The sciatic nerve is formed through a combination of motor and sensory fibers based on the spinal nerves of the lower back L4 to S3, known as the lumbosacral plexus. It is the largest and longest nerve in the human body and about as wide as an adult thumb. It begins at the base of the spine, runs along the back of each leg, and ends at the foot supplying the areas with fresh blood and nutrients. There are sciatic nerve branches that consist of primary branches and smaller branches.
Contents
Sciatic Nerve Branches
The nerve splits into two main branches near the back of the knee called the popliteal fossa.
This fossa is located slightly above the joint behind the knee.
The popliteal fossa is a diamond-shaped space that acts as the conduit for the blood vessels and nerves.
Primary branches
From the popliteal fossa:
The tibial nerve continues down the back of the calf to the heel and bottom of the foot.
The common peroneal nerve, aka common fibular nerve, travels sideways along the outer part of the knee to the outer border of the lower leg and foot.
Both nerves convert into small sensory nerves in the calf that supply the outer side of each foot.
The sciatic nerve breaks off into smaller branches, known as collaterals, that include:
These are muscle branches that supply the muscles in the thigh, including the hamstring group and the adductor magnus muscles along the inner thigh.
Other small branches supply the leg and foot muscles.
Articular branches supply the back of the hip joint, the back and side of the knee joint.
The sciatic nerve does not supply structures in the buttocks; however, pain commonly radiates/spreads into this area when the nerve is impaired, impinged, and inflamed.
Blood Supply
The delivery of nutrients to the sciatic nerve is done through blood vessels that also contribute to the nerve’s function. Any interruption of blood flow to the sciatic nerve can cause pain and dysfunction. The sciatic nerve and the sciatic nerve branches receive their blood supply from two sources that include:
The extrinsic system is made up of nearby arteries and veins.
The intrinsic system includes arteries and veins that run along the nerve and are embedded deep in a sheath known as the epineurium of connective tissue that envelops the nerve.
The intrinsic blood supply can be affected by conditions like diabetes, which can contribute to symptoms associated with diabetic neuropathy.
Both systems connect at various junction points.
Nerve Function
The combination of sensory and motor fibers that make up the sciatic nerve provides the essential functions in the lower limbs allowing the body to:
Stand
Walk
Run
Climb
Lift
A healthy sciatic nerve is well protected around the low back and buttock muscles where it starts, and it cannot be palpated or felt by touching or pressing on the area. When the nerve gets inflamed, injured, or pinched, the leg can feel stiff and inflexible when trying to move and can lead to pain, weakness, and tingling in the lower back, buttock, leg/s, and feet.
Anatomical Variations of the Nerve
Individuals can have variations in the anatomical structure of the sciatic nerve. These variations are considered normal, but they can increase the risk of developing sciatica brought on by impingement, entrapment, or irritation of the nerve root/s. Variations in sciatic nerve branches include:
The nerve divides above the piriformis muscle; one portion passes through the piriformis, with the other portion exiting the pelvis below the muscle. This is the most common variation.
The nerve divides above the piriformis muscle; one portion passes through the piriformis, with the other portion exiting the pelvis above the muscle.
The nerve divides above the piriformis, with one portion traveling in front while the other travels behind it.
Undivided sciatic nerve exits through the piriformis muscle.
Undivided sciatic nerve exits from behind the top part of the piriformis.
Around 10% of individuals have a nerve that divides above the popliteal fossa and does not merge but courses down in two separate branches.
The sciatic nerve and the sciatic nerve branches are significant components of the body. It supplies motor functions to move the legs and feet and provides sensory functions along the nerve path. Keeping the sciatic nerve healthy is key in helping to prevent back and spinal issues. Chiropractic can help realign the sciatic nerve and educate on maintaining the nerve’s health.
Body Composition
Fitness Motivation
New workout routine
Individuals that don’t feel like returning to previous workout routines are recommended to try out other fitness options. If the gym isn’t cutting it or there is burnout with the current routine, switch things up. This can include:
Virtual group classes.
1-on-1 personal training.
Outdoor activities.
All are valid options to explore if in a rut with the current routine.
The important thing is to find what works for you.
Allow the body to rest
Individuals may want to push it to the limit to get back into shape, but rest days are essential for healthy muscle development and improved performance.
Noticing the body is more sore and exhausted after a workout is an indication that the body needs rest. This also includes:
Maintaining proper hydration.
Stretching out the muscles regularly.
Taking days off from exercising are necessary to:
Prevent muscle fatigue.
Reduce the risk of injury.
Allow for adequate muscle recovery.
Long term commitment is key
It can be discouraging to commit to a workout schedule only to notice minor changes to strength and fitness.
However, small improvements do accumulate over time.
Small increases over time can have a huge impact on overall strength and fitness.
Keep the bigger picture in mind to remain positive.
References
Davis D, Vasudevan A. Sciatica. [Updated 2019 Feb 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: www.ncbi.nlm.nih.gov/books/NBK507908/
Barral J, Croibier A. Manual Therapy for the Peripheral Nerves. Elsevier Health Sciences; 2007.
Ryan MM, Jones HR Jr. Mononeuropathies. In: Neuromuscular Disorders of Infancy, Childhood, and Adolescence. Elsevier; 2015:243-273. doi:10.1016/b978-0-12-417044-5.00014-7
In today’s podcast, Dr. Alex Jimenez and PUSH Fitness owner, Daniel Alvarado discuss how PUSH was created and demonstrate how the right motivation can help people achieve their goals as well as, improving their overall health and wellness.
Discussion
Dr. Alex Jimenez and PUSH Fitness owner, Daniel Alvarado introduce today’s podcast.
[00:00:01] Daniel Alvarado: You know what keeps them moving and growing and living? Tell me. It is another catfish or that predator. So we never have predators in our lives. We stay stuck, and we don’t progress anything. So every time we ask God to take away the stress or God take away this issue. We’re asking God to make us weaker, not stronger. OK. Because instead of asking like, “Hey God? Make me more creative. Make me more passionate, make me more patient.” We ask for, hey, take away this, but then we still want everything else that comes along with it. How does that work? It’s not easy.
[00:00:41] Dr. Alex Jimenez DC*: I don’t know. I mean, if you think about it’s from the first time we’re born. It’s not easy. You got to be one in a trillion sperm, really, and only God is very clear that if you don’t get to that egg first, you’re done. So from the moment where we’re given a chance, we’re on the point of destruction from the beginning. Exactly. So, in essence, why did that sperm get to that egg? So you can pass and fight through it.
[00:01:19] Daniel Alvarado: All right, so then you think of everything else as far as how people complain, how people say, you know, I want more money, I want this, but they don’t look at everybody’s backstory, the backend and the behind the curtains. They think, “Oh man, Jimenez, you are a doctor?” You don’t know how many times you’ve lost and rebuilt your practice or if you’re a gym owner and you haven’t made it. You don’t know how often you have to go in at 4:00 in the morning to get a workout in because you have to train people all day long to ensure that this business stays afloat. You know, people don’t see the back. You see, they’re quick to say, Oh, must be easy. No, it’s not easy until you step into the person’s shoes because you’re the one that has to sign the checks. You’re the one that has to stay up at night and figure out payroll. You’re the one that has to be creative and figure out how you’re going to make ends meet. You are the one that constantly has to be on it. You know, as much as you want to kick back and say whatever and do this, and I would love to work out four or five hours a day. That’s my passion and your passion.
[00:02:23] Dr. Alex Jimenez DC*: It’s my passion too.
[00:02:24] Daniel Alvarado: And can we? No, right. What do we have to do? Do we have to be meticulous? We have to be disciplined and ensure we have a proper order to stay on top of the schedule. Yes or no? Absolutely. Exactly. You know, so I’m saying at the end of the day that if you don’t have something chasing you, I mean, you become fat and dormant and become lazy.
[00:02:45] Dr. Alex Jimenez DC*: I think nature is designed to eliminate you. Alex would say, you know, it’s survival, the fittest limiting the species or whatever he’d call it when he’s in biochemistry. You see, I got to tell you it’s not easy to be a business owner. It’s not. It’s not easy when you have no sleep. Ever since I’ve known you, you’ve put the time in from early hours, and you here at 4:30 in the morning and here what time it is? Now you’re here, and we’re here sharing some stories. You know, it’s one of those things where it’s going to be nonstop all our lives. But here’s the thing if you don’t do it, it doesn’t stimulate you to become good at what you do, right? You become lethargic. Everything goes bad. You slowly begin the process of ceasing to exist.
[00:03:36] Daniel Alvarado: Right. So we all need rest to rejuvenate. Get creative. It’s scientifically proven. You need that to reset. You have to. Otherwise, you burn out. Right? But after how many days of rest, one or two where you get this disconnect spastic. Then afterward, you are like, “Alright, cool. I rested enough.” So you don’t stay stuck there.
[00:04:04] Dr. Alex Jimenez DC*: No, and I pray for vacation, right? And when I get it, after about three days, I’m like, OK, all right. I’m done.
[00:04:10] Daniel Alvarado: Let’s go.
[00:04:11] Dr. Alex Jimenez DC*: Yeah, OK, what I’m going to break. What am I going to do? That’s how we are.
[00:04:15] Daniel Alvarado: Exactly. But that’s what makes you so successful.
