Can healthcare professionals implement an inclusive and positive approach for gender affirming healthcare for non-binary individuals?
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Introduction
When it comes to many individuals looking for the right healthcare options for their ailments and general well-being, it can be scary and challenging to some, including many individuals within the LGBTQ+ community. Many individuals need to research when finding positive and safe healthcare facilities that listen to what the person is dealing with when getting a routine check-up or their ailments treated. Within the LGBTQ+ community, many individuals do find it difficult to express what is affecting their bodies due to past traumas of not being seen or heard due to their identities, pronouns, and orientation. This can cause numerous barriers between them and their primary doctor, leading to a negative experience. However, when medical professionals provide a positive, safe environment, listen to the person’s ailments, and be non-judgmental to their patients, they can open the doors to improving inclusive healthcare wellness within the LGBTQ+ community. Today’s article focuses on one identity within the LGBTQ+ community, known as non-binary, and how inclusive healthcare can be optimized while benefitting many individuals dealing with general aches, pains, and conditions within their bodies. Coincidentally, we communicate with certified medical providers who incorporate our patients’ information to provide a safe and positive experience in inclusive healthcare. We also inform them that there are non-surgical options to reduce the effects of general aches and pain while restoring their quality of life. We encourage our patients to ask amazing educational questions to our associated medical providers about their symptoms correlating with body pain in a safe and positive environment. Dr. Alex Jimenez, D.C., incorporates this information as an academic service. Disclaimer
What Is Non-Binary Gender?
The term non-binary is used within the LGBTQ+ community to describe a person who doesn’t identify as a male or female within the gender identity spectrum. Non-binary individuals can even fall under various gender identities that make them who they are. These can include:
Genderqueer: An individual who doesn’t follow the traditional gender norm.
Agender: An individual who doesn’t identify with any gender.
Genderfluid: An individual whose gender identity is not fixed or can change over time.
Intergender: An individual who identifies as a combination of male and female.
Androgynous: An individual whose gender expression combines masculine and feminine traits.
Gender Non-Conforming: An individual who doesn’t conform to society’s expectation of gender identity.
Transgender: An individual whose gender identity is different from their assigned gender at birth.
When it comes to non-binary binary individuals looking for healthcare treatment for their ailments, it can be a bit of a challenge as many individuals who identify as non-binary within the LGBTQ+ community have to deal with the socio-economic impact when getting treatment, which can lead to unnecessary stress when going in for a routine check-up or getting their ailments treated. (Burgwal et al., 2019) When this happens, it can lead to a negative experience for the individual and make them feel inferior. However, when healthcare professionals take the time to be properly trained, use the correct pronouns, and create an inclusive, positive, and safe space for individuals who identify as non-binary, it can open the doors to creating more of an inclusive awareness and lead to more appropriate care for the LGBTQ+ community. (Tellier, 2019)
Optimizing Your Wellness- Video
Do you or your loved ones are dealing with consistent pain in their bodies that makes it difficult to function? Do you feel stress in different body locations that correlate with musculoskeletal disorders? Or do your ailments seem to be affecting your daily routine? More often than not, in today’s ever-changing world, many individuals are researching safe and inclusive healthcare treatments to reduce their ailments. It is an important aspect to many individuals within the LGBTQ+ community, as finding the appropriate care they need can be stressful. Many healthcare professionals must provide the best possible healthcare and interventions within the LGBTQ+ community to understand the health disparities that they are experiencing. (Rattay, 2019) When healthcare professionals create a negative experience with their patients within the LGBTQ+ community, it can cause them to develop socio-economic stressors that can overlap with their pre-existing condition, creating barriers. When disparities are associated with socio-economic stressors, it can lead to poor mental health. (Baptiste-Roberts et al., 2017) When this happens, it can lead to coping mechanisms and resilience that can correlate with serious implications for the person’s overall health and well-being. However, all is not lost, as many healthcare professionals are integrating into safe, affordable, and positive healthcare spaces for individuals who identify as non-binary. We here at Injury Medical Chiropractic and Functional Medicine Clinic will work on reducing the effects of health disparities while raising awareness to continuously improve positive and inclusive experiences for non-binary individuals seeking inclusive healthcare. Check out the video above to learn more about optimizing wellness to improve your health and well-being.
How To Optimize Non-Binary Inclusive Healthcare?
When it comes to inclusive health care for non-binary individuals within the LGBTQ+ community, many healthcare providers must honor the individual’s gender identity while creating a positive and trusting relationship to reduce the ailments they are experiencing. By making a safe and positive experience for their patients, LGBTQ+ individuals will start to address to their doctors what issues they are experiencing, and it allows the doctor to come up with a personalized health care plan that is catered to them while improving their health outcomes. (Gahagan & Subirana-Malaret, 2018) At the same time, being an advocate and systemically improving, including gender-affirming care, can lead to positive results and benefit LGBTQ+ individuals. (Bhatt et al., 2022)
References
Baptiste-Roberts, K., Oranuba, E., Werts, N., & Edwards, L. V. (2017). Addressing Health Care Disparities Among Sexual Minorities. Obstet Gynecol Clin North Am, 44(1), 71-80. doi.org/10.1016/j.ogc.2016.11.003
Bhatt, N., Cannella, J., & Gentile, J. P. (2022). Gender-affirming Care for Transgender Patients. Innov Clin Neurosci, 19(4-6), 23-32. www.ncbi.nlm.nih.gov/pubmed/35958971
Burgwal, A., Gvianishvili, N., Hard, V., Kata, J., Garcia Nieto, I., Orre, C., Smiley, A., Vidic, J., & Motmans, J. (2019). Health disparities between binary and non binary trans people: A community-driven survey. Int J Transgend, 20(2-3), 218-229. doi.org/10.1080/15532739.2019.1629370
Gahagan, J., & Subirana-Malaret, M. (2018). Improving pathways to primary health care among LGBTQ populations and health care providers: key findings from Nova Scotia, Canada. Int J Equity Health, 17(1), 76. doi.org/10.1186/s12939-018-0786-0
Rattay, K. T. (2019). Improved Data Collection for Our LGBTQ Population is Needed to Improve Health Care and Reduce Health Disparities. Dela J Public Health, 5(3), 24-26. doi.org/10.32481/djph.2019.06.007
Tellier, P.-P. (2019). Improving health access for gender diverse children, youth, and emerging adults? Clinical Child Psychology and Psychiatry, 24(2), 193-198. doi.org/10.1177/1359104518808624
As the body ages, individuals want to stay active and maintain a healthy pain free lifestyle. Can regenerative cells for arthritis and cartilage damage be the future of neuromusculoskeletal medicine and joint healing?
