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Digestive Disorders: Heartburn, Acid Reflux, and GERD

Digestive Disorders: Heartburn, Acid Reflux, and GERD

Digestive disorders affect millions of individuals and cover a variety of diseases ranging from mild to severe. These conditions involve the digestive tract, also known as the gastrointestinal or GI tract. The digestive disorders of heartburn, acid reflux, and gastroesophageal reflux disease/GERD are related and have similar symptoms but are different. Accurately diagnosing digestive disorders involves a thorough medical history, imaging and lab tests, and physical examination to develop the proper treatment plan.

Digestive Disorders: Heartburn, Acid Reflux, and GERD

Digestive Disorders

The gastrointestinal tract includes the esophagus, liver, gallbladder, stomach, pancreas, and large and small intestines.

Heartburn

Heartburn has nothing to do with the heart but describes a burning sensation in the chest. Individuals experience heartburn when stomach acid flows back into the esophagus. Occasional heartburn after eating spicy foods or foods an individual is not used to is common and is no cause for alarm. Most can manage the discomfort symptoms with lifestyle adjustments and over-the-counter medications. Chronic heartburn that interferes with daily/nightly routines could indicate a more serious condition requiring medical care. Symptoms include:

  • The burning discomfort sensations in the stomach and chest regions are usually worse after eating a meal, bending down, at night, and when lying down.
  • A bitter or acidic taste.

Acid Reflux

The esophagus comprises mainly smooth muscle that extends from the throat down through the chest cavity and past the abdomen, where it connects with the stomach. When swallowing, the esophagus opens and squeezes food down to the bottom, where a valve (lower esophageal sphincter LES) separates it from the stomach. The valve is normally closed. When swallowing, it opens so that food can pass through and then closes up. Acid reflux is a disorder that causes the valve to open when it’s not supposed to. This allows stomach contents like acid, digestive juices, enzymes, and food to flow backward from the stomach into the esophagus, causing heartburn symptoms. This usually happens when the lower esophageal sphincter is under added pressure, weakened, or malfunctioning. Symptoms can be caused by:

  • Overeating.
  • Eating spicy or acidic foods that can trigger symptoms.
  • Eating right before going to bed.
  • Medications.
  • Over alcohol consumption.
  • Exercising after eating.
  • Pregnancy.
  • Smoking.

Acid reflux and heartburn affect everyone, but most can handle the discomfort by taking antacids and avoiding the foods that brought it on. Occasional acid reflux can be treated with over-the-counter medication, including:

GERD

Acid reflux can potentially progress to gastroesophageal reflux disease, a more serious form of acid reflux that lasts longer. GERD is frequent heartburn that happens two or more times a week. Other signs and symptoms can include:

  • Regurgitation of food or sour liquid.
  • Difficulty swallowing.
  • Inflammation of vocal cords.
  • A sensation of a lump in the throat.
  • Coughing to clear throat constantly.
  • Asthma-like symptoms.
  • Chest pain, especially when lying down at night.

Various factors can cause GERD, that include lifestyle and physiological. It can develop as a result of the following:

  • Delayed stomach emptying.
  • Being overweight or obese.
  • Medications.
  • Pregnancy.
  • Hiatal hernias.
  • Smoking.
  • Connective tissue disorders like scleroderma.

Some individuals with digestive disorders may need more extensive diagnostic evaluations, including GI endoscopy, laboratory tests, and imaging.

Chiropractic Treatment

Body misalignments, unhealthy posture, and restrictive positions can contribute to digestive disorders that put pressure on the stomach and chest, triggering symptoms. A chiropractor can realign the body and take the stress off the joints and spine, relieving the pressure on the nerves. They can also strengthen the muscles through adjustments that help alleviate pressure on the stomach. A chiropractor designs a treatment plan that suits the individual’s needs, including stretches and exercises, nutrition, and health coaching to achieve and manage a healthy weight.


Chiropractic Precision


References

Carvalho de Miranda Chaves, Renata, et al. “Respiratory physiotherapy can increase lower esophageal sphincter pressure in GERD patients.” Respiratory medicine vol. 106,12 (2012): 1794-9. doi:10.1016/j.rmed.2012.08.023

Harding, Susan M. “Acid reflux and asthma.” Current opinion in pulmonary medicine vol. 9,1 (2003): 42-5. doi:10.1097/00063198-200301000-00007

Kahrilas, Peter J. “Regurgitation in patients with gastroesophageal reflux disease.” Gastroenterology & hepatology vol. 9,1 (2013): 37-9.

Pope, C E 2nd. “Acid-reflux disorders.” The New England journal of medicine vol. 331,10 (1994): 656-60. doi:10.1056/NEJM199409083311007

The MET Technique On Myofascial Trigger Points & Gait Performance

The MET Technique On Myofascial Trigger Points & Gait Performance

Introduction

How a person walks or their gait performance can determine how their body’s balance and stability are functioning. Since the body has many muscles, ligaments, and tissues in the musculoskeletal system protecting the spine and the vital organs that work together to maintain proper functionality when a person is in motion; however, the body can succumb to numerous issues that can affect a person’s gait performance and cause the upper and lower extremities to develop myofascial trigger points in the muscle fibers. When these issues begin to cause dysfunction in the body, it can lead to many disorders associated with gait disturbances. Today we will focus on how to approach gait disturbances, how trigger points affect gait performances, and how treatment techniques like MET can help. We provide information about our patients to certified medical providers that offer available therapy techniques like MET (muscle energy techniques) for individuals dealing with gait disturbances associated with trigger points that correlate to how a person walks. We encourage each patient appropriately by referring them to our associated medical providers based on their diagnosis results. We accept that education is a spectacular way when asking our providers the most crucial questions at the patient’s acknowledgment. Dr. Alex Jimenez, D.C., assesses this information as an educational service. Disclaimer

 

How To Approach Gait Disturbances?

 

Have you been dealing with mobility issues when walking? How about feeling stiffness in your hips or lower body extremities? Or have you experienced headaches or neck pain? Many of these issues are associated with gait disturbances that can affect your ability to walk. When it comes to gait disturbances, studies reveal that underlying systemic disorders or other environmental factors could trigger the prevalence of gait disturbances. Regarding gait disturbances, it is important to know that as the body ages, it can cause issues to the musculoskeletal system naturally, and environmental factors can further affect the central nervous system to cause gait disturbances. Additional studies have mentioned that gait disorders in the elderly could potentially lead to various issues that affect a person’s quality of life. When approaching gait disturbances, many doctors will examine to see the causes of these gait disturbances that correlate with the musculoskeletal system. It could be:

  • Orthopedic problems
  • Neurological conditions
  • Musculoskeletal disturbances
  • Metabolic disturbances

Many of these issues can cause the lower half of the body to shift the skeletal joints, leading to tight, stiff muscles and developing tiny hard nodules in the muscle fibers that can further affect gait performance.