[00:04:17] Dr. Alex Jimenez DC*: Yeah. Well, it drives us, and it drives us to create who we are. And it also gives us a vision as to what we’re going to do. When we start this podcast, you know, Daniel, we want to get or tell the people a bit of the story of what you do and tell them about, you know, where you’ve been and what’s been happening with you. OK. So for me, it’s very important to share with the people what is happening. I’ve always been one to say, you know, I see how hard you work, and I see how much effort you put into things. But I’d like to know a bit of you as to what made you and what kind of makes you click a little bit. When I discuss these things, I want to ask you what made you begin PUSH? What made you start this massive organization?
How PUSH Fitness Started
PUSH Fitness owner, Daniel Alvarado explains how PUSH started.
[00:05:16] Daniel Alvarado: I want to reach the masses of people and help people. So in all reality, my sister, my brother-in-law, my brother, we’ve all come from platforms as far as I’m speaking, preaching, singing, whatever it is. I was always kind of the black sheep. And I mean it in a good way because I wasn’t trained differently. I just was very rebellious. That makes any sense. I wanted to create my own. So if someone is going right, I go left. If the people go right, I go left. I was always trying to find a different way, and I was stubborn enough to become the most successful by the end. But that’s what allowed me to create this place to reach the masses of people and have my platform of change in people’s lives.
[00:06:14] Dr. Alex Jimenez DC*: Let me ask you when you first started PUSH; what was your reason you started it out? You were always into fitness ever since I’ve known you; you’ve always been into a deep understanding. You see, I love sharing that story with people about when I first met you; you were driven. I mean, you were hunting for knowledge. You were trying to figure out what it was that made people tick, and you wanted to teach people… A little cocky, I’d say. But being 18 years old, I mean, who isn’t right at that age? You haven’t been thumped in the head a couple of times. But you did, and you shared it with people, and you did that. But what made you? What drove you? Because I got to tell you, I’m a big believer, Daniel, about when you evaluate families, I see how hard your dad works. I see how your mom’s incredible in terms of what she does. She wins these CrossFit competitions just on meer drive. You have to turn off the lights to get her off the wall because she keeps on going, right? I mean, what is it that what do you feel drove you and what started the whole philosophy of trying to help people out?
[00:07:24] Daniel Alvarado: I mean, you put in my parent’s work ethic; they just never stop. They still don’t stop and try to move forward despite what life throws at them, and they’re successful in their way. They never stop working towards their marriage, towards their love, towards serving each other. They showed me that we always have to help people, and they serve each other. They serve at the church, and they serve wherever they go. No matter where my dad is, he’s always trying to help. It doesn’t matter. You try to take out your trash can and table; whatever it is, he will help. But that’s where I learned it from him. You don’t just go anywhere and just be wherever you go. You always serve. And that’s my interfaith mentality. You know, it’s biblical. Wherever you are, we are supposed to serve people as husbands and wives. We’re supposed to serve each other. That’s what makes us so successful. You know, you look at Jesus in the Bible, and what do you do? You serve people. He helped people. Not the norm. The most unorthodox, nonreligious people. You know, all the people there that needed the most help, not the most religious. And I think that’s what I love to do. I love helping the people that need the most help. The unconventional. Not the people that are all ready to let go. I mean, don’t get me wrong, I do love helping them. But I guess I like helping the unorthodox.
[00:09:08] Dr. Alex Jimenez DC*: Yeah. You know what, when you mentioned that about your dad, one of the things I noticed is that I came here to work out at around six o’clock in the morning and it was freezing outside, literally freezing. You had a flat tire. Your dad was lifting in the car by himself to get that tire up. Yeah, it was crazy. By the time I got there, I was like, Is this guy working on it? There was no jack, and he was picking up the car himself. He’s pushing that thing up and lifting the vehicle to fit the tire on. I was like; You got to be kidding me. You didn’t even know until I told you, and you said, “Man, my dad never asked for help.”, you know, he does it. That’s one of the things you said, and that’s who we are. We are our parents. We eventually become our parents to some extent, and that’s very much how you are. Your philosophies have guided the PUSH fitness entourage, and the people who come here have been like extreme athletes. Tell me a bit of that in terms of what drove you to pick athleticism as your way of serving.
[00:10:11] Daniel Alvarado: I think I’ve seen the potential of what people can be pushed to if you believe in them. Often, people will, you know, people do believe in themselves, but it’s amazing what you see people become or individuals or athletes. When you say, Hey, I believe you. Someone that is not your mom, not your dad, because it’s kind of expected. You know, not that they have to tell you that, but you know, it’s kind of sometimes expected. You’re right. Yes, exactly. But then you have this stranger saying, I believe you genuinely wholeheartedly, and it brings out that much more in you. I know that’s how I was, and I still remember various times where you tapped me on the shoulder and said, you know. What are you doing? You can, and I’m very different; I don’t need someone to preach to me. It might get going, and that gets you going to move on to the next level of the mountain. And that’s what I love seeing as a potential that you could bring down in all individuals.
[00:11:32] Dr. Alex Jimenez DC*: When you see it, pretty much you’ve been able to see everyone crack. What is it you look for when you see them kind of hit that wall when you start working with an individual with a specific set, whatever sport they’re in, or whatever their dreams are? Weight loss or whatever it is. What is it you look for?
[00:11:50] Daniel Alvarado: To see the reason why they’re quitting. Are they genuinely tired, or have they been babied so much by society that they don’t know how to push for themselves anymore? It’s a sensitive society nowadays; you can’t push kids because they get their feelings hurt or feel this way or that way. And sometimes it’s like you got to wake your butt up; if not, you will not make it in this life. Nothing comes easy, and I think we’re expecting things to become easy because we’re, you know, microwave generation, where everything wants to be done so quickly. So I look for the reason as to why they’re quitting. This is genuinely why they are tired, and are they going to throw up? All right. But you remember firsthand that when I worked out with you, I went to the restroom and threw up. I came right back. Why? Because it’s what you build with that person that respect, you know, why would you want someone who is an equivalent you when he gets hard, you know?
[00:12:59] Dr. Alex Jimenez DC*: Yeah, exactly right.
[00:13:00] Daniel Alvarado: How are you going to count on them? How do you depend on them? When it gets tough, they are going to jump off the wagon; that’s it. You are left alone.
The Right Motivation
PUSH Fitness owner, Daniel Alvarado explains to Dr. Alex Jimenez how the right motivation can influence not only kids but adults as well.
[00:13:09] Dr. Alex Jimenez DC*: You know you’re given responsibility. A huge one with a lot of the El Paso kids in whatever sports they do and whatever the sport, whether it be agility, sport-based or just some sort of sport-based system where they’re just kind of, you know, let’s say, hockey or even things like tennis or golf. But they all have a moment of reaching within. I love how you do that in terms of going ahead and seeing the depths of what is wrong with them, and you can connect with them like no other. I’ve noticed that every single time with my kids, too, when you train them. Did you ask why? So really, at that point, you know, no one cares what you know, they care that you care and that caring allows them to open up, huh?
[00:13:55] Daniel Alvarado: Right? Yeah, it does. You know, it makes them feel like, you know, I do have it in me. I need a quit babying in myself. And I need to get up and get after this because no one will give it to me, and I got to get up after it and work for it. Period.
[00:14:11] Dr. Alex Jimenez DC*: I would tell my daughter when they would come in and say, “You know what? I’m not coming in, you know, I’m not going today.” And I said, All right, well, let me call Daniel. “No!” Now they sense the obligation and trust you have put into their hearts like no other? Because that’s what they want. They want someone to believe in them.
[00:14:35] Daniel Alvarado: Exactly, to push them.
[00:14:37] Dr. Alex Jimenez DC*: That’s why the push to PUSH, you know, there’s another way there’s the adage the push. You know, these are vital points. Do you have to deal with the mind-stuff while working with them? How do you work on developing a child’s mind or working them through their mental impediments or their mental kind of dynamics to make them better of who they are? If that makes sense.
[00:15:04] Daniel Alvarado: You had to build a foundation with them. First, you had to build trust with them. You can just go in and yell at them, Hey, let’s go. Move your butt! You know, you can’t do that. You have to build a relationship first, have them trust you, and understand why you’re pushing them. And then when they’re at the brink of giving up, and you yell at them, and they know why you’re screaming at them. A good parent after they spank them and ground them. They’ll tell them the reason why they did that. But they don’t stop loving them. They appreciate it because they know they’re wrong. Right? It’s the same concept here. Obviously, I yell at them after they know, like, hey yeah, I was sulking, and you start feeling sorry for myself and get after it, right?
[00:15:53] Dr. Alex Jimenez DC*: You know, from my own experience with what you did. You see, you have a lot of moms watching you train their kids. Moms are sharp. There’s nothing more intelligent than a mother in this world. And they intuitively, they understand, and they feel the depths of the change in the child. Right? So when they see the depths of the difference in the child, they trust you. And this is in mass because I have like a whole wall of families, moms, dads. They bring their kids no matter what. Tired, cold, sleet, rain, snow. They bring their kids here to train with you and your entire crew with the philosophies of pushing to those limits. You know, how does that feel when you see those kids excel?
[00:16:45] Daniel Alvarado: I feel proud. I’m pretty much over the moon because you see the hard work you took to instill that time into them and make sure their full potential came out. So it’s rewarding, and it’s inexplicable.
