Field hockey is one of the world’s oldest team sports, dating back to the classical Greek era. It also is recognized as one of the oldest college sports in America. It is a game where teams composed of 11 players, including one goalkeeper, come together on a field and use hockey sticks to drive a ball into a net to score points. The winner is determined by whoever has the most points at the end of the game. The sport requires high aerobic and anaerobic fitness to provide endurance, strength to position, trap, pass, and hit the ball, push and flick the ball, and acceleration/speed and agility. Here we look at the basic fitness components and chiropractic care benefits.
Field Hockey
Aerobic Fitness
Field hockey players need to have high levels of endurance to perform. The game consists of 2 35 – minute halves, with a 10-minute break, plus stoppages. This consistent use of energy and muscular strength requires the cardiovascular system to supply oxygen through the blood.
A conditioning workout should include long-distance and interval training.
Long-distance running or biking is a great way to build up the endurance to run back and forth on the field.
To keep workouts fun, alternate between long-distance and interval.
Strength and Power
Players need to be physically strong to power through an opponent, drive the ball, or push the ball out from another player’s stick. Incorporating exercises that strengthen the entire body will help.
Body-weight workouts will work if you don’t have access to a gym or weights.
Squats, glute bridges, and lunges can help build a strong lower body.
Push-ups and tricep dips are great for the upper body.
Lower body injuries are common. The risk can be reduced by 50% through regular participation in a strength training program with a resistance component, such as neuromuscular training.
Agility
The ability to change direction quickly is important, as players will change direction at least every 5 seconds during a game.
Players should include interval training to increase quickness and agility.
Common agility drills are ladder drills, lateral sprints, and hill climbs.
Flexibility
Healthy hamstring and lower back flexibility maintain stability and balance, which is also important for injury prevention.
Field hockey fitness is about perfecting moves to become an automatic reaction.
Chiropractic Benefits
After putting their body through intense training, players can benefit from sports massage and chiropractic. Benefits include:
Increased Range of Motion
The sport requires a wide range of motion. A misaligned area like the spine and hips causes weakness in the muscles and tendons near the joints causing the player to take on awkward positioning that can lead to various neuromusculoskeletal issues and injuries. Chiropractic reset and realignment maintain body flexibility, muscle relaxation, optimal circulation and strengthen the areas causing weakness.
Enhanced Balance and Coordination
Balance and coordination are critical as the players sprint, shift, twist, and turn. The eyes and ears are the main balance components, but the nervous system plays a role. Chiropractic spinal alignment increases the nervous system’s function of sending signals to the rest of the body.
Speeds up Recovery From Injury
Chiropractic helps heal injury quicker because fluids and nutrients released after an adjustment will move toward the damage expediting healing. Chiropractic breaks up scar tissue and trigger points to rebuild that strength and stamina without the risk of worsening or further injury.
Chiropractic care will improve how the central nervous system communicates with the rest of the body.
Strength Training
References
Espí-López, Gemma V et al. “Effect of manual therapy versus proprioceptive neuromuscular facilitation in dynamic balance, mobility and flexibility in field hockey players. A randomized controlled trial.” Physical therapy in sport: official journal of the Association of Chartered Physiotherapists in Sports Medicine vol. 32 (2018): 173-179. doi:10.1016/j.ptsp.2018.04.017
Krzykała, M et al. “Does field hockey increase morphofunctional asymmetry? A pilot study.” Homo : internationale Zeitschrift fur die vergleichende Forschung am Menschen vol. 69,1-2 (2018): 43-49. doi:10.1016/j.jchb.2018.03.003
Reilly, T, and A Borrie. “Physiology applied to field hockey.” Sports medicine (Auckland, N.Z.) vol. 14,1 (1992): 10-26. doi:10.2165/00007256-199214010-00002
Tapsell, Liam C et al. “Validity and Reliability of a Field Hockey-Specific Dribbling Speed Test.” Journal of strength and conditioning research vol. 36,6 (2022): 1720-1725. doi:10.1519/JSC.0000000000003700
Dr. Jimenez, D.C., presents how Lyme disease can cause referred pain to the body in this 3-part series. Many environmental factors can cause numerous issues in the body that can lead to overlapping risk profile symptoms in the muscles and joints. In today’s presentation, we examine the different treatment protocols for Lyme disease. Part 1 looks at the body’s genes and looks at the right questions to ask. Part 2 looks at how Lyme disease is associated with chronic infections and how it affects the body. We mention our patients to certified medical providers that provide available therapy treatments for individuals suffering from chronic conditions associated with Lyme disease. We encourage each patient when it is appropriate by referring them to associated medical providers based on their diagnosis or needs. We understand and accept that education is a marvelous way when asking our providers’ crucial questions at the patient’s request and acknowledgment. Dr. Alex Jimenez, D.C., uses this information as an educational service. Disclaimer
The Biofilm In The Body
Dr. Alex Jimenez, D.C., presents: The elimination of all biofilms makes no more sense than trying to sterilize the gut. So biofilms are this adherent polysaccharide matrix. We like to think of it as a fruit cocktail jello. So you’ve got the jello and all the different pieces of fruit in there, and each other type of fruit might even be a different species of bacteria. And one of those bacteria can make penicillinase, and it can elaborate a cloud of penicillinase into the matrix, protecting even species that can’t make it. And we already talked about how these biofilms can be operant in probiotic colonization, but they are also part of several problematic infections.