 

How Do Trigger Points Affect Gait Performances

 

So how can these tiny hard nodules affect gait performance in the body? These small hard nodules are trigger points and often correlate with overlapping risk profiles associated with musculoskeletal disorders. “Clinical Application of Neuromuscular Techniques,” written by Leon Chaitow, N.D., D.O, and Judith Walker DeLany, L.M.T., mentioned that various additional causes and maintaining factors may be associated with dysfunctional patterns that correlate with trigger point involvement. The book also says that different influences affecting the muscles can increase trigger point activity while inducing influences from acute or chronic soft tissue dysfunction. Research studies reveal that myofascial pain syndrome is a collection of sensory, motor, and autonomic symptoms that correlate with musculoskeletal symptoms like local/referred pain, decreased range of motion, and muscle weakness. When trigger points are causing problems in the muscle fibers, it can affect a person’s gait performance and cause them to lose function when walking.

 


Balance Issues Associated With Myofascial Trigger Points-Video

Have you been dealing with balancing issues when walking? Do your muscles feel tight in certain areas? Or do constant headaches or neck pain affect your day? The video above explains what can cause balancing issues that affect gait performance and cause numerous symptoms like headaches and neck pain. Many balance issues are associated with myofascial trigger points affecting your gait performance. Myofascial trigger points can overlap risk profiles that can affect the muscle fibers in the body. Many correlating factors can affect a person’s gait performance, leading to musculoskeletal disorders related to trigger points. When musculoskeletal disorders are correlated with myofascial trigger points, it can decrease a person’s health and wellness if not treated early on. Fortunately, some treatments incorporate techniques to reduce muscle and joint pain while alleviating symptoms associated with myofascial trigger points.


How The MET Technques Helps With Gait Performance & Trigger Points

When a person is dealing with imbalances affecting their gait performance and having overlapping risk profiles associated with trigger points, treatment techniques can help improve their gait while reducing pain-like symptoms. Many pain specialists will use the MET technique (muscle energy technique) to help stretch affected muscles that are stiff and help regain mobility back to the body. Therapies like chiropractic care utilize this technique combined with spinal manipulation to help realign the body while loosening up stiff muscles affecting gait performance. When a person continues treatment care to regain mobility, it allows them to be aware of how they walk and carry themselves without pain.

 

Conclusion

How a person walks is how their balance and stability function in different environments. A person’s gait performance has to maintain the functionality that allows the various muscles, ligaments, and tissues in the musculoskeletal system to move. When environmental factors or musculoskeletal disorders affect the different muscles, it can cause overlapping issues that affect gait performance. To that point, it leads to stiffness and pain associated with trigger points. Luckily techniques like the MET combined with chiropractic care can help realign the body and loosen up stiff muscles and joints to regain mobility back to the body and help improve overall gait performance.

 

References

Chaitow, Leon, and Judith Walker DeLany. Clinical Application of Neuromuscular Techniques. Churchill Livingstone, 2002.

Jafri, M Saleet. “Mechanisms of Myofascial Pain.” International Scholarly Research Notices, U.S. National Library of Medicine, 2014, www.ncbi.nlm.nih.gov/pmc/articles/PMC4285362/.

Marshall, Frederick J. “Approach to the Elderly Patient with Gait Disturbance.” Neurology. Clinical Practice, U.S. National Library of Medicine, June 2012, www.ncbi.nlm.nih.gov/pmc/articles/PMC3613197/.

Pirker, Walter, and Regina Katzenschlager. “Gait Disorders in Adults and the Elderly : A Clinical Guide.” Wiener Klinische Wochenschrift, U.S. National Library of Medicine, Feb. 2017, www.ncbi.nlm.nih.gov/pmc/articles/PMC5318488/.

Disclaimer

Sleeping Health: El Paso Back Clinic

Sleeping Health: El Paso Back Clinic

Healthy sleep is vital for having enough energy, thinking clearly, and managing everyday stresses confidently. Chronic unhealthy sleep patterns and/or insomnia can lead to and contribute to various health issues. This includes daytime fatigue, irritability, difficulty concentrating, delayed reaction time, constantly getting sick, and memory problems. Sleeping health problems can get worse with every night of poor rest. Injury Medical Chiropractic and Functional Medicine Clinic provide treatment, training, and tools to realign and relax the body and restore healthy sleep.

Sleeping Health: EP's Chiropractic Specialists

Sleeping Health Problems

Lack of sleep disrupts and slows down nerve impulses and transmissions throughout the body. This can lead to health problems that can include:

  • Excessive fatigue
  • Brain fog
  • Slow responses
  • Physical performance problems
  • Inability to remember
  • Low sex drive
  • Chronic illness
  • Over time the risk of developing a serious medical condition increases and can include:
  • Anxiety
  • Depression
  • High blood pressure
  • Diabetes
  • Weakened immune system
  • Stroke
  • Heart attack
  • Seizures

Staying On

There is some research that insomnia is associated with hyperarousal or the state of staying on. It often starts with a stressful event that sets off the body’s systems, causing the inability to relax completely. Body discomfort and pain symptoms can also present when the mind and body can’t relax. The entire body can tighten/stiffen, causing aches, soreness, and pain. Continuation of sleeping health problems of the cycle leads to more stress.

Healthy Sleep Benefits

Adults need seven to nine hours of sleep every night to operate optimally. The benefits of healthy sleep include:

  • Healthy immune system function.
  • Thorough tissue and muscle repair.
  • Remembering and recalling things comes easier.
  • Improved insulin regulation, helping to manage food cravings and weight.
  • Enhanced regulation of cortisol.
  • Improved mood and outlook.

