For individuals with back pain, how can health practitioners incorporate non-surgical solutions to reduce spinal pain?
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Introduction
The spine is one of the most important structures in the human body, providing host mobility and stability when vertical pressure is pressing on the spinal structure. The spine is surrounded by various muscles, ligaments, and tissues that help support the upper and lower body portions and extremities. When normal factors like heaving lifting, improper stances, obesity, or pre-existing conditions start to affect the body, it can cause the spinal structure to potentially cause unwanted issues that lead to back, neck, and shoulder pain. When experiencing these three common body pains often correlate with other associated symptoms that can affect the other extremities. When this happens, many individuals begin to miss out on work or daily activities that can cause them to be miserable, and they even try to look for various solutions to reduce the pain they are experiencing. Today’s article looks at one of the common body pains like back pain and how it can cause numerous issues that affect a person’s ability to function, and how non-surgical solutions can not only reduce the pain-like effects but also provide the necessary relief that many people deserve in their health and wellness journey. We speak with certified medical providers who incorporate our patients’ information to provide numerous treatment plans to ease the pain-like symptoms associated with spinal issues causing back pain. We also inform our patients that there are non-surgical options to reduce these pain-like issues and restore spinal mobility to the body. We encourage our patients to ask intricated and educational questions to our associated medical providers about the pain-like symptoms they are experiencing correlating with the lower back. Dr. Alex Jimenez, D.C., utilizes this information as an academic service. Disclaimer.
Back Pain Affecting The Spine
Do you often experience radiating pain in your lower back that causes symptoms of numbness or tingling sensations down to your legs and feet? Do you feel muscle stiffness in the morning while getting up, only to slowly disappear throughout the day? Or do you feel symptoms of muscle aches and pain when carrying a heavy object from one location to another? Many individuals, more often than not, have dealt with back pain associated with various factors. With back pain being in the top three common problems in the workforce, many individuals have dealt with the common problem in multiple ways. From improper heavy lifting to excessive sitting at a desk, back pain can cause musculoskeletal issues that many are trying to find relief. Low back pain can either be acute or chronic, depending on the severity. It can lead to mobility impairment within the thoracic, lumbar, and sacroiliac spinal regions, causing referred pain to the lower extremities. It can lead to a life of impairment without any symptoms or signs of serious medical or psychological conditions associated with environmental factors. (Delitto et al., 2012) Back pain is also associated with spinal conditions like inflammation, asymmetric loading, and muscle strain, which can cause the spinal structures to be compressed, thus causing disc herniations. (Zemková & Zapletalová, 2021)
Additionally, back pain is a multifactorial musculoskeletal condition that causes many individuals to be in a socio-economic situation that can decrease their quality of life. Many examples of back pain are correlated with altered motor control within the spinal erector muscles that causes impaired proprioception in the spine. (Fagundes Loss et al., 2020) When this happens to many individuals, they often experience a hindrance of lumbar stability, body balance, posture, and postural control. At the same time, when many working individuals are having severe back pain associated with everyday factors, the amount of pain they are in can change the threshold of the mechanoreceptors that are transmitting the pain signals through the spinal cord. To this point, back pain can affect the neuromuscular response and affect normal musculoskeletal functionality. Fortunately, numerous treatments can help reduce back pain and provide relief to spinal pain that is affecting many individuals.
The Role Of Chiropractic Care- Video
How many times a day do you experience back pain associated with stiffness, general aches, or pains that are affecting your ability to work? Do you notice you hunching more when moving from one location to another? Or do you feel aches and pain in your back after stretching in the morning? Many individuals dealing with these common environmental factors are closely associated with back pain. Back pain is in the top three most common problems many individuals have experienced at some point in their lives. More often than not, many people have dealt with back pain by using home remedies to reduce the pain-like effects. However, research studies reveal that when many individuals start to ignore the pain, it can lead them to a life of disability and cause numerous amounts of distress if not treated right away. (Parker et al., 2015) Hence, non-surgical treatments can not only reduce the pain associated with back pain but also help restore spinal mobility. Non-surgical treatments like chiropractic care incorporate spinal manipulation, which can positively affect the spine. (Koes et al., 1996) What chiropractic care does is that it includes mechanical and manual manipulation techniques to stretch out tight muscles and reduce trigger points from reforming. The video above shows how chiropractic care can positively affect the individual while being part of a health and wellness journey to reducing back pain.
Non-Surgical Spinal Decompression For Back Pain
Just like chiropractic care, spinal decompression is another non-surgical treatment that uses traction to gently pull and stretch the spine to alleviate compressed spinal discs associated with back pain and help stretch out tight muscles. When many people start to incorporate spinal decompression as part of their routine, they will notice that spinal decompression can reduce intradiscal pressure within the negative range. (Ramos, 2004) What this does is that when the spinal discs are being pulled by gentle traction, all the fluids and nutrients that were not hydrating the disc flow back and help kickstart the body’s natural healing process. When many people begin to utilize spinal decompression for their back pain, they will notice a huge reduction in their pain after a few consecutive sessions. (Crisp et al., 1955) When many people start to combine other various non-surgical therapies with spinal decompression, they will be able to regain their spinal mobility while being more mindful of what environmental factors are affecting their spine and not repeat the issue to allow back pain to return.
