Back Clinic Mobility & Flexibility: The human body retains a natural level to ensure all its structures are functioning properly. The bones, muscles, ligaments, tendons, and other tissues work together to allow a range of movement and maintaining proper fitness and balanced nutrition can help keep the body functioning properly. Great mobility means executing functional movements with no restrictions in the range of motion (ROM).
Remember that flexibility is a mobility component, but extreme flexibility really is not required to perform functional movements. A flexible person can have core strength, balance, or coordination but cannot perform the same functional movements as a person with great mobility. According to Dr. Alex Jimenez’s compilation of articles on mobility and flexibility, individuals who don’t stretch their body often can experience shortened or stiffened muscles, decreasing their ability to move effectively.
Can individuals improve their brain function by incorporating yoga as part of their routine to reduce stress and improve mental health?
Introduction
Many people are impacted by life stressors that can cause overlapping risk profiles in their bodies. Stress or cortisol is a vital hormone that affects organs and tissues in the body and can help regulate the body’s response to stress. Whether preparing for a big presentation, studying for an important exam, or dealing with a heavy workload, stress can play a part in these scenarios. Too much stress can impact not only the musculoskeletal function of the body but also brain function, which is why many individuals are looking for ways to lower stress levels in their bodies and give their brains a break. Today’s article looks at how stress is associated with brain function and how therapeutic exercises like yoga can improve brain function and relieve stress. We discuss with certified medical providers who inform our patients how stress can have a negative impact on the brain’s functionality. While asking informed questions to our associated medical providers, we advise patients to incorporate various therapeutic exercises like yoga to help lower stress levels in the body and improve brain function. Dr. Alex Jimenez, D.C., encompasses this information as an academic service. Disclaimer.
Stress & Brain Function
How often do you get headaches or migraines, causing you to be anxious constantly? Do you feel muscle tension or pain after a long, strenuous day? Or do you feel more tired throughout the day even though you slept a full night? Many scenarios correlate with stress and can impact a person’s well-being. While stress is often correlated with negative emotions , it is an acute adaptive response to environmental stimuli in the body and the brain. (McEwen & Akil, 2020) Now, the brain and stress have a wonderful relationship with each other, as the brain is the main controller for the body, providing neuron signals to each of the body’s systems and helping with stress reactivity when environmental factors are in play. Cortisol is a stress hormone that, at the basal levels, is highly important for maintaining healthy brain development and function. When dealing with a highly stressful situation can cause cortisol levels to be elevated and lead to the development of free radical formation that is toxic to the brain. (Herzberg & Gunnar, 2020)
When high-stress levels start to impact brain function in the body, the brain can inform the immune system to produce an excess of inflammatory cytokines to attach themselves to healthy cells and lead to the development of stress-induced inflammation caused by repeated social defeat (RSD). When RSD starts to activate the immune cells in the brain, it can enhance neuroinflammation and influence the endothelial cells of the brain to recruit and transport the peripheral monocytes into stress-sensitive neural regions. (Bower & Kuhlman, 2023) When this happens, it can take a person a long time to reduce their stress levels. However, many individuals who are dealing with stress can find therapeutic ways to not only reduce their stress levels but also protect and improve their brain function.
Is Motion Key To Healing- Video
Yoga For Brain Function
When it comes to reducing stress, many people can incorporate hobbies or therapies that they enjoy and help relax their bodies. One of the various therapies that can help reduce stress and improve brain function is yoga. Yoga is a mindfulness-based intervention that can be used for pain management and help improve pain-like symptoms associated with stress. (Krese et al., 2022) Now, yoga is incorporated into a non-surgical treatment plan for many individuals who have chronic stress affecting their bodies while improving their brain function. When people start doing yoga for the first time, a professional yoga instructor will begin to show them various poses to help stretch their muscles that are tight from the impact of stress, clear their minds from everyday stressors, and even restore their balance. Yoga may be highly effective for many individuals since it is a community-based and holistic intervention that can improve brain function through breathwork, stretching, and holding various postures and meditation. (Stephens et al., 2023) Additionally, yoga can help enhance the brain structure to improve the neurocognitive function of balance and concentration. (Babakhani et al., 2024)
Yoga Equals Stress Relief
Additionally, when people start to incorporate yoga as part of their routine, they will notice their stress levels go down due to being more mindful about what stressors are affecting them and making small changes in their lifestyle. At the same time, yoga can help stretch and strengthen weak muscles by enhancing motor capacity, including muscle strength, balance, and flexibility, and improving non-motor symptoms like alleviating cognitive impairment. (Fan et al., 2020) This is because exercises like yoga can help relieve stress, and when a person is concentrating on going to yoga, they will begin to see improvement in their bodies and brain function. Utilizing the beneficial properties of yoga can help many people be more mindful of their minds and bodies while also improving their brain function.
