Individuals with the autoimmune disease lupus may be more sensitive to sun exposure. Are there ways to help protect the skin?
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Lupus Sun Exposure
Lupus is an autoimmune disease in which the body mistakenly attacks the joints, muscles, and skin. Around 5 million individuals worldwide, and 1.5 million in the United States, have been diagnosed with lupus. The disease is most common in early to mid-adulthood, and 90% develop in women. (Lupus Foundation of America, 2021) For some, the symptoms manifest as joint swelling or muscle soreness. Skin rashes, mottling or red or purple marbled skin, and sun sensitivity are common lupus symptoms. (Medline Plus, 2024) While exposure to UV radiation from natural and artificial light can be damaging to everyone, minimal exposures can cause a flare-up for those with chronic lupus.
Certain medications can impact individual sensitivity to the sun and UV radiation.
Sun Exposure
Lupus can increase photosensitivity or immune system reaction to the sun’s rays. This symptom affects 40% and 70% of individuals with lupus. (Lupus Foundation of America, 2021) UV radiation damages cells and alters DNA. However, the damage can be more severe in those with lupus because their cells are more sensitive, and damaged cells are removed from the body more slowly, which can cause an attack on the immune system. (Lupus Foundation of America, 2021)
Symptoms
UV light and certain artificial light sources can trigger reactions in those with lupus. These reactions can happen immediately or develop weeks later and include: (Lupus Foundation of America, 2013)
Rashes or skin lesions that appear after sun exposure can come and go within hours or days, or they can last for months. (Lupus Foundation of America, 2013) UV light can also cause a lupus flare-up of symptoms, including fatigue, joint pain, tingling, and numbness. (Lupus Foundation of America, 2021)
Protection
Protecting the skin from UV radiation is recommended for everyone, but it is especially important for individuals with photosensitivity from lupus. Some strategies to protect the skin include.
Sunscreen
Applying sunscreen to the skin provides a chemical or physical barrier to UV radiation. (MD Anderson, 2024) Most commercial sunscreens offer a combination of protection:
Physical Barriers
These include minerals like titanium dioxide or zinc oxide.
The finely ground minerals lay on top of the skin’s surface and reflect UV rays away.
Chemical Absorbers
These offer a thin, protective film that absorbs UV rays before they can penetrate the skin.
Proper sunscreen application is crucial, regardless of which type is chosen. The recommended application is to apply a palmful of sunscreen every two hours or more often if it gets wet or sweaty. Look for sunscreens that offer broad-spectrum protection against:
Ultraviolet A (UVA) rays
Ultraviolet B (UVB) rays
A sun protection factor (SPF) of at least 30 is recommended.
Most clothing offers protection against UV radiation.
Individuals can purchase clothing or hats with UV-blocking properties or washing products for their clothes to increase their level of UV protection. (American Cancer Society, 2024)
Sunglasses are also important against UV radiation, eye damage, and other problems.
Utilize Shade Areas
In the summer, the sun is strongest in most locations between 10 a.m. and 4 p.m. UV rays can pass through windows, and the body is exposed to UV radiation on cloudy days (American Cancer Society, 2024). Avoiding sunlight or other strong sources of UV radiation will help protect the skin. Staying indoors or in shaded areas is the best choice during these hours.
Seeing a Healthcare Provider
Lupus treatment varies and changes over time. Individuals with lupus schedule regular appointments with their healthcare provider to review treatment and symptoms, especially after sun exposure. Avoiding sun exposure by seeking shade and wearing sunscreen and protective clothing can help reduce the chances of experiencing a flare-up. Some cases of photosensitivity are mild, while others can require more intense treatments to avoid larger flare-ups.
Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop a personalized care plan for each patient through an integrated approach to treating injuries and chronic pain syndromes, improving flexibility, mobility, and agility programs to relieve pain and help return to normal and optimal function. If other treatments are needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments.
Can incorporating walking help accomplish health goals for individuals trying to burn fat?
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Walking To Burn Calories and Fat
Walking has many wonderful benefits that include:
Improving fitness
Strengthening bones
Easing joint pain
Improving mental health
What to know
Taking it easy at first and steadily working on the basics can help individuals reach their health goals. Two keys to burning more fat when walking are:
Walk with enough speed and intensity to burn fat for energy.
The longer you walk, the more stored fat is burned instead of the sugars for quick bursts of exercise.
While any exercise can burn calories, brisk walking and other aerobic exercises are especially recommended for burning internal abdominal visceral fat. This fat contributes to the waistline and increases the risk of diabetes and heart disease. (Bairapareddy, K. C. et al., 2018)
Fat-Burning Zone
The American Heart Association categorizes brisk walking at a pace of 2.5 miles per hour as a moderate-intensity aerobic activity. (American Heart Association, 2024) The target heart rate for exercising at this level of intensity should be 50% to 70% of an individual’s maximum heart rate. For more vigorous activities, the heart rate should be about 70% to 85% of an individual’s maximum heart rate. (American Heart Association, 2021) Working out at a low to moderate intensity can help burn fat because the body uses stored fat as fuel compared with workouts of higher intensity that depend on carbohydrates. (Carey D. G. 2009)
The heart rate range for this zone varies by age. An age heart rate zone chart can help individuals find the right numbers. While exercising, take your pulse to check your heart rate. Heart rate apps and pulse monitors have been built into activity monitors and smartwatches. While exercising in this zone, breathing is heavier, and there is a feeling of increased exertion and sweating, but individuals should be able to carry on a conversation. (Centers for Disease Control and Prevention, 2022)
Beginners should gradually build up walking time and speed.
A beginner’s walking plan starts with 15 minutes daily, five days a week, and continued improvement in walking technique.
Increase walking time by 5 minutes per session each week.
Increasing Walking Intensity
If the heart rate is still below 60% of the maximum heart rate, individuals need to intensify the workout to burn fat. Ways to do this include:
Adding Distance and Time
Make the walk longer to keep the body working harder and maintain a brisk pace. Adding additional minutes will burn additional stored fat. However, since not everyone has the time there are other options.