References
Crisp, E. J., Cyriax, J. H., & Christie, B. G. (1955). Discussion on the treatment of backache by traction. Proc R Soc Med, 48(10), 805-814. www.ncbi.nlm.nih.gov/pubmed/13266831
Delitto, A., George, S. Z., Van Dillen, L., Whitman, J. M., Sowa, G., Shekelle, P., Denninger, T. R., & Godges, J. J. (2012). Low Back Pain. Journal of Orthopaedic & Sports Physical Therapy, 42(4), A1-A57. doi.org/10.2519/jospt.2012.42.4.a1
Fagundes Loss, J., de Souza da Silva, L., Ferreira Miranda, I., Groisman, S., Santiago Wagner Neto, E., Souza, C., & Tarrago Candotti, C. (2020). Immediate effects of a lumbar spine manipulation on pain sensitivity and postural control in individuals with nonspecific low back pain: a randomized controlled trial. Chiropr Man Therap, 28(1), 25. doi.org/10.1186/s12998-020-00316-7
Koes, B. W., Assendelft, W. J., van der Heijden, G. J., & Bouter, L. M. (1996). Spinal manipulation for low back pain. An updated systematic review of randomized clinical trials. Spine (Phila Pa 1976), 21(24), 2860-2871; discussion 2872-2863. doi.org/10.1097/00007632-199612150-00013
Parker, S. L., Mendenhall, S. K., Godil, S. S., Sivasubramanian, P., Cahill, K., Ziewacz, J., & McGirt, M. J. (2015). Incidence of Low Back Pain After Lumbar Discectomy for Herniated Disc and Its Effect on Patient-reported Outcomes. Clin Orthop Relat Res, 473(6), 1988-1999. doi.org/10.1007/s11999-015-4193-1
Ramos, G. (2004). Efficacy of vertebral axial decompression on chronic low back pain: study of dosage regimen. Neurol Res, 26(3), 320-324. doi.org/10.1179/016164104225014030
Zemková, E., & Zapletalová, L. (2021). Back Problems: Pros and Cons of Core Strengthening Exercises as a Part of Athlete Training. International Journal of Environmental Research and Public Health, 18(10), 5400. doi.org/10.3390/ijerph18105400
For older individuals experiencing posture problems, slumping, slouching, and upper back pain, could adding rib cage exercises help bring relief and prevent the condition from worsening?
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Improved Posture
It’s common to associate a collapsed upper back posture with age, but other factors can also contribute to the problems. (Justyna Drzał-Grabiec, et al., 2013) The rib cage and the pelvis are important to body structure and comprise much of the core. If these bone structures become misaligned due to unhealthy posture, the muscles that attach to them become tight, weak, or both, and the surrounding muscles have to compensate, causing a worsening of the condition and further injury.
Unhealthy postures can be caused by a rib cage that compresses down onto the pelvic bone.
As the upper back slumps or compresses, height can begin to decrease.
Posture awareness exercises can help lift the rib cage off the pelvic bone.
Rib Cage Exercises
This exercise can be done sitting or standing. A daily routine can help improve posture and relieve back problems and pain.
The sitting version helps keep the focus on doing the exercise right.
The standing version challenges body awareness, allowing the individual to feel how the rib cage and upper back movements affect pelvic and lower back posture.
To begin, it is recommended to start in a sitting position.
Once the basics are learned, then certainly progress to standing.
Exercise
Position the pelvis so it is in a slight forward tilt.
This forward tilt will exaggerate the low back curve slightly while tightening the lower back muscles in a good way.
Establishing and maintaining this curve in the sitting position should feel natural.
Inhale and exaggerate the upward lift of the rib cage.
Inhaling causes the spine and ribs to extend slightly.
Exhale and allow the rib cage and upper back to return to their natural position.
Repeat up to 10 times once or twice a day.
For this exercise, use breathing to develop the rib cage’s lift and carriage incrementally.
Don’t max out on the spinal extension.
Instead, focus on how breathing/inhaling supports the movement of the ribs and upper back and develops the muscles from there.
Try to lift the rib cage equally on both sides as the body allows.
With practice, individuals will realize the healthy posture changes and increased distance between the ribs and pelvis.
Guidance and Variation
Perform the exercise with the back against a wall for upper back guidance.
Another variation of the pelvis and rib cage posture training exercise is to raise the arms.
This will create a different posture awareness training perspective.
Focus on rib cage movement when the arms are raised.
Does lifting the arms make the exercise easier, harder, or different?
To enhance posture improvement, stretch the pectoral muscles.
Yoga
Individuals looking for more ways to strengthen healthy posture should consider yoga.
A study published in the International Journal of Yoga suggests that a great way to activate the core may be to include a variety of yoga postures into the routine. (Mrithunjay Rathore et al., 2017) The ab muscles attach to various places on the rib cage and play a role in posture, alignment, and balance. The researchers identified two muscles, the external obliques, and the transverse abdominal, as key to a healthily aligned posture.
Core Strength
References
Drzał-Grabiec, J., Snela, S., Rykała, J., Podgórska, J., & Banaś, A. (2013). Changes in the body posture of women occurring with age. BMC geriatrics, 13, 108. doi.org/10.1186/1471-2318-13-108
Rathore, M., Trivedi, S., Abraham, J., & Sinha, M. B. (2017). Anatomical Correlation of Core Muscle Activation in Different Yogic Postures. International journal of yoga, 10(2), 59–66. doi.org/10.4103/0973-6131.205515
Papegaaij, S., Taube, W., Baudry, S., Otten, E., & Hortobágyi, T. (2014). Aging causes a reorganization of cortical and spinal control of posture. Frontiers in aging neuroscience, 6, 28. doi.org/10.3389/fnagi.2014.00028
Facet hypertrophy is an incurable, chronic disease that affects the facet joints in the spine. Can recognizing symptoms, help in diagnosis, and treatment?
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Facet Hypertrophy
Facet hypertrophy causes the facet joints in the spine to enlarge. They are found where the vertebrae come into contact on the back of the vertebrae that form the backbone. These joints stabilize the spine when twisting and bending. Hypertrophy results when damage wears down the cartilage that cushions the bones that meet in the joint. This can include:
Aging
Wear and tear
Arthritis
Other joint diseases can damage facet joints.
Swelling, new bone growth, and bone spurs can occur as the joint tries to repair the damaged cartilage. The swelling and new bone growth can narrow the spinal canal and compress surrounding nerves, causing pain and other sensation symptoms. This ailment does not have a cure and worsens over time. The objective of treatment is to manage the pain symptoms and slow down the disease’s progress.