References
Babakhani, M., Rahzani, K., Hekmatpou, D., & Sheykh, V. (2024). The effect of super brain yoga on the cognitive function of hemodialysis patients. Heliyon, 10(16), e36384. doi.org/10.1016/j.heliyon.2024.e36384
Bower, J. E., & Kuhlman, K. R. (2023). Psychoneuroimmunology: An Introduction to Immune-to-Brain Communication and Its Implications for Clinical Psychology. Annu Rev Clin Psychol, 19, 331-359. doi.org/10.1146/annurev-clinpsy-080621-045153
Fan, B., Jabeen, R., Bo, B., Guo, C., Han, M., Zhang, H., Cen, J., Ji, X., & Wei, J. (2020). What and How Can Physical Activity Prevention Function on Parkinson’s Disease? Oxid Med Cell Longev, 2020, 4293071. doi.org/10.1155/2020/4293071
Herzberg, M. P., & Gunnar, M. R. (2020). Early life stress and brain function: Activity and connectivity associated with processing emotion and reward. Neuroimage, 209, 116493. doi.org/10.1016/j.neuroimage.2019.116493
Krese, K. A., Donnelly, K. Z., Etingen, B., Bender Pape, T. L., Chaudhuri, S., Aaronson, A. L., Shah, R. P., Bhaumik, D. K., Billups, A., Bedo, S., Wanicek-Squeo, M. T., Bobra, S., & Herrold, A. A. (2022). Feasibility of a Combined Neuromodulation and Yoga Intervention for Mild Traumatic Brain Injury and Chronic Pain: Protocol for an Open-label Pilot Trial. JMIR Res Protoc, 11(6), e37836. doi.org/10.2196/37836
McEwen, B. S., & Akil, H. (2020). Revisiting the Stress Concept: Implications for Affective Disorders. J Neurosci, 40(1), 12-21. doi.org/10.1523/JNEUROSCI.0733-19.2019
Stephens, J. A., Hernandez-Sarabia, J. A., Sharp, J. L., Leach, H. J., Bell, C., Thomas, M. L., Buryznska, A. Z., Weaver, J. A., & Schmid, A. A. (2023). Adaptive yoga versus low-impact exercise for adults with chronic acquired brain injury: a pilot randomized control trial protocol. Front Hum Neurosci, 17, 1291094. doi.org/10.3389/fnhum.2023.1291094
Can individuals with body pain incorporate Pilates to reduce general aches and pains while strengthening muscles in the body?
Introduction
Environmental factors like poor posture, improper steps, mechanical overload, physical inactivity, and poor dieting can affect a person’s health and wellness, leading to body pains in the neck, shoulders, and back. When this happens, the surrounding muscles become weak and overstretched over time, causing pain and discomfort in different body areas. However, many individuals thinking about their health and wellness can seek various treatment options to reduce the pain and discomfort in their bodies and help improve their muscle strength. Today’s article looks at how body pain can affect posture, what Pilates is, how this exercise regime can be incorporated for body pain, and its benefits. We talk with certified associated medical providers who inform our patients about how incorporating Pilates can reduce body pain. While asking associated medical providers intricate questions, we advise patients to incorporate Pilates as part of their routine and how it can improve their muscle strength. Dr. Alex Jimenez, D.C., includes this information as an academic service. Disclaimer.
How Body Pain Can Affect Posture
Do you experience stiffness or general aches and pains in different muscle areas? Do you often feel constantly tired throughout the entire day? Or do you notice your posture worsening after looking at a computer or phone screen? Many of these environmental factors can lead to pain and discomfort in the body, which then can cause issues that many individuals will tend to ignore until it becomes too much. For instance, environmental factors like obesity are commonly associated with musculoskeletal problems and incorrect body posture, which can be represented as a causal factor for impairment to the body. (Calcaterra et al., 2022) This is because many individuals don’t realize that improper posture can be associated with body pain and, if not corrected, can lead to overlapping risk factors in the musculoskeletal system. Hence, many individuals start seeking treatments to improve postural alignment, but it can also be used to prevent and treat musculoskeletal pain. (Matsutani et al., 2023)
The Non-Surgical Approach To Wellness- Video
What Is Pilates?
While many people seek treatment for their body pain and improve muscle strength, many have started exercising to reduce the stress and discomfort caused by body pains associated with the musculoskeletal system. Since everyone knows that exercising is excellent for health and wellness, it can also help make the body healthier. Many individuals looking for an exercise routine have various options, including Pilates.
Developed in the early 20th century, Joseph Pilates created a system of exercises primarily focused on controlled muscle movement, stretching, and breathing known as Pilates. It has become popular later in the years not only as a physical fitness routine but also as a rehabilitation program. (Byrnes et al., 2018) Pilates uses a combination of repetitive exercises to create muscular exertion and is designed to increase muscle strength and endurance, enhance flexibility, and improve posture and balance. (Kloubec, 2011)
How Is It Incorporated For Body Pain?
While many people are dealing with body pain, some may wonder how Pilates is incorporated into a health and wellness treatment plan. Well, when environmental factors like poor posture and body pain associated with the musculoskeletal system start to cause pain and discomfort to the body. At the same time, that pain and discomfort, if not treated, will also affect the spine’s alignment, causing more musculoskeletal problems. (Shadi et al., 2024) Additionally, Pilates can be combined with non-surgical treatments like chiropractic care to help improve musculoskeletal pain and restore a person’s strength, flexibility, and mobility. This, in turn, promotes mindfulness and a faster recovery. Many individuals will begin to notice that combining a therapeutic exercise method like Pilates and non-surgical treatments can allow the individual to be pain-free and experience additional benefits. This will enable people to understand the impact of stretching exercises caused by Pilates on the components of musculoskeletal fitness aimed at rehabilitation or physical conditioning. (Dos Reis et al., 2024)
The Benefits Of Pilates
Many people will notice how Pilates can help their bodies through these benefits. This includes:
Adapting Pilates to your fitness level and needs: Anyone can start Pilates at any fitness level and go at their own pace.
Core strength increases: Pilates can help strengthen the core muscles, which correlates to improved posture and a strong body.
Strengthening muscles: Pilates can help strengthen and elongate muscles to help individuals look toned.