Picking Up The Pace
Even for a short walk, make a goal to perform faster than normal, walking faster using correct posture, arm motion, and a powerful stride. It can help to time the walking route and challenge yourself to complete it faster each time. One study looked at individuals walking 3.6 miles per hour, 4.1 mph, and 4.6 mph. Accelerating to 4.6 mph burned more than 50% more calories than going from 3.6 mph to 4.1 mph. (Schwarz, M. et al., 2006)
Adding Intervals
Intervals add intensity and also help increase the overall pace. The aforementioned strategies to walk faster incorporate intervals, where individuals increase their speed for a set distance or time, alternating with a slower pace. Research on individuals with diabetes found that those who did interval walking for four months lost six times as much weight as those who walked steadily. (Karstoft K. et al., 2013)
Adding Hills and/or Stairs
Incorporating hills or stair-climbing into some walking sessions helps you stay challenged and makes workouts more intense. If there is no access to outdoor hills or stairs, use a treadmill – start with a slight incline and work up to a steeper one, or get on a stair-stepping machine at the gym. There is no need to walk briskly on hills, as one study showed that walking slowly on an incline was an effective workout that didn’t cause knee joint stress, especially for obese individuals. (Haight, D. J. et al., 2014)
Switch Up Workouts
Mix up different walking workouts like intervals, short and fast walks, and long and moderate walks. Meditative, mindful walks also have stress-reducing benefits that help lower cortisol, which can contribute to weight gain. Individuals who can’t spend 45 continuous minutes walking make the most of the available time. Try and fit in two to four 15-minute walks at a brisk pace. It’s also recommended to include other types of moderate-intensity exercise and activities that include:
Bicycle riding on level terrain
Water aerobics
Using an elliptical trainer
Ballroom dancing
Gardening
Doubles tennis or pickleball
Challenge the body in new ways to burn fat, build muscle, and raise basal metabolic rate. With a boosted metabolism, the body burns more calories all day.
Sample Walking Workout
You can use a treadmill or walk outside. Make sure you have athletic shoes that are flat and flexible and have the proper support and cushioning for a long walk. Wear breathable clothing, which allows freedom of movement and wicks away sweat.
Warmup
Start with 5 to 10 minutes of easy walking, increasing speed gradually.
The warmup is important to burn stored blood sugar and deplete the ready energy stored in the muscles.
This signals the body that a longer exercise session is underway.
As a result, the body prepares to burn stored fat.
Pick Up The Speed
To burn fat, the body needs to be in the fitness zone, with a heart rate of 60% to 70% of the maximum heart rate.
Check heart rate every 10 minutes to stay in the zone.
Stay In The Fitness Zone
For 30 to 50 minutes or more.
If your heart rate dips, pick up the speed.
Cool Down
End with 5 to 10 minutes at an easier pace to cool down.
Injury Medical Chiropractic and Functional Medicine Clinic
Using an integrated approach to treat and prevent injuries and chronic pain syndromes, improve flexibility, mobility, and agility, and help individuals return to normal activities, Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers, trainers, and specialists to develop a personalized fitness program. Each case is different and requires reviewing individual medical history and physical examination to determine the proper training plan. Dr. Jimenez has partnered with top trainers, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments and fitness training plans.
Weight Loss Techniques
References
Bairapareddy, K. C., Maiya, A. G., Kumar, P., Nayak, K., Guddattu, V., & Nayak, V. (2018). Effect of aerobic exercise on echocardiographic epicardial adipose tissue thickness in overweight individuals. Diabetes, metabolic syndrome and obesity : targets and therapy, 11, 303–312. doi.org/10.2147/DMSO.S145862
Carey D. G. (2009). Quantifying differences in the “fat burning” zone and the aerobic zone: implications for training. Journal of strength and conditioning research, 23(7), 2090–2095. doi.org/10.1519/JSC.0b013e3181bac5c5
Schwarz, M., Urhausen, A., Schwarz, L., Meyer, T., & Kindermann, W. (2006). Cardiocirculatory and metabolic responses at different walking intensities. British journal of sports medicine, 40(1), 64–67. doi.org/10.1136/bjsm.2005.020198
Karstoft, K., Winding, K., Knudsen, S. H., Nielsen, J. S., Thomsen, C., Pedersen, B. K., & Solomon, T. P. (2013). The effects of free-living interval-walking training on glycemic control, body composition, and physical fitness in type 2 diabetic patients: a randomized, controlled trial. Diabetes care, 36(2), 228–236. doi.org/10.2337/dc12-0658
Haight, D. J., Lerner, Z. F., Board, W. J., & Browning, R. C. (2014). A comparison of slow, uphill and fast, level walking on lower extremity biomechanics and tibiofemoral joint loading in obese and nonobese adults. Journal of orthopaedic research : official publication of the Orthopaedic Research Society, 32(2), 324–330. doi.org/10.1002/jor.22497
For individuals who are feeling back pain, neck pain, or shoulder pain, can using postural techniques help decrease pain and develop strategies to maintain correct posture?
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Maintaining Correct Posture
Exercise and postural correction are two of the most important strategies to manage pain. (Robin McKenzie, the great spine guru PT, (May S. and Donelson R. 2008) However, it is not easy to maintain correct posture as the day progresses. While working or driving, most of us forget to be mindful of our posture; we slip back into unhealthy habits of sitting slouched, to the side, forward, etc, which often leads to continued pain and movement limitations. Studies on postural correction and its effect on overall back or neck pain levels are limited. (Lederman E. 2011) However, some studies show that a forward-head posture increases stress and load on the neck. (Hansraj K. K. 2014) If an individual has pain that improves with sitting upright, perhaps checking posture as the day progresses could be beneficial. There are ways to start changing posture and maintain the change. First, visit a physical therapist, spine specialist, or chiropractor to learn how to sit or stand to manage posture problems. They can teach individuals how to attain healthy posture and manage their condition. These strategies can then be used to maintain correct posture.
Lumbar Support
A lumbar roll/support is one of the simplest ways to attain and maintain a healthy sitting posture. These specialized pillows can help maintain the forward curve in the lower back. Maintaining the lumbar lordosis curve is essential for keeping stress off the back muscles, joints, and discs. Lumbar support pillows can be found in various stores, office supply stores, or purchased online. A physical therapist PT can help train individuals to use a lumbar roll properly.
