and the signals they transmit about underlying issues can be subtle which individuals tend to not notice until the little problems become major ones. It’s important to look at life habits and be honest about changes that may need to be implemented to improve health, lessen the risk of chronic health conditions, and improve quality of life.


Multidisciplinary Evaluations and Treatment


References

Binder, A., Noetzel, S., Spielvogel, I., & Matthes, J. (2021). “Context, Please?” The Effects of Appearance- and Health-Frames and Media Context on Body-Related Outcomes. Frontiers in public health, 9, 637354. doi.org/10.3389/fpubh.2021.637354

Uhlmann, L. R., Donovan, C. L., Zimmer-Gembeck, M. J., Bell, H. S., & Ramme, R. A. (2018). The fit beauty ideal: A healthy alternative to thinness or a wolf in sheep’s clothing? Body image, 25, 23–30. doi.org/10.1016/j.bodyim.2018.01.005

Ding, D., Van Buskirk, J., Nguyen, B., Stamatakis, E., Elbarbary, M., Veronese, N., Clare, P. J., Lee, I. M., Ekelund, U., & Fontana, L. (2022). Physical activity, diet quality and all-cause cardiovascular disease and cancer mortality: a prospective study of 346 627 UK Biobank participants. British Journal of sports medicine, bj sports-2021-105195. Advanced online publication. doi.org/10.1136/bjsports-2021-105195

Adhikari, P., & Gollub, E. (2021). Evaluation of the Small Changes, Healthy Habits Pilot Program: Its Influence on Healthy Eating and Physical Activity Behaviors of Adults in Louisiana. European journal of investigation in health, psychology, and education, 11(1), 251–262. doi.org/10.3390/ejihpe11010019

How dietary factors influence disease risk. National Institutes of Health (NIH)

Ikonte, C. J., Mun, J. G., Reider, C. A., Grant, R. W., & Mitmesser, S. H. (2019). Micronutrient Inadequacy in Short Sleep: Analysis of the NHANES 2005-2016. Nutrients, 11(10), 2335. doi.org/10.3390/nu11102335

Pezeshki, A., Zapata, R. C., Singh, A., Yee, N. J., & Chelikani, P. K. (2016). Low protein diets produce divergent effects on energy balance. Scientific reports, 6, 25145. doi.org/10.1038/srep25145

Gammone, M. A., Riccioni, G., Parrinello, G., & D’Orazio, N. (2018). Omega-3 Polyunsaturated Fatty Acids: Benefits and Endpoints in Sport. Nutrients, 11(1), 46. doi.org/10.3390/nu11010046

Oddo, V. M., Welke, L., McLeod, A., Pezley, L., Xia, Y., Maki, P., Koenig, M. D., Kominiarek, M. A., Langenecker, S., & Tussing-Humphreys, L. (2022). Adherence to a Mediterranean Diet Is Associated with Lower Depressive Symptoms among U.S. Adults. Nutrients, 14(2), 278. doi.org/10.3390/nu14020278

Adults, Surgeon General Report, CDC.

Koh, Y. S., Asharani, P. V., Devi, F., Roystonn, K., Wang, P., Vaingankar, J. A., Abdin, E., Sum, C. F., Lee, E. S., Müller-Riemenschneider, F., Chong, S. A., & Subramaniam, M. (2022). A cross-sectional study on the perceived barriers to physical activity and their associations with domain-specific physical activity and sedentary behavior. BMC public health, 22(1), 1051. doi.org/10.1186/s12889-022-13431-2

Saint-Maurice, P. F., Graubard, B. I., Troiano, R. P., Berrigan, D., Galuska, D. A., Fulton, J. E., & Matthews, C. E. (2022). Estimated Number of Deaths Prevented Through Increased Physical Activity Among US Adults. JAMA internal medicine, 182(3), 349–352. doi.org/10.1001/jamainternmed.2021.7755

Nayor, M., Shah, R. V., Miller, P. E., Blodgett, J. B., Tanguay, M., Pico, A. R., Murthy, V. L., Malhotra, R., Houstis, N. E., Deik, A., Pierce, K. A., Bullock, K., Dailey, L., Velagaleti, R. S., Moore, S. A., Ho, J. E., Baggish, A. L., Clish, C. B., Larson, M. G., Vasan, R. S., … Lewis, G. D. (2020). Metabolic Architecture of Acute Exercise Response in Middle-Aged Adults in the Community. Circulation, 142(20), 1905–1924. doi.org/10.1161/CIRCULATIONAHA.120.050281

Melaku, Y. A., Reynolds, A. C., Gill, T. K., Appleton, S., & Adams, R. (2019). Association between Macronutrient Intake and Excessive Daytime Sleepiness: An Iso-Caloric Substitution Analysis from the North West Adelaide Health Study. Nutrients, 11(10), 2374. doi.org/10.3390/nu11102374

Jamieson, J. P., Black, A. E., Pelaia, L. E., Gravelding, H., Gordils, J., & Reis, H. T. (2022). Reappraising stress arousal improves affective, neuroendocrine, and academic performance outcomes in community college classrooms. Journal of experimental psychology. General, 151(1), 197–212. doi.org/10.1037/xge0000893

Smelling Sickness, Body Odor May Be A Sign of Disease. NIH, News in Health.newsinhealth.nih.gov/2018/09/smelling-sickness

Vernia, F., Di Ruscio, M., Ciccone, A., Viscido, A., Frieri, G., Stefanelli, G., & Latella, G. (2021). Sleep disorders related to nutrition and digestive diseases: a neglected clinical condition. International journal of medical sciences, 18(3), 593–603. doi.org/10.7150/ijms.45512