Natural energy booster: Like many exercise routines, Pilates can give people an energy boost through focus breathing. This increases circulation, stimulating the muscles and spine.
Utilizing Pilates for rehabilitation combined with non-surgical treatment can allow individuals to be more mindful of their bodies and to make tiny changes in their routines. This allows the chances of pain and discomfort from returning, allowing individuals to have a healthier lifestyle.
References
Byrnes, K., Wu, P. J., & Whillier, S. (2018). Is Pilates an effective rehabilitation tool? A systematic review. J Bodyw Mov Ther, 22(1), 192-202. doi.org/10.1016/j.jbmt.2017.04.008
Calcaterra, V., Marin, L., Vandoni, M., Rossi, V., Pirazzi, A., Grazi, R., Patane, P., Silvestro, G. S., Carnevale Pellino, V., Albanese, I., Fabiano, V., Febbi, M., Silvestri, D., & Zuccotti, G. (2022). Childhood Obesity and Incorrect Body Posture: Impact on Physical Activity and the Therapeutic Role of Exercise. Int J Environ Res Public Health, 19(24). doi.org/10.3390/ijerph192416728
Dos Reis, A. L., de Oliveira, L. C., & de Oliveira, R. G. (2024). Effects of stretching in a pilates program on musculoskeletal fitness: a randomized clinical trial. BMC Sports Sci Med Rehabil, 16(1), 11. doi.org/10.1186/s13102-024-00808-6
Matsutani, L. A., Sousa do Espirito Santo, A., Ciscato, M., Yuan, S. L. K., & Marques, A. P. (2023). Global posture reeducation compared with segmental muscle stretching exercises in the treatment of fibromyalgia: a randomized controlled trial. Trials, 24(1), 384. doi.org/10.1186/s13063-023-07422-w
Shadi, N., Khalaghi, K., & Seyedahmadi, M. (2024). Comparing the effects of Pilates, corrective exercises, and Alexander’s technique on upper cross syndrome among adolescent girls student (ages 13-16): a six-week study. BMC Sports Sci Med Rehabil, 16(1), 143. doi.org/10.1186/s13102-024-00933-2
For individuals dealing with newly formed or chronic lower back pain, can making daily walks a part of a weekly routine help relieve pain and discomfort symptoms and prevent strains and injuries?
Walking For Low Back Pain Relief
Walking is recommended to treat and prevent chronic or recurrent lower back pain. A study found that a personalized and progressive weekly walking program that builds up to 130 minutes of moderate intensity can significantly relieve severe lower back pain and prevent future flare-ups. (Pocovi N. C. et al., 2024) Walking is a cost-effective and easily accessible way to relieve lower back pain and prevent recurring or future injuries. It strengthens the back muscles, improves posture, and stabilizes the spine. (Suh JH, et al., 2019) Other benefits include improved overall physical health, posture, and circulation.
How Walking Helps
Walking for low back pain relief and general movement is better than not engaging in physical activities for individuals with recurrent lower back pain. Being sedentary can worsen back pain symptoms. (National Library of Medicine. 2019) Walking is second nature and is easy to incorporate into a weekly routine to help relieve back pain and improve overall health (Macquarie University, 2024)
Increases Spinal Flexibility
Walking and gentle movements increase the lower back’s functional range of motion, improve spinal flexibility, and reduce stiffness. (Smith J. A. et al., 2022)
Stabilizes Lumbar/Low Back Muscles
Walking builds muscle endurance and strength in the paraspinal muscles, increasing lumbar spinal stabilization. (Suh JH, et al., 2019)
Strengthens Core Muscles
Walking increases the body load and strengthens core muscles like the transversus abdominis, which lowers the risk of chronic lower back pain. (Lee J. S. and Kang S. J. 2016)
Improves Posture
Movement of the legs during walking enhances bodily awareness and helps correct posture.(Henry M. and Baudry S. 2019)
Increases Blood Circulation
Walking increases blood circulation to the muscles, supplying essential nutrients to spinal discs. It also reduces the frequency and severity of lower back muscle spasms. (Sitthipornvorakul E. et al., 2018)
Lubricates Spinal joints
Low-impact walking improves synovial fluid production and circulation, lubricating the lumbar spine’s facet joints and other joints that tend to get achy, such as the knees. (Zhang S. L. et al., 2013)
Relieves Inflammation
Walking helps reduce the presence of pro-inflammatory cytokines, like (IL-8 and TNF-alpha) associated with chronic lower back pain. (Slouma M. et al., 2023)
Promotes Weight Loss
Walking and a healthy diet can help individuals lose excess fat, which puts added strain on the lower back and correlates with lumbar intervertebral disc degeneration. (Wang M. et al., 2024)
Stress Relief
Regular walking can reduce mental stress associated with chronic lower back pain. (Choi S. et al., 2021)
Releases Endorphins
Moderate to vigorous physical activity, like walking at about 3 miles per hour for a half-hour daily, stimulates the release of endorphins, the body’s natural pain relievers. (Bruehl S. et al., 2020)
Walking Correctly
To get all the benefits of walking for low back pain relief, it is recommended to practice the following (Macquarie University, 2024)
Start slowly.
Gradually build intensity.
Stay consistent with the walking program.
Track progress to maintain motivation.
Healthcare Provider Consultation
Walking is a low-risk, low-impact activity well-tolerated by most individuals with nonspecific low back pain. (Pocovi N. C. et al., 2022) Because it doesn’t involve twisting or vigorous movements, it is considered a safe exercise for individuals with back pain symptoms (Gordon R. and Bloxham S. 2016). However, individuals experiencing severe lower back pain due to a traumatic injury or medical condition should consult a healthcare provider before starting a regular walking program.