Utilize the Slouch Overcorrect Exercise
The slouch overcorrect exercise is a simple maneuver for training the body to find and maintain its neutral position. It involves slowly shifting from a slouched position to an overcorrected postural position. Once posture is overcorrected, a slight relaxation from a fully erect posture will return to sitting properly. Practicing this exercise daily can help train the body to feel the muscles, listen to the body, and maintain proper posture. The muscles have memory, and the more often the body is placed in optimal posture, the muscles memorize their healthy, pain-free positioning.
Kinesiology Tape
Kinesiology tape is a flexible cotton adhesive that facilitates muscle contractions and inhibits muscle spasms and pain. (Han J. T. et al., 2015) Using the tape is a simple way to help facilitate the postural support muscles. The tape can be applied to the middle trapezius and rhomboid muscles to help support the shoulder blades and spine. Kinesiology tape for postural control also gently pulls on the muscles when slouching to remind the individual to sit up or stand straight.
Scapular Stabilization Exercises
A physical therapist or chiropractor can help improve posture through targeted exercises. Strengthening the muscles attached to the shoulder blades can help individuals better control their posture. (Shiravi S. et al., 2019) Exercises like the prone T, I, or Y can help improve the muscles’ neuromuscular recruitment to maintain correct posture.
Use an Alarm
Setting an alarm while working can help train the body to maintain correct posture. Most of us sit at a computer, desk, or workstation with proper posture, but depending on what we’re working on, we eventually slouch, lean to the side, or have a forward head posture. Pretty much all computers and phones have an alarm setting or app. Use the alarm or timer to go off every 20 to 30 minutes. When the alarm rings, look at your posture to recognize what you’re doing, get up and move around to stretch the body, sit and readjust, reset the alarm, and continue working. As you get better at maintaining appropriate posture, you won’t need the alarm anymore, and readjusting will become automatic.
Chiropractic Team
Sitting and standing with unhealthy posture can significantly cause back, neck, and shoulder pain. By visiting a chiropractic and physical therapy team and learning to attain and maintain correct posture, you can quickly relieve pain, resolve musculoskeletal issues, and prevent future pain symptoms. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop a personalized care plan for each patient through an integrated approach to treating injuries and chronic pain syndromes, improving flexibility, mobility, and agility programs to relieve pain and help return to normal and optimal function. If other treatments are needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments.
Scapular Winging In-Depth
References
May, S., & Donelson, R. (2008). Evidence-informed management of chronic low back pain with the McKenzie method. The spine journal : official journal of the North American Spine Society, 8(1), 134–141. doi.org/10.1016/j.spinee.2007.10.017
Lederman E. (2011). The fall of the postural-structural-biomechanical model in manual and physical therapies: exemplified by lower back pain. Journal of bodywork and movement therapies, 15(2), 131–138. doi.org/10.1016/j.jbmt.2011.01.011
Hansraj K. K. (2014). Assessment of stresses in the cervical spine caused by posture and position of the head. Surgical technology international, 25, 277–279.
Han, J. T., Lee, J. H., & Yoon, C. H. (2015). The mechanical effect of kinesiology tape on rounded shoulder posture in seated male workers: a single-blinded randomized controlled pilot study. Physiotherapy theory and practice, 31(2), 120–125. doi.org/10.3109/09593985.2014.960054
Shiravi, S., Letafatkar, A., Bertozzi, L., Pillastrini, P., & Khaleghi Tazji, M. (2019). Efficacy of Abdominal Control Feedback and Scapula Stabilization Exercises in Participants With Forward Head, Round Shoulder Postures and Neck Movement Impairment. Sports health, 11(3), 272–279. doi.org/10.1177/1941738119835223
Skeletal muscles attached to the arms, legs, neck, back, and trunk bones are voluntary and consciously controlled. Weakness or inability to control these muscles can signal a health issue like a neuromuscular disorder or electrolyte imbalance. Can recognizing the symptoms can help healthcare providers develop effective treatment programs?
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Voluntary Muscles
Voluntary muscles are the skeletal muscles that attach to bones and control movement of the limbs, head, neck, and body under an individual’s conscious control. Skeletal muscles are controlled by neuromuscular signals from the brain that communicate with individual muscle fibers and cause them to contract.
Difference
Voluntary muscles are skeletal muscles that contract and relax under conscious control.
These muscles attach to bones and regulate movement of the body.
Involuntary muscles are not under conscious control.
Involuntary muscles involve automatic internal processes needed for survival, like controlling blood vessels and organs like the heart, lungs, and digestive system.
They contract and relax automatically and receive signals from the autonomic nervous system, which regulates internal bodily functions.
Voluntary
Voluntary muscles are skeletal muscles that comprise 40% of the body’s weight and 50% to 75% of the body’s proteins. These muscles can convert chemical and mechanical energy to cause voluntary muscle contraction and movement. (Trovato F.M. et al., 2016) Skeletal muscle comprises fascicles or bundled units of multiple muscle fibers or muscle cells. Each muscle fiber consists of a cross-banded structure further divided into myofibrils containing thick myosin and thin actin myofilaments, which give the muscle its stripe appearance, and the structure gives the characteristic striated structure. (Trovato F.M. et al., 2016) Muscle contraction occurs when these myofilaments move closer together, stimulated by the release of the neurotransmitter acetylcholine from nerve cells that communicate with the muscle fiber.
Involuntary
The autonomic nervous system controls involuntary muscles, regulating their contraction and relaxation. This system also controls the activity of organs and blood vessels for essential daily functions, including breathing, circulation, digestion, heartbeat regulation, and urination. Most involuntary muscles are composed of smooth muscles. Smooth muscles do not have the striated structure of skeletal muscles and consist of sheets or layers of smooth muscle cells. When the autonomic nervous system stimulates these muscle cells to contract by releasing hormones or other chemical signals, smooth muscle cells shorten through the movement of actin and myosin myofilaments. Involuntary smooth muscles include the blood vessel walls, diaphragm, intestines, and bladder. (Webb R. C. 2003) One exception of an involuntary muscle is the myocardium, or heart muscle. The myocardium comprises a specialized cardiac muscle cell found only in the heart. Cardiac muscle is striated like skeletal muscle but is controlled by the autonomic nervous system and pacemaker cells, causing it to contract automatically and rhythmically.