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Regenerative Cells For Arthritis and Cartilage Damage
Individuals want to continue to do the physical activities they love, which require healthy joints. Scientists are learning how to harness the abilities of regenerative cells to repair and regrow damaged and deteriorated cartilage. Current stem cell treatment of cartilage problems has not been shown to reverse the effects of arthritis and while studies show clinical improvement, further research is necessary. (Bryan M. Saltzman, et al., 2016)
Cartilage and How It Gets Damaged
Cartilage is a type of connective tissue. In the joints, there are a few types of cartilage. The most commonly referred to is the smooth lining known as articular or hyaline cartilage. This type forms a smooth layer of cushion on the end of a bone at the joint. (Rocky S. Tuan, et al., 2013)
The tissue is very strong and has the ability to compress and absorb energy.
It is very smooth allowing a joint to glide effortlessly through a limb’s range of motion.
When joint cartilage is damaged, the cushioning can wear down.
In traumatic injuries, a sudden force can cause the cartilage to break off and/or suffer damage, that exposes the underlying bone.
In osteoarthritis – degenerative or wear-and-tear arthritis, the smooth layer can wear down thin and unevenly.
Eventually, the cushion wears away, the joints become inflamed and swollen and movements become stiff and painful.
There are treatments for arthritis and cartilage damage, but these treatments are usually focused on relieving symptoms by smoothing down the damaged cartilage or replacing the joint surface with an artificial implant, like knee replacement or hip replacement surgeries. (Robert F. LaPrade, et al., 2016)
Regenerative Cells
Regenerative stem cells are special cells that have the ability to multiply and develop into different types of tissue. In an orthopedic surgery setting for joint problems, stem cells are obtained from adult stem cell primary sources which are bone marrow and fatty tissue. These cells have the ability to develop into cartilage cells, called chondrocytes. (Rocky S. Tuan, et al., 2013)
They also help by stimulating the body to reduce inflammation, stimulate cell repair, and improve blood circulation.
This process is caused by cellular signals and growth factors to stimulate the body to activate the healing processes.
Once stem cells have been obtained, they need to be delivered to the area of cartilage damage.
Cartilage is a complex tissue that is described as a scaffold structure that is composed of collagen, proteoglycans, water, and cells. (Rocky S. Tuan, et al., 2013)
To regenerate cartilage, the complex tissues must also be reconstructed.
There are studies on types of tissue scaffolds engineered to recreate a similar type of cartilage structure.
The stem cells can then be injected into the scaffold, in hopes of restoring a normal type of cartilage.
Non-Surgical Arthritis Treatments
Standard treatments such as cortisone shots or physical therapies work as well and provide benefits that could be utilized in combination with regenerative cells for arthritis and cartilage damage in the near future. Data takes time and therefore how this impacts the long-term health of a joint needs continued research in terms of tissue engineering and cell delivery to determine the best approach to help individuals.
Arthritis
References
LaPrade, R. F., Dragoo, J. L., Koh, J. L., Murray, I. R., Geeslin, A. G., & Chu, C. R. (2016). AAOS Research Symposium Updates and Consensus: Biologic Treatment of Orthopaedic Injuries. The Journal of the American Academy of Orthopaedic Surgeons, 24(7), e62–e78. doi.org/10.5435/JAAOS-D-16-00086
Saltzman, B. M., Kuhns, B. D., Weber, A. E., Yanke, A., & Nho, S. J. (2016). Stem Cells in Orthopedics: A Comprehensive Guide for the General Orthopedist. American journal of orthopedics (Belle Mead, N.J.), 45(5), 280–326.
Tuan, R. S., Chen, A. F., & Klatt, B. A. (2013). Cartilage regeneration. The Journal of the American Academy of Orthopaedic Surgeons, 21(5), 303–311. doi.org/10.5435/JAAOS-21-05-303
“For individuals looking to improve their quality of life, can substituting healthy meal ingredients be a simple step toward better health?”
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Food Substitutions
Eating well does not mean having to give up favorite foods. Part of the enjoyment of home cooking is putting one’s own style on each dish. Individuals soon discover they prefer healthy food substitutions to the original high-fat, high-sugar, or high-sodium ingredients. Healthy swaps can be introduced gradually to allow the taste buds to adapt. It is possible to reduce:
Calories
Unhealthy fats
Sodium
Refined sugars
Simply making smart swaps that replace some ingredients with more beneficial ones.
Ingredients for Healthier Meals
Recipes are the sum of their parts. A dish made with multiple ingredients adds its own nutrition for healthy or unhealthy. Ingredients high in calories, saturated fat, added sugars, and/or sodium can make a dish less nutritious. By making strategic food substitutions, individuals can transform a high-calorie, high-fat, sugary dish into something more nutritious. When done regularly this adjustment leads to long-term healthy behavior changes. Making small adjustments leads to improvements in weight management, heart health, and risk of chronic diseases.
Substituting Unhealthy Fats and Oils
Fat is a necessary nutrient, however, diets high in saturated fat have been linked with an increased risk of coronary artery disease, (Geng Zong, et al., 2016)
and high cholesterol levels. (American Heart Association. 2021)
Foods like butter, coconut oil, and lard are some of the most used saturated fats.
Conversely, research shows that eating more unsaturated fats is usually associated with better cardiovascular health and lower overall mortality. (Harvard T.H. Chan School of Public Health. 2016)
Instead of baking with butter, try using applesauce, mashed avocados, or mashed bananas.