Types
Facet hypertrophy can be described as unilateral or bilateral.
Symptoms can have a wide range of intensity, from a dull ache to chronic, disabling pain. The location of symptoms depends on the affected joint and the nerves involved, Pain manifests when the enlarged joints and new bone growth compresses the nearby nerves. The result leads to nerve damage and the following symptoms: (Weill Cornell Medicine Brain & Spine Center. 2023) (Cedars Sinai. 2022)
Stiffness, especially when standing up or getting out of a chair.
Inability to stand straight when walking.
Inability to look up to the left or right without turning the whole body.
Reduced range of motion and mobility.
Numbness or a tingling sensation of pins and needles.
Radiating pain from the affected joint into the buttocks, hips, and upper thigh when the affected joint/s are in the lower back.
Radiating pain from the affected joint into the shoulder, neck, and back of the head when the affected joint/s are in the upper back.
Headaches when the affected joint is in the neck.
Causes
A common cause is the age-related degeneration of the joints, called spondylosis. Research indicates that more than 80% of individuals who are 40 or older have radiologic evidence of spondylosis, even though they may not have symptoms. (The University of Toledo Medical Center. N.D.) The following conditions can also increase the risk of facet hypertrophy (Weill Cornell Medicine Brain & Spine Center. 2023)
Unhealthy posture
Being overweight or obese
Sedentary lifestyle
Injury or trauma to the spine
Inflammatory conditions like rheumatoid arthritis or ankylosing spondylitis
Osteoarthritis
Genetic predisposition to the condition
Diagnosis
Diagnosis can be challenging when neck or back pain is the main complaint, as symptoms can mimic conditions such as sciatica from a herniated disc or hip arthritis. (Weill Cornell Medicine Brain & Spine Center. 2023)
A healthcare provider will conduct a complete physical examination, medical history, and discussion of symptoms.
CT scans with or without myelogram – the use of contrast dye in the space around the spinal cord.
MRI
X-rays with or without a myelogram
A diagnosis is confirmed by injecting a diagnostic block that involves administering an anesthetic injection, sometimes with an anti-inflammatory like cortisone, into the joint or nerves near the affected joint. Two injections are given at different times to confirm the effect. (Romain Perolat et al., 2018)
If immediate relief improves after each injection, the facet joint is confirmed as the source of the pain symptoms.
If the block does not decrease the pain, the facet joint is probably not the source of the pain symptoms. (Brigham and Women’s Hospital. 2023)
Treatment
There is no cure for facet hypertrophy.
The goal of treatment is to make the pain more manageable.
Conservative treatment is usually successful in making a difference.
Nonsteroidal anti-inflammatory – aspirin, ibuprofen, and naproxen.
Muscle relaxers – cyclobenzaprine or metaxalone.
Steroid injection into the facet joints.
Injection of platelet-rich plasma/PRP into the joints.
Medial Branch or Facet Block
A medial branch block injects local anesthetic near the medial nerves that connect to an inflamed joint.
Medial nerves are small nerves outside the joint space near the nerve that transmit signals and other impulses to the brain.
A facet block injects the medication outside the joint space near the nerve that supplies the joint called the medial branch.
Neurolysis
Neurolysis, also known as rhizotomy or neurotomy, is a procedure that destroys affected nerve fibers to relieve pain, reduce disability, and reduce the need for analgesics. This treatment can relieve pain for six to 12 months until the nerve regenerates, where further treatments may be necessary. (Matthew Smuck et al., 2012) Neurolysis can be performed using one of the following techniques (Romain Perolat et al., 2018)
Radiofrequency ablation RFA – the application of heat through radiofrequency.
Cryoneurolysis – the application of cold temperatures to the targeted nerve.
Chemical neurolysis – applying chemical agents, like a combination of phenol and alcohol.
Severing the nerves with surgical instrumentation.
Surgery
When one or more facet joints are severely damaged, they can become nonfunctional and painful. Surgery may be recommended when symptoms are not relieved by other therapies. (Ali Fahir Ozer, et al., 2015)
Prognosis
Facet hypertrophy is a chronic condition that progresses with age and does not affect life expectancy. (Weill Cornell Medicine Brain & Spine Center. 2023) The disorder is incurable, but symptoms can be managed with conservative therapies
A healthcare provider can help develop a treatment plan based on the extent and location of the joint affected.
Early diagnosis and treatment can help individuals achieve the best results.
Maintaining an active lifestyle and healthy weight can help prevent further joint stress. Individuals may be recommended to do regular stretching and strengthening exercises to lower inflammation, reduce stress, and improve overall health.
Facet Syndrome Treatment
References
Perolat, R., Kastler, A., Nicot, B., Pellat, J. M., Tahon, F., Attye, A., Heck, O., Boubagra, K., Grand, S., & Krainik, A. (2018). Facet joint syndrome: from diagnosis to interventional management. Insights into imaging, 9(5), 773–789. doi.org/10.1007/s13244-018-0638-x
Smuck, M., Crisostomo, R. A., Trivedi, K., & Agrawal, D. (2012). Success of initial and repeated medial branch neurotomy for zygapophysial joint pain: a systematic review. PM & R : the journal of injury, function, and rehabilitation, 4(9), 686–692. doi.org/10.1016/j.pmrj.2012.06.007
Ozer, A. F., Suzer, T., Sasani, M., Oktenoglu, T., Cezayirli, P., Marandi, H. J., & Erbulut, D. U. (2015). Simple facet joint repair with dynamic pedicular system: Technical note and case series. Journal of craniovertebral junction & spine, 6(2), 65–68. doi.org/10.4103/0974-8237.156049
When a groin strain injury happens, can knowing the symptoms help in the diagnosis, treatment, and recovery times?