Chiropractic Treatment

Chiropractic care, massage, and decompression therapy can help break the cycle. Breaking the process is necessary to help the body recover and rehabilitate properly. Treatment retrains the body to relax; stretching and pulling the muscles increases blood circulation, as well as advanced and improved brain signals telling the body to relax. A chiropractor will evaluate the individuals sleeping patterns and recommend various solutions. The benefits for individuals with sleep issues include:

  • Alleviates muscle tension.
  • Stimulates nerve circulation and blood flow.
  • Relaxes the whole body.
  • Enhances central nervous system function.
  • Relieves pain and discomfort.
  • A chiropractor will also provide the following:
  • Sleeping position recommendations.
  • Postural stretches and exercises.
  • Recommendations on supportive mattresses.
  • Ergonomics for work, home, and bed.

Chiropractic’s Evolution


References

Hale, Deborah, and Katherine Marshall. “Sleep and Sleep Hygiene.” Home healthcare now vol. 37,4 (2019): 227. doi:10.1097/NHH.0000000000000803

Liu, Amy. “Sleep Training.” Pediatric annals vol. 49,3 (2020): e101-e105. doi:10.3928/19382359-20200218-01

What Are Sleep Deprivation and Deficiency?www.nhlbi.nih.gov/health/sleepdeprivation#:~:text=Sleep%20deficiency%20is%20linked%20to,adults%2C%20teens%2C%20and%20children.

What Makes You Sleep? www.nhlbi.nih.gov/health/sleep-deprivation/body-clock

How Sleep Affects Your Health www.nhlbi.nih.gov/health/sleep-deprivation/health-effects

Riemann, Dieter. “Sleep hygiene, insomnia, and mental health.” Journal of sleep research vol. 27,1 (2018): 3. doi:10.1111/jsr.12661

Years of Back Muscle Rigidity: El Paso Back Clinic

Years of Back Muscle Rigidity: El Paso Back Clinic

Individuals can experience back muscle rigidity for years and not realize it. This is because the muscles tighten incrementally, and slowly the body begins to acclimate to the feeling and positioning that it becomes normal. And it continues with gradually increased aches and pains. Not until an individual has experienced a therapeutic massage and chiropractic adjustment do they realize just how tight and stiff they were. This is when individuals realize how their musculoskeletal system works and need to maintain loose, flexible muscle tissue for mobility and function. Injury Medical Chiropractic and Functional Medicine Clinic can treat, rehabilitate, educate, and improve an individual’s overall health.

Years of Back Muscle Rigidity: EP Chiropractic Injury Team

Muscle Rigidity

When the body needs to move, the brain sends a nerve signal to the muscles in that region, causing the muscles to tighten or contract. Muscles can contract a little or a lot, depending on the activity. After contracting, the muscles relax until the next time they are needed. Muscle rigidity happens when a muscle or a group of muscles stays fully or partly contracted for an extended period. The nerve signals keep telling the muscle to contract even when the muscle is no longer needed. This can last for several hours or days.

The longer the muscle remains contracted, the more symptoms present and persist. Muscle rigidity is often triggered by stress. Stress affects the body’s nervous system, including nerves and their function. The nervous system can respond to stress by generating additional pressure on the blood vessels, reducing blood circulation, and causing tension and pain.

Causes

Certain medications, such as statins, can cause muscle rigidity, and several conditions can also contribute to it. These include:

  • Dehydration is a condition as a result of not drinking enough water.
  • A repetitive strain injury is an injury to the muscles or nerves due to muscle overuse.
  • Pinched nerves.
  • Delayed-onset muscle soreness is stiffness and pain that develops hours or days after strenuous physical activity and exercise.
  • Chronic fatigue syndrome is a condition that causes extreme fatigue, sleep problems, and pain.
  • Myofascial pain syndrome is a chronic disorder where pressure on sensitive muscle points causes pain.
  • Rheumatoid arthritis is a chronic inflammatory disorder affecting the joints.
  • Fibromyalgia is a chronic disorder that can cause muscle soreness, pain, and rigidity.
  • Claudication is a condition in which cramping occurs due to a lack of blood flow to the muscles, usually in the legs.
  • Lyme disease and Rocky Mountain spotted fever wick-borne illnesses that can cause nerve damage.
  • Amyotrophic lateral sclerosis is a neurodegenerative disease that causes nerve problems and a loss of voluntary muscle control.
  • Chronic exertional compartment syndrome is a muscle and nerve condition that causes pain and swelling.
  • Dystonia is a condition that causes random/involuntary muscle contractions.
  • Lupus is a chronic inflammatory disease that can cause joint pain and stiffness.
  • Parkinson’s disease is a neurological disease that affects movement.
  • Polymyalgia rheumatica is a chronic inflammatory disease that can cause muscle pain and stiffness.
  • Bacterial and Viral infections.

Treatment

The objective of treatment is to train the muscles to relax completely. The specific treatment used can vary depending on the cause and severity.

Chiropractic

Chiropractic treatment will address the condition or injury and then the muscle rigidity. Treatment involves massaging (manually and percussively) the areas to relax and stretch the tight tissues. Chiropractic releases and realigns the misaligned joints and bones to their proper position. The central nervous system recognizes the new positioning as naturally energy efficient. However, there will still be aches and soreness as the body adjusts until it becomes more consistent and normal for the individual.

Home Therapy

Home therapy is recommended with physical therapy and/or chiropractic to maintain flexibility and make necessary changes/adjustments to a treatment plan as the patient progresses and the muscles start to adhere to the massaging, manipulation, and training. They can include the following:

  • Applying a warm compress or heating pad to the affected area increases circulation.
  • Targeted gentle stretches.
  • Avoiding certain activities that could trigger the muscle to become rigid again until the body is ready.
  • Encouraging the muscles to relax using:
  • Yoga
  • Deep breathing
  • Meditation
  • Tai chi
  • Biofeedback
  • Music and art therapy
  • Aromatherapy

Sciatica Explained


References

Chandwani D, Varacallo M. Exertional Compartment Syndrome. [Updated 2022 Sep 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: www.ncbi.nlm.nih.gov/books/NBK544284/

Chu, Eric Chun-Pu et al. “Chiropractic care of Parkinson’s disease and deformity.” Journal of medicine and life vol. 15,5 (2022): 717-722. doi:10.25122/jml-2021-0418

Joshi, Aditi et al. “Effectiveness of Myofascial Release (MFR) vs. High-Frequency Transcutaneous Electrical Nerve Stimulation (TENS) for Pain Relief and Functional Improvement in College Students With Trapezius Myalgia.” Cureus vol. 14,10 e29898. 4 Oct. 2022, doi:10.7759/cureus.29898

Tan, Xueli, et al. “The efficacy of music therapy protocols for decreasing pain, anxiety, and muscle tension levels during burn dressing changes: a prospective randomized crossover trial.” Journal of burn care & research: official publication of the American Burn Association vol. 31,4 (2010): 590-7. doi:10.1097/BCR.0b013e3181e4d71b

Digestive Enzymes: El Paso Back Clinic

Digestive Enzymes: El Paso Back Clinic

The body makes digestive enzymes to help break down food carbohydrates, fats, and proteins. Healthy digestion and nutrient absorption depend on these enzymes, a protein that speeds up chemical reactions in the mouth, pancreas, and intestines. Certain health conditions like pancreatic insufficiency and lactose intolerance can cause low enzyme levels and insufficiency and may need replacement digestive enzymes to help prevent malabsorption. That’s where digestive enzyme supplements come in.