Limit High Impact Activities
High-impact activities like running on hard surfaces or playing sports can exacerbate chronic lower back pain. If there is chronic lower back pain, it is recommended to limit activities that involve: (Al-Otaibi S. T. 2015)
Heavy lifting
Repetitive bending
Twisting motions
Injury Medical Chiropractic and Functional Medicine Clinic
Walking for low back pain relief. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.
Movement as Medicine
References
Pocovi, N. C., Lin, C. C., French, S. D., Graham, P. L., van Dongen, J. M., Latimer, J., Merom, D., Tiedemann, A., Maher, C. G., Clavisi, O., Tong, S. Y. K., & Hancock, M. J. (2024). Effectiveness and cost-effectiveness of an individualised, progressive walking and education intervention for the prevention of low back pain recurrence in Australia (WalkBack): a randomised controlled trial. Lancet (London, England), 404(10448), 134–144. doi.org/10.1016/S0140-6736(24)00755-4
Suh, J. H., Kim, H., Jung, G. P., Ko, J. Y., & Ryu, J. S. (2019). The effect of lumbar stabilization and walking exercises on chronic low back pain: A randomized controlled trial. Medicine, 98(26), e16173. doi.org/10.1097/MD.0000000000016173
National Library of Medicine., & InformedHealth.org [Internet]. Cologne, G. I. f. Q. a. E. i. H. C. I. (2022). Low back pain: Learn More – Why movement is so important for back pain. www.ncbi.nlm.nih.gov/books/NBK284944/
Smith, J. A., Stabbert, H., Bagwell, J. J., Teng, H. L., Wade, V., & Lee, S. P. (2022). Do people with low back pain walk differently? A systematic review and meta-analysis. Journal of sport and health science, 11(4), 450–465. doi.org/10.1016/j.jshs.2022.02.001
Suh, J. H., Kim, H., Jung, G. P., Ko, J. Y., & Ryu, J. S. (2019). The effect of lumbar stabilization and walking exercises on chronic low back pain: A randomized controlled trial. Medicine, 98(26), e16173. doi.org/10.1097/MD.0000000000016173
Lee, J. S., & Kang, S. J. (2016). The effects of strength exercise and walking on lumbar function, pain level, and body composition in chronic back pain patients. Journal of exercise rehabilitation, 12(5), 463–470. doi.org/10.12965/jer.1632650.325
Henry, M., & Baudry, S. (2019). Age-related changes in leg proprioception: implications for postural control. Journal of neurophysiology, 122(2), 525–538. doi.org/10.1152/jn.00067.2019
Sitthipornvorakul, E., Klinsophon, T., Sihawong, R., & Janwantanakul, P. (2018). The effects of walking intervention in patients with chronic low back pain: A meta-analysis of randomized controlled trials. Musculoskeletal science & practice, 34, 38–46. doi.org/10.1016/j.msksp.2017.12.003
Zhang, S. L., Liu, H. Q., Xu, X. Z., Zhi, J., Geng, J. J., & Chen, J. (2013). Effects of exercise therapy on knee joint function and synovial fluid cytokine levels in patients with knee osteoarthritis. Molecular medicine reports, 7(1), 183–186. doi.org/10.3892/mmr.2012.1168
Slouma, M., Kharrat, L., Tezegdenti, A., Metoui, L., Ghazouani, E., Dhahri, R., Gharsallah, I., & Louzir, B. (2023). Pro-inflammatory cytokines in patients with low back pain: A comparative study. Reumatologia clinica, 19(5), 244–248. doi.org/10.1016/j.reumae.2022.07.002
Wang, M., Yuan, H., Lei, F., Zhang, S., Jiang, L., Yan, J., & Feng, D. (2024). Abdominal Fat is a Reliable Indicator of Lumbar Intervertebral Disc Degeneration than Body Mass Index. World neurosurgery, 182, e171–e177. doi.org/10.1016/j.wneu.2023.11.066
Choi, S., Nah, S., Jang, H. D., Moon, J. E., & Han, S. (2021). Association between chronic low back pain and degree of stress: a nationwide cross-sectional study. Scientific reports, 11(1), 14549. doi.org/10.1038/s41598-021-94001-1
Bruehl, S., Burns, J. W., Koltyn, K., Gupta, R., Buvanendran, A., Edwards, D., Chont, M., Wu, Y. H., Qu’d, D., & Stone, A. (2020). Are endogenous opioid mechanisms involved in the effects of aerobic exercise training on chronic low back pain? A randomized controlled trial. Pain, 161(12), 2887–2897. doi.org/10.1097/j.pain.0000000000001969
Pocovi, N. C., de Campos, T. F., Christine Lin, C. W., Merom, D., Tiedemann, A., & Hancock, M. J. (2022). Walking, Cycling, and Swimming for Nonspecific Low Back Pain: A Systematic Review With Meta-analysis. The Journal of orthopaedic and sports physical therapy, 52(2), 85–99. doi.org/10.2519/jospt.2022.10612
Gordon, R., & Bloxham, S. (2016). A Systematic Review of the Effects of Exercise and Physical Activity on Non-Specific Chronic Low Back Pain. Healthcare (Basel, Switzerland), 4(2), 22. doi.org/10.3390/healthcare4020022
Al-Otaibi S. T. (2015). Prevention of occupational Back Pain. Journal of family & community medicine, 22(2), 73–77. doi.org/10.4103/2230-8229.155370
Can using a cane help individuals after an injury, living with chronic pain or balance issues, or post-surgery?