So there are several strategies to modify biofilms, making them more porous to the immune system and antibiotics. So Lactoferrin is one, Colostrum, which contains Lactoferrin in a bunch of other products as well. Serum-derived bovine immune globulin is egg divide-derived immune globulin for your sensitive patients. Probiotics and prebiotics can have biofilm activity. And then enzymes, as we mentioned before, are a carbohydrate structure, and enzymes can break down that matrix and make it more porous. So can Xylitol and EDTA be strong anti-film actors and stevia?
Lyme Serology Test
Dr. Alex Jimenez, D.C., presents: So Lyme serology testing needs to be more sensitive for diagnosis, especially during the early or late stages. And we’ll see why in a minute. So the standard two-tiered test requires a screening test of either an ELISA test or an IFA and then a confirmation test of a Western blot. The International Lyme and Associated Disease Society or ILADS and others argue that this two-tiered test should be only for surveillance or research purposes but not for diagnosis in individuals. So here’s what that scheme looks like, you either get an EIA or an IFA, and if it’s positive or equivocal, you go onto a Western blot. If you’ve had symptoms for less than 30 days, you get both an IGM and an IGG. If you’ve had symptoms for more than 30 days, you only get an IGG. Now, there are special criteria for reading the Western blot. They require multiple positive bands depending on whether it’s an IGM or an IGG blot. If your screening test is negative and you’ve been sick for less than 30 days, you should be retested in, you know, at some recovery point. You should consider a different diagnosis if you have been sick for more than 30 days. And we are going to talk about why this scheme is problematic.
So it’s highly specific. This two-tiered test is 99 to hundred percent specific, but its sensitivity is rather poor, perhaps even lower than 50%. So, here’s the data on that. We see the number of patients in the study, the patients versus controls, and the sensitivity and specificity. We also see totals, and the total sensitivity was 46%, while the total specificity was 99%. So as a test, think about it; we all learned about appendicitis in med school. You must take out a few normal appendices to ensure you get all the bad ones. If you’re missing half of the Lyme disease cases, many people will go onto tertiary disease.
Testing For Lyme Disease
Dr. Alex Jimenez, D.C., presents: So what about seronegative Lyme? So people who had the test and it was negative. Well, here’s a female patient who had what appeared to be Lyme arthritis despite recurrent negative Borrelia Burgdorferi tests. So she was found to have a different species of Borrelia garinii, and multiple courses of antibiotics didn’t do the tricks. So she had more courses of antibiotics and synovectomy, which eventually did help. This test says that Lyme borreliosis patients with live spirochetes in body fluids have a low or negative level of Borrelia antibodies in their serum. This indicates that an efficient diagnosis of Lyme borreliosis must be based on various techniques such as serology, PCR, and culture. And in this study, spirochetes were isolated from skin cultures obtained from multiple lesions. These spirochetes were identified as not Borrelia Bergdorferi but instead as Borrelia Afzelii.
However, Serum Borellia Burgdorferi tests were repeatedly negative. One of the problems with these tests is that the kit that comes approved is based on Borelli Burgdorferi, B-31 strain. And we see from these seronegative Lyme tests that some other strains and species may be involved. So the IDSA guidelines state that there is no convincing biological evidence for symptomatic chronic Borrelia Burgdorferi infection among patients after recommended treatment regimens for Lyme disease. This was noted in a culture-proven case of antibiotic failure with Borrelia Burgdorferi infections in 1989.
So, what about the animal model? There was an antibiotic failure in an animal model, this mouse model. In this dog model, there’s an antibiotic failure. In this Macaque monkey model, there’s an antibiotic failure. And in this particular study, Borrelia Burgdorferi can withstand antibiotic treatment when administered post-dissemination in primates. And as we’ll see in a little bit, many patients with Lyme disease are diagnosed post-dissemination. So these findings raises important questions to discuss with patients about the pathogenicity of antibiotic-tolerant persisters and whether or not they can contribute to symptoms post-treatment in Lyme disease. Human studies suggest that 25 to as many as 80% of patients have persistent symptoms after two to four weeks of antibiotic therapy. In this study, up to 40% of patients were found to have a persistent infection after the recommended IDSA treatment. So in this study, the patient’s condition deteriorated despite receipt of repeat courses of antibiotic therapy over two years.
The Protocols
Dr. Alex Jimenez, D.C., presents: They then received 12 months of intravenous antibiotics and 11 months of oral inter condition improved significantly. You’re going to see that we don’t have to resort to these long courses of antibiotics so much anymore because we have different tools. But this suggests that a longer duration may be helpful. Our study substantiates Borrelia persistence in some erythema migraine patients at the site of the infectious lesion site, despite antibiotic treatment over reasonable periods. And this was not because of rising MIC (minimal borreliacidal concentrations) levels. Therefore, resistance mechanisms other than the acquired resistance to antimicrobial agents should be considered in patients with Lyme Borrelia resistant to treatment. And in this study, a declining antibody response, which has been noted following antibiotic treatment in mice and in antibiotic-treated dogs, occurs despite low levels of persistent spirochetes. Our results show spirochetes are viable and transmissible and express antigens following antibiotic treatment.