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Groin Strain Injury
A groin strain is an injury to an inner thigh muscle. A groin pull is a type of muscle strain affecting the adductor muscle group (the muscles help pull the legs apart). (Parisa Sedaghati, et al., 2013) The injury is caused when the muscle is stretched beyond its normal range of motion, creating superficial tears. Severe strains can tear the muscle in two. (Parisa Sedaghati, et al., 2013)
A groin muscle pull causes pain and tenderness that worsens when squeezing the legs together.
There may also be swelling or bruising in the groin or inner thigh.
An uncomplicated groin pull takes four to six weeks to heal with proper treatment. (Andreas Serner, et al., 2020)
Symptoms
A groin pull can be painful, interfering with walking, navigating stairs, and/or driving a car. In addition to pain, other symptoms around the injured area include: (Parisa Sedaghati et al., 2013)
A popping sound or snapping sensation when the injury occurs.
Increased pain when pulling the legs together.
Redness
Swelling
Bruising of the groin or inner thigh.
Groin pulls are graded by severity and how much they impact mobility:
Grade 1
Mild discomfort but not enough to limit activities.
Grade 2
Moderate discomfort with swelling or bruising that limits running and/or jumping.
Grade 3
Severe injury with significant swelling and bruising can cause pain while walking and muscle spasms.
Signs of a severe groin strain
Difficulty walking
Groin pain while sitting or resting
Groin pain at night
A healthcare provider should see severe groin pulls because the muscle may have ruptured or be on the verge of rupturing.
In severe cases, surgery is necessary to reattach the torn ends.
Groin pulls are sometimes accompanied by a stress fracture of the pubis/forward-facing pelvic bones, which can significantly extend healing and recovery time. (Parisa Sedaghati et al., 2013)
Causes
Groin pulls are often experienced by athletes and individuals who play sports where they must stop and change directions quickly, placing excessive strain on the adductor muscles. (Parisa Sedaghati et al., 2013) The risk is increased in individuals who: (T. Sean Lynch et al., 2017)
Have weak hip abductor muscles.
Are not in adequate physical condition.
Have a previous groin or hip injury.
Pulls can also occur from falls or extreme activities without the proper conditioning.
Diagnosis
A healthcare provider will perform a thorough investigation to confirm the diagnosis and characterize the severity. This involves: (Juan C. Suarez et al., 2013)
Medical History Review
This includes any previous injuries and specifics about where and when the symptoms started.
Physical Examination
This involves palpating – lightly touching and pressing the groin region and manipulating the leg to understand better where and how extensive the injury is.
Imaging Studies
Ultrasound or X-rays.
If a muscle rupture or fracture is suspected, an MRI scan may be ordered to visualize soft tissue injuries and stress fractures better.
Differential Diagnosis
Certain conditions can mimic a groin pull and require different treatments. These include: (Juan C. Suarez, et al., 2013)
Sports Hernia
This type of inguinal hernia occurs with sports and work injuries.
It causes a portion of the intestine to pop through a weakened muscle in the groin.
Hip Labral Tear
This is a tear in the cartilage ring of the labrum outside the rim of the hip joint socket.
Hip Osteoarthritis
This is the wear-and-tear form of arthritis that can present with groin pain symptoms.
Osteitis Pubis
This is inflammation of the pubic joint and surrounding structures, usually caused by the overuse of the hip and leg muscles.
Referred Groin Pain
This nerve pain originates in the lower back, often due to a pinched nerve, but is felt in the groin.
Treatment
Beginning treatment is conservative and includes rest, ice application, physical therapy, and prescribed gentle stretching and exercises.
Individuals may need crutches or a walking device to reduce pain and prevent further injury if the pain is significant. (Andreas Serner, et al., 2020)
Physical therapy will be a part of the treatment plan.
Over-the-counter pain medications like Tylenol/acetaminophen or Advil/ibuprofen can help with pain relief short term.
If there is severe pain from a grade 3 injury, prescription medications may be used for a short period to help minimize pain. (Andreas Serner, et al., 2020)
Sedaghati, P., Alizadeh, M. H., Shirzad, E., & Ardjmand, A. (2013). Review of sport-induced groin injuries. Trauma monthly, 18(3), 107–112. doi.org/10.5812/traumamon.12666
Serner, A., Weir, A., Tol, J. L., Thorborg, K., Lanzinger, S., Otten, R., & Hölmich, P. (2020). Return to Sport After Criteria-Based Rehabilitation of Acute Adductor Injuries in Male Athletes: A Prospective Cohort Study. Orthopaedic journal of sports medicine, 8(1), 2325967119897247. doi.org/10.1177/2325967119897247
Lynch, T. S., Bedi, A., & Larson, C. M. (2017). Athletic Hip Injuries. The Journal of the American Academy of Orthopaedic Surgeons, 25(4), 269–279. doi.org/10.5435/JAAOS-D-16-00171
Suarez, J. C., Ely, E. E., Mutnal, A. B., Figueroa, N. M., Klika, A. K., Patel, P. D., & Barsoum, W. K. (2013). Comprehensive approach to the evaluation of groin pain. The Journal of the American Academy of Orthopaedic Surgeons, 21(9), 558–570. doi.org/10.5435/JAAOS-21-09-558
Athletes and physically active individuals who participate in activities, exercises, and sports that involve kicking, pivoting, and/or shifting directions can develop pelvis overuse injury of the pubic symphysis/joint at the front of the pelvis known as osteitis pubis. Can recognizing the symptoms and causes help in treatment and prevention?
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Osteitis Pubis Injury
Osteitis pubis is the inflammation of the joint that connects the pelvic bones, called the pelvic symphysis, and the structures around it. The pubic symphysis is a joint in front of and below the bladder. It holds the two sides of the pelvis together in the front. The pubis symphysis has very little motion, but when abnormal or continued stress is placed on the joint, groin and pelvic pain can present. An osteitis pubis injury is a common overuse injury in physically active individuals and athletes but can also occur as the result of physical trauma, pregnancy, and/or childbirth.