Walking With A Cane
A cane is an assistive device that can help individuals walk after injury or surgery and aids with balance and stability. It can be used for:
Balance or Stability Issues
Canes can help with minor balance or stability issues, such as weakness in the leg or trunk, or after an injury.
Pain
Canes can help reduce stress on painful joints or limbs.
Independence
Canes can help people continue living independently, especially the elderly.
There are different types of canes, including single-point and quad canes. Single-point canes are generally the least expensive. Quad canes have four points and can provide more stability. It is important to use it correctly to prevent falls and injuries.
Post-surgery or Injury
A cane can help reduce pressure on the leg or back after surgery or injury. Healthcare providers may recommend a cane as a step-down device after using a walker or crutches. Before walking with the cane, ensure it is at the right height. Hold the cane in the hand on the opposite side of the injury. Hold the cane’s handle at the level of the bend in the wrist when standing with the elbow slightly bent. (American Academy of Orthopaedic Surgeons, 2020) If there are issues in both legs or a cane is used after back surgery, keep the cane in the hand with the most support.
Step forward with the cane and injured leg at the same time.
Step the non-injured leg up with the cane firmly on the ground to meet the injured leg.
The feet should be side by side.
Walking Normally
Once comfortable taking practice steps, try walking normally with the cane. Step forward with the cane and injured leg simultaneously. The cane should be off the ground when the wounded leg is in the air. Firmly plant the cane when stepping onto the injured leg. Step forward with the cane and the injured leg first, then step past the injured leg with the good leg.
Step down with the injured leg while lowering the cane to the step below.
Make sure the cane is firmly on the stairs.
Bring the good leg down to the same step.
If a handrail is available, use it. Although doing so may require moving the cane to the other hand, even if it’s on the same side as the injured leg, it will improve stability and reduce the risk of falling. Once proficient on the stairs, individuals may alternate placing one foot on each step.
Walking With Chronic Pain
Walking with a cane with a chronic pain condition is similar to using it with an injury. The location of the pain will determine which hand the cane is held in. If the pain is on the right side of the body, keep the cane on the left side or vice versa. If chronic pain is not in the legs but, for example, back pain makes it difficult to walk, hold the cane on either side, whichever feels more supportive and comfortable. If there is weakness on one side of the body or decreased sensation/numbness in one of the legs or feet, hold the cane on the opposite side of the pain, weakness, or numbness. Walking with a cane can also benefit individuals with other medical conditions. For example, assistive devices may be recommended for those with balance issues. (National Library of Medicine, 2023)
Cane Types
There are two primary types of canes, characterized by their points, and choosing the right one depends on the reason it’s needed. (Arthritis Foundation, N.D.)
Single-point
Single-point canes have one tip at the end.
These are recommended for those who need to relieve some pressure off an injured leg or need support due to occasional difficulties with balance.
Quad
Quad canes have four tips or feet to provide more stability.
They provide more support and are recommended for those with significant weakness in one leg or difficulty maintaining their balance while walking.
The traditional cane has a rounded C handle. Other types have contoured handles for a more secure grip. Talk to a doctor, physical therapist, or other health care professional for suggestions on which cane is right for you.
Losing Balance
A potential risk of using a cane is losing balance. If unable to maintain balance with a cane, individuals may want to consider a different walking device, such as a walker or crutches. To reduce the risk of falls, consider the following tips (American Academy of Orthopaedic Surgeons, 2020)
Wear shoes with nonskid soles.
Add lighting so you can see where you are walking.
Remove throw rugs or objects that can cause tripping.
Arrange furniture to allow for wide walking paths throughout the home.
Carry objects in a backpack or fanny pack rather than holding them.
Injury Medical Chiropractic and Functional Medicine Clinic
Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other associated medical professionals to develop a personalized treatment plan to help relieve muscle pain, improve the body’s flexibility and mobility, resolve musculoskeletal issues, and prevent future pain symptoms from reoccurring.
Hirayama, K., Otaka, Y., Kurayama, T., Takahashi, T., Tomita, Y., Inoue, S., Honaga, K., Kondo, K., & Osu, R. (2022). Efficiency and Stability of Step-To Gait in Slow Walking. Frontiers in human neuroscience, 15, 779920. doi.org/10.3389/fnhum.2021.779920
Individuals walking with a limp that results in pain could have an antalgic gait, an abnormal walking pattern commonly seen in emergency clinics and primary care offices. Can recognizing the symptoms help healthcare providers develop an effective treatment for the underlying cause?
Antalgic Gait
Limping and having an antalgic gait usually indicate a larger issue within the leg or lower back. It is the most common type of abnormal gait. There are various causes of antalgic gait, including acute injuries and gradually progressing medical conditions. The most common causes include osteoarthritis in one of the leg’s joints, lumbar radiculopathy, or an injury to a ligament or tendon. Paying attention to when the limping occurs, and any accompanying symptoms can help determine its origins.
Walking
When limping, the stance phase during walking is shorter than the swing phase. Individuals may widen their legs apart to provide a support base to compensate for the imbalance. In severe cases, an individual may swing their leg irregularly or take several side steps.