This is a biostatistical review of the papers that the IDSA used to argue that there’s no compelling evidence of persistent symptoms after treatment and that repeated antibiotic treatment does not work. And they conclude that this biostatistical review reveals that re-treatment can be beneficial. Primary outcomes originally reported as statistically insignificant were likely underpowered. The positive treatment effects of Ceftriaxone are encouraging and consistent with persistent infection, a hypothesis deserving additional study. All right, so now we are going to start applying appropriate sequence diagnostic steps for Lyme disease.
What Symptoms To Look For?
Dr. Alex Jimenez, D.C., presents: The International Lyme and Associated Disease Society, or ILADS, has published evidence-based guidelines for managing and treating LymeLyme, and they’ve done something unique in the practice guidelines space. They publish an appendix, and then in this appendix, they compare the ILADS versus the IDSA guidelines for every single recommendation. So we see the management of an exodus species bite. So exodus tick bites typically have many useful symptoms, but the best treatment for chronic Lyme disease is early treatment of acute Lyme disease. But this is hard because the erythema migraines rash only shows up in about half of the patients with Lyme disease. And the central clearing makes it look like the bullseye rash, which is the stereotypical or classical erythema migraines rash. That central clearing only shows up in about half of the rashes. In fact, in one case series of 11 erythema migraine rashes, they were misdiagnosed as cellulitis, even though all 11 patients showed clinical evidence of Lyme disease progression.
To that point, making it even more difficult is that only about half of the patients with Lyme disease remember a tick bite. So it’s important to think about Lyme disease anytime you’re evaluating somebody suffering from flu-like symptoms off-season. So if they have the summer flu, they feel Lyme disease. So what are some symptoms? Severe unrelenting, life-altering fatigue. Now we’re talking about chronic Lyme disease here, not acute Lyme disease. Acute Lyme disease symptoms include low-grade to even significant fever, chills, body aches, and sweating. But we’re talking about chronic Lyme disease and its symptoms, which include severe unrelenting, life-altering fatigue, migrating arthralgias, and myalgias which can progress over time. What is this migrating business? It means that the left knee hurts so bad a person can hardly walk, but now three days have gone by, their left knee doesn’t hurt at all, but their left shoulder is killing them. This is known as referred pain, where one location in the body is dealing with pain instead of the main source that has been affected. This causes the sensory nerves to top go haywire in the body and, over time, develop overlapping symptoms that can affect the vital organs, muscles, joints, and tissues.
These symptoms correlate with joint inflammation going on here. Memory impairment, brain fog, mood swings, and anxiety all progress. What about the patient’s history? Living in or traveling to a tick-infested area is an important piece of history. A known tick bite, even though half the patients don’t know about it, that’d be useful. A rash, even though half the patients don’t have one, that’d be useful. And then the symptoms we described.
So what about the physical exam? Unfortunately, it’s generally non-specific, but you must carefully consider neurological, rheumatological, and cardiac symptoms when suspicious of Lyme disease. You know, you might find arthritic kinds of symptoms. You might discover meningitic signs. And anyone who has Bell’s Palsy should be ruled out for Lyme disease. Bell’s Palsy is Lyme disease until proven otherwise.
Another interesting thing is doing vibratory sense evaluation by confrontation. And what’s interesting is you do it, put your finger on the bottom of the metatarsal and put the tuning fork on the top of the metatarsal or metacarpal. And you wait until you can’t feel it transmitting the bone, right, and if the patient says that they don’t feel it, and you still do, that’s probably not normal.
Conclusion
Dr. Alex Jimenez, D.C., presents: When treating Lyme disease associated with chronic infections, if the immune system is not responding in a way that we would expect a healthy person’s immune system to respond, then providing additional tests to figure out the symptoms causing overlapping risk factors are useful. Remember that treating chronic infection is a master’s class in functional medicine. We must use all of our tools and do laps around the matrix. Every time you get a new piece of data, it is interesting. We need to think about the matrix in total. We need to consider the five modifiable factors of psychosocial, spiritual, mental, emotional, and spiritual aspects of what the patient is going through. And remember that your ATMs are not your destiny. And that infectious agents often modify the local and systemic immune response displaying self-stealth pathology, which can be in the body for years. Talking with your patient about what is happening in their genes and providing a personalized treatment plan to give them the tools for their health and wellness.
The body has around 1,000 ligaments that connect bones and joints. Ligaments are strong bands of tissue that support joint mobility and stabilize the muscles and bones. An injury to one or more ligaments can cause inflammation, swelling, discomfort, and instability. The PCL refers to the posterior cruciate ligament that runs along the back of the knee joint. This ligament connects the femur/thigh bone to the tibia/shinbone. Anyone can suffer from an injury to the posterior cruciate ligament. It can be caused by the knee hitting a dashboard in an automobile collision, a worker twisting or falling on a bent knee or a sports contact injury. The Injury Medical Chiropractic and Functional Medicine Clinic Team provide soft tissue work, trigger point therapy, and targeted non-surgical treatment through advanced therapy methods and technologies.
Posterior Cruciate Ligament
The posterior cruciate ligament – PCL is located inside the knee, just behind the anterior cruciate ligament – ACL. It is one of several ligaments that connect the femur/thighbone to the tibia/shinbone. The posterior cruciate ligament keeps the tibia from moving backward.