[00:17:03] Dr. Alex Jimenez DC*: Let me ask you this. You’re not young, and you’re in your 30s, which is a very young age. However, you’ve lived long enough to see some of these kids go on in to do their thing. Tell me how that feels in terms of you watching them develop in terms of their they’re who they are, and what they develop because of the foundation, or at least influenced by the foundation of just don’t give up and keep on pushing through it. How does it feel? What do you think?
[00:17:36] Daniel Alvarado: In a lot of sense, a lot of pride, because you can see what they could have been in there, what they couldn’t have been in times. Some kids do come from poor extremities. And so to see them excel believing themselves, go to college, get a successful job, and be something of a higher profession that otherwise they thought they couldn’t build or settle for less and not letting them settle for less is amazing. That’s why I keep doing what I’m doing.
[00:18:17] Dr. Alex Jimenez DC*: Do these kids keep calling you and talking to you personally?
[00:18:21] Daniel Alvarado: Yeah, they do. They still keep up with me as far as what they’re doing, how they’re doing. They’ll come in and work out. So, you know, to share with me everything. It’s fun. You build that long-lasting relationship.
[00:18:35] Dr. Alex Jimenez DC*: If you could come up with a couple of words indicating what makes PUSH unique and you can look deep inside your heart and figure out what it would be a word to get an obituary being read about you. What would they say about PUSH and you, huh? Would you want them to say?
[00:18:55] Daniel Alvarado: Honestly, that they had somebody other than their parents believe in them.
[00:19:03] Dr. Alex Jimenez DC*: That’s amazing. That’s a considerable component of everything that’s going on. When do you think someone actually should be coming out to this place and enjoying the kind of lifestyle that this place, you know, helps enhance their lives with? When is that time?
[00:19:21] Daniel Alvarado: Whenever. Whenever you want to be a better version of yourself.
[00:19:25] Dr. Alex Jimenez DC*: What do you think people sometimes think about, you know, why shouldn’t they come in? What should not be an impediment of them coming in here?
[00:19:35] Daniel Alvarado: Their image. They can’t do it, that they’re not like, you know, they’re obese, having problems, low back problems, and looking foolish. You know, the whole thing is that in the day, we’ve all looked foolish to an extent or another. But the point is if I always assumed what others thought and paid attention to how I felt this was for members and not being good enough, then I wouldn’t be where I’m at.
[00:20:03] Dr. Alex Jimenez DC*: I tell you, I’ve learned a lot from you, and if anything, my kids have learned a lot from you by just your persistence. You know, I can honestly tell you that my son is better as an athlete because of your relationship with you. But let me ask you, what kind of physical and emotional changes have you watched your clients attain their goals?
[00:20:34] Daniel Alvarado: Hearing people say. “He saved me from diabetic medications.” We hear people say like I would have died, been in this obese state, and you saved my life. And that’s how do you not get emotional with things like that? How do you not get emotional and people saying, like, you know, I thought I couldn’t walk or had this muscle imbalance, or how do you say where I have this one client that couldn’t build muscle? I can’t remember the terminology, but the fact that she can build muscle now, where the doctor told her she wouldn’t be able to squat a bar, and now she’s squatting over one hundred and thirty-five pounds, that’s phenomenal. How does that not keep you motivated to get up every day when you don’t feel like getting up? You know, and I’ll repeat it, in King David’s words. You know when you had to encourage yourself because somebody is not always there to inspire you. So you do have to encourage yourself so you can be the best or somebody else that needs it more than you. Ultimately, someone has more complicated than you, and you can always help somebody under you.
Conclusion
Dr. Alex Jimenez recaps today’s podcast.
[00:21:52] Dr. Alex Jimenez DC*: Well, Daniel, you said it is very short and essential keywords. You know, we appreciate you. We’re here at the push fitness center. You know you got some information there that you can use to find Mr. Alvarado. The PUSH fitness center is a monster center with many people who care and change people’s lives. Suppose you guys have any questions, comments, or ideas about what we do for people. Let us know, and we’re here to serve as Daniel is. Thank you very much, brother, and I appreciate everything you’ve done. And God bless, brother.
Muscle spasms also referred to as muscle cramps, are painful contractions and tightening of the muscles. They are common, involuntary, and unpredictable. Temperature drops and cold weather can cause the muscles and joints to contract and tighten, leading to spasms and pain. Chiropractic, physical therapy massage, exercises, stretching, and an anti-inflammatory diet can bring relief and help strengthen the muscles to prevent future episodes.
Contents
Muscle Spasms
Spasms are common and can affect any of the muscles. They can involve part of a muscle, all of a muscle, or several muscles in a group. Spasms occur when the muscle/s involuntary and forcibly contract uncontrollably and are unable to relax. The most common sites for muscle spasms include:
As the weather gets colder, this causes the muscles in the body to lose heat, causing them to contract. As a result, the muscles and joints become tighter, stiffer, and decrease mobility and range of motion. This forces the muscles to work harder than usual to compensate. This can increase the fatigue of the muscles, leading to more prolonged bouts of pain and discomfort after physical activity, movement, exercise, etc.
Symptoms and Causes
A cramp can last a few seconds or last up to 15 minutes. During a muscle spasm, the following may be experienced:
Twitching in the muscle.
Pain in the muscle.
Throbbing.
Hardness and/or stiffness.
The muscles appear physically distorted.
Because the muscles have to work harder, the cold weather can increase muscle spasms. One of the most common causes of muscle spasms is overuse and fatigue. However, exact causes vary from person to person. Some experts believe that one or more of the following contribute to the spasms/cramps, and they include:
Dehydration.
Stress.
Not stretching the body regularly.
Muscle fatigue.
Restricted blood circulation.
Involuntary nerve discharge/s.
Over-exercising.
Exercising in the heat.
Exhaustion of salts and minerals:
Potassium
Magnesium
Calcium
Possible causes for leg cramps at night or nocturnal leg cramps specifically include:
Sitting for too long without moving around to keep circulation healthy.
Sitting with unhealthy posture.
Overusing the muscles.
Standing or working on hard floors.
Dealing With The Cold
One way to deal with the cold is to warm up before any physical activity. Taking a few minutes to get the heart rate up can increase the blood flow and flexibility of the muscles. This will ensure the muscles are functioning correctly and avoid the need to work harder to stop spasms. When a cramp strikes, there are a few steps to try to alleviate the spasm:
Stretching the affected area.
Massaging the affected area manually with a massage roller, percussive massager.
Stand up.
Move around.
Apply heat or ice.
A warm bath, shower with massage setting if possible.
Herzberg J. Stevermer J. Treatments for Nocturnal Leg Cramps. (www.aafp.org/afp/2017/1001/od3.pdf) Am Fam Physician 2017;96(7):468-469. Accessed 3/1/2021.
A neuromuscular massage is a form of manual massage used to release strained muscles. Strained areas are also known as trigger points that tend to be the cause of muscular pain symptoms. Trigger points are small areas of the muscle that contract the tissue. The lack of blood and nutrients in these areas causes an inability for the muscles to relax. The area becomes hypersensitive, causing fatigue, weakness, inflammation, and pain. Trigger points can lead to referred pain in which other areas of the body experience sensations of pain, tingling or numbness.
Contents
Neuromuscular Massage
Neuromuscular massage treatment involves applying alternating levels of concentrated pressure on the trigger point/s done through manual and instrument manipulation. Neuromuscular therapy is also called trigger point myotherapy. The American Academy of Pain Management recognizes this form of treatment as an effective treatment for pain caused by soft tissue injury.
Deep Tissue Massage
A deep tissue massage is generally used to address muscle aches and pains and is administered on an on-off basis. Neuromuscular manual therapy techniques are specialized and designed to correct pain and movement dysfunction by treating:
Neuromuscular massage is considered an ongoing treatment.
Massage Reduces Pain
Muscles, when spasming, are painful to the touch. The pain is caused by ischemic muscle tissue. Ischemia means the muscle is lacking proper blood flow because of the spasm. This causes adverse effects because the muscles are not receiving enough blood; the muscles also do not receive enough oxygen.
The lack of oxygen causes the muscles to produce lactic acid.
The lactic acid causes the muscles to feel sore following physical activity.
Neuromuscular massage therapy relaxes the muscles releasing the lactic acid, allowing the muscles to receive enough blood and oxygen. Neuromuscular therapy can feel painful at first, but the pressure of the massage will alleviate the muscle spasm/s. It is crucial to communicate with the chiropractor and massage therapist about the pressure – whether it is too much, too little, feels better, feels worse, etc. Massage therapy pressure should never be overly painful. Individuals often describe the pressure as good pain, where they can feel the difference. Following a neuromuscular massage, the soreness should fade after twenty-four to thirty-six hours. The tight muscles should remain relaxed for four to fourteen days, depending on activities and stress levels.
Massage Treatment
Medical issues and conditions for which neuromuscular massage can treat include:
Tendonitis
Headaches
Temporomandibular joint pain – TMJ disorders
Jaw pain
Carpal tunnel
Upper back pain
Low back pain
Sciatica
Hip pain
Knee pain
Iliotibial band syndrome
Calf cramps
Plantar fasciitis
Neuromuscular Massage Benefits
Individuals who undergo neuromuscular massage therapy can experience the following benefits:
Reduced and/or complete elimination of pain.
Increased blood circulation.
Body toxin release.
Increased flexibility and strength.
Better movement.
Improved posture.
Balanced musculoskeletal and nervous systems.
Increased energy and vitality.