Symptoms
The most common symptom is pain over the front of the pelvis. The pain is most often felt in the center, but one side may be more painful than the other. The pain typically radiates/spreads outward. Other signs and symptoms include: (Patrick Gomella, Patrick Mufarrij. 2017)
Lower abdominal pain in the center of the pelvis
Limping
Hip and/or leg weakness
Difficulty climbing stairs
Pain when walking, running, and/or shifting directions
Clicking or popping sounds with movement or when shifting directions
Pain when lying down on the side
Pain when sneezing or coughing
Osteitis pubis can be confused with other injuries, including a groin strain/groin pull, a direct inguinal hernia, ilioinguinal neuralgia, or a pelvic stress fracture.
Causes
An osteitis pubis injury usually occurs when the symphysis joint is exposed to excessive, continued, directional stress and overuse of the hip and leg muscles. Causes include: (Patrick Gomella, Patrick Mufarrij. 2017)
Sports activities
Exercising
Pregnancy and childbirth
Pelvic injury like a severe fall
Diagnosis
The injury is diagnosed based on a physical examination and imaging tests. Other tests may be used to rule out other possible causes.
The physical exam will involve manipulation of the hip to place tension on the rectus abdominis trunk muscle and adductor thigh muscle groups.
Pain during the manipulation is a common sign of the condition.
Individuals may be asked to walk to look for irregularities in gait patterns or to see if symptoms occur with certain movements.
X-rays will typically reveal joint irregularities as well as sclerosis/thickening of the pubic symphysis.
Magnetic resonance imaging – MRI may reveal joint and surrounding bone inflammation.
Some cases will show no signs of injury on an X-ray or MRI.
Treatment
Effective treatment can take several months or longer. Because inflammation is the underlying cause of symptoms, the treatment will often involve: (Tricia Beatty. 2012)
Rest
Allows the acute inflammation to subside.
During recovery, sleeping flat on the back may be recommended to reduce pain.
Ice and Heat Applications
Ice packs help reduce inflammation.
The heat helps ease pain after the initial swelling has gone down.
Physical Therapy
Physical therapy can be extremely helpful in treating the condition to help regain strength and flexibility. (Alessio Giai Via, et al., 2019)
Anti-inflammatory Medication
Over-the-counter nonsteroidal anti-inflammatory medications – NSAIDs like ibuprofen and naproxen can reduce pain and inflammation.
Assistive Walking Devices
If the symptoms are severe, crutches or a cane may be recommended to reduce stress on the pelvis.
Cortisone
There have been attempts to treat the condition with cortisone injections, but the evidence supporting its use is limited and needs further research. (Alessio Giai Via, et al., 2019)
Prognosis
Once diagnosed, the prognosis for full recovery is optimal but can take time. It can take some individuals six months or more to return to pre-injury level of function, but most return by around three months. If conservative treatment fails to provide relief after six months, surgery could be recommended. (Michael Dirkx, Christopher Vitale. 2023)
Sports Injuries Rehabilitation
References
Gomella, P., & Mufarrij, P. (2017). Osteitis pubis: A rare cause of suprapubic pain. Reviews in urology, 19(3), 156–163. doi.org/10.3909/riu0767
Via, A. G., Frizziero, A., Finotti, P., Oliva, F., Randelli, F., & Maffulli, N. (2018). Management of osteitis pubis in athletes: rehabilitation and return to training – a review of the most recent literature. Open access journal of sports medicine, 10, 1–10. doi.org/10.2147/OAJSM.S155077
Dirkx M, Vitale C. Osteitis Pubis. [Updated 2022 Dec 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: www.ncbi.nlm.nih.gov/books/NBK556168/
For individuals suffering from allergies, could using acupuncture help relieve and manage symptoms?
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Acupuncture Can Help With Allergies
Acupuncture is becoming a more respected alternative treatment for various medical issues, from anxiety to fibromyalgia to weight loss. There is evidence that acupuncture can help with allergies by alleviating symptoms and improving the quality of life. (Shaoyan Feng, et al., 2015) The American Academy of Otolaryngology-Head and Neck Surgery Foundation recommends doctors offer acupuncture to patients looking for nonpharmacological treatments for their allergies or refer them to an acupuncturist. (Michael D. Seidman, et al., 2015)
Acupuncture
Acupuncture is a traditional Chinese medicine/TCM practice in which extremely thin needles are inserted into the body at specific points, creating a network of energy pathways known as meridians.
These pathways circulate vital life energy/chi or qi.
Each meridian is associated with a different body system.
Needles are placed to target the organs associated with the condition being treated.
Acupuncture can help with allergies by targeting several meridians, including the lungs, colon, stomach, and spleen. These meridians are believed to circulate defensive life energy or a type of immunity energy.
A backup of defensive energy or a deficiency can cause allergy symptoms like swelling, watery eyes, runny nose, sneezing, allergic eczema, and conjunctivitis. (Bettina Hauswald, Yury M. Yarin. 2014)
The objective is to stimulate the points to restore balance in the energies and relieve symptoms.
Scientific Theories
One theory is the needles work directly on nerve fibers, influencing messages to the brain or the autonomic nervous system and transmission of signals within the body, including the immune system. (Tony Y. Chon, Mark C. Lee. 2013)
Another is the needles influence certain activities of cells, particularly the transport, breakdown, and clearance of bioactive mediators.
The combination of these actions is thought to decrease inflammatory conditions like allergic rhinitis – hay fever, in which the inside of the nose becomes inflamed and swollen after breathing in an allergen. (Bettina Hauswald, Yury M. Yarin. 2014)
A 2015 review concluded there have been high-quality randomized controlled trials demonstrating acupuncture’s efficacy in treating seasonal and perennial allergic rhinitis. Smaller studies have shown some preliminary benefits of acupuncture when compared with antihistamines, but more research is needed. (Malcolm B. Taw, et al., 2015)
Treating Allergies
Some individuals who choose acupuncture are seeking alternatives to standard treatment like medications, nasal sprays, and immunotherapy.