Injury
Posterior cruciate ligament injuries are far less common than ACL – anterior cruciate tears. PCL injuries make up less than 20% of all knee ligament injuries. It is more common for PCL tears to occur with other ligament injuries. A PCL injury can cause mild, moderate, or severe damage and is rated into four different categories:
Grade I
A partial tear is present in the ligament.
Grade II
There is a partial tear.
The ligament can feel loose.
Grade III
The ligament is completely torn.
The knee is unstable.
Grade IV
The PCL is injured.
Other knee ligaments are damaged.
Individuals with posterior cruciate ligament injuries can have short or long-term symptoms. Typically, long-term symptoms occur when an injury slowly develops over time. In mild cases, individuals may still be able to walk, and their symptoms may be less noticeable. Common symptoms associated with PCL injuries include:
Difficulty placing weight on the injured knee.
Stiffness.
Walking difficulties.
Difficulty descending stairs.
A wobbly sensation inside the knee.
Inflammation and swelling can be mild to severe.
Knee pain.
Pain that worsens over time.
Over time, tears could lead to the development of osteoarthritis.
There is an increased risk of extensive damage and chronic pain conditions if left untreated.
Chiropractic Care
The continued participation in work or activity following a mild injury is the primary reason individuals undergo therapy, injections, or surgical repairs. Knee injuries need immediate attention to prevent worsening or further damage. A chiropractor will examine the knee, check the range of motion and ask about symptoms. They may request imaging tests to determine the extent of the damage. These tests may include the following:
X-rays.
Magnetic resonance imaging.
CT scan.
During the physical examination, they will check all the structures of the injured knee and compare them to the non-injured knee. The wounded knee may appear to sag backward when bent or could slide back too far, specifically when beyond a 90-degree angle. Treatment depends on the severity of the injury. Common treatments include:
Crutches
Crutches may be recommended to limit the weight placed on the knee.
Knee Brace
A special brace can address instability and help prevent the tibia bone from sagging backward.
Gravity tends to pull the bone backward when lying down.
Chiropractic and Physical Therapy
As the swelling goes down, a carefully personalized rehabilitation program can begin.
This procedure is less invasive compared to traditional surgical methods.
Recovery time varies from person to person. If the injury is mild, it may only take around ten days to heal. If surgery was needed, recovery could take about six to nine months. Full recovery typically requires 6 to 12 months.
Bedi A, Musahl V, Cowan JB. Management of Posterior Cruciate Ligament Injuries: An Evidence-Based Review. Journal of the American Academy of Orthopedic Surgery. 2016 May;24(5):277-89. Accessed 7/26/21.
Lu, Cheng-Chang, et al. “Twelve Weeks of a Staged Balance and Strength Training Program Improves Muscle Strength, Proprioception, and Clinical Function in Patients with Isolated Posterior Cruciate Ligament Injuries.” International journal of environmental research and public health vol. 18,23 12849. 6 Dec. 2021, doi:10.3390/ijerph182312849
Pierce, Casey M et al. “Posterior cruciate ligament tears: functional and postoperative rehabilitation.” Knee surgery, sports traumatology, arthroscopy: official journal of the ESSKA vol. 21,5 (2013): 1071-84. doi:10.1007/s00167-012-1970-1
Schüttler, K F et al. “Verletzungen des hinteren Kreuzbands” [Posterior cruciate ligament injuries]. Der Unfallchirurg vol. 120,1 (2017): 55-68. doi:10.1007/s00113-016-0292-z
Zsidai, Bálint, et al. “Different injury patterns exist among patients undergoing operative treatment of isolated PCL, combined PCL/ACL, and isolated ACL injuries: a study from the Swedish National Knee Ligament Registry.” Knee surgery, sports traumatology, arthroscopy: official journal of the ESSKA vol. 30,10 (2022): 3451-3460. doi:10.1007/s00167-022-06948-x
As individuals try to avoid sugar as best as possible, alternative sweeteners are becoming more popular. A new addition is monk fruit sweetener, also called monk fruit extract. Monk fruit is a small, round fruit native to southern China. Unlike some chemically based sugar alternatives, monk fruit extract is considered natural. The sweetener has been around for decades but has become more available in the United States. The zero-calorie extract can be used as a standalone sweetener in foods and drinks and as a flavor enhancer.
Monk Fruit Sugar Alternative
Manufacturers remove the seeds and skin, crush the fruit, and extract the juice, which is then dried into a concentrated powder. Unlike most fruits, the natural sugars in monk fruit are not what gives it its sweetness. Instead, the intense sweetness comes from antioxidants (commonly found in plant foods, antioxidants fight off free radicals that can cause health problems like cancer and heart disease) called mogrosides. The mogroside is the sweetest part of the fruit, with a taste over 100 times sweeter than sugar and no calories.
Safe For Consumption
Monk fruit has the generally recognized as safe -GRAS label from the U.S. Food and Drug Administration with no reported side effects. However, it is advised to read the ingredients label before buying this sweetener. Some of the cheaper products combine other sweeteners with monk fruit extract. Some contain erythritol, a sugar alcohol that can cause stomach bloating or upset stomach.