These plant-based alternatives don’t overload the body with saturated fat.
Try using half butter and half an alternative to cut calories and fats.
For cooking, try sautéing, roasting, or pan-frying in olive or avocado oil.
Both contain healthy monounsaturated fats.
These oils can be used for dipping bread with dinner or for a quick snack.
Fresh herbs or a dash of balsamic vinegar can add flavor.
Refined Sugars
Enjoying sweets can be healthy, but the objective is to be mindful of how much-refined sugar is consumed. Sweet flavors send signals to the reward centers in the brain, increasing positive associations with sugar. However, eating high amounts of sugar can lead to:
An array of other herbs and spices can amplify the flavor of meals.
Purchase or create various flavor blends.
For example, cumin, chili powder, oregano, and red pepper flakes can spice up a dish or a blend of thyme, paprika, garlic powder, and onion powder can add savory notes.
A study found that adding lemon juice to recipes could reduce sodium content and add tanginess. (Sunkist Growers. 2014)
Whole Grains
Individuals don’t have to choose brown rice or whole wheat pasta for every meal but try to select whole grains half of the time. Food substitutions that can help achieve the halfway point include:
Popcorn or whole wheat crackers instead of refined flour crackers.
Whole wheat pizza crust instead of regular crust.
Substitute brown rice for white in stir-fries or casseroles.
Oatmeal instead of refined grain cereal.
Whole wheat pasta for spaghetti and meatballs or other pasta dishes.
Quinoa as a side dish instead of white rice or couscous.
More whole grains equals more fiber and B vitamins to help sustain energy, prevent blood sugar spikes, and promote digestive health. Eating more whole grains has been linked with a reduced risk of heart disease (Caleigh M Sawicki, et al. 2021) and a lower risk of colon cancer. (Glenn A. Gaesser. 2020)
Finding the right combination of each of these substitutions takes time. Go slow and taste often to see how each substitution affects a recipe’s taste and texture.
Boost Metabolism
References
Zong, G., Li, Y., Wanders, A. J., Alssema, M., Zock, P. L., Willett, W. C., Hu, F. B., & Sun, Q. (2016). Intake of individual saturated fatty acids and risk of coronary heart disease in US men and women: two prospective longitudinal cohort studies. BMJ (Clinical research ed.), 355, i5796. doi.org/10.1136/bmj.i5796
American Heart Association. Saturated fat.
Harvard T.H. Chan School of Public Health. Different dietary fat, different risk of mortality.
Faruque, S., Tong, J., Lacmanovic, V., Agbonghae, C., Minaya, D. M., & Czaja, K. (2019). The Dose Makes the Poison: Sugar and Obesity in the United States – a Review. Polish journal of food and nutrition sciences, 69(3), 219–233. doi.org/10.31883/pjfns/110735
Harvard Health Publishing. The sweet danger of sugar.
American Heart Association. How much sugar is too much?
Centers for Disease Control and Prevention. How to Reduce Sodium Intake.
Sunkist Growers. Sunkist Growers and Chefs from Johnson & Wales University Release New S’alternative® Research.
Sawicki, C. M., Jacques, P. F., Lichtenstein, A. H., Rogers, G. T., Ma, J., Saltzman, E., & McKeown, N. M. (2021). Whole- and Refined-Grain Consumption and Longitudinal Changes in Cardiometabolic Risk Factors in the Framingham Offspring Cohort. The Journal of nutrition, 151(9), 2790–2799. doi.org/10.1093/jn/nxab177
Gaesser G. A. (2020). Whole Grains, Refined Grains, and Cancer Risk: A Systematic Review of Meta-Analyses of Observational Studies. Nutrients, 12(12), 3756. doi.org/10.3390/nu12123756
Individuals striving to be healthy may not know where or how to start. Can hiring a health coach help individuals start their wellness journey and reach their goals?
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Hiring A Health Coach
It’s easy to get caught up in the desire to make changes, but it is another thing to actually set a consistent plan in motion. Hiring a health coach can help individuals understand the information, develop an effective wellness routine that suits their lifestyle, and achieve health and wellness goals. A primary healthcare provider could be a resource and have referrals to reputable health coaches in the area.
What Do They Do?
Health coaches are experts in helping individuals reach health and wellness goals. This can be:
Reducing stress
Improving self-care
Focusing on nutrition
Starting exercise
Improving quality of life
A health coach helps create a plan and makes it happen.
Health and wellness coaches use motivational interviewing and evidence-based approaches to empower individuals in their wellness journey. (Adam I Perlman, Abd Moain Abu Dabrh. 2020)
They help identify areas that need improvement, develop a plan, and encourage the individual all the way like a personal fitness trainer.
Health coaches work with physicians and/or other health professionals in a clinical setting or as individual providers.
Their role is to provide a holistic approach to health and wellness.
A health coach is someone who helps organize and balance various aspects of an individual’s life so they can learn to maintain optimal health.
They will help overcome barriers when struggling.
A health coach listens and provides support for whatever an individual’s goals may be.
A health coach is there until the goal is reached.
Qualifications
It is important to ensure the providers being considered have the necessary qualifications. Because some certification programs offer a focus on specific areas like nutrition, it’s recommended to identify what is needed before choosing a health coach. Health coaches do not need a university degree, however, many certifications are affiliated with colleges and have educational partnerships that qualify coursework and award college credits. Training to become a health coach consists of: (Shivaun Conn, Sharon Curtain 2019)
Health
Fitness
Goal setting
Coaching concepts
Nutritional concepts
Motivational interviewing
Stress management
Changing behaviors
Health Goal Examples
Health coaching is not a one-size-fits-all approach. A primary healthcare provider or physician provides a diagnosis and medical plan, and a health coach helps guide and support the individual through the plan. However, hiring a health coach does not require a medical condition to employ services. A few examples of health goals that health coaches address include:
There are many types of health coaches and some may specialize, therefore try to determine the expertise needed to achieve the goals.
Budget
Determine how much money will be invested, as many insurance providers do not cover the cost of a health coach.
Health coaches may charge between $50 to $300 per session.