Digestive Enzymes: EP's Functional Chiropractic TeamDigestive Enzymes

Digestive enzymes are a vital part of digestion; without them, the body can’t break foods down, and nutrients can’t be fully absorbed. A lack of digestive enzymes can lead to gastrointestinal/GI symptoms and cause malnourishment, even with a nutritious diet. The result is unpleasant digestive symptoms that can include:

  • Poor absorption of nutrients
  • Bloating
  • Stomach pain
  • Nausea
  • Vomiting

Digestive enzyme supplements have been used for treating common forms of gut irritation, heartburn, and other ailments.

Enzyme Types

The main digestive enzymes made in the pancreas include:

Amylase

  • It is also made in the mouth.
  • Breaks down carbohydrates, or starches, into sugar molecules.
  • Low amylase can lead to diarrhea.

Lipase

  • This works with liver bile to break down fats.
  • Lipase insufficiency causes decreased levels of fat-soluble vitamins A, D, E, and K.

Protease

  • This enzyme breaks down proteins into amino acids.
  • It also helps keep bacteria, yeast, and protozoa out of the intestines.
  • A shortage of protease can lead to allergies or toxicity in the intestines.

Enzymes made in the small intestine include:

Lactase

  • Breaks down lactose, a sugar found in dairy products.

Sucrase

  • Breaks down sucrose, a sugar found in fruits and vegetables.

Insufficiency

When the body does not produce enough digestive enzymes or doesn’t release them correctly. A few types include:

Lactose Intolerance

  • The body does not produce enough lactase, making digesting the natural sugar in milk and dairy products difficult.

Exocrine Pancreatic Insufficiency

  • EPI is when the pancreas does not produce enough of the enzymes necessary to digest carbohydrates, proteins, and fats.

Congenital Sucrase-Isomaltase Deficiency

  • The body does not have enough sucrase to digest certain sugars.

Symptoms

Common digestive enzyme insufficiency symptoms:

Talking to a doctor if symptoms persist is recommended, as these could be signs of gut irritation or indicate a more serious condition.

Supplements

Prescription Enzymes

Depending on the severity, individuals diagnosed with enzyme insufficiency may need to take prescription digestive enzymes. These supplements assist in food breakdown and nutrient absorption. The most common enzyme replacement therapy is pancreatic enzyme replacement therapy or PERT. PERT is a prescribed medication that includes amylase, lipase, and protease. Individuals with cystic fibrosis often have pancreatic enzyme insufficiency, as the body can’t release the enzymes properly. And individuals with pancreatitis require PERT because their pancreas develops mucus and scar tissue over time.

Over-The-Counter Enzymes

Over-the-counter digestive enzyme supplements can contain amylase, lipase, and protease and can help with acid reflux, gas, bloating, and diarrhea. Some contain lactase and alpha-galactosidase. Alpha-galactosidase can help break down a non-absorbable fiber called galactooligosaccharides /GOS, mostly found in beans, root vegetables, and certain dairy products.

Certain foods contain digestive enzymes, including:

  • Honey
  • Avocados
  • Bananas
  • Pineapples
  • Mangos
  • Papayas
  • Ginger
  • Sauerkraut
  • Kiwi
  • Kefir

Supplementing the diet with some of these foods can help with digestion.


Functional Nutrition


References

Beliveau, Peter J H, et al. “An Investigation of Chiropractor-Directed Weight-Loss Interventions: Secondary Analysis of O-COAST.” Journal of manipulative and physiological therapeutics vol. 42,5 (2019): 353-365. doi:10.1016/j.jmpt.2018.11.015

Brennan, Gregory T, and Muhammad Wasif Saif. “Pancreatic Enzyme Replacement Therapy: A Concise Review.” JOP: Journal of the pancreas vol. 20,5 (2019): 121-125.

Corring, T. “The adaptation of digestive enzymes to the diet: its physiological significance.” Reproduction, nutrition, developpement vol. 20,4B (1980): 1217-35. doi:10.1051/rnd:19800713

Goodman, Barbara E. “Insights into digestion and absorption of major nutrients in humans.” Advances in physiology education vol. 34,2 (2010): 44-53. doi:10.1152/advan.00094.2009

Vogt, Günter. “Synthesis of digestive enzymes, food processing, and nutrient absorption in decapod crustaceans: a comparison to the mammalian model of digestion.” Zoology (Jena, Germany) vol. 147 (2021): 125945. doi:10.1016/j.zool.2021.125945

Whitcomb, David C, and Mark E Lowe. “Human pancreatic digestive enzymes.” Digestive diseases and sciences vol. 52,1 (2007): 1-17. doi:10.1007/s10620-006-9589-z

Aerobic Exercise Health: El Paso Back Clinic

Aerobic Exercise Health: El Paso Back Clinic

Aerobic Exercise Health: The body adapts differently to different types of exercise. Aerobic, cardio, and endurance all refer to activities stimulating heart and breathing rates to provide the muscles with oxygenated blood. The oxygen is delivered by blood pumped from the heart through the arteries and returns to the heart through the veins. This explains all the heavy breathing during workouts. Aerobic exercise increases energy production in the muscle cells and blood delivery in the cardiovascular system.

Aerobic Exercise Health: EP Chiropractic Fitness Team

Aerobic Exercise Health

The Heart

All the muscles get to rest on and off when in use. The heart is a unique muscle that pumps blood through the body that never gets time off. This is why it is important to strengthen the heart. With aerobic exercise, the heart’s chamber/left ventricle gets larger, producing more blood per pump to the rest of the body. This improves cardiac output for the blood pumped by the heart per minute. When the heart is stronger, pumping more blood per beat means it doesn’t have to beat as rapidly. A lower resting heart rate is associated with a reduced risk of cardiovascular disease and promotes long and healthy life.