Use
It has been found to be a healthy option for lowering overall sugar intake. However, consuming monk fruit or any sweetener should be done in moderation and with a healthy nutrition plan. It comes in powder or liquid form. As a natural alternative, it can be used:
As s sugar substitute for favorite baking, cooking, soup, sauce recipes, etc.
For drinks like coffee, tea, lemonade, smoothies, etc.
Added on breakfast dishes like oatmeal or yogurt.
Whipped into frosting or a mousse.
The ultra-sweetness means that little is required as it goes a long way. It is recommended to drink regular water or tea and eat foods without the sweetener because, over time, the taste buds adjust and do not need the sweetener as much. Consult a doctor, dietician, or nutritionist to determine if this sugar alternative is right for you and the benefits.
What Is It?
References
Chen, W J et al. “The antioxidant activities of natural sweeteners, mogrosides, from fruits of Siraitia grosvenori.” International journal of food sciences and nutrition vol. 58,7 (2007): 548-56. doi:10.1080/09637480701336360
EFSA Panel on Food Additives and Flavourings (FAF) et al. “Safety of use of Monk fruit extract as a food additive in different food categories.” EFSA journal. European Food Safety Authority vol. 17,12 e05921. 11 Dec. 2019, doi:10.2903/j.efsa.2019.5921
Lobo, V et al. “Free radicals, antioxidants, and functional foods: Impact on human health.” Pharmacognosy reviews vol. 4,8 (2010): 118-26. doi:10.4103/0973-7847.70902
Pawar, Rahul S et al. “Sweeteners from plants–with emphasis on Stevia rebaudiana (Bertoni) and Siraitia grosvenorii (Swingle).” Analytical and bioanalytical chemistry vol. 405,13 (2013): 4397-407. doi:10.1007/s00216-012-6693-0
Dr. Jimenez, D.C., presents how chronic infections are associated with Lyme disease in this 3-part series. Many environmental factors often play a role in our health and wellness. In today’s presentation, we look at genes and how to answer the right questions. Part 12 looked at what Lyme disease does to the body. Part 3 looks at treatment protocols for Lyme disease. We mention our patients to certified medical providers that provide available therapy treatments for individuals suffering from chronic infections associated with Lyme disease. We encourage each patient when it is appropriate by referring them to associated medical providers based on their diagnosis or needs. We understand and accept that education is a marvelous way when asking our providers’ crucial questions at the patient’s request and acknowledgment. Dr. Alex Jimenez, D.C., uses this information as an educational service. Disclaimer
Chronic Infections
Dr. Alex Jimenez, D.C., presents: We will have an interesting, brief discussion about evidence of an atomic force micrograph of a borrelia burgdorferi biofilm. This is a talk about stealth pathology and chronic infection in general, and we are using Lyme as a backdrop, but this is far from a comprehensive course on Lyme disease. So, let’s dive in because we are going to learn a lot about stealth pathology and a lot about Lyme disease. How do you begin thinking about chronic occult infection and stealth pathology? It starts with the basic functional medicine model.
It would help if you dealt with the phenotype. You know, your genes are not your destiny. Well, your phenotype isn’t your destiny either because it’s malleable. And how do we change your phenotype by dealing with the exposome, internal exposome, lifestyle issues, air, water, food pollution, medications, environmental toxins, xenobiotics, those kinds of things? Other exposomes include internal metabolic byproducts, lipid peroxides, oxidative stress, protein addicts, inflammation, the microbiome, et cetera. And then cognitive thoughts, beliefs, fears, phobias, isolation stressors, et cetera. And these cognitive processes have profound effects on immune responses. And then, on top of that, you have to deal with the pathogen. You must understand the biology, life cycle, and genetics of the pathogen you’re dealing with. You must also understand the pathophysiology, stealth pathology, cooperation, biofilm production, and interactions with the host immune system. And it’s important to remember that we’re talking about chronic infection here, not acute infection.
Acute Infections
Dr. Alex Jimenez, D.C., presents: If your patient has an acute infection, like pneumonia or meningitis, get them on IV antibiotics immediately, and don’t wait for your functional medicine workup. So how do you even begin to think about this? Well, you start with a comprehensive physical exam and look carefully at the question, when was the last time your patient was truly well? We like to think of it like this. If wellness is a straight line at some point, it broke right at that place, right around there. This can happen several times, so it might have broken ten years ago. And they came along with this new normal, but it broke numerous times again. And so, at each of those breaks in the overall health, what happened? What were the antecedents? What were the triggers?
Mediators For Genes
Dr. Alex Jimenez, D.C., presents: What were the mediators? And then, look at a physical and nutritional exam and, again, for antecedent triggers and mediators. And then create a timeline to look for the antecedent triggers and mediators. People come with baggage. They’ve been given this diagnosis and that diagnosis. And the other diagnosis, you know, they might have seronegative, rheumatoid arthritis, they might have fibromyalgia, chronic fatigue syndrome, maybe somebody said they had Epstein-Barr virus. Whatever it is, we need to look at those diagnoses critically and do whatever’s necessary. More tests, consultations, whatever’s required to rule it in or out. And from there, we populate a matrix. And this matrix is a living document because every time a new bit of data comes in, we need to fit that into the matrix.