Weakened Voluntary Muscles
Skeletal muscle diseases, neuromuscular disorders, and other causes can weaken muscles. Neuromuscular or skeletal muscle disorders affect the nerves that send electrical signals to voluntary skeletal muscles to control movement. When the nerves are damaged, communication between the nerves and muscles becomes disrupted. This can result in significant muscle weakness, atrophy, and loss of function. Most neuromuscular disorders are genetic or caused by issues with the immune system. Nerves communicate with muscles through the release of neurotransmitters at the neuromuscular junction, which is the space between a nerve cell and muscle fiber. Neuromuscular disorders can damage the nerve or the neuromuscular junction. Neuromuscular disorder symptoms can include: (Cleveland Clinic, 2023)
Numbness and tingling
Muscle weakness
Muscle twitches, cramps, or spasms
Muscle pain
Muscle atrophy
Decreased coordination
Balance problems
Drooping eyelids and double vision from eye muscle weakness.
Difficulty swallowing due to weakness of the pharynx.
Difficulty breathing due to weakness of the diaphragm.
Common Neuromuscular Disorders
Amyotrophic Lateral Sclerosis – ALS
More commonly known as Lou Gehrig’s disease, it is a genetic disorder that results from hardening of the spinal cord.
It causes damage to the nerves that control muscles and voluntary movement.
Charcot-Marie-Tooth Disease
This is a class of peripheral nerve disorders that cause muscle weakness, atrophy, and loss of sensation, most commonly in the legs and feet.
It is a genetic disorder caused by a gene mutation that damages myelin, or the insulating sheath that surrounds all nerves and supports the conduction of electrical signals.
Multiple Sclerosis – MS
MS causes degeneration of the myelin sheath surrounding nerves, decreasing the impulses along the nerves to muscles.
It can result in muscle weakness, which is often more severe on the dominant side of the body.
There are different forms of MS, but the condition is often progressive and gets worse over time if left untreated.
Muscular Dystrophies
These are genetic diseases characterized by gradual loss of motor function, muscle weakness and atrophy, walking gait problems, progressive respiratory failure, and cardiomyopathy.
There are nine types of muscular dystrophy, all caused by genetic mutations.
Myasthenia Gravis
This is an autoimmune disease that causes inflammation throughout the body.
An autoimmune disease occurs when the immune system attacks healthy cells by mistake.
With myasthenia gravis, the body produces antibodies that attack the receptors for acetylcholine, reducing the body’s ability to contract muscles.
This leads to muscle weakness, atrophy, and fatigue.
Myopathies
These are diseases of muscles that cause muscle weakness and atrophy.
Depending on the type, they may progress and get worse over time.
Electrolyte Imbalances
Muscle weakness can result from altered sodium, potassium, calcium, or magnesium levels.
Always seek immediate medical attention for any sudden, unexplained muscle weakness. Individuals who experience skeletal muscle weakness should discuss the type and duration of symptoms with their doctor, specialist, physical therapist, or chiropractor, as this might be a sign of a medical condition such as a neuromuscular disorder. Working with a chiropractic team can help expedite healing. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop a personalized treatment program through an integrated approach to treat injuries and chronic pain syndromes, improving flexibility, mobility, and agility, relieving pain, and helping individuals return to normal activities. If other treatments are needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments.
Chiropractic Massage Therapy
References
Trovato FM, I. M., Conway N, Castrogiovanni P. (2016). Morphological and functional aspects of human skeletal muscle. J Funct Morphol Kinesiol., 1(3), 289-302. doi.org/https://doi.org/10.3390/jfmk1030289
Webb R. C. (2003). Smooth muscle contraction and relaxation. Advances in physiology education, 27(1-4), 201–206. doi.org/10.1152/advan.00025.2003
Replenishing electrolytes and maintaining hydration is essential for individuals who work out, fitness enthusiasts, and those who play recreational or serious sports and want to improve overall health. Can making a homemade sugar-free electrolyte drink help individuals achieve health goals faster?
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Homemade Electrolyte Drink
Sports drinks can help replenish the body’s lost electrolytes. Individuals who follow a low-carb diet and exercise or who are on a low-carb diet and get sick need double the added electrolytes. There is evidence that electrolytes are very effective in regulating the body’s fluid balance, especially during and after exercise or illness, and for those on a strict low-carb diet. (Maughan R. J. 1991)
Why More Electrolytes Are Needed
On a low-carb diet, insulin levels drop, so the kidneys retain less sodium. As the body excretes water, important minerals, such as the electrolytes calcium, sodium, magnesium, chloride, and potassium, are also excreted from the body’s system. Therefore, it is important to replenish them to avoid negative symptoms like lightheadedness and dehydration—especially when exercising or ill. (Bostock E. C. S. et al., 2020)
Two tablespoons of lemon juice contain almost the same amount of potassium in an 8-ounce sports drink.
A pinch of salt supplies 110 milligrams of sodium, the same amount in 8 ounces of a sports drink.
Individuals can make a low-carb homemade electrolyte sports drink. Many sports drinks contain a lot of sugar and other additives. The science behind why many of these drinks contain sugar is that a quick hit of sugar provides glucose for replenishing energy stores. Most individuals benefit from having small amounts of carbohydrates during heavy exercise. However, those who want to avoid sugar might want a sugar-free option to replace fluids and electrolytes.
Basic Recipe
Homemade Electrolyte Drink Mix:
1 cup or 8 ounces of non-carbonated water
Two tablespoons of lemon juice
A small pinch of salt—a teaspoon contains 2,300 milligrams of sodium, but the body needs 1/20th of a teaspoon.
Flavoring and sweetener for taste are optional. Try unsweetened Kool-Aid, Crystal Light Drink Mix, or sugar-free flavored syrups.
If avoiding artificial sweeteners, Stevia could be an option.
Sports Drink Ingredients
What goes into most sports drinks and adapting to a low-carb diet?
Water
Water is a primary ingredient, as the goal is to hydrate the body.
Sugar
Sports drinks can contain a lot of sugar, but only about half the sugar of most commercial beverages. For example,
A 20-ounce bottle of Gatorade has about 34 grams of sugar.
A 20-ounce soda has about 69 grams of sugar.