Vascular

Each time the heart beats, blood pumps from the left ventricle into the aorta and flows into a branching vessel network. Every artery in the body provides resistance to the circulation that the heart pushes against. The resistance provided can vary, depending on overall health and health conditions.

  • Aerobic exercise training reduces the workload by reducing arterial stiffness.
  • Aerobic exercise increases heart rate, pushing more blood through the arteries.
  • The inner wall of the arteries recognizes the increased blood flow causing the arteries to widen.
  • With regular training, the arteries acclimate and become more effective at expanding with each rush of blood.
  • No aerobic activity can cause the arteries to stiffen, causing circulation problems.
  • Increased arterial stiffness is associated with coronary artery plaque development.
  • Aerobic exercise impacts the vascular system by promoting capillary growth.
  • Capillaries are microscopic vessels where oxygen diffuses from red blood cells to the muscle and other cells.
  • The body stimulates a molecule called vascular endothelial growth factor to grow additional capillaries to regulate energy demand more efficiently.
  • Older individuals benefit from aerobic activity similarly to young individuals.

Metabolic

Along with cardiovascular benefits, aerobic exercise increases the muscles’ energy production. The energy is produced in muscle cells primarily through an oxidative energy system. Oxidative energy production takes place within cells called mitochondria. Once blood delivers oxygen to the muscle cells, it can be used to produce energy that powers the muscles.

  • Aerobic exercise training improves the muscle cells’ ability to burn fat by generating more mitochondria and enhancing functionality.
  • Following each training session, the body burns more fat than usual.
  • Aerobic training can increase resting metabolic rate, resulting in more calories burned.
  • It can increase post-exercise oxygen consumption/EPOC, resulting in increased calorie burn after training in addition to calories burned during exercise.

Muscle

The muscles adapt from aerobic training. Muscles are made up of various fiber types.

  • Aerobic exercise training primarily influences type 1 fibers, known as slow-twitch fibers.
  • The name comes from the proteins responsible for their contractions.
  • Relative to type 2a fibers/fast-twitch, type 1 fibers contract more slowly but have an increased capacity to contract over and over for longer.
  • Aerobic training results in hypertrophy of type 1 muscle fibers by adding more slow-twitch proteins.

Strengthening the heart and making arteries more flexible directly impacts health and physical function. Aerobic exercise strengthens and trains the heart to circulate blood efficiently. Injury Medical Chiropractic and Functional Medicine Clinic can develop a personalized health plan for your needs.


Aerobic Exercise Health: Dance Workout


References

Arbab-Zadeh, Armin, et al. “Cardiac remodeling in response to 1 year of intensive endurance training.” Circulation vol. 130,24 (2014): 2152-61. doi:10.1161/CIRCULATIONAHA.114.010775

Gavin, Timothy P et al. “No difference in the skeletal muscle angiogenic response to aerobic exercise training between young and aged men.” The Journal of physiology vol. 585, Pt 1 (2007): 231-9. doi:10.1113/Physiol.2007.143198

Hellsten, Ylva, and Michael Nyberg. “Cardiovascular Adaptations to Exercise Training.” Comprehensive Physiology vol. 6,1 1-32. 15 Dec. 2015, doi:10.1002/cphy.c140080

Nauman, Javaid, et al. “Temporal changes in resting heart rate and deaths from ischemic heart disease.” JAMA vol. 306,23 (2011): 2579-87. doi:10.1001/jama.2011.1826

Popel, A S. “Theory of oxygen transport to tissue.” Critical reviews in biomedical engineering vol. 17,3 (1989): 257-321.

Seals, Douglas R et al. “Aerobic exercise training and vascular function with aging in healthy men and women.” The Journal of physiology vol. 597,19 (2019): 4901-4914. doi:10.1113/JP277764

Vocal Cord Injury: El Paso Back Clinic

Vocal Cord Injury: El Paso Back Clinic

Automobile collisions, work, sports, and personal accidents can cause neck injuries that can affect other areas, leading to long-term health problems. Neck injuries involving soft tissue damage frequently persist after the incident. One of the injuries includes vocal cord damage caused by impact to the larynx. The larynx, or voicebox, is an organ that is behind the Adam’s apple. A neck injury impacting the larynx can affect the ability to speak and breathe and cause vocal cord paralysis. Treatment can involve surgery, voice therapy, physical therapy, and chiropractic.

Vocal Cord Injury: EP Chiropractic Injury Specialists

Vocal Cord Injury

The vocal cords are two flexible bands of muscle tissue at the entrance of the trachea. The vocal cords are normally in a relaxed open position to allow breathing. When talking, the bands combine and vibrate to make a sound. Surgery, viral infections, certain cancers, and neck trauma can cause vocal cord paralysis. In this condition, nerve damage blocks or inhibits impulses from transmitting to the voice box. The muscles, usually one of them, become paralyzed, preventing swallowing and ingesting saliva through the windpipe/trachea. In rare cases, both muscles are unable to move.

Symptoms

Signs and symptoms can include:

  • Difficulty breathing
  • Shortness of breath.
  • Hoarse breathing.
  • Noisy breathing.
  • Speaking problems
  • The need to take frequent breaths while speaking.
  • Loss of vocal pitch.
  • Inability to talk loudly.
  • Trouble Swallowing
  • Choking or coughing when swallowing.
  • Loss of gag reflex.
  • Frequent coughing and throat clearing.

Causes

Neck or Chest Injury

  • Trauma to the neck or chest can injure the voice box nerves.

Infections

  • Infections like Lyme disease, Epstein-Barr virus, and herpes can cause inflammation and nerve damage.

Tumors

  • Tumors, cancerous and noncancerous, can grow inside or around the muscles, cartilage, and nerves.

Neurological

  • Neurological conditions like multiple sclerosis or Parkinson’s disease can lead to vocal cord paralysis.

Surgical Injury

  • Surgical procedure mistakes or complications on or near the neck or upper chest can result in damage to the voice box nerves.
  • Surgeries to the thyroid or parathyroid glands, esophagus, neck, and chest have an increased risk.

Stroke

  • A stroke chokes blood flow to the brain and can damage the region of the brain that transmits messages to the voice box.

Treatment

Treatment is determined by a doctor based on the individual medical condition and diagnostic tests. Treatment can involve:

Speech Therapy

Speech therapy is recommended as the laryngeal muscles are strengthened through various exercises, improving breathing function. A speech therapist will begin working with the individual on exercises targeting the weakened vocal folds by enhancing airflow and blood circulation.