The functional medicine workup has a layer on the bug’s biology and pathophysiology. And here is what we call the infectious Denee disease conundrum in these five areas where these bacteria seem to be able to figure out how to evade antibiotic and antimicrobial herbs and pharmaceuticals and our immune system. And then always remember the fundamental functional medicine adage, which is, unless there is a compelling reason to do otherwise, start in the gut. So start in the gut unless there’s a compelling reason to do otherwise, and here is why. So baseline nutritional deficiencies can be caused by many different antecedences and triggers. Let’s take just one as an example. People are in autonomic dysregulation, causing fight-or-flight responses. Fight or flight shunts blood away from your gut, which means you are not digesting or absorbing efficiently.
How Do Chronic Infections Affect The Body
Dr. Alex Jimenez, D.C., presents: That means that you’re functionally malnourished. Also, you’re shunting blood away from your gall. So the gut-associated lymphoid tissue comprises 70% of your entire immune system, intimately associated with the gut; you’re shunting blood away from that. So you’re functionally immune compromised just from autonomic balance issues. So what does cause increased baseline oxidative stress, impaired immune function, and impaired mucosal defenses that result in the proliferation of some of these endogenous viruses? In middle teens, you are colonized or dormant, infected with Epstein-Barr, cytomegalovirus, and some herpes simplex viruses may bloom. That increases your susceptibility to infection. These things increase the frequency, severity, and duration of infection. And here’s where amplification loops begin. This causes exacerbations in oxidative stress in your mucosal damage.
And then sick behaviors of anorexia and so on result in these amplification loops. And now, the problem is getting bigger and bigger, and the body’s ability to solve this problem is shrinking. And that’s where functional medicine interventions are so powerful and important. And the question always comes up, “Do I have enough time? Do I have enough data, if you will, to even begin treatment?” We want to simplify functional medicine to show you how powerful it is. Let’s say assimilation is an example. We’re just going to pick four ways to intervene in assimilation. We’re going to say there’s no problem in assimilation, so we’re not going to do anything. Or there’s a mild problem. So we’re going to put them on an elimination diet; maybe there’s a more moderate problem.
Conclusion
Dr. Alex Jimenez, D.C., presents: So we’re going to add to that elimination diet, say, colostrum. And then, for a severe problem, we’re going to layer on top of that a GI-focused medical food. So this is a more complex medical food. So we have these four interventions. Now, we’re considering intervening at all the functional medicine matrix nodes. In that case, we have the, you know, the seven physiologic nodes, what we think are often overlooked, the mental, emotional, and spiritual domains of wellness, the five modifiable lifestyle factors, and so on. So you end up with about 19 and more if you’re doing labs because you’ll intervene on all those. But four to the 19th power is the number of different combinations or ways this can happen. This becomes unique in the world intervention for your patient. So never be afraid to start and do another lap around the matrix by adding more information, and think about the next step. Now, we want to talk about the quality of evidence that we find in evidence-based medicine. A 2005 research paper published by Dr. Iondas titled “Why Most Published Research Finds Are False?” The research shows an increasing concern that most current published research findings are false, as studies show that many claims are more false than true for many designs and settings. The research is more or less an accurate measure of the prevailing bias.
Nerve irritation occurs when the nerves exiting the spine become irritated and sensitized. Also known as nerve gliding restriction, it is a condition whereby a nerve becomes irritated by inflamed swelling of structures close to the nerve, such as joints, ligaments, muscles, or discs, that have sustained an accumulative strain which results in swelling and inflammation. A thorough chiropractic assessment and examination can diagnose the extent of the irritation and develop a personalized treatment plan.
Nerve Irritation
When swelling and inflammation interfere with the nerve root, the nerve transmits signals to the brain to let it know there is a threat. The brain interprets these signals and creates a protective response to avoid worsening the damage to the nerve. The protective reactions vary from person to person but can include the following:
Muscle tightness and guarding
Aching sensation
Cramping
Radiating discomfort or pain
Pins and needles
Tingling
Numbness
Nerve root irritation also inhibits the body from recovering as fast as it should.
Nerve irritation is not to be confused with nerve root compression or radiculopathy. This is when the nerve becomes compressed/pinched, resulting in the loss of its functions like muscle strength and sensation. Sometimes individuals with nerve irritation can also experience increased neural tension. The nerves adapt to the mechanical loads placed on them through regular movements. Restrictions to neural mobility can cause symptoms to worsen along the pathway and distribution of the nerve.
The nervous system consists of the brain, spine, and nerve branches.
The branches, similar to electrical cables, cannot stretch.
Tension is generated when straightening out body areas, creating a pull and gliding of the nerve to the spinal cord.
When nerve irritation occurs, signals are sent to protect the body, brain, spine, and branches.
Causes
Most commonly, nerve irritation occurs when a structure adjacent to the nerve; this could be a joint, ligament, and/or muscle that accumulates strain and becomes dysfunctional, swollen, inflamed, and/or spasms resulting from protective guarding.
Mild nerve irritation can include accumulated strain from postural overload and swelling from a minor tear in an adjacent ligament.
Often nothing shows as a problem on an MRI scan.
Severe nerve irritation can include disc herniation and shows up on an MRI scan; surgery could be required in some cases.
Symptoms
Stiffness
Tightness
Aches
Pains
Persist even after days of rest, stretching, targeted exercises, avoiding movements, etc.