Sports drinks have less sugar to prevent gastrointestinal cramping during exercise and strenuous physical activity. Although Gatorade contains less sugar than soda, depending on individual health goals, it may not be the best option. Studies of nutritional needs during exercise for those restricting carbohydrates are not extensive. However, it is known that when individuals cut carbs, their bodies switch from primarily using carbohydrates to using fat for energy. This change, known as keto-adaptation, can take two to three weeks. Native populations, like the Inuit, traditionally ate a very low-carbohydrate diet and could maintain vigorous endurance for a long time without ill effects. (Phinney S. D. 2004) This suggests that bodies adapt to using fat for energy during physical activity and exercise over time. However, cutting carbohydrates too much and too soon can lead to symptoms like the keto flu. (Harvard Medical School, 2018). Individuals may need to replace carbohydrates during training for longer, more vigorous workouts, such as running longer than an hour. In addition, what is eaten before and after exercise can also affect physical performance. Working with a registered dietitian, nutritionist, or health coach could be helpful to achieve specific fitness goals.
Electrolytes
Electrolytes are molecules of certain minerals that contain an electrical charge. The nervous system runs on those charges generated by manipulating molecules called ions. (Faber D. S. and Pereda A. E. 2018) Every body function that depends on the nervous system, which includes muscle movement, breathing, digestion, thinking, etc., requires electrolyte activity. Those who exercise strenuously for long periods, individuals who follow a low-carb diet, or those with illness may need extra salt and potassium. Sports drinks contain small amounts of sodium and potassium. A balanced diet will supply plenty of minerals for electrolyte needs for individuals engaged in moderate exercise.
Using an integrated approach to treat and prevent injuries and chronic pain syndromes, improve flexibility, mobility, and agility, and help individuals return to normal activities, Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop a personalized treatment, nutrition, and fitness programs. Each case is different and requires reviewing individual medical history and physical examination to determine the proper and most effective plan. Dr. Jimenez has teamed up with top trainers, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments and training.
Is Intermittent Fasting the Ultimate Weight Loss Hack?
References
Maughan R. J. (1991). Fluid and electrolyte loss and replacement in exercise. Journal of sports sciences, 9 Spec No, 117–142. doi.org/10.1080/02640419108729870
Bostock, E. C. S., Kirkby, K. C., Taylor, B. V., & Hawrelak, J. A. (2020). Consumer Reports of “Keto Flu” Associated With the Ketogenic Diet. Frontiers in nutrition, 7, 20. doi.org/10.3389/fnut.2020.00020
Phinney S. D. (2004). Ketogenic diets and physical performance. Nutrition & metabolism, 1(1), 2. doi.org/10.1186/1743-7075-1-2
Faber, D. S., & Pereda, A. E. (2018). Two Forms of Electrical Transmission Between Neurons. Frontiers in molecular neuroscience, 11, 427. doi.org/10.3389/fnmol.2018.00427
Proper shoes are highly recommended when playing sports, whether professional or recreational. Can wearing pickleball footwear help increase optimal performance and prevent injuries?
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Pickleball Footwear
Pickleball has become quite popular because individuals of all ages and abilities can play it. Although it is a relatively new sport, it emerged in 1965. (USA Pickleball, 2021) It’s now one of the fastest-growing sports, with over 8 million players nationwide. (Brandon, 2023) The game can be played with most shoes designed for sports, like running or cross-fit shoes. There are shoes specifically for pickleball that improve traction, enhance stability and cushioning, and increase impact absorption. For those getting into the game long-term, investing in high-quality pickleball footwear is a worthwhile investment that can contribute to long-term enjoyment and injury prevention.
The Demands of Pickleball
Like tennis or table tennis, pickleball involves dynamic and fast-paced movements, including lateral strides, pivoting, and quickly changing direction. The body has to move forward, backward, and side to side across the court and pivot. When chasing the ball, to control the shots, produce power, decrease the risk of injury, and change direction while maintaining balance, the feet, body, and shoes must work together to make all this possible. One consideration depends on where the game will be played, whether flat ground or a harder surface. Wearing sneakers or tennis shoes is recommended for flat-ground play, as they provide supportive cushioning and shock absorption. For harder surfaces like concrete or hardwood courts, specialized shoes like those designed for pickleball are recommended.
Benefits
Some of the benefits of investing in pickleball footwear include.
Optimal Traction
Traction is incredibly important in pickleball. Optimal traction can help players execute quick movements, maintain stability, and prevent slips and falls. When looking for the right shoes, consider traction-specific materials like rubber, nylon, and leather. Individuals are most likely to find rubber pickleball shoes because they’re cheaper and commonly used in other outdoor sport-specific shoes, such as soccer. Nylon is more expensive but offers better traction than rubber and is often used in high-tech sneakers because it provides significant shock absorption and long-term durability. Leather is the most expensive material but offers the best grip. Because of its natural look and feel, it is also becoming more popular in sneakers.
Stability and Support
Moving from side to side in a lateral fashion requires players to be on top of their balance and maintain steadiness when making shots. Pickleball shoes are designed to support stability and can help reduce injuries like sprains.
Impact Absorption Cushioning
Pickleball footwear is designed similarly to running shoes, with cushioned comfort and a midsole that offers shock absorption and reduces the impact felt in the joints, including the knees, lower back, and feet. Individuals can find pickleball footwear that utilizes various sports technologies, like gel inserts or responsive foam, which can help cushion and reduce the impact on the joints. When cushioned, the body can maintain more balance, promote positive movement habits, prevent muscular fatigue and joint pain, help reduce overall stress, and allow individuals to play harder without experiencing pain. Long-term benefits result in a stronger, more flexible body.
Proper Fit and Considerations
Make sure that the pickleball shoes fit well and provide adequate support. Measure your feet using a ruler or measuring tape, and have the measurements handy while shopping. Suggestions include:
Look for shoes that fit snugly but don’t allow the feet to move around too much during play.
Pay attention to arch support.
Individuals with high arches should look for shoes with adjustable straps or more supportive materials built into the sole.
Using an integrated approach to treat and prevent injuries and chronic pain syndromes, improve flexibility, mobility, and agility, and help individuals return to normal activities, Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop a personalized fitness program. Each case is different and requires reviewing individual medical history and physical examination to determine the proper training plan. Dr. Jimenez has teamed up with top trainers, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments if other training is needed.
For individuals dealing with headaches, can utilizing self-care techniques help ease symptoms?
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Headaches Self Care
There are different self-pain-relieving approaches to ease headache-related pain that use non-medication options. While headache self-care pain-relieving techniques can help temporarily, they are recommended to help ease headache symptoms until professional treatment is available. Individuals are encouraged to try multiple strategies to find the right treatment regimen that works for them, which is usually a process of trial and error. Self-care headache relief maneuvers can include temple massages, breathing exercises, exercise, or applying a cold pack to the head.