Others are looking for ways to enhance the effectiveness of medications already being taken, such as antihistamines or nasal sprays, or shorten how long or how frequently they are needed.
Initial treatment usually involves weekly or twice-weekly appointments over several weeks or months, depending on symptom severity.
Improperly administered acupuncture needles can cause serious side effects that range from infections, punctured organs, collapsed lungs, and injury to the central nervous system. (National Center for Complementary and Integrative Health. 2022) Before trying acupuncture, consult your primary healthcare provider, allergist, or integrative medicine specialist to make sure it’s a safe and viable option and the best way to integrate it into overall allergy care.
Fighting Inflammation Naturally
References
Feng, S., Han, M., Fan, Y., Yang, G., Liao, Z., Liao, W., & Li, H. (2015). Acupuncture for the treatment of allergic rhinitis: a systematic review and meta-analysis. American journal of rhinology & allergy, 29(1), 57–62. doi.org/10.2500/ajra.2015.29.4116
Seidman, M. D., Gurgel, R. K., Lin, S. Y., Schwartz, S. R., Baroody, F. M., Bonner, J. R., Dawson, D. E., Dykewicz, M. S., Hackell, J. M., Han, J. K., Ishman, S. L., Krouse, H. J., Malekzadeh, S., Mims, J. W., Omole, F. S., Reddy, W. D., Wallace, D. V., Walsh, S. A., Warren, B. E., Wilson, M. N., … Guideline Otolaryngology Development Group. AAO-HNSF (2015). Clinical practice guideline: Allergic rhinitis. Otolaryngology–head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 152(1 Suppl), S1–S43. doi.org/10.1177/0194599814561600
Hauswald, B., & Yarin, Y. M. (2014). Acupuncture in allergic rhinitis: A Mini-Review. Allergo journal international, 23(4), 115–119. doi.org/10.1007/s40629-014-0015-3
Taw, M. B., Reddy, W. D., Omole, F. S., & Seidman, M. D. (2015). Acupuncture and allergic rhinitis. Current opinion in otolaryngology & head and neck surgery, 23(3), 216–220. doi.org/10.1097/MOO.0000000000000161
Individuals with digestive problems that cannot be diagnosed could be experiencing functional gastrointestinal disorders. Could understanding the types help in developing effective treatment plans?
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Functional Gastrointestinal Disorders
Functional gastrointestinal disorders, or FGDs, are disorders of the digestive system in which the presence of structural or tissue abnormality cannot explain symptoms. Functional gastrointestinal disorders lack identifiable biomarkers and are diagnosed based on symptoms. (Christopher J. Black, et al., 2020)
Rome Criteria
FGDs used diagnoses of exclusion, meaning that they could only be diagnosed after organic/identifiable disease was ruled out. However, in 1988, a group of researchers and healthcare providers met to devise strict criteria for the diagnosis of the various types of FGDs. The criteria is known as the Rome Criteria. (Max J. Schmulson, Douglas A. Drossman. 2017)
Vomiting and Aerophagia – cyclic vomiting syndrome, adolescent rumination syndrome, and aerophagia
Abdominal Pain-Related Functional GI Disorders include:
functional dyspepsia
IBS
Abdominal migraine
Childhood functional abdominal pain
Childhood functional abdominal pain syndrome
Constipation – functional constipation
Incontinence – nonretentive fecal incontinence
Diagnosis
Although the Rome criteria allow the diagnosis of FGDs to be symptom-based, a healthcare provider may still run standard diagnostic tests to rule out other diseases or look for structural problems resulting in symptoms.
Treatment
Although no visible signs of disease or structural problems may be identified as causing the symptoms, it does not mean that they are not treatable and manageable. For individuals who suspect they may have or have been diagnosed with a functional gastrointestinal disorder, it will be essential to work with a healthcare provider on a working treatment plan. Treatment options can include: (Asma Fikree, Peter Byrne. 2021)
Physical therapy
Nutritional and dietary adjustments
Stress management
Psychotherapy
Medication
Biofeedback
Eating Right To Feel Better
References
Black, C. J., Drossman, D. A., Talley, N. J., Ruddy, J., & Ford, A. C. (2020). Functional gastrointestinal disorders: advances in understanding and management. Lancet (London, England), 396(10263), 1664–1674. doi.org/10.1016/S0140-6736(20)32115-2
Schmulson, M. J., & Drossman, D. A. (2017). What Is New in Rome IV. Journal of neurogastroenterology and motility, 23(2), 151–163. doi.org/10.5056/jnm16214
Sperber, A. D., Bangdiwala, S. I., Drossman, D. A., Ghoshal, U. C., Simren, M., Tack, J., Whitehead, W. E., Dumitrascu, D. L., Fang, X., Fukudo, S., Kellow, J., Okeke, E., Quigley, E. M. M., Schmulson, M., Whorwell, P., Archampong, T., Adibi, P., Andresen, V., Benninga, M. A., Bonaz, B., … Palsson, O. S. (2021). Worldwide Prevalence and Burden of Functional Gastrointestinal Disorders, Results of Rome Foundation Global Study. Gastroenterology, 160(1), 99–114.e3. doi.org/10.1053/j.gastro.2020.04.014
Hyams, J. S., Di Lorenzo, C., Saps, M., Shulman, R. J., Staiano, A., & van Tilburg, M. (2016). Functional Disorders: Children and Adolescents. Gastroenterology, S0016-5085(16)00181-5. Advance online publication. doi.org/10.1053/j.gastro.2016.02.015
Fikree, A., & Byrne, P. (2021). Management of functional gastrointestinal disorders. Clinical medicine (London, England), 21(1), 44–52. doi.org/10.7861/clinmed.2020-0980
For individuals experiencing pelvis pain symptoms and associated problems, can integrating pelvic floor physical therapy exercises help with treatment and prevention?