Stretching feels good at first, but the pain returns or worsens a few hours later or the next day.
The irritation blocks the effective recovery of muscle, joint, tendon, and ligament discomfort symptoms.
Chiropractic Care
Treatment involves various therapies and strengthening the supporting structures while relaxing and releasing tight structures to avoid recurring injuries. Chiropractic care realigns the spine, corrects joints that have shifted out of place, helps to regulate the nervous system’s function, and relieves irritation and inflammation. Whether in the form of an adjustment, traction, or guided exercise, all systems in the body are moved closer to a balanced state. This includes the:
Nervous system
Immune system
Respiratory system
Circulatory system
Endocrine system
Skeletal system
All help support the body’s self-healing process and increase the nervous system’s function.
The chiropractic team will guide the patient through the rehabilitation process to get back to full strength.
Peroneal Nerve Irritation
References
Ellis, Richard F, and Wayne A Hing. “Neural mobilization: a systematic review of randomized controlled trials with an analysis of therapeutic efficacy.” The Journal of manual & manipulative therapy vol. 16,1 (2008): 8-22. doi:10.1179/106698108790818594
Gibson, William, et al. “Transcutaneous electrical nerve stimulation (TENS) for neuropathic pain in adults.” The Cochrane database of systematic reviews vol. 9,9 CD011976. 14 Sep. 2017, doi:10.1002/14651858.CD011976.pub2
O’Shea, Simone D et al. “Peripheral muscle strength training in COPD: a systematic review.” Chest vol. 126,3 (2004): 903-14. doi:10.1378/chest.126.3.903
Rozmaryn, L M et al. “Nerve and tendon gliding exercises and the conservative management of carpal tunnel syndrome.” Journal of hand therapy: official Journal of the American Society of Hand Therapists vol. 11,3 (1998): 171-9. doi:10.1016/s0894-1130(98)80035-5
Sipko, Tomasz, et al. “Mobility of cervical spine and postural equilibrium in patients with spinal overload syndrome.” Ortopedia, traumatologia, rehabilitacja vol. 9,2 (2007): 141-8.
Dr. Jimenez, D.C., presents how to find the right diet for cardiometabolic syndrome in this 2-part series. Many environmental factors often play a role in our health and wellness. In today’s presentation, we continue discussing how genes play with the cardiometabolic diet. Part 1 looked at how every body type is different and how the cardiometabolic diet plays its role. We mention our patients to certified medical providers that provide available therapy treatments for individuals suffering from chronic conditions associated with metabolic connections. We encourage each patient when it is appropriate by referring them to associated medical providers based on their diagnosis or needs. We understand and accept that education is a marvelous way when asking our providers’ crucial questions at the patient’s request and acknowledgment. Dr. Alex Jimenez, D.C., uses this information as an educational service. Disclaimer
Omega-3s & Genes
Dr. Alex Jimenez, D.C., presents: We’ve found that fish oils or omega-3s can lower triglycerides, small-density LDL, and sometimes lower LDL and keep HDL regulated. But these studies were back when they were supplementing with more of an even DHA/EPA ratio. But that’s something to be observant of; the study showed that giving them fish oil lowers their small density LDL and triglycerides. They also found that if they gave them a lower fat food plan, and a lower fat diet, they found it lowered their LDL and small density LDL. A moderate fat diet reduced their LDL, but it increased their small density LDL. And they found that average alcohol consumption lowered their HDL and increased their LDL. So that’s not a good sign when that happens. So the opposite of what you want to occur with a moderate alcohol consumption diet or food plan.
So going back to APO-E4 in the body, how would this gene be affected when dealing with viral infections like herpes or cold sores? So research studies have revealed that APO-E4 and herpes simplex one viruses can affect the brain’s cerebral tissues. So the research also indicates that patients with APO-E4 are more susceptible to getting the herpes virus. And remember, herpes simplex one virus is what causes cold sores. What about HSV and dementia? How would that correlate with the body? The research indicates that HSV increases the risk of dementia. And what the thought is is that just like the herpes virus can come out and cause cold sores, it can internally manifest, and you can get these episodes where HSV becomes active in the brain, which can cause some of the pathogenesis of dementia or Alzheimer’s disease.
APO-E & Finding The Right Diet
Dr. Alex Jimenez, D.C., presents: And there was a study that showed that if you gave patients with dementia antivirals, it decreased the risk of getting dementia. So what do we do with the APO-E genotype? If you have APO-E2, APO-E3, or APO-E4, you can start them on the cardiometabolic food plan. If they’re on the SAD diet, the standard American diet, then putting them on the cardiometabolic food plan is just a good idea. It’s going to start shifting them in the right direction. What about additional consideration if they have APO-E3/4 and APO-E4/4? There are a couple of reasons you should jump in on this. They like it more when you customize a diet to a patient’s genetics. So if you can say, listen, we have your genes, and we know that you would do better if you had lower saturated fat, or if you don’t do so well on alcohol X, Y, or Z, it makes them pay attention more.