Self-Care Relief
Commonly used for tension headaches or migraine, a few examples of self-care techniques include (Espí-López G. V. et al., 2016)
Massaging the temples, neck, or scalp with the hand, fingers, or a massage tool.
Applying a cold pack to the affected area.
Heat can be used on the affected area, like a headband or a hot shower.
Compression such as a handkerchief or belt wrapped tightly around the head or pressing firmly on the painful area.
Compression is more commonly utilized in migraineurs versus scalp massage in people with tension headaches. This is often due to the throbbing sensation caused by a migraine versus a tension headache, which feels like a tight grip or band around the head.
Individuals with cluster headaches are more likely to utilize unique approaches, such as covering one ear, rotating the head, shallow breathing, moving around, or closing the nostril on the same side as the head pain.
Various scientific studies support the potential benefit of these complementary therapies. However, individuals should talk with a healthcare provider to choose the best strategy for their headache type and their unique needs/goals. Working with a chiropractic team can help expedite healing. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop a customized treatment plan through an integrated approach to treating injuries and chronic pain syndromes, improving flexibility, mobility, and agility, relieving pain, and helping individuals return to normal activities. If other treatments are needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments.
Tension Headaches and Chiropractic Care
References
Espí-López, G. V., Zurriaga-Llorens, R., Monzani, L., & Falla, D. (2016). The effect of manipulation plus massage therapy versus massage therapy alone in people with tension-type headache. A randomized controlled clinical trial. European journal of physical and rehabilitation medicine, 52(5), 606–617.
Millstine, D., Chen, C. Y., & Bauer, B. (2017). Complementary and integrative medicine in the management of headache. BMJ (Clinical research ed.), 357, j1805. doi.org/10.1136/bmj.j1805
Can understanding the philosophy of intuitive eating help individuals achieve and maintain health goals by breaking free from diets and getting healthy by improving their relationship with food and exercise?
Contents
Intuitive Eating
Intuitive eating is a non-diet approach to eating that focuses on listening to the body with internal body cues. Strict food rules are the main reason diets don’t work and negatively impact overall health and well-being. (Linardon, J., & Mitchell, S. 2017) Intuitive eating is characterized by eating in response to physiological hunger and satiety cues rather than emotional cues. The body was born to eat when hungry and stop when full. However, this natural way of eating can get lost in emotions, food rules, and restrictions. Fortunately, getting back to intuitive eating is possible for everyone.
How Does It Work?
Intuitive eating is a non-diet approach that steps away from a diet mentality and applies healthy behaviors around food. It focuses on unlearning external rules, like diet rules and expectations of what and how much to eat, and emphasizes internal cues like hunger, fullness, and how foods make you feel. It is based on principles that help build a healthier relationship with food. Individuals become aware of what to eat, how much to eat, and when to eat naturally, without worry or guilt.
Mindful Eating
Mindful eating is not the same thing as intuitive eating. Individuals can think of mindful eating as a skill or practice, while intuitive eating is a philosophy.
Principles
Understanding the ten core principles and how they work together is important.
Remove The Diet Mentality
Let go of the quick fixes and gimmick diets. These offer false hope that weight loss is easy, quick, and permanent and can make individuals feel like failures for losing and regaining weight.
Honor Hunger
Hunger is a normal, biological process. The body requires adequate amounts of energy and carbohydrates to function properly. Ignoring these cues and hunger can lead to cravings, overeating, and binges. Learning to honor hunger cues sets the stage for rebuilding trust with food. A food scale can help determine proper portions.
Make Friends With Food
Allow yourself unconditional permission to eat what you want. This means including all foods without labeling them as good or bad. Once an individual tells themself they can’t have a certain food, they can feel deprived, and intense cravings can build that often lead to overeating, binges, and extreme food guilt.
Get the Food Police Out Of Your Head
Learn to say no to self-induced thoughts of good or bad based on what is being eaten or how many calories are involved. Diets often say eating too many calories or enjoying a cookie is bad. These rules and restrictions can lower self-esteem and cause feelings of guilt. Removing negative food thoughts, guilt, and other rules is critical to intuitive eating.
Respect The Body’s Fullness
Listen for body cues that say you are full. This means your body is no longer hungry and should stop eating. Enjoy the flavors, stay aware of satiety signals throughout meals, and always be aware of your fullness level.
Satisfaction Factor
Learn to find joy and satisfaction in the eating experience. Eating what they want in an inviting environment promotes happiness and satisfaction, and a positive eating experience has been shown to promote satisfaction with even less food.
Honor Feelings Without Using Food
Don’t fix problems with food. Learn healthy ways to cope with emotions like stress, anxiety, anger, or boredom without turning to food. Feeding emotional hunger only makes feelings worse and adds guilt to the mix.
Respect Your Body
Body size and shape are unique for each person. Acceptance is an important part of self-respect and love. Instead of being critical, embrace individual genetic blueprints.
Being unrealistic and critical about one’s body makes it difficult to reject the diet mentality.
Exercise
Exercise doesn’t have to be intense or extreme to be effective. Individuals should focus on how good it feels to be active and moving their bodies rather than how many calories are burned during the workout sessions. Feeling great and motivated about exercise is easy when there is increased energy, better sleep, and improved quality of life.
Honor Health
Individuals don’t have to be perfect eaters. Infrequently eating a certain snack or meal won’t make you gain weight or cause health problems.
It’s what is eaten consistently over time that matters. Making food choices that taste good and nourish the body is what counts.
Weight Loss Benefits
Intuitive eating is not designed for weight loss. It aims to improve an individual’s relationship with food, including building healthier food behaviors and not focusing on the weight scale. However, learning to be an intuitive eater can help individuals lose weight by allowing the body to break the diet cycle and settle into its natural set point weight range.