Physical Therapy and Chiropractic

Treatment involves performing gentle exercises that work on the vocal cords gradually and progressively but does not stress them. Chiropractors work with the physical therapist performing high-velocity, low-amplitude manipulation targeted at the lower neck and upper thoracic area, the C3/T1 vertebrae. A treatment plan will also use massage, non-surgical decompression, instrument/tool-assisted soft-tissue mobilization, low laser or ultrasound, and at-home stretches and exercises.

Surgery

Surgery could be necessary for individuals experiencing no improvement despite doing the prescribed speech and physical therapy exercises. Different types of procedures are based on the degree and extent of the paralysis:

  • Injections – Collagen and fillers are injected into the vocal cords to reposition the affected muscles closer to the larynx.
  • Phonosurgery – The vocal cords are repositioned through restructuring.
  • Tracheotomy – If the vocal folds are closing, a surgeon may make an incision in the neck at the opening of the windpipe and insert a breathing tube. This bypasses the air blockage caused by the vocal folds and promotes proper air circulation.

Cervical Spine Instability


References

Chen, Ching-Chang, et al. “Long-term result of vocal cord paralysis after anterior cervical discectomy.” The European spine journal: official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society vol. 23,3 (2014): 622-6. doi:10.1007/s00586-013-3084-y

Dankbaar JW, et al. Vocal cord paralysis: Anatomy, imaging, and pathology. Insights in Imaging. 2014; doi:10.1007/s13244-014-0364-y.

Fitzpatrick, P C, and R H Miller. “Vocal cord paralysis.” The Journal of the Louisiana State Medical Society: official organ of the Louisiana State Medical Society vol. 150,8 (1998): 340-3.

Kriskovich, M D et al. “Vocal fold paralysis after anterior cervical spine surgery: incidence, mechanism, and prevention of injury.” The Laryngoscope vol. 110,9 (2000): 1467-73. doi:10.1097/00005537-200009000-00011

Vocal fold paralysis. National Institute on Deafness and Other Communication Disorders. www.nidcd.nih.gov/health/vocal-fold-paralysis. Accessed May 18, 2022.

Vocal fold paralysis. American Speech-Language-Hearing Association. www.asha.org/public/speech/disorders/Vocal-Fold-Paralysis. Accessed May 18, 2022.

Waddell, Roger K. “Chiropractic care for a patient with spasmodic dysphonia associated with cervical spine trauma.” Journal of chiropractic medicine vol. 4,1 (2005): 19-24. doi:10.1016/S0899-3467(07)60108-6

Sports Exercise Medicine: El Paso Back Clinic

Sports Exercise Medicine: El Paso Back Clinic

Sports exercise medicine – SEM addresses and treats physical activity/sports-related injuries using chiropractic care, physical therapy, therapeutic massage, functional nutrition, and targeted rehabilitation exercises. Sports medicine aims to prevent injury and keep individuals safe when pursuing their training goals. It combines general medical education with sports science principles, exercise physiology, biomechanics, orthopedics, nutrition, and sports psychology.

Sports Exercise Medicine: EP's Chiropractic Team

Sports Exercise Medicine

Sports medicine specialists focus on medical, therapeutic, and functional aspects to rehabilitate and strengthen the body to improve physical performance. Conditions include:

A sports exercise medicine team can include medical and non-medical specialists. This includes:

  • Coaches
  • Athletic trainers
  • Personal trainers
  • Chiropractors
  • Physical therapists
  • Nutritionists
  • Physicians
  • Surgeons
  • Sports psychologists

Sports exercise medicine is not a medical specialty but means the health care providers have undergone training focused on the medical aspects of physical activities/sports, fitness, and exercise.

Doctors and Physicians

Sports medicine physicians are medical doctors who specialize in diagnosing and treating sports and exercise-related injuries and conditions. These physicians are certified in family medicine, emergency medicine, pediatrics, internal medicine, or orthopedics. They are qualified to treat:

  • Muscle, bone, joint, and nerve injuries.
  • Head injuries.
  • Chronic conditions.
  • Return-to-play decisions.
  • Injury prevention.
  • Nutrition and supplements.

Orthopedic surgeons focus on the surgical treatment, repair, and restoration of sports and physical activity injuries.

Psychologists

Sports psychology focuses on athletes’/sports enthusiasts’ mental and emotional states. Athletes go through various stresses that a sports psychologist can train to regulate anxiety and improve focus specifically on their sport. They use tools and techniques like psychotherapy, stress management, and goal-setting to help athletes maintain mental and emotional balance during competition or injury recovery. Professional sports teams employ psychologists to help prepare the team for competition or develop strategies to overcome mental or emotional challenges affecting performance.

Sports Science

Sports science is the focused study of physiology, anatomy, and psychology related to human movement and physical activity. Exercise science is primarily focused on clinical research, including:

  • Physiological responses to exercise.
  • Effectiveness of exercise techniques.
  • Impact of performance supplements.

Chiropractic Sports Physician

Chiropractic care is a non-invasive, medication-free treatment alternative that can help individual athletes find relief from various musculoskeletal issues. A chiropractic sports physician has the tools and skills necessary to optimize the performance of an individual’s musculoskeletal and nervous systems. This specialized training allows sports chiropractors to provide therapies to heal injuries effectively, maintain strength and prevent injury. The benefits of applying chiropractic medicine include the following:

  • It is a non-invasive treatment.
  • Improves overall range of motion.
  • Reduces and alleviates discomfort symptoms.
  • Stretches and strengthens the body.
  • Assists in post-surgical repair.
  • Decreases recovery time.

Sport Rehabilitation


References

Brown, G J. “Sports medicine at work.” British journal of sports medicine vol. 33,1 (1999): 5.

Hsu, Joseph R et al. “Clinical Practice Guidelines for Pain Management in Acute Musculoskeletal Injury.” Journal of orthopedic trauma vol. 33,5 (2019): e158-e182. doi:10.1097/BOT.0000000000001430

Kaufman, Matthew W et al. “The Impact of Supplements on Sports Performance for the Trained Athlete: A Critical Analysis.” Current sports medicine reports vol. 21,7 232-238. 1 Jul. 2022, doi:10.1249/JSR.0000000000000972

King, J B. “Sports medicine.” Journal of the Royal Society of Medicine vol. 79,8 (1986): 441-2. doi:10.1177/014107688607900803

Kreher, Jeffrey B, and Jennifer B Schwartz. “Overtraining syndrome: a practical guide.” Sports health vol. 4,2 (2012): 128-38. doi:10.1177/1941738111434406

McCrory, P. “What are sports and exercise medicine?.” British journal of sports medicine vol. 40,12 (2006): 955-7.