Because now it’s personalized. It’s not like, “Hey, everybody, just eat healthily.” It’s more personalized to your genetics. So, that would be a reason to start this from the get-go. But get them on the cardiometabolic food plan, and they should begin to feel better. But we would start by putting the whole thing in perspective that this APO-E3/4 and APO-E4/4 is not a death sentence. It’s a clue of how you respond to your environment and what we need to watch out for. It does not mean that you are going to get Alzheimer’s. The majority of people with Alzheimer’s do not have APO-E4. You have a higher risk of getting Alzheimer’s if you have APO-E4. And that’s where functional medicine comes in to risk-stratify them.
Finding The Right Diet For You
Dr. Alex Jimenez, D.C., presents: We recommend a lower simple carbohydrate diet or a higher glycemic index diet. And diet and food plan interchangeably, but patients call it a food plan because diet has negative connotations. So we avoid the word diet because when people hear or speak it, some people are triggered by it. You have people with food disorders and people with bad experiences with diets. A lower fat and a lower saturated fat food plan or recommendation is something to consider and be more aggressive with omega-3s. And if you start giving omega-3s to the patients, it is best to check their omega-3 levels and see if they begin to fluctuate. If they start shifting for the better, then we strongly advise against alcohol and monitor these patients for cognitive decline; there are different tools that you can use.
When it comes to omega-3s, it is best to do a cognitive test to keep an eye on their mentation. So if it starts to decline, you’re jumping in way before you have a major problem. And because of the issue of them not being able to deal with viral infections like herpes. And because the herpes virus may play a role in getting dementia, you may consider lysine supplementation. Arginine can deplete lysine. So if you end up eating a lot of pumpkin seeds and a lot of almonds and whatnot that have higher amounts of arginine, you can counteract that with lysine. And the research suggested that you need about two grams of lysine daily. But remember, every patient is different, so don’t just throw everybody on lysine if they have APO-E3/4, APO-E4, or APO-E44 3 but just something to consider.
So final thoughts on APO-E and nutrition. There are many pieces to the puzzle. Do not be dogmatic and say you have these genes, so you must do this. Just realize there are so many different genes, so many other variabilities, and recognize that it’s not that race can have something to do with how APO-E is affected. For example, they did a study that found that people in Nigeria had higher amounts of APO-E4, and the APO-E4 four did not increase their risk of dementia. So there are other pieces of the puzzle, monitor biomarkers and continue to adjust the plan. Next, we will discuss dealing with people with high triglycerides and high LDL.
What To Do With Abnormal Lipids?
Dr. Alex Jimenez, D.C., presents: So how do you take the abnormal lipid findings that you see on your profiles of your patients, those biomarkers, as all of us check? And how do you adjust the cardiometabolic food plan? What of the highlights of a cardiometabolic food plan that you will do for your patient in response to their lipids? Let’s first review a few things we know about how to modulate the diet’s lipids. First, we know that if you go from a standard American diet to the cardiometabolic food plan. You remove the trans fatty acids, and if you remove the trans fatty acids, then you will see a decrease in LDL cholesterol triglycerides. You’ll get an improvement in HDL; to say it another way, if your diet is high in trans fatty acids, you’ll have a higher LDL you have, you’ll have more elevated triglycerides, and you’ll have lower HDL.
How To Modulate Your Diet
Dr. Alex Jimenez, D.C., presents: What else about modulating the diet? If you have longer chain fatty acids that are not polyunsaturated, you’ll have an increase in your LDL and triglycerides and an increase or no change in your HDL cholesterol. On the other hand, we focus a lot on the shorter chain fatty acids and functional medicine. So if you have shorter chain fatty acids that are less than ten carbons, you’ll have lower LDL cholesterol triglycerides and increased HDL. So you can see with the cardiometabolic food plan, by addressing with the patient, their fat source, you can begin to impact LDL cholesterol without anti-triglycerides, without any other modulation other than dietary habit. And then finally, we know the data early and some of the most recent meta-analyses of changing simple sugars in the diet.
We know that that can, in its own right, increase LDL cholesterol triglycerides, and you get a lowering of HDL. So let’s put this all in context. What do we want to do for our patients to decrease the risk of coronary artery disease or atherosclerosis fat disease? We want their LDL cholesterol to be in a lower range. We do not wish for that LDL to be oxidized. We want the HDL to be higher. And if we can get triglycerides down through dietary change, then that gives us a clue that they might not be dysfunctional in the insulin metabolism. Then finally, with omega-3 fatty acids or adding omega-3 fatty acids or mono-concentrated fatty acids, we’ll lower LDL cholesterol triglycerides, and we’ll get an increase in HDL cholesterol. This is associated with a reduction in cardiovascular risk independent of lipid levels.
Conclusion
Dr. Alex Jimenez, D.C., presents: How is that affecting the body? It is because you have inflammatory drivers independent of your serum lipids that will increase your risk of atherosclerosis disease. It comes to saturated fat and fat content. Balancing the proteins, and the fat, you don’t have as much oxidative stress associated with inflammation after a meal. Thus, even if you have an elevated LDL level, you have less chance of having an increased oxidized LDL. Incorporating fibrous foods, antioxidants, lean meats, dark leafy greens, and supplements into a healthy diet can help lower LDL and fatty acids in the body and reduce all these comorbidities causing issues to your health and wellness.
So, those are just some tips and tricks for diet prescription to reduce cardiometabolic syndrome. And we encourage your patients to add more greens, legumes, nuts, and seeds, making the plant-based diet a mainstay for their heart health.
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Posterior Cruciate Ligament