Body Composition
Fatigue
When it comes to getting fit, remember it is a long-distance marathon, not a quick sprint. Whether physical, mental, or a combination, fatigue is a common obstacle for successfully reaching health goals. Physical fitness requires energy:
Energy for work or school.
Energy to set up the gear or get to the gym.
Energy for the workout.
Energy to prepare regular healthy meals.
Combined with the pressures of everyday life can make it a challenge to work out consistently. The objective is to make gradual changes rather than significant immediate changes. This will help prevent/avoid early burnout and help lead to maintaining healthy habits. One tip could be scheduling the workouts and meal prep time for the day or week when most active. For example, knowing that after work or school, the body can’t take a workout and needs to crash at the end of the day, set up the exercise for the morning or afternoon. And once the workouts become a routine, energy levels will improve, allowing for more activity.
References
Bervoets, Diederik C et al. “Massage therapy has short-term benefits for people with common musculoskeletal disorders compared to no treatment: a systematic review.” Journal of physiotherapy vol. 61,3 (2015): 106-16. doi:10.1016/j.jphys.2015.05.018
Field, Tiffany. “Massage therapy research review.” Complementary therapies in clinical practice vol. 24 (2016): 19-31. doi:10.1016/j.ctcp.2016.04.005
Furlan, Andrea D et al. “Massage for low-back pain.” The Cochrane database of systematic reviews,9 CD001929. 1 Sep. 2015, doi:10.1002/14651858.CD001929.pub3
Qaseem, Amir et al. “Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians.” Annals of internal medicine vol. 166,7 (2017): 514-530. doi:10.7326/M16-2367
A sports hernia is a soft tissue injury that happens in and around the groin area. It is a strain or tear of any soft-tissue muscles, tendons, or ligaments in the lower abdomen or groin area. It usually happens during physical sports activities that require fast, quick, sudden changes of direction and/or intense twisting movements. Despite its name, a sports hernia is not a hernia in the classic sense. The condition’s proper term is athletic pubalgia. However, a sports hernia can lead to an abdominal hernia. The condition can happen to both men and women.
Contents
Anatomy
The soft tissues most affected by sports hernias are the oblique muscles in the lower abdomen, along with the tendons that attach the oblique muscles to the pubic bone, are the most at risk. In many cases, the tendons that attach the thigh muscles to the pubic bone or adductors are also stretched or torn.
Core Muscle Injury
A core muscle injury is when the deep layers of the abdominal wall weaken or tear. This can cause nerve irritation and contribute to uncomfortable symptoms of numbness or tingling. The most common causes include:
Planting the feet and turning or twisting with maximum force.
Constant repetitive hip and pelvic twisting motions.
Imbalances between the hip and abdominal muscles can also, over time, cause overuse injuries.
Weakness in the abdominals and improper or no conditioning can also contribute to injuries.
Chronic groin pain is the primary symptom of a core muscle injury.
Sharp groin pain with exertion.
Basic movements like sitting down or getting out of bed can also present with pain or discomfort.
Pain on one side of the groin.
Pain or numbness that radiates into the inner thigh.
Pain when coughing or sneezing.
Tenderness or pressure on the lower abdominal area.
Pain decreases with rest.
Diagnosis
A doctor will discuss symptoms and how the injury occurred. They will run a series of strength tests like a sit-up or trunk flex against resistance. If it is a sports hernia, there will be tenderness in the groin or above the pubis, along with discomfort and pain. Further tests will include MRI, ultrasound, or X-rays to rule out hip, low back, or pelvis injuries to confirm a core muscle injury.
Non-Surgical Treatment
Rest
In the first 7 to 10 days after the injury resting and icing the area is recommended.
If there is a bulge in the groin, compression or a wrap can help relieve symptoms.
Chiropractic and Physical therapy
Two weeks after the injury, chiropractic adjustments and physical therapy exercises are recommended to improve strength and flexibility in the abdominal and inner thigh muscles.
For most cases, 4 to 6 weeks of chiropractic and physical therapy will resolve any pain and allow the individual to return to their exercise or sports activity.
Anti-inflammatory Medications
A doctor could recommend non-steroidal anti-inflammatory medications to reduce swelling and pain.
If the symptoms persist over a prolonged period, a doctor may suggest a cortisone injection.
If the pain comes back when resuming the physical activities, surgery could be needed to repair the torn tissues.
Surgical Treatment
Repairing the torn tissues can be done with a traditional open procedure that involves one long incision or a minimally invasive endoscopic procedure. In an endoscopy, the surgeon makes smaller incisions and uses a small camera, called an endoscope, to see inside the abdomen. The results of traditional and endoscopic procedures are the same. Most individuals can return to sports and physical activities 6 to 12 weeks after surgery.
Body Composition
Muscle Gain
Individuals can’t lose fat forever. At some point, they need to work on developing muscle or work to preserve the muscle that is already present. This requires a different diet and exercise plan than one designed for fat loss. Instead of getting the body into a catabolic state, the body needs to be in an anabolic state where the body builds tissue instead of breaking it down. To build muscle, the body needs resources meaning proper nutrition and sufficient protein intake to increase muscle mass. Maintaining an energy surplus of around 15% is appropriate for developing musculature, meaning a moderately active individual with a BMR of 1,600 calories would want to their intake to about 2,852 calories a day.
References
Hoffman, Jay R et al. “Effect of protein intake on strength, body composition and endocrine changes in strength/power athletes.” Journal of the International Society of Sports Nutrition vol. 3,2 12-8. 13 Dec. 2006, doi:10.1186/1550-2783-3-2-12
Larson, Christopher M. “Sports hernia/athletic pubalgia: evaluation and management.” Sports health vol. 6,2 (2014): 139-44. doi:10.1177/1941738114523557
Poor, Alexander E et al. “Core Muscle Injuries in Athletes.” Current sports medicine reports vol. 17,2 (2018): 54-58. doi:10.1249/JSR.0000000000000453
Thorborg, Kristian et al. “Clinical Examination, Diagnostic Imaging, and Testing of Athletes With Groin Pain: An Evidence-Based Approach to Effective Management.” The Journal of orthopedic and sports physical therapy vol. 48,4 (2018): 239-249. doi:10.2519/jospt.2018.7850
Tyler, Timothy F et al. “Groin injuries in sports medicine.” Sports health vol. 2,3 (2010): 231-6. doi:10.1177/1941738110366820
Any job-related back injury can significantly complicate an individual’s life. Dealing with the pain, trying to figure out how to get things done while in recovery, and workers’ compensation to protect individuals who are injured on the job, getting them healthy without the stress of worrying about losing money from missing work.
Contents
Job-Related Injury
According to the Occupational Safety and Health Administration or O.S.H.A., a job-related injury is one that either contributed to or is caused by something in the work environment that injures an individual or exacerbates/worsens a previous injury. This is a general overview of the definition, and there are some exceptions. For example, being at the place of work as a general public citizen and not working when an injury happens will not be covered. If not sure whether a back injury is job-related, it’s better to be cautious and report the incident as soon as it happens.
Common Back Injuries
Back injuries are the most common job-related injuries. Back injuries are the number one reason individuals cannot work, whether they hurt their back at home or on the job. The Bureau of Labor Statistics found that nearly 40% of all musculoskeletal injuries that resulted in lost workdays were because of back injuries. The most common back injuries include:
Every state’s workers’ compensation program is different; however, the basic components are the same throughout. This means that if a workers’ compensation claim is approved and an individual cannot work because of their injury, they can expect to receive a regular base salary during treatment, rehabilitation, and recovery. Individuals also continue to receive medical coverage through the company, while the workers’ compensation fund should pay for treatment and diagnostics related to the injury.
When A Back Injury Occurs at Work
When a back happens at work, inform the employer as soon as possible. Do not be embarrassed or feel as if it is not a big deal to seek workers’ compensation. It is an insurance program for both the individual and the employer. An employer pays into the state’s workers’ compensation program for limited liability when employees get injured. Individuals don’t pay for the program, but it protects the individual in case something happens.
Letting an injury go untreated might not be anything at first, but months and years later, it can come back and be worse than when it first happened, causing greater damage, added medical costs, and procedures that the individual has to pay for out of pocket.
Once an individual knows they have a back injury, it is recommended to seek treatment as soon as possible to prevent worsening the injury or create new ones and develop a treatment, rehabilitation, and strengthening program. If an individual needs emergency care, tell the doctors about the work injury and precisely what happened. Emergency medical care should be sought out when:
There is a loss of function in any of the limbs.
There is a persistent numbness with the back pain.
There is nausea, dizziness, or vomiting after the injury.
There is a fever with back pain.
Loss of consciousness.
Loss of bowel or bladder control.
If the injury is not immediate and progresses gradually, but suspect that it is from work, it should be reported and examined by a medical professional.
Treatment
Proper treatment for a back injury depends on the severity of the injury. Those who prefer non-invasive, medication-free treatment are able to recover with chiropractic or physical therapy. Chiropractic doctors are experts in the spine and the musculoskeletal system. Chiropractic treatment is safe, and proven, and can help relieve pain, restore function, to get back to work safely.
Body Composition
Resistance Exercise
Resistance workouts are made to stress the muscles resulting in muscle gain. Resistance exercise makes the body adapt by growing the muscles to make them more capable of handling intense forces without strain. The stress of resistance exercise causes the muscle fibers to tear at the cellular level. Then, special muscle cells, known as satellite cells, jump into action to repair, rebuild, and grow the muscle. These types of exercises include high-intensity workouts or compound exercises that increase muscle growth. However, there needs to be a healthy balance between workouts and rest to support healthy hormone levels and maximize muscle gain.