Some will offer packages, memberships, and/or discounts.
Certifications
Look into their certification.
Is it accredited?
This will ensure choosing a coach who has received the training and expertise needed to provide quality care.
Compatibility
Consult with potential coaches.
Ask questions and see if they are compatible with specific health goals.
Interview as many as needed.
Availability/Location
Virtual sessions, in-person meetings, and/or a combination?
How long are the sessions?
Frequency of meetings?
Finding a coach that is flexible and convenient will help maintain a healthy coach/client relationship.
Multidisciplinary Evaluation and Treatment
References
Perlman, A. I., & Abu Dabrh, A. M. (2020). Health and Wellness Coaching in Serving the Needs of Today’s Patients: A Primer for Healthcare Professionals. Global advances in health and medicine, 9, 2164956120959274. doi.org/10.1177/2164956120959274
Conn, S., & Curtain, S. (2019). Health coaching as a lifestyle medicine process in primary care. Australian journal of general practice, 48(10), 677–680. doi.org/10.31128/AJGP-07-19-4984
Individuals dealing with various conditions and diseases and ongoing research to find treatments, where do human regenerative cells come from?
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Regenerative Cells
Regenerative cells are stem cells that are specialized to potentially develop into many different types of cells. They are unlike any other cell because:
Being unspecialized they have no specific function in the body.
They can become specialized cells like – brain, muscle, and blood cells.
They can divide and renew continually for a long period.
Blood stem cells are currently the only type that is regularly used in treatment.
For leukemia or lymphoma, only adult cells are used in a procedure known as a bone marrow transplant. (Cleveland Clinic. 2023)
For regenerative cell research, the cells can come from different sources, including adult donors, genetically altered human cells, or embryos.
Bone Marrow Transplants
Bone marrow cells produce all of the body’s blood cells, including red and white blood, and platelets.
Hematopoietic stem cells are those found in bone marrow that is the parent for the different types of cells.
Hematopoietic cells are transplanted in individuals with cancer to replenish bone marrow.
The procedure is often used during high-dose chemotherapy that destroys the existing cells in the bone marrow.
Donated stem cells are injected into a vein and settle in the bone marrow where they begin to produce new healthy blood cells. (Cleveland Clinic. 2023)
Peripheral Blood Transplants
For some time the only source to extract hematopoietic cells was from bone marrow.
Researchers found that many of these cells were freely circulating in the blood.
Scientists learned how to extract the cells from the blood and transplant them directly.
This type of transplant is a peripheral blood stem cell transplant/PBSCT and has become the more common procedure, however, both methods are still used. (Cleveland Clinic. 2023)
PBSCT is less invasive and does not require the removal of marrow from the hip bone.
Somatic Cells
Adult stem cells are called somatic and are acquired from a donor.
Embryonic stem cells were first grown in a laboratory in 1998 for reproductive research, which created controversy because they were extracted from human embryos that were destroyed or harvested for science. Today their primary use is for research into treatments and potential cures for:
Embryonic cells are pluripotent, which means they can grow into the three types of germ cell layers – ectoderm, mesoderm, and endoderm – that make up the human body and can develop into each of the more than 200 types of cells. (National Institutes of Health. 2016)
Induced Pluripotent Cells
Induced pluripotent stem cells/iPSCs are somatic cells that have been genetically reprogrammed to behave like embryonic cells.
Simara, P., Motl, J. A., & Kaufman, D. S. (2013). Pluripotent stem cells and gene therapy. Translational research : the journal of laboratory and clinical medicine, 161(4), 284–292. doi.org/10.1016/j.trsl.2013.01.001
Finkbeiner, S. R., & Spence, J. R. (2013). A gutsy task: generating intestinal tissue from human pluripotent stem cells. Digestive diseases and sciences, 58(5), 1176–1184. doi.org/10.1007/s10620-013-2620-2
Al-Shamekh, S., & Goldberg, J. L. (2014). Retinal repair with induced pluripotent stem cells. Translational research : the journal of laboratory and clinical medicine, 163(4), 377–386. doi.org/10.1016/j.trsl.2013.11.002
Back problems and discomfort symptoms are a common ailment that many types of healthcare providers diagnose and treat it. Can knowing a little about what each back pain specialist does and what they have to offer help in choosing a provider?
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Back Pain Specialists
Nowadays individuals have options for treating back pain. Primary healthcare providers, general practitioners, pediatricians, and emergency room workers are usually the first to examine the injury or problem. If they are unable to properly diagnose or treat the injury, they will refer the individual to a specialist. Specialists include:
Osteopaths
Chiropractors
Orthopedists
Rheumatologists
Neurologists
Neurosurgeons.
They specialize in chronic conditions and diseases like arthritis or problems like herniated discs. Complementary and alternative providers treat individuals solely or with help from a care team. They look at the whole body and focus on improving overall function.
Family and General Practitioners
When neck or back pain begins a regular doctor that’s usually a family or general practitioner/GP or primary care provider PCP is a recommended place to start. They will:
Order diagnostic tests.
Recommend exercises and stretches.
Prescribe medication.
Refer the patient to a physical therapist or other back pain specialist.
However, studies suggest general providers can be uninformed and slow to adopt new back treatments. (Paul B. Bishop, Peter C. Wing. 2006) It is recommended to research possible treatment options, ask a lot of questions during an appointment, and ask or request a referral to a specialist.
Pediatricians
Pediatricians diagnose and treat children. They cover a wide range of issues including back problems and injuries. As with a general practitioner or primary care provider, a child’s pediatrician is the place to start. Depending on the child’s needs, they’ll refer them to the proper specialist.