Causes and Symptoms
Antalgic gait can be caused by pain in any part of the lower extremity. Limping when walking may be a primary concern but is rarely the only complaint. Other associated symptoms may also be present, depending on the cause. These include:
Limited range of motion
Joint stiffness
Muscular weakness
Numbness and tingling
Pain
Swelling
Leg instability or buckling
Clicking or popping
Common Causes include:
Hip, knee, and/or Foot problems
When the hip, knee, ankle, or foot joints are injured or have some issue, walking can be painful and lead to a limp.
Sprains, Strains, or Soft-tissue Injuries
Sprains, strains, and soft-tissue injuries can result from acute injury or chronic, repetitive activities over time. (Pirker W. and Katzenschlager R. 2017) Sprains affect the body’s ligaments, while strains impact muscle tendons. However, sprains and strains occur when the impacted structure is overstretched or partially torn. The damage can lead to pain and antalgic gait. An injury to several other soft-tissue structures, including a bursa or fluid-filled sacs that reduce friction, meniscus, or fat pad, can also lead to limping. Symptoms typically include swelling, pain, and limited range of motion. More severe injuries can also make the leg feel unstable and cause it to give way when walking. Sometimes, bruising can also occur in the area of the injury. (American Academy of Orthopaedic Surgeons, 2020)
Osteoarthritis
Osteoarthritis occurs when the smooth, articular cartilage that lines the ends of bones begins to thin and deteriorate. This can alter the normal movement of a joint and lead to pain. Osteoarthritis symptoms gradually progress, affect individuals over 50, and worsen after periods of sedentary activity (Arthritis Foundation, Osteoarthritis, N.D.) Typically, it results in pain, stiffness, clicking, and occasionally swelling in the affected joint. These symptoms are usually worse in the morning and at the end of a long activity day. Moving around and warming the joint improves osteoarthritis symptoms. (Arthritis Foundation, Osteoarthritis, N.D.)
Lower Back Radiculopathy
Lumbar radiculopathy is when the nerve roots branching off the spine’s lower region become compressed or inflamed. This can occur because of disc issues like bulging, degeneration, herniation, bone spurring, or, rarely, a growth or tumor. (Johns Hopkins Medicine, 2024) Because these nerves control movement, sensation, and strength in the legs and feet, irritation in one can lead to limping. (Yokogawa N. et al., 2015) The antalgic gait from this condition frequently comes on suddenly and is commonly accompanied by back pain symptoms. This can include shooting pain and paresthesia in the leg. Depending on which nerve is involved, individuals may also experience muscular weakness in certain areas of the lower extremity. Sometimes, the affected leg feels like it will buckle while standing or walking. (Johns Hopkins Medicine, 2024)
Other causes include:
Broken bones
Tumors
Infections
Blood clots
Vascular issues
Treatment
Treatment for antalgic gait depends on the underlying cause but can include:
Rest, ice, and elevation are important for injuries. Individuals can control their initial symptoms by icing, elevating the leg, and resting from irritating activities.
Activity modifications
Antibiotics for infections
Pain relievers
Anti-inflammatories
Physical therapy is also frequently initiated to strengthen the core and alleviate walking symptoms.
A spinal injection or surgery can reduce the pressure on the nerve root if conservative interventions fail to improve antalgic gait patterns. (Johns Hopkins Medicine, 2024)
Crutches, canes, walkers, or assistive devices can reduce pressure traveling through an affected joint and improve overall walking quality. A study found that using a cane for two months helped reduce pain and improve function in individuals with knee osteoarthritis. (Fang M. A. et al., 2015)
Injury Medical Chiropractic and Functional Medicine Clinic
Though it can be tempting to ignore the limp and push through it, discussing the condition with a healthcare provider is important. A thorough medical exam and diagnostic tests, such as X-ray, MRI, or EMG, can help determine the underlying causes of a limp, help discover the cause of the problem, and help improve the quality of walking. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop personalized treatment programs. Using an integrated approach to treating injuries and chronic pain syndromes to improve flexibility, mobility, and agility and help individuals return to normal activities. Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers if other treatments are needed.
Chiropractic and Integrative Healthcare
References
Pirker, W., & Katzenschlager, R. (2017). Gait disorders in adults and the elderly : A clinical guide. Wiener klinische Wochenschrift, 129(3-4), 81–95. doi.org/10.1007/s00508-016-1096-4
Yokogawa, N., Toribatake, Y., Murakami, H., Hayashi, H., Yoneyama, T., Watanabe, T., & Tsuchiya, H. (2015). Differences in Gait Characteristics of Patients with Lumbar Spinal Canal Stenosis (L4 Radiculopathy) and Those with Osteoarthritis of the Hip. PloS one, 10(4), e0124745. doi.org/10.1371/journal.pone.0124745
Fang, M. A., Heiney, C., Yentes, J. M., Harada, N. D., Masih, S., & Perell-Gerson, K. L. (2015). Effects of contralateral versus ipsilateral cane use on gait in people with knee osteoarthritis. PM & R : the journal of injury, function, and rehabilitation, 7(4), 400–406. doi.org/10.1016/j.pmrj.2014.09.018
Individuals with inflammation, pain, and swelling on the tops of their feet or hands could be experiencing extensor tendonitis. What treatment options are available?
Extensor Tendonitis
These tendons attach to muscles that straighten the fingers and lift the toes and the top of the foot. Extensor tendonitis is a condition characterized by inflammation of the tendons on the tops of the hands and feet. It often results from overuse of the muscles and from wearing tight shoes. Symptoms tend to worsen with activity and improve with rest. The condition does not usually require surgery; treatments include medications, home remedies/activity modification, and physical therapy.