Muscle Imbalances, Gait Patterns, & The MET Technique

Muscle Imbalances, Gait Patterns, & The MET Technique

Introduction

When it comes to the body, the various muscles, tissues, joints, and organs provide functionality and movement when it is in motion. Everyone worldwide cares for their bodies by resting them when needed, eating numerous foods to provide energy, and staying active to live longer. However, over time, many factors can contribute to the body by causing many individuals to develop musculoskeletal issues that can affect a person’s posture and the sensory-motor functions that the body provides to maintain motion and stability. In today’s article, we examine muscle imbalances, how it affects the body’s gait pattern, and how the MET technique can help with muscle imbalances. We provide information about our patients to certified medical providers that offer available therapy techniques like MET (muscle energy techniques) for individuals dealing with chronic conditions associated with muscle imbalances that could affect a person’s gait pattern and lead to pain in the muscles and joints. We encourage each patient appropriately by referring them to our associated medical providers based on their diagnosis results. We accept that education is a spectacular way when asking our providers the most crucial questions at the patient’s acknowledgment. Dr. Alex Jimenez, D.C., assesses this information as an educational service. Disclaimer

 

What Are Muscle Imbalances?

Have you been dealing with tight back, shoulders, and hip muscles? Do you feel one side of your body is weaker than the other? Or do you feel unstable when walking? Many people who are experiencing these issues are associated with muscle imbalances that are affecting their bodies. So what are muscle imbalances, and how does it affect the body? Well, according to “Clinical Applications of Neuromuscular Techniques,” written by Leon Chaitow, N.D, D.O, and Judith Walker DeLany, L.M.T., stated that the soft tissues in our bodies are often changed from their normal elastic, pliable, and toned functional status to short, fibrous and weak function in the different muscle groups. Since the body compensates (without any chronic symptoms) to everyday activities, when the body’s muscles and tissues are exhausted, it can cause the symptoms to develop over time, causing pain, muscle restriction, and limited range of motion to the body. Thus, these symptoms often correlate to musculoskeletal disorders, leading to muscle imbalances.

 

 

Other issues that can cause muscle imbalances in the body could result from muscle injuries from traumatic forces. Research studies have revealed that repetitive motions from traumatic injuries could result in microtrauma tears to the muscles and tendons, which can develop into muscle-referred pain and increase the risk of chronic joint inflammation. To that point, it can lead to referred pain in different body areas and affect a person’s stability. When the body is dealing with traumatic injuries that affect the muscles over time, many people shift how they walk or change their postures to compensate for the pain, which can change their gait patterns.

 

How Does It Affect The Body’s Gait Pattern?

 

When a person is walking, their entire body is in motion, and over time their posture will change depending on the upper body’s weight bearing down to the hips and lower extremities. Studies reveal that loss of muscle strength can be characterized by musculoskeletal disorders like osteoarthritis that can cause pain symptoms, reduce physical function, decrease range of motion, and muscle/joint instability. So how would muscle imbalances affect the body’s gait pattern? First, we must look at the influences that the neurological and metabolic functions of the central nervous system provide on the musculoskeletal system. The central nervous system sends neuron signals to each muscle group from the upper and lower extremities to allow the individual to walk, run, and do other motor functions. When muscle imbalances are associated with traumatic injuries, it can cause the body to be hunched over over time, causing the short muscles to be tight and the long muscles to be weak. To that point, it can lead to a chain of dysfunctional phases of the gait cycle and its associated symptoms. Some of the signs that can affect a person’s gait pattern include:

  • Associated joint restriction on the hips
  • Muscle tension on the pelvis and lower extremities
  • Muscle tightness in the cervical-thoracic region of the back
  • Trigger points on the lower extremities causing referred pain

 


How Muscle Imbalances Associate With Low Back Pain- Video

Have you been dealing with pain in your joints or muscles? Do you find it difficult to walk or carry heavy objects? Or have you been experiencing tight hips and shoulders? Many of these issues are due to muscle imbalances associated with traumatic injuries. The video above explains how muscle imbalances could be related to low back pain. When environmental factors or traumatic forces begin to affect the muscles and joints in the body, it can change a person’s gait pattern (how they walk) and develop into chronic issues affecting the body. When the muscles are imbalanced and cause gait problems, it can lead to muscle and joint pain associated with poor posture and other chronic conditions. When this happens, it can lead to dysfunctional phases of the gait pattern. Luckily there are many treatments and techniques to reduce pain and restore gait function to the body.


How The MET Technique Help With Muscle Imbalances

Going to therapy treatments to restore muscle functionality, enable the body to recover naturally, and reduce the chances of future injuries to come back. When the body is dealing with muscle imbalances, there are many treatments and techniques that many pain specialists, like chiropractic care that are utilized to restore the body and prevent injuries from re-occurring. One of the techniques is called the MET technique (muscle energy technique). The MET technique is a form of manual therapy that uses isometric stretches to reduce pain in the soft tissues and lengthen weak muscles. Studies reveal that when pain specialists use the MET technique combined with other treatments like physical therapy and spinal manipulation, it can help reduce the pain affecting the muscle fibers while restoring the body to normalcy and lengthening tight muscles. When the MET technique is combined with other forms of therapy, it can help stretch and strengthen the weak muscles and allows the individual to be aware of how their posture is being corrected.

 

Conclusion

It is important to everyone that different factors and injuries could result from muscle imbalances that can affect your posture. Muscle imbalances in the body can lead to unwanted symptoms of muscle weakness, pain, and dysfunctional gait patterns that correlate with musculoskeletal disorders. Going to therapy treatments and incorporating techniques like MET, physical activities, and chiropractic care can help the body be restored and prevent future injuries from returning and affecting a person’s health and wellness.

 

References

Chaitow, Leon, and Judith Walker DeLany. Clinical Applications of Neuromuscular Techniques. Churchill Livingstone, 2003.

Joshi, Reema, and Nishita Poojary. “The Effect of Muscle Energy Technique and Posture Correction Exercises on Pain and Function in Patients with Non-Specific Chronic Neck Pain Having Forward Head Posture-a Randomized Controlled Trail.” International Journal of Therapeutic Massage & Bodywork, U.S. National Library of Medicine, 1 June 2022, www.ncbi.nlm.nih.gov/pmc/articles/PMC9134480/.