Emergency Healthcare Providers
When there is serious neck or back trauma, individuals need to go to the emergency room. Trauma can include automobile collisions, sports accidents, work accidents, and/or personal home accidents. Someone with a possible spinal injury should not be moved. (W Yisheng, et al., 2007) Go to the ER if there is back pain with loss of bowel or bladder control, or the legs become progressively weaker. These are symptoms of an emergency condition known as cauda equina syndrome. (American Association of Neurological Surgeons. 2023)
Orthopedists
Orthopedists and orthopedic surgeons treat the musculoskeletal system, which includes:
Muscles
Bones
Joints
Connective tissues
Cartilage
Common orthopedic issues include:
Repetitive stress injuries
Sports injuries
Bursitis
Tendonitis
Ruptured discs
Nerve impingement
Scoliosis
Osteoporosis
Osteoarthritis
Orthopedics can overlap with other specialties. As orthopedists and rheumatologists both treat arthritis and orthopedic surgeons and neurosurgeons do some of the same procedures that include spinal fusions and discectomies.
Rheumatologists
A rheumatologist treats autoimmune, inflammatory, and musculoskeletal conditions that can include different types of arthritis, lupus, and Sjogren’s syndrome. A primary care provider may refer a patient to a rheumatologist if they have symptoms that include:
Sacroiliitis – inflammation of the sacroiliac joint at the base of the spine.
Axial spondylosis – a form of spinal arthritis.
Axial spondylosis – spinal arthritis that causes the bones to fuse together.
Rheumatologists can also treat spinal stenosis or advanced osteoarthritis as they overlap with orthopedists.
Neurologists
A neurologist specializes in the function of the nervous system. They treat disorders of the brain, spinal cord, and nerves that include:
Parkinson’s disease
Multiple sclerosis
Alzheimer’s disease
Chronic back or neck pain
They are experts in the origins of pain. (David Borsook. 2012) However, a neurologist does not perform spine surgery.
Neurosurgeons
A neurosurgeon specializes in nervous system surgical procedures that include the brain, spine, and spinal cord. However, neurosurgeons do not provide overall treatment for back pain because they are usually the last to be seen after exhausting all other treatment options.
Osteopaths
An osteopath is a licensed physician who practices medicine using conventional treatments and osteopathic manipulative medicine. They have the same education as an MD plus 500 hours of musculoskeletal system studies. (National Library of Medicine. 2022) They take the same exams and are licensed as an MD. Many osteopaths are primary care providers. For back pain, they will focus on:
Posture rehabilitation and training.
Stretching
Therapeutic massage
Spinal manipulation
The goal is to relieve pain and muscle tension, increase mobility, and improve musculoskeletal function.
Physiatrists
Physiatrists are holistic providers that focus on physical function. They can be thought of as a primary care provider plus a physical therapist. These back pain specialists provide rehabilitation for various types of conditions and injuries including:
Back pain
Sports injuries
Stroke
Often they will coordinate a team of specialists to develop a targeted treatment plan.
Chiropractor
Chiropractic is a hands-on alternative medicine. The goal is to restore neuromusculoskeletal function by realigning the spine to its proper form. They do this with spinal manipulations, non-surgical mechanical decompression, traction, and massage techniques. (Michael Schneider, et al., 2016)
The purpose of most chiropractic adjustments is to relax and retrain tight muscles and increase flexibility.
Chiropractic helps to relieve stiff muscles and restore range of motion.
Individuals may not be referred to a chiropractor if they:
Have loose-joints
Have connective tissue problems or conditions.
Have osteoporosis/thinning bones
All types of back pain specialists provide various forms of therapy that may be able to help.
Spinal Decompression in Depth
References
Bishop, P. B., & Wing, P. C. (2006). Knowledge transfer in family physicians managing patients with acute low back pain: a prospective randomized control trial. The spine journal : official journal of the North American Spine Society, 6(3), 282–288. doi.org/10.1016/j.spinee.2005.10.008
Yisheng, W., Fuying, Z., Limin, W., Junwei, L., Guofu, P., & Weidong, W. (2007). First aid and treatment for cervical spinal cord injury with fracture and dislocation. Indian journal of orthopaedics, 41(4), 300–304. doi.org/10.4103/0019-5413.36991
Schneider, M., Murphy, D., & Hartvigsen, J. (2016). Spine Care as a Framework for the Chiropractic Identity. Journal of chiropractic humanities, 23(1), 14–21. doi.org/10.1016/j.echu.2016.09.004
Individuals that experience nerve pain in the foot could be caused by a number of different conditions, can recognizing the most common causes help in developing an effective treatment plan?
Contents
Nerve Pain In The Foot
These sensations can feel like a burning, shooting, electrical, or stabbing pain and can happen while in motion or at rest. It can occur on the top of the foot or through the arch. The area closest to the nerve may be sensitive to the touch. A number of different conditions can cause nerve pain in the foot, including:
Morton’s neuroma
Pinched nerve
Tarsal tunnel syndrome
Diabetic peripheral neuropathy
Herniated disc
Morton’s Neuroma
Morton’s neuroma involves the nerve that runs between the third and fourth toes, but can sometimes occur between the second and third toes becoming thicker. Typical symptoms include a burning or shooting pain in the area, usually while walking. (Nikolaos Gougoulias, et al., 2019) Another common symptom is the sensation of pressure beneath the toes like the sock is bunched up underneath. Treatments can include:
Arch supports
Cortisone injections to decrease swelling
Footwear modifications – can include lifts, orthotics combined with metatarsal pads, and rocker soles, to provide cushion where needed.
Things that increase the risk of developing the condition include:
Regularly wearing high-heels – the condition occurs more frequently in women.
Shoes that are too tight.
Participating in high-impact sports like running.
Having flat feet, high arches, bunions, or hammertoes.
Pinched Nerve
A pinched nerve can feel like shooting or burning pain. Nerve entrapment can occur in various regions of the foot or the area on top of the foot may feel sensitive. Causes can be caused by: (Basavaraj Chari, Eugene McNally. 2018)
Trauma that causes swelling.
Blunt impact.
Tight shoes.
Treatment can include:
Massage
Physical therapy
Rest
Footwear modifications
Anti-inflammatories.
Things that increase the risk of developing a pinched nerve in the foot include:
Poor-fitting footwear.
Repetitive stress injury.
Trauma to the foot.
Obesity.
Rheumatoid arthritis.