Hormones
There are three primary hormones that stimulate muscle hypertrophy. They are:
Insulin-like growth factor 1 IGF-1
Growth hormone GH
Testosterone
Muscle protein synthesis is a critical process in muscle hypertrophy and happens after weight training. The hormones signal to the muscle to repair and rebuild after workout sessions. GH is released in high quantities during sleep, which is why proper sleep is needed to help reach body composition goals. When nutrition, workouts, and hormonal effects are combined, muscle-building happens. Figuring out the right balance is essential for reaching health goals.
References
Burton, A K, and E Erg. “Back injury and work loss. Biomechanical and psychosocial influences.” Spine vol. 22,21 (1997): 2575-80. doi:10.1097/00007632-199711010-00021
Taking it slow after spinal surgery is recommended to optimize a full recovery. What usually happens is that an individual starts feeling normal/better, so they begin to engage in a few daily activities. Then pain presents, letting the individual know that they have done too much too soon. The pain does not necessarily signal re-injuring the area, but recovery should be treated seriously. More than 50% of patients have successful spine surgery, but repeat surgeries do not tend to be quite as effective. Doing too much too early during recovery can result in severe re-injury or creating new injuries. So when can an individual get back to everyday life?
Contents
Surgery Recovery
Recovery after back surgery is different for everyone. Low back lumbar fusion surgeries usually require more recovery time than lumbar non-fusion surgeries, like:
Laminectomy – when the lamina portion of a vertebra is removed.
Microdiscectomy – the removal of abnormal disc material
Cervical spine surgeries.
Individuals who have undergone a procedure where two or more vertebrae have been surgically fused should expect a longer recovery. A typical timeline for lumbar fusion usually involves around three months. What happens is individuals want to get up and move, doing household activities almost immediately because they feel so good, but this is because of the pain medications. Strong pain medication use ends by four to six weeks. It is not until after 12 weeks or three months with post-operative chiropractic rehabilitation and physical therapy that individuals are encouraged to engage in specific physical activities that will optimize the healing process.
Taking It Slow With Certain Activities
Specific activities should not be engaged in after lumbar fusion surgery, as it requires a higher level of caution during recovery.
No Bending, Lifting, and Twisting
Bending, lifting, and twisting all require the direct use of the back muscles. Performing these movements can cause serious damage and hinder proper healing. Therefore it is recommended not to bend, lift, or twist for six weeks.
No Taking Baths or Swimming
Taking showers can be done right away with protective plastic or a sponge bath for a few days after surgery, but it is advised not to take baths or go swimming for three weeks.
No Cardiovascular Exercise
While the back may be feeling better after the spine surgery, cardiovascular exercise is not recommended for at least six to 12 weeks as it is too strenuous on the back. Light walking is fine, but the doctor and a chiropractor and physical therapist will develop a controlled, progressive exercise program for the individual. The program usually starts between 6 weeks and three months after surgery. This can include working out on an elliptical machine, a stationary bike, or easy treadmill walking.
Listening to The Body
The doctor will be clear about what can and can’t be done immediately following back surgery. Therefore it is crucial to follow the instructions to avoid any complications and listen to the body. Don’t push through activity or try taking on too much. Give the body and spine time to heal, taking it slow. There is time to get back to normal activities, but if re-injury or new injuries occur, rehabilitation/recovery could become the regular activity.
Body Composition
Malnutrition
Malnutrition is defined as deficiencies, excesses, or imbalances in an individual’s energy intake and/or nutrients. Protein-energy deficiency is one of the most common forms of malnutrition, and this health condition has an immediate and negative impact on body composition. The deficit wreaks havoc on skeletal muscle mass as the body progressively goes into starvation mode, breaking down the protein stored in the muscle for fuel.
Micronutrient deficiency is a lack of minerals and vitamins that support vital bodily processes like cell regeneration, immune system health, and eyesight. Common examples include iron or calcium deficiencies. Micronutrient deficiency has the most significant impact on normal physiological functions, processes and can happen in conjunction with a lack of protein-energy. This is because most micronutrients are obtained from food. Nutritional deficiencies of specific micronutrients can affect processes like building and repairing muscle; protein deficiency has a more pronounced effect on body composition because lowered protein intake can lead to muscle mass loss. Malnutrition and nutritional deficiencies in adults include:
Physical function, including handgrip strength and physical performance, diminishes.
Serious medical conditions can result from fluid accumulation like edema.
References
Daniell, James R, and Orso L Osti. “Failed Back Surgery Syndrome: A Review Article.” Asian spine journal vol. 12,2 (2018): 372-379. doi:10.4184/asj.2018.12.2.372
Kinesthesia is the body’s ability to sense movement, position, action, and location, also known as proprioception. An example is when moving the arm, the brain and body are aware that the arm has moved. When dealing with chronic back pain, individuals are unable to function normally with regular everyday movements causing discomfort.
Chronic back pain can make an individual feel like a stranger in their body, altering their perception. Tension develops throughout the body due to the pain, causing tightness and positional adaptations that are unfamiliar, awkward, and unhealthy for the musculoskeletal system. These body positioning changes continue while the individual is unaware of what they are doing, causing further strain and injury.
Contents
Kinesthesia
Kinesthesia is essential for overall coordination, balance, and posture as long as the movements are done correctly with proper form. Chronic back pain can affect kinesthesia differently. Individuals can misjudge and estimate that their bodies’ ability to lift, carry, or open something is more complicated or easier than it is. This can exceed the body’s tolerances, causing:
Strains
Sprains
Severe injuries
Once the back starts to hurt, this causes the individual’s sense of kinesthesia to compensate for the pain. As a result, individuals may knowingly or unknowingly attempt to carry out uncoordinated, awkward movements and positions, making things worse.
Motor Control
Motor control is the ability to control movement. When experiencing back pain, individuals adjust their motor control to avoid specific movements that cause back pain. Motor control adaptations and kinesthesia involve body positioning and heightened responsiveness to stimuli, like muscle spasms. Even moderate back pain can cause awkward and dangerous responses causing individuals to overcompensate or become too cautious, worsening or creating new injuries in the process. The body is performing movements that do not follow proper form, even though an individual thinks they are protecting themselves.
Building Healthy Proprioception
A recommended strategy for building kinesthesia to benefit the back and the rest of the body is yoga. Yoga helps build bodily sensory awareness. It trains the body when sending significant signals from the muscles, joints, and tendons back to the proprioceptive centers in the brain. This happens immediately and increases over time.
Yoga Poses
Creating positive awareness of the body’s movements will help relieve back pain as the body learns to feel, understand, and control the muscles. Here are a few poses to help, along with video links.
Body awareness is critical, but if an individual moves in a way that’s not natural to the body, it can cause injury. Kinesthesia and healthy posture can help avoid back pain and other health issues. A professional chiropractor can alleviate back pain, educate on proper form and recommend specific stretches and exercises to strengthen the body to prevent injury.
Body Composition
Magnesium
Magnesium supports a healthy immune system. It helps maintain:
Healthy bone structure
Muscle function
Insulin levels
Magnesium assists the body with ATP energy metabolism and acts as a calcium blocker. This reduces cramping and aids in muscle relaxation after physical activity/exercise. Magnesium is essential in biochemical reactions in the body. A slight deficiency can lead to an increased risk of cardiovascular disease and a higher risk of insulin resistance. Many magnesium-rich foods are high in fiber, like:
Studies have shown that consuming a diet rich in Magnesium also provides a higher intake of dietary fiber. Dietary fiber aids in:
Digestion
Helps control weight
Reduces cholesterol
Stabilizes blood sugar
The best sources of Magnesium include:
Spinach, swiss chard, and turnip greens
Almonds and cashews
Flax, pumpkin, and chia seeds
Cocoa
References
Meier, Michael Lukas et al. “Low Back Pain: The Potential Contribution of Supraspinal Motor Control and Proprioception.” The Neuroscientist: a review journal bringing neurobiology, neurology and psychiatry vol. 25,6 (2019): 583-596. doi:10.1177/1073858418809074
Tong, Matthew Hoyan et al. “Is There a Relationship Between Lumbar Proprioception and Low Back Pain? A Systematic Review With Meta-Analysis.” Archives of physical medicine and rehabilitation vol. 98,1 (2017): 120-136.e2. doi:10.1016/j.apmr.2016.05.016
Wang, Jinsong, et al. “Dietary magnesium intake improves insulin resistance among non-diabetic individuals with metabolic syndrome participating in a dietary trial.” Nutrients vol. 5,10 3910-9. 27 Sep. 2013, doi:10.3390/nu5103910
In today’s podcast, Dr. Alex Jimenez DC, Health Coaches Adriana Caceres and Faith Arciniega, Massage Therapist Amparo Armendáriz-Pérez, and Clinical Nutritionist Ana Paola Rodriguez Arciniega discuss today what they do and offer with Functional Medicine.
Discussion
Dr. Alex Jimenez introduces his guests.