Types
Tendonitis can develop in any tendon of the extensor muscles. These tendons are long, thin bands of tissue that can be felt on the tops of the hands and feet. The structures attach to muscles on one end and bones of the fingers and toes on the other. The extensor tendons in the hands include: (American Society for Surgery of the Hand, 2024)
The extensor digitorum communis straightens the index, middle, ring, and small fingers.
The extensor digiti minimi straightens the small finger.
The extensor indicis proprius straightens the index finger.
The extensor pollicis longus and extensor pollicis brevis muscles move the thumb into the thumb-up position.
The extensor digitorum longus and extensor digitorum brevis muscles lift the second, third, fourth, and fifth toes.
The extensor hallucis longus lifts the big toe.
Tendonitis vs Tendinopathy
Chronic tendon pain can lead to a condition known as tendinopathy.
Tendonitis results from inflammation.
Tendinopathy is the degeneration/micro-tearing of a tendon that occurs with long-term overuse.
Knowing which condition you are dealing with is important because it requires different treatments.
Symptoms
The primary symptom is pain in the affected tendon/s. Individuals may also experience swelling, and the skin can become red or warm to the touch. Extensor tendonitis can cause pain when using the affected muscles, moving the hand or foot in the opposite direction, and stretching the tendons. Usually, the pain worsens when using the affected muscles and improves with rest.
Causes
Extensor tendonitis in the hands usually results from overuse, which causes inflammation. However, it can also result from trauma, such as falling on the hand or an injury during physical or sports activities. Common activities include: (Hanson Z. C., and Lourie G. M. 2022)
Manual labor work
Typing
Computer mouse use
Weightlifting
Gymnastics
Playing a musical instrument
Extensor tendonitis in the foot can also result from overuse activities like running, especially uphill. However, it can also occur from wearing overly tight or tightly laced shoes for physical activities like running or dancing. Less common causes include: (Arthritis Foundation, N.D.)
Medical conditions like diabetes or arthritis
Medication side effects
Infection
Joint deformities
Treatment
Extensor tendonitis usually improves with conservative treatment, which includes self-care, activity modification, physical therapy, and medication.
Medications
Individuals can treat inflammation with non-steroidal anti-inflammatory drugs NSAIDs like:
Ibuprofen
Naproxen
Aspirin
Acetaminophen can help reduce pain.
In some cases, individuals may need prescription anti-inflammatory medications like corticosteroids or pain relievers for short-term use.
Self-Care and Activity Adjustments
Self-care includes:
Rest and avoid any activities that increase pain symptoms. If you can’t avoid them completely, take frequent breaks to allow the muscles to relax.
Apply ice to the hand or foot several times daily for up to 20 minutes.
Compression wraps should be applied on the foot or hand using an elastic bandage or soft splint to help support the injured tendons and reduce swelling.
Elevate the hand or foot if swollen above the heart level when resting.
Activity Adjustments
Modifying activities can help address the underlying cause/s.
Hand extensor tendonitis can develop from poor positioning.
Setting up an ergonomic workstation can help.
Consult a coach or trainer if the tendonitis is related to sports or exercise.
Individuals might need to adjust their technique or training schedule to decrease pressure on the tendons.
Physical Therapy
Physical therapy is an effective treatment. A therapy team can help determine the condition’s underlying cause and provide a personalized treatment program. Interventions can include:
Pain-reducing treatments like ultrasound, electrical stimulation, electroacupuncture, and laser therapy.
Extensor tendonitis can take weeks or even months to fully heal. Early diagnosis and determining the condition’s underlying cause rather than just treating symptoms are recommended for a faster and optimal recovery. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop personalized treatment programs through an integrated approach to treating injuries and chronic pain syndromes, improving flexibility, mobility, and agility, relieving pain, and helping individuals return to normal activities. Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers if other treatments are needed.
Hanson, Z. C., & Lourie, G. M. (2022). Middorsal Wrist Pain in the High-Level Athlete: Causes, Treatment, and Early Return to Play. Orthopaedic journal of sports medicine, 10(4), 23259671221088610. doi.org/10.1177/23259671221088610
Bronner, S., Ojofeitimi, S., & Rose, D. (2008). Repair and rehabilitation of extensor hallucis longus and brevis tendon lacerations in a professional dancer. The Journal of orthopaedic and sports physical therapy, 38(6), 362–370. doi.org/10.2519/jospt.2008.2749
Skeletal muscles attached to the arms, legs, neck, back, and trunk bones are voluntary and consciously controlled. Weakness or inability to control these muscles can signal a health issue like a neuromuscular disorder or electrolyte imbalance. Can recognizing the symptoms can help healthcare providers develop effective treatment programs?
Voluntary Muscles
Voluntary muscles are the skeletal muscles that attach to bones and control movement of the limbs, head, neck, and body under an individual’s conscious control. Skeletal muscles are controlled by neuromuscular signals from the brain that communicate with individual muscle fibers and cause them to contract.
Difference
Voluntary muscles are skeletal muscles that contract and relax under conscious control.
These muscles attach to bones and regulate movement of the body.
Involuntary muscles are not under conscious control.
Involuntary muscles involve automatic internal processes needed for survival, like controlling blood vessels and organs like the heart, lungs, and digestive system.
They contract and relax automatically and receive signals from the autonomic nervous system, which regulates internal bodily functions.