Tarsal Tunnel Syndrome
Another type of nerve entrapment is tarsal tunnel syndrome. Tarsal tunnel syndrome is “anything that produces compression on the posterior tibial nerve.” (American College of Foot and Ankle Surgeons. 2019) The tibial nerve is located near the heel. Symptoms include numbness and foot cramps, burning, tingling, or shooting sensations that often radiate from the instep/arch. Both can worsen while the foot is at rest, like when sitting or sleeping. Treatment can consist of:
Placing padding in the shoe where the foot is being compressed to relieve the pain.
Custom foot orthotics.
Cortisone shots or other anti-inflammatory treatments.
Surgery may be necessary to release the nerve.
Conditions that compress the tibial nerve and can lead to tarsal tunnel syndrome include:
Flat feet
Fallen arches
Ankle sprain
Diabetes
Arthritis
Varicose veins
Bone spurs
Diabetic Peripheral Neuropathy
Long-term high blood sugar/glucose associated with diabetes can lead to a form of nerve damage known as peripheral neuropathy. (Centers for Disease Control and Prevention. 2022) Neuropathy pain feels like burning or shooting pain, or the sensation of walking on bubble wrap that usually shows up overnight. The pain can come and go as well as a gradual loss of feeling in the feet that begins in the toes and moves up the foot. It’s estimated that around half of individuals with diabetes will eventually develop neuropathy. (Eva L. Feldman, et al., 2019) Treatments can include:
Physical therapy massage to increase circulation.
Topical treatments with capsaicin.
Vitamin B.
Blood sugar management.
Alpha lipoic acid.
Medication.
Individuals with diabetes have an increased risk of developing peripheral neuropathy if:
Blood sugar is not well-controlled.
Diabetes has been present for many years.
Kidney disease.
Smoke.
Overweight or obese.
Herniated Disc
Nerve pain in the foot can be caused by spinal issues. A herniated disc in the lower back can irritate and compress the nerves, causing pain that radiates down the leg and foot. Additional symptoms usually include muscle weakness in the legs and/or numbness and tingling. Most herniated discs don’t require surgery and get better with conservative treatment. (Wai Weng Yoon, Jonathan Koch. 2021) If symptoms don’t improve or worsen, a healthcare provider may recommend surgery. Herniated discs are most common in young and middle-aged adults. Increased chances of developing a herniated disc can come from:
Degenerative changes in the spine from normal age wear and tear.
Physically demanding job.
Lifting incorrectly.
Overweight or obese.
Genetic predisposition – family history of herniated discs.
Spinal Stenosis
Spinal stenosis occurs when the spaces in the spine begin to narrow, creating pressure on the spinal cord and nerve roots. It is usually caused by wear and tear on the spine as the body ages. Stenosis in the lower back can cause burning pain in the buttocks and leg. As it progresses pain can radiate into the feet along with numbness and tingling. Conservative treatment consists of physical therapy exercises and non-steroidal anti-inflammatory medications/NSAIDs. (Jon Lurie, Christy Tomkins-Lane. 2016) Cortisone injections can be beneficial and if the condition worsens, surgery may be an option. Risk factors include:
Physical trauma – after surgery or an automobile or sports accident.
Certain cancer, antiviral medications, or antibiotics.
Complex regional pain syndrome.
Tumors that irritate and/or compress a nerve.
Liver or kidney disease.
Infectious diseases – Lyme disease complications or viral infections.
Nerve pain in the foot is definitely a reason to see a healthcare provider. Early diagnosis can help prevent symptom progression and future problems. Once the cause of the pain has been identified, the healthcare team can work together to develop a personalized treatment plan to release compressed nerves and restore mobility and function. See a healthcare provider right away if the pain and symptoms worsen, or if there are difficulties standing or walking.
Chiropractic After Accidents and Injuries
References
Gougoulias, N., Lampridis, V., & Sakellariou, A. (2019). Morton’s interdigital neuroma: instructional review. EFORT open reviews, 4(1), 14–24. doi.org/10.1302/2058-5241.4.180025
Chari, B., & McNally, E. (2018). Nerve Entrapment in Ankle and Foot: Ultrasound Imaging. Seminars in musculoskeletal radiology, 22(3), 354–363. doi.org/10.1055/s-0038-1648252
Feldman, E. L., Callaghan, B. C., Pop-Busui, R., Zochodne, D. W., Wright, D. E., Bennett, D. L., Bril, V., Russell, J. W., & Viswanathan, V. (2019). Diabetic neuropathy. Nature reviews. Disease primers, 5(1), 42. doi.org/10.1038/s41572-019-0097-9
Yoon, W. W., & Koch, J. (2021). Herniated discs: when is surgery necessary?. EFORT open reviews, 6(6), 526–530. doi.org/10.1302/2058-5241.6.210020
Lurie, J., & Tomkins-Lane, C. (2016). Management of lumbar spinal stenosis. BMJ (Clinical research ed.), 352, h6234. doi.org/10.1136/bmj.h6234
Staff, N. P., & Windebank, A. J. (2014). Peripheral neuropathy due to vitamin deficiency, toxins, and medications. Continuum (Minneapolis, Minn.), 20(5 Peripheral Nervous System Disorders), 1293–1306. doi.org/10.1212/01.CON.0000455880.06675.5a
Nowadays, individuals trying to avoid surgery have more therapy options. Can regenerative medicine help treat neuromusculoskeletal injuries?
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Regenerative Medicine
Regenerative medicine utilizes the body’s raw cells and is used in cancer treatment and to reduce the risk of infections. (American Cancer Society. 2020) Researchers are looking for other ways to use these cells in medical therapies.
What are These Cells
Stem cells are unspecialized cells that can develop into any cell and in certain cases renew themselves an unlimited number of times. (National Institutes of Health. 2016)
Regenerative cell therapy uses these cells as a treatment for a disease or condition.
Regenerative cells are given to individuals to replace cells that have been destroyed or have died.
In the case of cancer, they may be used to help the body regain the ability to produce regenerative cells after treatment. (American Cancer Society. 2020)
For individuals with multiple myeloma and certain types of leukemia, regenerative cell therapy is used to eliminate cancer cells.