[01:00:11] Dr. Alex Jimenez DC*: Welcome, guys. We’re here talking today about what we do. Today is a special day. It’s my father’s birthday, Alberto Jimenez. Alberto Augusto Jimenez. He is an immigrant from Colombia who gave me my knowledge. My amazing father. So happy birthday, dad. We’re going to be talking today is we’re going to be talking about what we do. We have a group of wonderful individuals here. We have five individuals. We have a whole lot more people in the background. So what we’re doing today is we’re beginning a process of notifying ourselves of a change that is going on. We’re going to be talking about nutrition, wellness, exercise, what we do in the office, how we do a little bit different techniques within the office, and how we compare and contrast to other services and let people understand what we do as we do change. So today, we’re in a new podcast room where we left the Push Fitness Center, which is now going to be another big, fantastic thing. So as they do the construction, we moved our podcast here. So you’re going to notice that we’re going to be communicating from this particular podcast. Still, we’re so connected to our Push counterparts and our Push Fitness centers and Daniel Alvarado, and we’ll be making that happen as it starts coming up. So today, we’re going to be talking about nutrition. I have Ana Paola Rodriguiez Arciniega here, so say hello there. We have Faith Arciniega. We have Adriana Caceres, and we have Amparo Armendáriz-Pérez as a massage therapist there. So we are going to be talking about different things. So each one of us has different specialties. So I’m going to start with some of the unique things we’re doing in our office, such as the types of treatments we do. We deal with a lot of inflammation, many injuries, a lot of trauma, and many soft tissue injuries. But you can’t get away from soft tissue injuries without discussing inflammation. So at the basis of inflammation, what we do is we associate, collaborate, find out the coincidence of inflammation to injuries, and we deal with the true causation of inflammation and come up with treating protocols and health care plans that affect people and their disorders. So many people come to us with a back injury or a neck injury after, let’s say, a motor vehicle accident, a car accident, or a work-related accident. But they may also have, you know, subclinical issues of inflammation that are just looming and then aggravate the direct trauma that’s going on. So what we’re going to do is introduce our team here one at a time so we can see what’s going on. And we’re going to start with Ana Paola Rodriguez Arciniega. Ana, how are you doing?
[01:02:57] Ana Paola: I am doing fine, and how are you doing?
[01:03:00] Dr. Alex Jimenez DC*: Good, can you hear us OK over there?
[01:03:02] Ana Paola: Yes, I can hear you, OK.
[01:03:04] Dr. Alex Jimenez DC*: Excellent. Tell us a bit of what you do, and we actually because you work hand-in-hand with us all here, and you are our virtual eye in the sky for nutrition at this point. But the nutrition that you deal with works a little bit with functional medicine. Tell us what you do and how we integrate that particular type of practice in our office.
Ana Paola Rodriguez Arciniega
Clinical Nutritionist Ana Paola Rodriguez Arciniega introduces herself and talks about what she does.
[01:03:23] Ana Paola: OK, so I am the head nutritionist, and basically, what I do is I take care of their nutritional assessment. But as you said before, we try to look for the root causes, and this allows us to create a more integral treatment plan for our patients, so that is focusing a little bit more on finding what is the root cause of the inflammation because it is related to injuries, accident, and stress, and to maybe delay the recovery part of our patients. So this is what we are trying to do to get like a fast track recovery for our patients for nutrition because it has to do with that.
[01:04:09] Dr. Alex Jimenez DC*: Yes. And then? Don’t worry.
[01:04:17] Ana Paola: OK, I’m here.
[01:04:18] Dr. Alex Jimenez DC*: It’s all technology. Just keep on going and telling me. We’ll figure it out as we go.
[01:04:22] Ana Paola: So what we always start doing is very simple. I try to focus on what is going on with my patient physically, which has a lot to do with the body composition of my patient. So I find that that is the principle, not the principle, but the first step could do it that way. So we try to integrate this body composition analysis with the Inbody 770 machine that we use. And that way, we can correlate all the body composition, either a fat mass percentage or BMI or muscle mass or lean body mass, that our patient has and try to associate with injuries or correlated with inflammation. And it is often, very often, or all of the time, that we find a direct correlation with inflammation or this type of injury. Specifically, talking about intracellular and extracellular water is one of the most exciting starting with my patients. But the thing about nutritional assessment is that even if it’s like separated into different parts, it kind of overlaps within each other, and that is like the thing that has in common with functional medicine, functional nutrition, then trying to treat your patient as a holistic, like a whole person and try to integrate the nutritional part of it, the fast recovery of an injury, the massage therapist and of course, all the wellness part of their recovery that has to do with our health coaches. So mostly, what I think that I do right here is that I perform for that. I am part of a team that integrates like a holistic care plan for patients.
Adriana Caceres
Health Coach Adriana Caceres introduces herself and explains what she does.
[01:06:28] Dr. Alex Jimenez DC*: Well said. That is very, very good. I have to tell you there is no separating inflammation, nutrition, and injuries that there’s no way. So as we deal with it, we can learn about it. It’s almost like saying exercising and not talking nutrition. We have to deal with nutritional components. Now, specifically that we are talking about exercise. Adrianna, here, she’s our specialist and our expert on exercise physiology. She works with nutrition. She has extensive experience of working with clients online and in video as well as in your home. So she gets in there and exercises with you as she does her thing. Adriana, tell us a bit of your experience and what you do and what you offer these particular dynamics with our team here.
[01:07:14] Adriana Caceres: Sure. Well, my name is Adriana Caceres, and I’m your health coach, fitness trainer, and of course, exercise specialist. And as Ana was saying, nutrition and exercise go hand in hand. Nutrition is the base, but exercise gives you the mobility and gives you that range of mobility that you need to live a proper and, well, life until you know when you age. So definitely, it’s the base for a lot of recovery for injuries. The stretching is super important, and we use that a lot here to stretch our patients and make them do their small stretching so they can grow their range of mobility and have a better life in their daily life, their daily style. Right now, I work online a lot. So since COVID started, we started working out online with our patients and clients, and it’s different. But at the same time is super fun. The difference between going to an in-person exercise session and doing an online session is that you don’t have the time. We always hear excuses like; I can’t make it. I don’t have the time. I’m too busy. I know that I’m in pain, but I just think it’s too far. So the online cuts all those excuses. I mean, you’re doing that from the comfort of your home. You are just opening your TV or your computer, laptop, or tablet and connecting to a session. It’s on your time. So that helps a lot. The second excuse we always hear is if we are parents who watch our kids, what will I do? There’s no daycare, and this is just the same thing. It’s at your home, so you can even involve your family in this new and different lifestyle. Usually, when we have somebody who is overweight, it is a family. It’s the household. Because of course, it’s the same poor nutrition that they have or bad nutrition that they have and the same habits. So starting with the workouts online helps you realize, or your household realize that it’s a group thing, it’s a whole lifestyle, and you want to be the role model for your kids. You always want the best for your kids, so you want to be the role model for them. Normally they will. If you’re overweight or have a little extra pounds on, your kids usually will have the same habits. And of course, we’ll tend to be with the same kind of overweight that you have. So this helps them see a life change experience and get involved in this new experience.
[01:10:12] Dr. Alex Jimenez DC*: You know, now that you mention that, you know, it’s essential to be the change that you expect in the world. I think Gandhi or something that says, might that be the change you want to see? Right. So the thing is, when you go purchase foods or exercise in front of your kids and see what you do, this is who they will become and what do we want for our children? We want the best. Our legacy is our family sometimes or our friends. And when you have family, they’re watching you. They learn they observe and appreciate mom, you know, wiggling around the living room and dealing with it. Everyone’s got memories of their parents exercising or doing something. And then, you know what happens, later on, we end up becoming our parents? Right. So if we have good habits, we eventually will become habits. I have become my father, and it’s the truth. The reality is in my son, and I listen to him. He doesn’t realize it, but he says everything I used to say. So it’s a continuous change. So if you’ve got nutrition and exercise, which seems to be one of the most extraordinary kinds of collaborative associative and treatment protocols, you can’t separate exercise from recovery. So Parkinson’s… exercise, Alzheimer’s… exercise, diabetes… exercise, brain disorder… exercise, health issues… exercise is such an essential component of fitness that by not doing it and not being part of it, you’re going to minimize the ability to return to an optimal configuration. Now, whether you like it or not, exercising mobility is one of the most important key factors. I realize that when you start working on so many patients over the years, you kind of start kind of seeing the intent of God. Right. So the intent of God is mobility, and he gives you tons of joints. I mean, why does he give you so many joints so we can wiggle, OK? To move, right? So using that and integrating the brain and the function of the brain with your body moving and pumping, and blood does heal a lot of issues and should be part of most treatment protocols. Even if exercise doesn’t look like, let’s say, a Zumba class, maybe it’s just wiggling around in a chair or doing certain things. We can do it for a lot of people. People think that I’ve seen from, you know, a nine-month literally about to have a baby, women doing CrossFit, and the baby is born fine. The body is designed to handle certain things too. Older adults about 100 years old, exercising. And children, they love to exercise. So it’s an essential component. So yes, that is what you do, Adriana, and we integrate that in the office, and we look or minimize the excuses to do that, so that’s very important. So do you also do nutrition a little bit?
[01:13:06] Adriana Caceres: Yes, I do. I’m a nutrition consultant, so I do help a lot with that part. As I said, it goes hand in hand, definitely to have a higher health span. You want to have a healthy habit, so one thing is lifespan, and one thing is healthspan, and lifespan comes out of years we’re going to live. Yes, eventually, we’ll die, and then our health span is how we want to live them. Are we going to leave them healthy our last ten years? Are we going to be able to walk? Are we going to able to say, are we going to be able to get out of a bathtub? So that’s what you want to have, and that’s what we don’t think about when we say, Oh, you know what? I know what I’m doing, and I don’t think exercising is for me. Everybody has a fitness level, and everybody has a way. And the trick for this is to find what you want to do. And what we do here is a lot of that we build up people and save injury, save from injuries and, you know, prolong their life and prolong how they live, their life, their daily activities.