Overall Health Benefits
Intuitive eating has been shown to have both physical and emotional health benefits that include:
Higher levels of contentment and satisfaction
Reduced stress
Increased self-esteem
Better body image outlook
Improved cholesterol levels
Improved metabolism
Lower rates of emotional and disordered eating
In a 24-study review that examined the psychosocial effect intuitive eating had on adult women was associated with the following positive results (Bruce, L. J., and Ricciardelli, L. A. 2016)
Decreased eating disorders
Improved positive outlook on body image
Higher emotional functioning
Another study compared restrictive diets and intuitive eating among men and women. The study found that intuitive eating uniquely and consistently presented lower levels of disordered eating and body image concerns. (Linardon, J., & Mitchell, S. 2017) Participants using intuitive eating expressed high levels of body appreciation, and researchers suggested promoting the practice within public health approaches to eating disorder prevention. The study also supported intuitive eating by promoting body acceptance and removing unhealthy thinking about food and eating.
Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop a personalized treatment plan through an integrated approach to create personalized care plans for each patient and restore health and function to the body through nutrition and wellness, functional medicine, acupuncture, Electroacupuncture, and sports medicine protocols. If the individual needs other treatment, they will be referred to a clinic or physician best suited for them. Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, nutritionists, and health coaches to provide the most effective clinical treatments.
Eating Smart To Feel Better
References
Linardon, J., & Mitchell, S. (2017). Rigid dietary control, flexible dietary control, and intuitive eating: Evidence for their differential relationship to disordered eating and body image concerns. Eating behaviors, 26, 16–22. doi.org/10.1016/j.eatbeh.2017.01.008
Bruce, L. J., & Ricciardelli, L. A. (2016). A systematic review of the psychosocial correlates of intuitive eating among adult women. Appetite, 96, 454–472. doi.org/10.1016/j.appet.2015.10.012
Competitive swimmers, recreational, and swimming enthusiasts who experience pinching and sharp shoulder pain while swimming may suffer from shoulder impingement. Can understanding symptoms can help healthcare providers develop an effective treatment program?
Contents
Swimmer’s Shoulder
Swimmer’s shoulder, medically known as rotator cuff impingement syndrome, is a common injury among swimmers. It can limit swimming ability and normal arm use for functional tasks. It is caused by persistent and abnormal rubbing and pinching of the structures in the shoulder, causing pain and irritation of the shoulder’s rotator cuff tendons and the bursa. The injury affects 40% to 90% of swimmers at some point. (Wanivenhaus F. et al., 2012) Self-care treatment involves rest, anti-inflammatory medication, and exercise to restore normal shoulder mobility. Most cases resolve within a few months, but physical therapy may be needed along with continued exercises and stretches to maintain pain relief.
Anatomy
The shoulder is a complex joint with extreme mobility. It is comprised of three bones:
The scapula or shoulder blade.
The clavicle or collar bone.
The humerus or upper arm bone.
These three bones combine at various places to make up the joint. Several muscles attach to and move the joint. (Kadi R. et al., 2017) The rotator cuff is one group of four muscles deep in the shoulder surrounding the joint. When lifting the arm, these muscles contract to hold the ball in the joint’s socket, allowing the arm to be raised in a fluid and smooth motion. Several ligaments hold the shoulder joint together and connect the various bones of the shoulder, giving the joint stability when moving. (Kadi R. et al., 2017)
Shoulder pain when bearing weight through the arm.
Symptoms tend to be worse during or immediately after swimming.
This is due to the position of the arms and upper extremities while swimming. (Wanivenhaus F. et al., 2012) Reaching overhead and turning the hand inward can cause the rotator cuff tendons or shoulder bursa to become pinched underneath the acromion process of the shoulder blade, similar to the motion that occurs during the crawl or freestyle stroke. When pinching/impingement occurs, the tendons or bursa can become inflamed, leading to pain and difficulty with normal arm use. (Struyf F. et al., 2017) The condition may also occur due to the laxity of the shoulder ligaments. (Wanivenhaus F. et al., 2012) It is theorized that the ligaments in swimmers become stretched and lax, leading to shoulder joint instability. This can cause the shoulder joint to become loose and compress the shoulder structures.
Diagnosis
A clinical examination can diagnose cases of swimmer’s shoulder. (Wanivenhaus F. et al., 2012) The exam can include:
Palpation
Strength test
Specialized tests
One shoulder test that is often used is called Neer’s test. A physician elevates the arm overhead to the maximum degree during this examination. If this results in pain, the rotator cuff tendons may be compressed, and the test is positive. Individuals may begin treatment after the examination, but a doctor may also refer them for diagnostic testing. An X-ray may be taken to examine the bone structures, and an MRI may be used to examine the soft tissue structures, such as the rotator cuff tendons and the bursa.
Treatment
Appropriate treatment of swimmer’s shoulder involves managing pain and inflammation in your shoulder and improving the way your shoulder moves so you avoid pinching structures inside the joint. (Wanivenhaus F. et al., 2012) There are various treatments available and can include:
Rest
Physical therapy
Acupuncture
Non-surgical decompression
Targeted exercises and stretches
Medications
Injections
Surgery for serious cases
Physical Therapy
A physical therapist can treat shoulder impingement. They can assess the condition and prescribe treatments and exercises to improve mobility and strength. (Cleveland Clinic, 2023) They may use various treatment modalities to decrease pain and improve circulation to facilitate and expedite healing. Physical therapy treatments can include:
Ice
Heat
Trigger point release
Joint mobilizations
Stabilization
Stretching
Exercise
Electrical stimulation
Ultrasound
Taping
Medication
Medication may include over-the-counter anti-inflammatory medicine to help decrease pain and inflammation. A physician may prescribe stronger medication to manage inflammation if the condition is severe. While taking medication, the shoulder will need rest, so avoiding swimming or other shoulder movements for a week or two may be necessary.
Injections
Cortisone is a powerful anti-inflammatory medicine. Individuals may benefit from cortisone injections into their shoulders. (Wanivenhaus F. et al., 2012) When injected, cortisone decreases pain, reduces swelling in the rotator cuff and bursa, and improves shoulder mobility.
Surgery
If symptoms are persistent and fail to be alleviated with conservative treatments, surgery may be recommended. An arthroscopic procedure called subacromial decompression may be performed. (Cleveland Clinic, 2023) This type of surgery is done with small incisions, inserting a camera, and tiny tools. During this procedure, inflamed tissue and bone spurs are removed from the underside of the acromion process of the shoulder blade, allowing more space to the shoulder joint. Post-surgery, individuals can gradually return to swimming and all other activities in about eight weeks.