The therapy is called graft-versus-tumor effect/GvT, where a donor’s white blood cells/WBCs are used to eliminate the cancerous tumor. (American Cancer Society. 2020)
What They Can Treat
This is a new treatment that is still going through research. The Food and Drug Administration has only approved it for certain cancers and conditions that affect the blood and immune system. (Centers for Disease Control and Prevention. 2019) Regenerative cell therapy is FDA-approved to treat: (National Cancer Institute. 2015)
Leukemia
Lymphoma
Multiple myeloma
Neuroblastoma
It is also used to decrease the risk of infection after regenerative cell transplantation in individuals with blood cancers. (U.S. Food & Drug Administration. 2023)
Researchers are studying how these cells can treat other conditions. Clinical trials are analyzing how to use the therapy for neurodegenerative diseases like:
During regenerative cell therapy, the cells are given through an intravenous line. The three places where blood-forming cells can be obtained are bone marrow, the umbilical cord, and blood. Transplants can include: (American Cancer Society. 2020)
Autologous
The cells are taken from the individual who will be receiving the therapy.
Allogeneic
The cells are donated by another individual.
Syngeneic
The cells come from an identical twin, if there is one.
Safety
The therapy has shown to provide benefits but there are risks.
One risk is known as graft-versus-host disease – GVHD.
It occurs in one-third to half of allogeneic recipients.
This is where the body does not recognize the donor’s white blood cells and attacks them causing problems and symptoms throughout the body.
To treat GVHD medications are given to suppress the immune system to stop attacking the donor cells. (American Cancer Society. 2020)
The future of regenerative cell therapy is promising. Research is ongoing to find out how these cells can treat conditions and find new ways to treat and cure diseases.
Regenerative medicine has been researched for over twenty years for conditions like macular degeneration, glaucoma, stroke, and Alzheimer’s disease. (National Institutes of Health. 2022) This therapy is a new medical treatment that could be used in future therapies as part of a multidisciplinary approach to neuromusculoskeletal injuries and conditions.
For individuals with a broken collarbone, can conservative treatment help in the rehabilitation process?
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Broken Collarbone
Broken collarbones are very common orthopedic injuries that can occur in any age group. Also known as the clavicle, it is the bone over the top of the chest, between the breastbone/sternum and the shoulder blade/scapula. The clavicle can be easily seen because only skin covers a large part of the bone. Clavicle fractures are extremely common, and account for 2% – 5% of all fractures. (Radiopaedia. 2023) Broken collarbones occur in:
Babies – usually during birth.
Children and adolescents – because the clavicle does not fully develop until the late teens.
Athletes – because of the risks of being hit or falling.
Through various types of accidents and falls.
The majority of broken collarbones can be treated with nonsurgical treatments, usually, with a sling to let the bone heal and physical therapy and rehabilitation.
Sometimes, when clavicle fractures are significantly shifted out of alignment, surgical treatment may be recommended.
There are treatment options that should be discussed with an orthopedic surgeon, physical therapist, and/or a chiropractor.
A broken collarbone is not more serious than other broken bones.
Once the broken bone heals, most individuals have a full range of motion and can return to the activities before the fracture. (Johns Hopkins Medicine. 2023)
Types
Broken clavicle injuries are separated into three types depending on the location of the fracture. (Radiopaedia. 2023)
Mid-Shaft Clavicle Fractures
These occur in the central area which can be a simple crack, separation, and/or fractured into many pieces.
Multiple breaks – segmental fractures.
Significant displacement – separation.
Shortened length of the bone.
Distal Clavicle Fractures
These happen close to the end of the collarbone at the shoulder joint.
This part of the shoulder is called the acromioclavicular/AC joint.
Distal clavicle fractures can have similar treatment options as an AC joint injury.
Medial Clavicle Fractures
These are less common and often related to injury to the sternoclavicular joint.
The sternoclavicular joint supports the shoulder and is the only joint that connects the arm to the body.
Growth plate fractures of the clavicle can be seen into the late teens and early 20s.
The bruising can extend down to the chest and armpit.
Numbness and tingling down the arm.
Deformity of the collarbone.
In addition to swelling, some individuals may have a bump in the place where the fracture occurred.
It can take several months for this bump to fully heal, but this is normal.
If the bump appears inflamed or irritated, inform a healthcare provider.
Clavicular Swelling
When the sternoclavicular joint swells up or gets bigger, it is referred to as clavicular swelling.
It is commonly caused by trauma, disease, or an infection that affects the fluid found in the joints. (John Edwin, et al., 2018)
Diagnosis
At the healthcare clinic or emergency room, an X-ray will be obtained to assess for the specific type of fracture.
They will perform an examination to ensure the nerves and blood vessels surrounding the broken collarbone are unsevered.
The nerves and vessels are rarely injured, but in severe cases, these injuries can occur.
Treatment
Treatment is accomplished either by allowing the bone to heal or by surgical procedures to restore the proper alignment. Some common treatments for broken bones are not used for clavicle fractures.
For example, casting a broken collarbone is not done.
In addition, resetting the bone or a closed reduction is not done because there is no way to hold the broken bone in proper alignment without surgery.
If surgery is an option the healthcare provider looks at the following factors: (UpToDate. 2023)
Location of Fracture and Degree of Displacement
Nondisplaced or minimally displaced fractures are usually managed without surgery.
Age
Younger individuals have an increased ability to recover from fractures without surgery.
Shortening of the Fracture Fragment
Displaced fractures can heal, but when there is a pronounced shortening of the collarbone, surgery is probably necessary.
Other Injuries
Individuals with head injuries or multiple fractures can be treated without surgery.
Patient Expectations
When the injury involves an athlete, heavy job occupation, or the arm is the dominant extremity, there can be more reason for surgery.
Dominant Arm
When fractures occur in the dominant arm, the effects are more likely to be noticeable.
The majority of these fractures can be managed without surgery, but there are situations where surgery can produce better results.
Supports for Non-surgical Treatment
A sling or figure-8 clavicle brace.