Amparo Armendáriz-Pérez
Massage Therapist Amparo Armendáriz-Pérez introduces herself and talks about what she does.
[01:14:15] Dr. Alex Jimenez DC*: You know, it’s excellent that approach. Now we also have a young lady named Amparo Armendáriz-Pérez. So for Amparo, she does our massage. And what she does is she works on individuals with a deep level of knowledge of fitness. Now, she comes to us with a vast amount of personal experience working with people and her desire for health care. So I would like her to tell us. Welcome. And tell us about what you do in terms of massage as a component within this group.
[01:14:55] Amparo Armendáriz-Pérez: Thank you. Being here as a part of this family, this community of servers, because that’s what we do. We serve those that come to us. We’re all about education. So we’re listening to, you know, nutritional education, physical education on how to help them to make better choices for themselves. What I do is I discuss with our patients what I’m going to do for them, what’s happening as I put my hands on their muscles. What I feel, and they even ask me questions, Well, what is that? Why do I feel so restricted? What’s happening? So I enjoy helping them understand their own body with all my heart because they’re in their own body. We exist in our body, and we know we have hands and feet and all these components. But sometimes, when they’re not operating correctly, we don’t know why, and that’s very frustrating. And so, I enjoy discussing with the patients. OK, well, this is what I’m feeling, and how do you feel as I’m, you know, applying pressure here as we’re moving and grooving here? And the feedback is what helps them to accelerate. They want to learn more. They want to know; well, what else can I do? You know, when I go home, how do I prolong this feeling of feeling like I’m standing up straight now? Like I feel more empowered? You know, I didn’t realize my feet felt that way. I didn’t know my arm felt that way. And I understand where they’re coming from because massage therapy was one of my avenues of healing when I went through a healing process. So it’s just a fantastic tool to reach out to the patients and allow them to know that this is another way that we support them is not just OK; we’re going to do this one two three. No, it goes further than that. These are your muscles, and this is how you can assist yourself, and this is what we’re going to do for you. And you can take it a step further and understand that you have the power to help these muscles become more pliable through nutrition, exercise, movement, and anyway, shape or form. And you can put your hand on yourself and feel like, you know, that’s tight today. I think I can kind of touch that a little and massage that, and you don’t need a license to touch your arm. And I think that that’s what’s beautiful about what we do. We empower our patients, and that’s important.
[01:17:16] Dr. Alex Jimenez DC*: You know, when you were saying that in your approach, because I see that when you work on the patients, sometimes there are areas in the body that hurt. However, the human dynamics is that the body was designed with duality, such as one muscle affects another. The tricep, you know, pushes the bicep disengages. There’s a constant synergy with the muscular structure. Sometimes the pain or discomfort in those areas is remote or not, even in the area where you had, you know, you were initially told where the person’s issues were. Tell us a bit of that, Amparo. How you kind of tracked down the discomfort in, let’s say, an area over a problem that you’ve treated in the past.
[01:18:07] Amparo Armendáriz-Pérez: One of the most common areas I’ve experienced with many patients is when they discuss low back pain or sometimes even sciatic pain. And they tell me, you know, this is restricting me from sitting up straight. It’s restricting me from just going in the grocery store and walking to and from and not having to feel like I need to sit. And so, OK, I understand. And then they get on the table, and as I’m working on their back, I’m listening to what they’re saying. I also married together, what my hands are saying, and basically, my hands are just interpreting what their muscles are saying because sometimes, we can say something. I know in and out ourselves, OK, I feel this pain right here. However, the muscle is saying, well, something else is happening, and it’s extending, so they’ll tell me my pain is in the lower back while I follow the connection from that low back. And as I’m feeling alongside the side of their leg, I feel how tight it is, and it’s like, that’s got to be very restrictive down to the knee. And I’m like, OK, so let’s release that. And then as I’m working on that, it’s very powerful to hear the patient say, Wow, I can feel that, but you’re on my knee, and I’m like, It all goes together because the knee attachments go straight into the low back or into the hip area. And it was beautiful. Is that when they love to, everybody loves to learn about themselves? Why wouldn’t you want to know about yourself? It helps you become a better you. And so when I love to explain that to them, they’re like, Wow, so if I do this, I can feel better doing this. Absolutely. You know, ma’am or sir, right in here is where I’m touching. I’m massaging, and I’m applying compressions. It’s straightforward. It’s even over your clothes. I’m just playing some pressure right there, gently releasing, and they’re like, Wow, the movement is a lot better. And it’s interesting that just to the right around the knee, in the back and the front even, and it helps to release that low back pain.
[01:20:05] Dr. Alex Jimenez DC*: You know, you mentioned just like the referral pain patterns, it’s incredible. How the body adapts is like that gecko, you know, when it’s hot and lifts its left leg and throws up on a different leg; that’s what the human body works. So if you have a lower back problem, it will affect the mid-back. It will affect your knees. The knees and lower back are directly and indirectly related. So as we look at those dynamic changes. One of the things we look at as we track down the problem. OK, it’s not just so easy to treat a low back problem for what it is. We have to find out the problem for every person and every person’s design, and we can track it down quickly after a couple of minutes of working in your body. We got the suspect in, and it’s not so apparent many times that it’s just a low back problem. You mentioned sciatica. Sciatica is one of these things where it isn’t a disorder. It’s a group of syndrome disorders that creates a lot of drama, and it almost has its mind. It’s like, it’s like you’ve got stress or sciatica flares up. You got, you know, you get upset about financial worries, sciatica flares up. It’s like it sits there looming, and it bites you, and it causes a whole array of problems and hinders a lot of people, which we don’t want to do surgically. And sometimes, there are issues where it does require surgical intervention. We have diagnostic procedures to determine the differences over a thousand reasons, and I would venture to say there are even more than a thousand reasons for causing sciatica. So we got to get to the root cause of it. And does nutrition play? Yes. Will exercise play? Yes, we have to look at all these components. Now we have another individual here, that is Faith Arciniega. So Faith comes to us with a lot of great experiences. She’s going to be an incredible doctor, nurse practitioner. That’s the goal right now. She’s in the process of going through that, but she also does our health coach integration. So she does many different things from, you know, body compositions, as Ana mentioned, all the way to in laboratory tests and X-rays are integrated with Ana. So we facilitate the ability to communicate the issues, treat the problems, and develop an appropriate care plan. So Faith, tell us a bit of what you do here in this particular group of people?
Faith Arciniega
Health Coach Faith Arciniega introduces herself and explains what she does.
[01:22:27] Faith Arciniega: Absolutely. So as Dr. Jimenez mentioned, my name is Faith Arciniega. I bridged the gap between Ana and Adriana, and Amparo. We all work very closely together to ensure the patients leave here to understand better how their bodies should operate and function. So if the doctor goes in and finds out they’re having issues with their sciatica, I will go in before that gather together their medical history, see what’s going on, and see if they have problems with the gut. Depression, anxiety. And then, I would then communicate with Ana about those issues, and we can work together to find supplements or with the correct diet for them. So I work together with Ana and Adriana to ensure that the patient leads healthier and better understands their body because a car wouldn’t operate correctly. If we fill it with water, the human body will not function if we don’t fuel it correctly, so we teach them. How they should eat, what supplements they should take, and how they should exercise so that they’re moving and operating as they should be like the body was created to.
[01:23:26] Dr. Alex Jimenez DC*: You know, as like you, as you kind of work with patients, we mean right before we have this little unified meeting together. We noticed that we had a patient that had, you know, chronic inflammation and pain everywhere. And it’s crazy. But you know, the problem comes as a low back problem and leads to ankle issues. But we could see that there was a dietary issue, and it was almost like inflammation. No injury; keeps on inflaming. Then we find out that there’s a lot of sugar, many processed foods, a lot of meat. Well, to say that those are bad, it’s not just that easy, but we have to figure out the cause for that particular individual. We assess food sensitivities, and we do laboratory diagnostics. We figure out what it is the root cause. Not everything is a surgical procedure; as a matter of fact, most things are non-surgical. So what we try to do is is allow the intelligence of the body wants to figure it out, using the knowledge that we have and the expertise that we have in functional wellness and functional nutrition to be able to come up with a treatment plan that’s appropriate with exercise and the protocols that we use. So we have a lot going on here. So we wanted to do this as a beginning because we will be doing quite a few different presentations. But as we do changes, we haven’t been communicating well. So now what we’re going to be doing is we’re going to be coming back at different presentations, discussing particular topics. If you have a specific topic that you want us to discuss, particularly about an injury, inflammation, and a disorder that falls into the world of functional wellness and even functional medicine, we commonly associate and look for corporations related to the musculoskeletal system. So what we want to do is to be able to assess and determine the true causes because once we fix you, we want to improve you, right? We want to give you the tools to go on and live an extraordinary life because everyone here knows that I touted as much as possible. And man, if we’re designed to live 100 years and probably more, according to even the statisticians out there, if you take care of everything, the heart will continue to pump years after it’s removed from the body. So our body doesn’t get clogged with some atherosclerotic plaques or inflammatory disorders or some diseases or cancers; if we can keep it healthy, we will live a good life. God willing, God wants you to take you now. OK, so we all know that. So the focus of today was to present a little bit of a review. So Ana, thank you very much for helping us out. You know, a little bit of information there. You know, Faith, you’re out there. You’ve got the calm, soothing voice, and she’s cool with her voice there; you’ve got Amparo, which is our therapist that finds and tracks down. We got everyone here. We have many massage therapists that track down the issues. She’s just the one that has been able to formulate the ability to communicate the intention of the human body, which is and also the results, and that takes years to do. You can’t just go ahead and present yourself. Doctors worldwide will tell you a doctor that graduates, whether it’s in any clinical practice on his first day, is not the same doctor ten years later. And they’re like wine. They get better each time, and most of the time, you’ll find that doctors, the wiser they become, the more they rely on the wisdom of the body to manipulate and facilitate the healing process. So for Adriana, she’s our exercise, and she’ll have you dancing and doing the Zumba and seeing, you know, what’s best for you. And by the way, if you feel ugly that day, you can put the screen off, so you don’t have to be showing your body. You just know that she’s there, and you just tell her you’re doing the exercise. It’s pretty funny. Someone probably has the video off and is sitting there, you know, eating something. Yeah, I’m exercising, but we do have tools for that, like a cardio thing. They’ll tell us what your heart rate’s at; we will know if you are fibbing, but it doesn’t happen anyway. But anyway, it was a tremendous little connection today. It was the first, and we looked forward to more. Thank you, guys. Thank you very much, and does anyone have anything else to say. Faith, anything good, anything you want to add.