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Pelvic Floor Physical Therapy
The pelvic floor muscles are located at the base of the pelvis and protect the pelvic organs like the vagina, cervix, uterus, bladder, urethra, and rectum. (U.S. Food and Drug Administration. 2019)
When the muscles fail to function correctly, individuals can experience symptoms like:
Painful intercourse
Prolapse – when an organ or tissue drops or shifts out of place.
Urinary incontinence
Constipation problems
These conditions are common in pregnant individuals or older women.
These symptoms can be treated with pelvic floor physical therapy to alleviate discomfort. Pelvic floor physical therapy can help women and individuals with vaginas:
Alleviate issues like painful sex, urinary leakage, and prolapse.
In physical therapy, individuals work on breathing, relaxation, and lengthening and strengthening techniques to train their muscles to function optimally.
Causes of Pelvic Floor Issues
Pelvic floor dysfunction tends to happen with age, during pregnancy, or in combination with events like the postpartum period and menopause, which can lower hormone levels.
Individuals who are pregnant are especially prone to pelvic floor issues but might not know they have a problem.
The pregnancy weight of a uterus can pressure and strain the muscles.
If left untreated, these symptoms can worsen over time.
Pelvic Floor Physical Therapy
An individual will meet with a specialist to discuss symptoms and undergo a physical examination that includes:
Pelvic floor exam.
Evaluation of posture, mobility, and core strength.
Once the initial exams and evaluation are complete, the practitioner will go over pelvic floor exercises and provide a treatment plan.
Recommended exercises vary based on symptoms but focus on relaxing, stretching, and/or strengthening muscles.
Muscle Relaxation
To relax the muscles, a therapist may recommend breathing exercises.
For pregnant individuals, this means timing breaths with contractions.
For individuals experiencing constipation, breathing exercises can help the body relax and reduce strain.
Stretching Muscles
Stretching can help relieve muscle tightness and stiffness.
A therapist may help stretch the pelvic floor through various therapy modalities.
This type of physical therapy can help loosen tight muscles or help gently reset dislocated organs back into place.
Strengthening Muscles
After the pelvic floor is loose and relaxed, the focus typically switches to strengthening the muscles.
Strength work may target abdominal muscles or the pelvic floor muscles themselves.
With time, commitment, and targeted treatment, individuals can use pelvic floor physical therapy to loosen tissues, strengthen muscles, and restore function.
Sartori, D. V. B., Kawano, P. R., Yamamoto, H. A., Guerra, R., Pajolli, P. R., & Amaro, J. L. (2021). Pelvic floor muscle strength is correlated with sexual function. Investigative and clinical urology, 62(1), 79–84. doi.org/10.4111/icu.20190248
Raizada, V., & Mittal, R. K. (2008). Pelvic floor anatomy and applied physiology. Gastroenterology clinics of North America, 37(3), 493–vii. doi.org/10.1016/j.gtc.2008.06.003
Soave, I., Scarani, S., Mallozzi, M., Nobili, F., Marci, R., & Caserta, D. (2019). Pelvic floor muscle training for prevention and treatment of urinary incontinence during pregnancy and after childbirth and its effect on urinary system and supportive structures assessed by objective measurement techniques. Archives of gynecology and obstetrics, 299(3), 609–623. doi.org/10.1007/s00404-018-5036-6
For individuals trying to get into a regular fitness regimen, could using the FITT Principle help structure exercise, track progress, and achieve fitness goals?
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FITT Principle
The FITT principle is a set of guidelines for adjusting, revising, and improving exercise workouts. FITT is an acronym for:
Frequency
Intensity
Time
Type of exercise
Individuals take these elements to create and adjust workouts that fit their goals and fitness levels.
For example, this could be a workout of 3 to 5 days combined with low, medium, and high-intensity exercises for 30 to 60 minutes each session that incorporates cardio and strength training. Focusing on these details and progressing over time helps create an effective program.
Frequency
Workout frequency and how often the individual is going to exercise is the first thing to look at.
Frequency depends on various factors, including the type of workout being done, how hard the workout is, fitness levels, and exercise goals.
General exercise guidelines developed by the American College of Sports Medicine offer recommendations. (Carol Ewing Garber, et al., 2011)
Cardiovascular Workouts
Cardio workouts are usually scheduled more often.
Depending on goals, guidelines recommend moderate cardio exercise five or more days a week or intense cardio three days a week to improve health.
Individuals can adjust the exercise intensity level easily on a treadmill to provide excellent and convenient cardiovascular workouts.
Individuals who want to lose weight may want to work up to more workouts gradually.
However, more is not always better, and recovery time is essential. (Pete McCall. 2018)
For individuals following a split routine, like upper body one day and lower body the next, workouts can be more frequent than total body workouts.
Intensity
Workout intensity involves how hard the individual is pushing themselves during exercise. How it is increased or decreased depends on the type of workout. (Carol Ewing Garber, et al., 2011)
Cardiovascular Workouts
For cardio, individuals will monitor workout intensity by:
The general recommendation is to work at a moderate intensity for steady workouts.
Interval training is done at a higher intensity for a shorter period.
It’s recommended to mix up low, medium, and high-intensity cardio exercises to stimulate different energy systems and prevent overtraining. (Nathan Cardoos. 2015)
Strength Training
Individual intensity comprises the amount of weight being lifted and the number of reps and sets done.
The intensity can change based on health goals.
Beginners looking to build stability, endurance, and muscle are recommended to use a lighter weight and do fewer sets with high repetitions – for example, two or three sets of 12 to 20 reps.
Individuals wanting to grow muscle are recommended to do more sets with a moderate amount of reps – for example, four sets of 10 to 12 reps each.
Individuals who want to build strength are recommended to use heavy weights and do more sets with fewer reps – for example, five sets of three reps each.
The next element of the plan is how long the exercise will be during each session. Exercise length depends on individual fitness level and the type of workout being done.