Neme, Jamil R. “Balancing Act: Muscle Imbalance Effects on Musculoskeletal Injuries.” Missouri Medicine, U.S. National Library of Medicine, 2022, www.ncbi.nlm.nih.gov/pmc/articles/PMC9324710/.

Vodička, Tomáš, et al. “Could the Evaluation of Muscle Strength Imbalances Be Used as a Predictor of Total Hip Arthroplasty?” International Journal of Environmental Research and Public Health, U.S. National Library of Medicine, 11 May 2021, www.ncbi.nlm.nih.gov/pmc/articles/PMC8150769/.

Disclaimer

Nutrition and Chiropractic Care: El Paso Back Clinic

Nutrition and Chiropractic Care: El Paso Back Clinic

Nutrition and Chiropractic Care: Chiropractic care treats the body as a whole. It can relieve and alleviate ailments from injuries, conditions, or diseases to help maintain optimal health. A treatment plan includes nutrition recommendations to support the body’s systems, reduce inflammation responses, build muscle and bone strength, and maintain chiropractic adjustments.

Nutrition and Chiropractic Care: EP Functional Specialists

Nutrition and Chiropractic Care

Individuals can influence musculoskeletal system health by balancing what they consume. If food choices are unhealthy, the benefits of chiropractic may be lessened from the negative effects of unhealthy foods on the body.

Muscle Repair

Muscle injuries are common from normal wear and tear, work, sports, and personal injuries. Calorie-heavy foods can lead to increased weight. Increased weight puts extra stress on the body as it is healing, making the healing process last longer and less effective. A recommended nutritional plan to build muscle strength around the injured areas will supplement chiropractic care.

  • Adding protein-rich foods increases muscle building and repair.
  • Foods include sweet potatoes, salmon, eggs, spinach, bananas, nuts, and seeds.

Bone Health

Misalignment, imbalances, and injuries can be caused in part by weakness in various bones.

  • Calcium is integral in improving bone strength.
  • Foods high in calcium can benefit chiropractic adjustments by strengthening the skeletal system.
  • A balanced intake of calcium and magnesium helps build bone strength and decreases the chances of developing osteoporosis.
  • Magnesium can be found in almonds, spinach, avocado, cashews, and bananas.

Digestion

Chiropractic treatments also help promote healthy digestion by relieving tension in the stomach and helping to restore proper function in the organs and muscles. Regular chiropractic has been shown to reduce symptoms associated with constipation, bloating, diarrhea, nausea, irritable bowel syndrome – IBS, Crohn’s disease, colitis, GERD – Gastroesophageal Reflux Disease, and vomiting.

  • Foods that help maintain a healthy gut include brown rice, beans, oats, and fruits and vegetables.

Respiratory Health

Breathing problems come in various forms depending on the individual and their case. The ribs, upper chest, and neck muscles all support breathing. Stress can cause rapid and shallow breathing that overworks these muscles. Breathing problems often correlate with other health issues, including back and neck pain, poor digestion, fatigue, and tension headaches. Chiropractic pinpoints subluxations or undue interruption of the nerve signals and corrects any misalignments so that nerve signals flow properly.

  • Foods that help with lung health include tomatoes, apples, berries, and broccoli.

Nervous System Health

Chiropractic focuses on restoring the body to optimal function so that it can heal through normal nervous system function. Treatment resets the vertebrae into proper alignment, reducing swelling, blockages, and nerve stress, allowing the nervous system to function at full capacity.

  • Foods that can help are dark chocolate, spinach, avocados, garlic, and asparagus.

Circulatory System

Chiropractic adjustments increase blood circulation. Adjustments and massage loosen the muscles attached to the specific areas, which also promotes the flow and movement of waste in the lymphatic system in and out of specific areas.

  • Foods that help with circulation include onions, beets, citrus fruits, tomatoes, walnuts, and fatty fish.

Nutrition and chiropractic care go hand in hand. When the body gets the nutrition it needs, it works more efficiently.

An unhealthy diet can cause sluggishness, low energy, and increase inflammatory responses that can lead to chronic conditions. A nutritionist can create a personalized nutrition plan to maximize the benefits as they work together to improve overall health and wellness.


Intermittent Fasting


References

Elma, Ömer, et al. “Chronic Musculoskeletal Pain and Nutrition: Where Are We and Where Are We Heading?.” PM & R: the journal of injury, function, and rehabilitation vol. 12,12 (2020): 1268-1278. doi:10.1002/pmrj.12346

Elma, Ömer, et al. “Do Nutritional Factors Interact with Chronic Musculoskeletal Pain? A Systematic Review.” Journal of clinical medicine vol. 9,3 702. 5 Mar. 2020, doi:10.3390/jcm9030702

Holtzman, Denise, and Jeanmarie Burke. “Nutritional counseling in the chiropractic practice: a survey of New York practitioners.” Journal of chiropractic medicine vol. 6,1 (2007): 27-31. doi:10.1016/j.jcme.2007.02.008

Koehler, Karsten, and Clemens Drenowatz. “Integrated Role of Nutrition and Physical Activity for Lifelong Health.” Nutrients vol. 11,7 1437. 26 Jun. 2019, doi:10.3390/nu11071437

Lee, Mi Kyung, et al. “The use of nutritional guidance within chiropractic patient management: a survey of 333 chiropractors from the ACORN practice-based research network.” Chiropractic & manual therapies vol. 26 7. 20 Feb. 2018, doi:10.1186/s12998-018-0175-1

Mangano, Kelsey M et al. “Dietary protein is associated with musculoskeletal health independently of dietary pattern: the Framingham Third Generation Study.” The American journal of clinical nutrition vol. 105,3 (2017): 714-722. doi:10.3945/ajcn.116.136762

Mendonça, Carolina Rodrigues et al. “Effects of Nutritional Interventions in the Control of Musculoskeletal Pain: An Integrative Review.” Nutrients vol. 12,10 3075. 9 Oct. 2020, doi:10.3390/nu12103075

Tajary, Zahra, et al. “Musculoskeletal Pain Is Associated with Dietary Diversity Score among Community-Dwelling Older Adult: A Cross-Sectional Study.” International journal of food science vol. 2022 4228925. 7 Feb. 2022, doi:10.1155/2022/4228925