Recovery
Most episodes last about eight to ten weeks, and severe cases last up to three months. (Struyf F. et al., 2017) Often, the symptoms slowly resolve with rest and gentle stretching. As symptoms improve, individuals can slowly return to normal activity and swimming. However, performing prescribed exercises two to three times a week may be necessary to maintain shoulder strength and mobility and help prevent future episodes of shoulder impingement. Individuals experiencing any of these symptoms should visit their physician for an accurate diagnosis of their condition to begin proper treatment. Discuss goals with a healthcare professional and physical therapist.
Sports Injuries Rehabilitation
References
Wanivenhaus, F., Fox, A. J., Chaudhury, S., & Rodeo, S. A. (2012). Epidemiology of injuries and prevention strategies in competitive swimmers. Sports health, 4(3), 246–251. doi.org/10.1177/1941738112442132
Kadi, R., Milants, A., & Shahabpour, M. (2017). Shoulder Anatomy and Normal Variants. Journal of the Belgian Society of Radiology, 101(Suppl 2), 3. doi.org/10.5334/jbr-btr.1467
Struyf, F., Tate, A., Kuppens, K., Feijen, S., & Michener, L. A. (2017). Musculoskeletal dysfunctions associated with swimmers’ shoulder. British journal of sports medicine, 51(10), 775–780. doi.org/10.1136/bjsports-2016-096847
Can incorporating stretches and exercises help relieve pain and provide more support for individuals with knee pain?
Contents
Knee Strengthening
The knee is the largest joint connecting the shin and thigh bones. Its cartilage, muscles, ligaments, and nerves all play a role in maintaining the joint’s health and movement. Individuals of all ages can experience knee pain, but it is more common in those with labor-intensive jobs, arthritis, and athletes. A healthcare provider will prescribe targeted stretches and exercises for individuals with pain, inflammation, or a health disorder that affects the strength of their knees to relieve knee pain while strengthening the muscles around the joint. Knee stretches and exercises are great for those with sore knees and knee pain or stiffness, but they can also be used as preventative medicine.
Exercise Benefits
Doing knee-strengthening exercises can significantly improve joint health. The benefits associated with exercises include (Zeng C. Y. et al., 2021)
Avoid curving the spine to get closer to the thigh during the stretch. The key is not how far you can bend down but getting a deep stretch. Individuals not yet flexible enough to go all the way down should bend until comfortable but can still feel the stretch in their hamstrings. With practice and time, flexibility will improve. This stretch should be felt in the hamstrings.
Step Exercises
Step exercises, or step-ups, involve using a platform at least 6 inches high. To perform the exercise:
Put one foot onto the platform and use that leg to lift the other foot off the floor.
Hold the position with the foot hanging loosely for 3 to 5 seconds, then place the foot back on the floor.
Avoid locking the knees when stepping up on the platform. Locking the knees switches off the muscles that need strengthening (American Academy of Orthopaedic Surgeons, 2009). Step exercises work out various areas of the leg. Individuals should feel this exercise in the thigh, hip, and buttocks.
Post-Exercise Stretching
Post-exercise stretching is vital in physical rehabilitation and strengthening. Stretching after exercise, individuals can (Afonso J. Clemente. et al., 2021)
Relieve and reduce soreness.
Expedite recovery times.
Increase range of motion.
Strengthen the knees more quickly and effectively.
Post-exercise stretches for knee pain and weakness can include:
Quadricep Stretch
This stretch targets the quad muscles located in the thighs. To perform this stretch:
Stand with the feet planted flat on the floor, spaced the same width as the shoulders.
Bending the left knee, grab the foot with the left hand and pull the heel toward the buttocks.
Hold for 5 to 10 seconds.
Repeat on both sides.
What to Avoid
There is no need to pull the heel too far into the buttocks. The goal is to feel a deep stretch. Pushing it too far can lead to injury. (Lee J. H. et al., 2021)
Toe Touches
Toe touches will help stretch calve muscles and hamstrings. To perform this stretch:
Sit on the floor with the legs straight out in front.
Bend the body over the legs at the hips, reaching for the toes in front while maintaining a straight back.
Relax the shoulders and keep them away from the ears.
Once touching the toes, hold the stretch for 15 seconds.
What To Avoid
Individuals who cannot yet touch their toes should perform the same steps and reach only as far as is comfortably possible. Over time, flexibility will improve. (Lee J. H. et al., 2021)
Injury Medical Chiropractic Clinic
These are examples of exercises and stretches that a physical therapy and chiropractic team may prescribe. Each case is different and requires reviewing individual medical history and physical examination to determine the proper treatment program. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop a personalized treatment program through an integrated approach to treating injuries and chronic pain syndromes, improving flexibility, mobility, and agility to relieve pain and help individuals return to normal activities. If other treatments are needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments.
Knee Pain Rehabilitation
References
Zeng, C. Y., Zhang, Z. R., Tang, Z. M., & Hua, F. Z. (2021). Benefits and Mechanisms of Exercise Training for Knee Osteoarthritis. Frontiers in physiology, 12, 794062. doi.org/10.3389/fphys.2021.794062
Kothawale S. and Rao K. (2018). Effectiveness of positional release technique versus active release technique on hamstrings tightness. Int J Physiother Res., 6(1), 2619-2622. doi.org/https://dx.doi.org/10.16965/ijpr.2017.265
Wang, H., Ji, Z., Jiang, G., Liu, W., & Jiao, X. (2016). Correlation among proprioception, muscle strength, and balance. Journal of physical therapy science, 28(12), 3468–3472. doi.org/10.1589/jpts.28.3468
Afonso, J., Clemente, F. M., Nakamura, F. Y., Morouço, P., Sarmento, H., Inman, R. A., & Ramirez-Campillo, R. (2021). The Effectiveness of Post-exercise Stretching in Short-Term and Delayed Recovery of Strength, Range of Motion and Delayed Onset Muscle Soreness: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Frontiers in physiology, 12, 677581. doi.org/10.3389/fphys.2021.677581
Lee, J. H., Jang, K. M., Kim, E., Rhim, H. C., & Kim, H. D. (2021). Effects of Static and Dynamic Stretching With Strengthening Exercises in Patients With Patellofemoral Pain Who Have Inflexible Hamstrings: A Randomized Controlled Trial. Sports health, 13(1), 49–56. doi.org/10.1177/1941738120932911
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