Cardiovascular Workouts
The exercise guidelines suggest 30 to 60 minutes of cardio, but workout duration will depend on fitness level and type of exercise. ((Carol Ewing Garber, et al., 2011)
Beginners are recommended to start with a 15- to 20-minute workout.
Individuals with some workout experience and are doing steady-state cardio, like jogging or using a cardio machine, might exercise for 30 to 60 minutes.
For individuals doing interval training and working at very high intensity, the workout will be shorter, around 10 to 15 minutes of high-intensity interval training.
Having a variety of workouts of different intensities and durations will provide a solid, balanced cardiovascular program.
Strength Training
How long an individual strength trains will depend on the type of workout and schedule.
A total body workout can take over an hour.
A split routine can take less time by working fewer muscle groups in one session.
Type
The type of exercise you do is the last part of the FIIT principle.
It is easy to manipulate to avoid overuse injuries or weight loss plateaus.
Cardiovascular Workouts
Cardio is easy to adjust and change because any activity that increases heart rate counts.
Walking, dancing, running, cycling, swimming, and using an elliptical trainer are a few activities that can be incorporated.
Having multiple cardio activities is recommended to reduce burnout and keep workouts fresh.
Strength Training
Strength training workouts can also be varied.
They include any exercise where some type of resistance – bands, dumbbells, machines, etc. are used to work the muscles.
Bodyweight exercises can also be considered a form of strength training.
Strength workouts can be changed from total body training to adding, for example, supersets or pyramid training.
Incorporating new exercises for each body area is another way to vary the type of workouts.
Spending a few weeks working on functional strength movements, then switching to hypertrophy or strength-based training.
Each modality includes various alternative types of strength-based exercises.
Using FITT
The FITT principle outlines how to adjust workout programs to achieve better results. It also helps figure out how to change workouts to avoid burnout, overuse injuries, and plateaus.
For example, walking three times a week for 30 minutes at a moderate pace is recommended for a beginner to start out with. After a few weeks, the body adapts to the workout. This results in burning fewer calories, burnout, or weight management efforts, and goals are put on hold. This is where the FITT principles come in. For example, a change-up could include:
Changing frequency by adding another day of walking or jogging.
Changing intensity by walking faster, adding more challenging terrain like a hill, or jogging at certain intervals.
Walking for a longer time each workout day.
Changing the type of workout by swapping one or more of the walk sessions for cycling or aerobics.
Even just changing one element can make a big difference in the workout and how the body responds to exercise.
It’s important to change things up regularly to keep the body healthy and mind engaged.
Injury Prevention
One of the best things about using FITT is that it allows individuals to monitor the length and intensity of their workouts. When individuals work out too frequently or don’t get enough rest, they run the risk of overuse injuries, burnout, and muscle strains. The FITT principle encourages adding variety to workouts. When following this practice, it allows the body to rest and recover properly. Because individuals are not working the same muscle groups over and over again, better results are achieved.
Fighting Inflammation Naturally
References
Garber, C. E., Blissmer, B., Deschenes, M. R., Franklin, B. A., Lamonte, M. J., Lee, I. M., Nieman, D. C., Swain, D. P., & American College of Sports Medicine (2011). American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Medicine and science in sports and exercise, 43(7), 1334–1359. doi.org/10.1249/MSS.0b013e318213fefb
McCall Pete. 8 reasons to take a rest day. (2018) American Council on Exercise.
National Strength and Conditioning Association. (2017) Determination of resistance training frequency.
Schoenfeld, B. J., Ogborn, D., & Krieger, J. W. (2016). Effects of Resistance Training Frequency on Measures of Muscle Hypertrophy: A Systematic Review and Meta-Analysis. Sports medicine (Auckland, N.Z.), 46(11), 1689–1697. doi.org/10.1007/s40279-016-0543-8
Cardoos, Nathan MD. Overtraining Syndrome. (May/June 2015). Current Sports Medicine Reports 14(3):p 157-158. DOI: 10.1249/JSR.0000000000000145
For individuals trying to achieve healthy posture, could using posture awareness training be effective in treatment and prevention?
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Posture Awareness
Spinal curves help support the body’s weight, movement, and balance. Five areas include the neck, upper back, lower back, sacrum, and coccyx. The bottom of the spine or sacrum rests between the two hip bones that comprise the pelvis. Because of this location, the movements made with the pelvis significantly affect the spine. (Ibrahim Alkatout, et al., 2021) When the pelvis moves, the spine moves.
Posture-related back pain and associated symptoms are often caused by a weakened strength and flexibility ratio between the opposing muscle groups that hold the body upright.
Achieving healthy posture requires technique and consistent practice for maintaining a healthy pelvis and low back curve. (DeokJu Kim, et al., 2015)
Finding the low back curve and exploring how it responds when moving the pelvis is important to effective posture awareness training.
Kim, D., Cho, M., Park, Y., & Yang, Y. (2015). Effect of an exercise program for posture correction on musculoskeletal pain. Journal of physical therapy science, 27(6), 1791–1794. doi.org/10.1589/jpts.27.1791
Alkatout, I., Wedel, T., Pape, J., Possover, M., & Dhanawat, J. (2021). Review: Pelvic nerves - from anatomy and physiology to clinical applications. Translational neuroscience, 12(1), 362–378. doi.org/10.1515/tnsci-2020-0184
Żurawski, A. Ł., Kiebzak, W. P., Kowalski, I. M., Śliwiński, G., & Śliwiński, Z. (2020). Evaluation of the association between postural control and sagittal curvature of the spine. PloS one, 15(10), e0241228. doi.org/10.1371/journal.pone.0241228
Zemková, E., & Zapletalová, L. (2021). Back Problems: Pros and Cons of Core Strengthening Exercises as a Part of Athlete Training. International journal of environmental research and public health, 18(10), 5400. doi.org/10.3390/ijerph18105400
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