Conclusion
Dr. Alex Jimenez and crew recap on Functional Medicine.
[01:27:40] Faith Arciniega: No, just super excited for you all to come in here so that we can work together to find the best treatment plan for you. We’re all very passionate about patient care, and we’re excited to work with you.
[01:27:49] Dr. Alex Jimenez DC*: All right, Amparo?
[01:27:50] Amparo Armendáriz-Pérez: Just like, she said. We’re ready to help you be empowered. Understand that you are the boss of you.
[01:27:58] Dr. Alex Jimenez DC*: I’m the boss of me. I tell my wife that you know what she says all the time; you think you’re the boss of you, right?
[01:28:02] Dr. Alex Jimenez DC*: And like I’m saying, OK. Anyways.
[01:28:05] Dr. Alex Jimenez DC*: Ana, anything you have to say.
[01:28:10] Ana Paola: We’re so excited to work with all our patients, and we try to follow through and listen to all of the symptoms you’re having. So I guess that from our part, you will always have ears to follow through.
[01:28:32] Dr. Alex Jimenez DC*: Thank you so much. Adriana, anything?
[01:28:34] Adriana Caceres: Well, we are here waiting for all of you, and we have a great team, all very passionate, as you see. And we are just here waiting for you to come in, and we will help you resolve.
[01:28:47] Dr. Alex Jimenez DC*: We’re going to tear it up, guys. We’re going to tear it up. We’re going to make it. We’re going to happen. OK, so this is called Cobra Kai Chiropractic Center. OK, so if you think you’re going to come in here and just have a little talk? We’re going to get it on. We’re going to get it on with your body, and we’re going to take it to the next level. And yeah, we got to go, OK, we’re going to make the body what it should be, OK. And we’re going to release it without in pain, and it’s going to be a very comfortable dynamic. So thank you, guys, and we look forward to being connected the next one. So God bless you guys. Have a good one.
Psoriatic arthritis can develop in individuals who have psoriasis, affecting various joints, especially the knees. Psoriasis is a skin condition that causes skin cells to build up and form patches of itchy, dry skin known as plaques. Psoriatic arthritis is a long-term inflammatory disease that can cause inflammation, stiffness, and pain. Symptoms can progressively worsen over time without treatment. Early diagnosis is vital to minimize damage to the joints and slow the condition’s progress with treatment.
Contents
Psoriatic Arthritis
Psoriatic arthritis symptoms like stiffness and swelling can present differently from person to person. For example, some individuals with psoriatic knee arthritis will experience stiffness or pain in one knee, while others experience symptoms in both knees. Psoriatic arthritis in the knee can also cause swelling in the surrounding:
Ligaments
Tendons
Synovial membranes
Symptoms can also present in the:
Elbows
Feet
Hands
Symptoms
Symptoms usually begin between the ages of 30 and 50. Common symptoms include:
Stiffness after resting or sleeping.
Swelling.
Inflammation in the knee and surrounding area.
Warm or hot skin on the knee from the inflammation.
Pain in and around the joints, tendons, or ligaments.
Joint sticking, difficulty moving, or reduced range of motion.
Other symptoms include:
Back pain
Fatigue
Pain and redness in the eyes
Swollen fingers or toes
Difficulty walking from pain in the feet or Achilles tendon.
The severity of psoriasis does not determine psoriatic arthritis symptoms. Symptoms can go through a pattern of relapses and remissions. Individuals can have a sudden attack where symptoms get worse over a short time. After the flare-up, symptoms can improve as the condition goes into remission. Symptoms may not present for a long time until another flare-up. For example, an individual may have severe psoriasis but only mild psoriatic arthritis.
Causes
Psoriatic arthritis develops when the body’s immune system mistakenly attacks healthy cells and tissues. The faulty immune response causes the body to quickly generate new skin cells that stack on top of each other forming plaques. When the condition affects the joints, it leads to inflammation. While there is no apparent cause for psoriatic arthritis, researchers have found connections to genetics and the environment, as well as, individuals with close relatives that have psoriatic arthritis could be more likely to develop the condition. Other factors that could influence the development include:
Severe psoriasis
Traumatic injury/s
Obesity
Nail disease
Smoking
The condition can happen at any age, but according to the National Psoriasis Foundation, most individuals first notice symptoms about ten years after their psoriasis begins. However, only 30% of individuals with psoriasis develop psoriatic arthritis.
Diagnosis
Doctors use imaging tools to diagnose psoriatic arthritis in the knee. They will use:
MRI
X-rays
Ultrasound
To help them check for irregularities or signs of inflammation in the joint and surrounding tissues.
Additional tests are used to rule out other common forms of arthritis like rheumatoid and osteoarthritis.
Blood tests check for inflammation and specific antibodies.
In some cases, a small amount of fluid from the joint is taken to help eliminate the possibility of other underlying conditions like an infection.
Treatment
There is currently no cure for psoriatic arthritis, but treatments are being developed and show promise for long-term management. Current treatments focus on managing symptoms and improving the quality of life for the individual.
Biologics
Biologic medications like tumor necrosis factor or TNF inhibitors are recommended as the first-line therapy for most individuals with a new diagnosis of psoriatic arthritis. These meds help block TNF, which plays a crucial role in inflammation. They have shown to be effective at reducing the severity of symptoms and the frequency of flare-ups. Biologics can cause unwanted side effects, especially in individuals that experience frequent infections and need routine monitoring.
Small Molecule Medications
Individuals that cannot use biologic medications may be recommended a new class of medication called oral small molecules or OSMs. Examples include apremilast – Otezla and tofacitinib – Xeljanz.
Disease-modifying Antirheumatic Drugs
Disease-modifying antirheumatic drugs – DMARDs are a long-term option. They are used to slow the progression of psoriatic arthritis, and examples include methotrexate and cyclosporine. DMARDs work best when an individual begins taking them as early as they can take time to work. However, individuals are encouraged to continue taking them, even if symptoms do not improve right away.
Easing Inflammation
A doctor may prescribe nonsteroidal anti-inflammatory drugs – NSAIDs and corticosteroid injections when knee symptoms flare-up. These are short-term treatments that provide immediate relief, as long-term use can lead to side effects. Individuals can find relief with combined self-care that includes:
Taking over-the-counter NSAIDs like ibuprofen/Advil or naproxen/Aleve.
Applying ice and heat packs.
Gentle exercise to promote a full range of motion.
Gentle stretching or yoga can help relax tight muscles.
However, chiropractic is not the primary treatment for arthritis but is intended to be used in combination to relieve pain, loosen and stretch the muscles and balance the body.
InBody
Strength, Balance, and Improved Body Composition
Functional fitness is the ability to move comfortably every day. The benefits of physical activity also contribute to improved body composition. Working to reach a certain level of functional fitness can help the aging process that has been shown to reduce metabolic rate. Inactivity is why individuals lose Lean Body Mass as they age, leading to increased body fat. Lean Body Mass contributes to the body’s overall Basal Metabolic Rate or BMR, also known as metabolism. This is the number of calories the body needs to support essential functions. Everyone is encouraged to engage in strength training or resistance exercises, but specifically older adults. This can help regain muscle loss which can lead to an increase in lean body mass. The increase in Lean Body Mass increases BMR, which helps prevent fat gain.
References
Chang, K. L., et al. (2015). Chronic pain management: Nonpharmacological therapies for chronic pain [Abstract]. www.ncbi.nlm.nih.gov/pubmed/25970869
Chiropractic care for arthritis. (n.d.). arthritis.org/health-wellness/treatment/complementary-therapies/physical-therapies/chiropractic-care-for-arthritis
IFM's Find A Practitioner tool is the largest referral network in Functional Medicine, created to help patients locate Functional Medicine practitioners anywhere in the world. IFM Certified Practitioners are listed first in the search results, given their extensive education in Functional Medicine