Voluntary
Voluntary muscles are skeletal muscles that comprise 40% of the body’s weight and 50% to 75% of the body’s proteins. These muscles can convert chemical and mechanical energy to cause voluntary muscle contraction and movement. (Trovato F.M. et al., 2016) Skeletal muscle comprises fascicles or bundled units of multiple muscle fibers or muscle cells. Each muscle fiber consists of a cross-banded structure further divided into myofibrils containing thick myosin and thin actin myofilaments, which give the muscle its stripe appearance, and the structure gives the characteristic striated structure. (Trovato F.M. et al., 2016) Muscle contraction occurs when these myofilaments move closer together, stimulated by the release of the neurotransmitter acetylcholine from nerve cells that communicate with the muscle fiber.
Involuntary
The autonomic nervous system controls involuntary muscles, regulating their contraction and relaxation. This system also controls the activity of organs and blood vessels for essential daily functions, including breathing, circulation, digestion, heartbeat regulation, and urination. Most involuntary muscles are composed of smooth muscles. Smooth muscles do not have the striated structure of skeletal muscles and consist of sheets or layers of smooth muscle cells. When the autonomic nervous system stimulates these muscle cells to contract by releasing hormones or other chemical signals, smooth muscle cells shorten through the movement of actin and myosin myofilaments. Involuntary smooth muscles include the blood vessel walls, diaphragm, intestines, and bladder. (Webb R. C. 2003) One exception of an involuntary muscle is the myocardium, or heart muscle. The myocardium comprises a specialized cardiac muscle cell found only in the heart. Cardiac muscle is striated like skeletal muscle but is controlled by the autonomic nervous system and pacemaker cells, causing it to contract automatically and rhythmically.
Weakened Voluntary Muscles
Skeletal muscle diseases, neuromuscular disorders, and other causes can weaken muscles. Neuromuscular or skeletal muscle disorders affect the nerves that send electrical signals to voluntary skeletal muscles to control movement. When the nerves are damaged, communication between the nerves and muscles becomes disrupted. This can result in significant muscle weakness, atrophy, and loss of function. Most neuromuscular disorders are genetic or caused by issues with the immune system. Nerves communicate with muscles through the release of neurotransmitters at the neuromuscular junction, which is the space between a nerve cell and muscle fiber. Neuromuscular disorders can damage the nerve or the neuromuscular junction. Neuromuscular disorder symptoms can include: (Cleveland Clinic, 2023)
Numbness and tingling
Muscle weakness
Muscle twitches, cramps, or spasms
Muscle pain
Muscle atrophy
Decreased coordination
Balance problems
Drooping eyelids and double vision from eye muscle weakness.
Difficulty swallowing due to weakness of the pharynx.
Difficulty breathing due to weakness of the diaphragm.
Common Neuromuscular Disorders
Amyotrophic Lateral Sclerosis – ALS
More commonly known as Lou Gehrig’s disease, it is a genetic disorder that results from hardening of the spinal cord.
It causes damage to the nerves that control muscles and voluntary movement.
Charcot-Marie-Tooth Disease
This is a class of peripheral nerve disorders that cause muscle weakness, atrophy, and loss of sensation, most commonly in the legs and feet.
It is a genetic disorder caused by a gene mutation that damages myelin, or the insulating sheath that surrounds all nerves and supports the conduction of electrical signals.
Multiple Sclerosis – MS
MS causes degeneration of the myelin sheath surrounding nerves, decreasing the impulses along the nerves to muscles.
It can result in muscle weakness, which is often more severe on the dominant side of the body.
There are different forms of MS, but the condition is often progressive and gets worse over time if left untreated.
Muscular Dystrophies
These are genetic diseases characterized by gradual loss of motor function, muscle weakness and atrophy, walking gait problems, progressive respiratory failure, and cardiomyopathy.
There are nine types of muscular dystrophy, all caused by genetic mutations.
Myasthenia Gravis
This is an autoimmune disease that causes inflammation throughout the body.
An autoimmune disease occurs when the immune system attacks healthy cells by mistake.
With myasthenia gravis, the body produces antibodies that attack the receptors for acetylcholine, reducing the body’s ability to contract muscles.
This leads to muscle weakness, atrophy, and fatigue.
Myopathies
These are diseases of muscles that cause muscle weakness and atrophy.
Depending on the type, they may progress and get worse over time.
Electrolyte Imbalances
Muscle weakness can result from altered sodium, potassium, calcium, or magnesium levels.
Always seek immediate medical attention for any sudden, unexplained muscle weakness. Individuals who experience skeletal muscle weakness should discuss the type and duration of symptoms with their doctor, specialist, physical therapist, or chiropractor, as this might be a sign of a medical condition such as a neuromuscular disorder. Working with a chiropractic team can help expedite healing. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop a personalized treatment program through an integrated approach to treat injuries and chronic pain syndromes, improving flexibility, mobility, and agility, relieving pain, and helping individuals return to normal activities. If other treatments are needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments.
Chiropractic Massage Therapy
References
Trovato FM, I. M., Conway N, Castrogiovanni P. (2016). Morphological and functional aspects of human skeletal muscle. J Funct Morphol Kinesiol., 1(3), 289-302. doi.org/https://doi.org/10.3390/jfmk1030289
Webb R. C. (2003). Smooth muscle contraction and relaxation. Advances in physiology education, 27(1-4), 201–206. doi.org/10.1152/advan.00025.2003
IFM's Find A Practitioner tool is the largest referral network in Functional Medicine, created to help patients locate Functional Medicine practitioners anywhere in the world. IFM Certified Practitioners are listed first in the search results, given their extensive education in Functional Medicine
Extensor Tendonitis