The figure-8 brace has not been shown to affect fracture alignment, and many individuals generally find a sling more comfortable. (UpToDate. 2023)
Broken collarbones should heal within 6–12 weeks in adults
3–6 weeks in children
Younger patients are usually back to full activities before 12 weeks.
The pain usually subsides within a few weeks. (UpToDate. 2023)
Immobilization is rarely needed beyond a few weeks, and with a doctor’s clearance light activity and gentle motion rehabilitation usually begins.
Edwin, J., Ahmed, S., Verma, S., Tytherleigh-Strong, G., Karuppaiah, K., & Sinha, J. (2018). Swellings of the sternoclavicular joint: review of traumatic and non-traumatic pathologies. EFORT open reviews, 3(8), 471–484. doi.org/10.1302/2058-5241.3.170078
For individuals with aches and pains throughout their body, can a foot detox help bring relief?
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Foot Detox
A foot detox involves soaking the feet in an ionic bath to help remove toxins from the body. They can also be performed using acupressure, scrubs, foot masks, and pads. Combined with eliminating toxins, detox is also believed to help enhance blood circulation and provide body pain and discomfort relief. However, current evidence is limited and there has been no evidence to support that toxins can be released from the feet using an ionic bath. However, they have been found to provide other benefits, which include:
Relaxation
Lower stress levels
Enhanced skin health and hydration.
Reduced inflammation in individuals with skin disorders.
Foot detoxes are considered generally safe, but individuals are recommended to speak to their healthcare provider.
Potential Benefits
The potential health benefits include:
Reduces inflammation and swelling.
Improves stress levels and mood.
Can help with weight management.
Can help with heart health and increased blood circulation.
However, most reports surrounding the benefits of foot detox are not proven by research investigating whether the health claims are scientifically accurate. One study in 2012 found that foot detoxes did not produce the intended results and could not help remove toxins from the body. (Deborah A. Kennedy, et al., 2012) Other research surrounding foot baths and massages showed that they could help reduce symptoms of mood disorders like schizophrenia because of the relaxing effect they produce. (Kazuko Kito, Keiko Suzuki. 2016)
Ways Toxins are Removed From the Body
Toxins are filtered out of the body in a variety of ways. Breathing out expels carbon dioxide from the body. Another way is through the body’s natural processes. The body has organs and other systems to filter out and release toxins.
Specific organs, such as the liver, kidneys, and lymph nodes, filter and remove harmful and unneeded substances. (UW Integrative Health. 2021)
The health claims surrounding toxin removal through the feet are currently insubstantial because no evidence supports the effectiveness and the anecdotal evidence is not based on science.
Foot detoxes can be an enjoyable experience that can help relieve sore feet, relax the body, and offer relief for certain foot ailments. They could be an excellent addition to a self-care routine. Some of the most commonly used natural foot detoxes include the following.
Epsom Salt Foot Bath
Combining Epsom salts with warm water and soaking the feet for 20–30 minutes can help promote relaxation.
Apple cider vinegar foot baths are made by diluting 1 cup of vinegar in warm water and soaking the feet for 20–30 minutes.
There is limited research available to confirm the health claims.
The studies that have been done have found the reverse effect, that bathing the feet in apple cider vinegar and water can irritate the skin. (Lydia A Luu, et al., 2021)
Baking Soda and Sea Salt
Sea salt combined with baking soda dissolved in a bath and soak the feet for up to 30 minutes. While research is limited, some evidence supports the health benefits associated with sea salt that include: (Ehrhardt Proksch, et al., 2005)
Reduces inflammation in skin conditions, like atopic dermatitis.
Foot baths should be avoided for the following:
There are open sores on the feet that could be irritated by salt and other foot bath ingredients.
Individuals with a pacemaker or any electrical body implant.
Pregnant women.
Consult a healthcare provider before trying any new health protocols.
Foot Orthotics Benefits
References
Kennedy, D. A., Cooley, K., Einarson, T. R., & Seely, D. (2012). Objective assessment of an ionic footbath (IonCleanse): testing its ability to remove potentially toxic elements from the body. Journal of environmental and public health, 2012, 258968. doi.org/10.1155/2012/258968
Kito, K., & Suzuki, K. (2016). Research on the Effect of the Foot Bath and Foot Massage on Residual Schizophrenia Patients. Archives of psychiatric nursing, 30(3), 375–381. doi.org/10.1016/j.apnu.2016.01.002
UW Integrative Health. Improving your health by removing toxins from your body.
Akyuz Ozdemir, F., & Can, G. (2021). The effect of warm salt water foot bath on the management of chemotherapy-induced fatigue. European journal of oncology nursing: the official journal of European Oncology Nursing Society, 52, 101954. doi.org/10.1016/j.ejon.2021.101954
Vakilinia, S. R., Vaghasloo, M. A., Aliasl, F., Mohammadbeigi, A., Bitarafan, B., Etripoor, G., & Asghari, M. (2020). Evaluation of the efficacy of warm salt water foot-bath on patients with painful diabetic peripheral neuropathy: A randomized clinical trial. Complementary therapies in medicine, 49, 102325. doi.org/10.1016/j.ctim.2020.102325
Luu, L. A., Flowers, R. H., Gao, Y., Wu, M., Gasperino, S., Kellams, A. L., Preston, D. C., Zlotoff, B. J., Wisniewski, J. A., & Zeichner, S. L. (2021). Apple cider vinegar soaks do not alter the skin bacterial microbiome in atopic dermatitis. PloS one, 16(6), e0252272. doi.org/10.1371/journal.pone.0252272
Proksch, E., Nissen, H. P., Bremgartner, M., & Urquhart, C. (2005). Bathing in a magnesium-rich Dead Sea salt solution improves skin barrier function, enhances skin hydration, and reduces inflammation in atopic dry skin. International journal of dermatology, 44(2), 151–157. doi.org/10.1111/j.1365-4632.2005.02079.x
Kanwar A. J. (2018). Skin barrier function. The Indian Journal of Medical Research, 147(1), 117–118. doi.org/10.4103/0971-5916.232013
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