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.
Dr. Jimenez, D.C., presents how to implement exercise as part of your daily routine. Many factors and lifestyle habits tend to take over our daily lives, and in this 2-part series, we will look at how to implement exercise in a clinical setting. Part 2 will continue the presentation. We mention our patients to certified medical providers that provide available therapy treatments for individuals suffering from chronic conditions associated with Lyme disease. We encourage each patient when it is appropriate by referring them to associated medical providers based on their diagnosis or needs. We understand and accept that education is a marvelous way when asking our providers’ crucial questions at the patient’s request and acknowledgment. Dr. Alex Jimenez, D.C., uses this information as an educational service. Disclaimer
How To Implement Strategies?
Dr. Alex Jimenez, D.C., presents: Today we will discuss how to implement strategies using exercise as a prescription. Remember, just like we talked about how a healthy diet full of nutritious, whole foods can be used as a prescription, we want this science to make it to the patient and create outcomes because otherwise, this is just a bunch of things you know and not something that you know how to put into practice. So we’ve listened; we know that’s what you’re up to, so let’s get started. We will discuss some general aspects of implementing exercise as a prescription and some ideas we use in our practice. And then, of course, share the brilliant ideas with some of the other colleagues who also are figuring out ways to make this work in their practice. The first thing we want to share with you is when you’re approaching a patient with an exercise prescription, assuming the patient’s interested, you should ascertain first how this person is motivated.
Because it always makes sense to ride their motivation wave than to come from the standpoint that this is what I want from you, and this is why you need to do it. The first thing we want to put out there is that you want to ensure that this patient has a reason to want to exercise. So it’s less about a doctor’s orders or a provider’s recommendation, and you want to partner with our patients therapeutically, which means understanding their motivation. So for most people, there are two ways we can reinforce the outcome of a positive implementation of the exercise. First, we want to optimize those factors related to one-on-one communication with our patients. And then, number two, optimize the environment in our practice for success. Okay, so we’ll go over these things in detail now.
It only sometimes works if we give them a prescription and assume they want to do it. So if Joan Rivers was your patient in the past, this might have been her reason for not wanting to exercise, and you must be able to roll with it. Let’s talk about how we can do that. This works with patients, spouses, and children; it is wise to persuade people to do things and make them think it is their idea. So, with much bigger goals in mind, Nelson Mandela used the same principle. So we want you to think about who you are working with and who you are partnering with; these are some common functional medicine personas that you may come across, especially if you’re in more of a private practice, whether it’s cash or membership type of practice, you might see this persona in people.
Look For The Personas
Dr. Alex Jimenez, D.C., presents: Are these all personas the same? Not necessarily, as people have different reasons to exercise. For example, say you have a chronically ill individual who needs their hands to be held or have individuals who read many fitness magazines following these leaders through a whole lifestyle lens. And the way you engage with each of these personas is based on their goal for exercise. So, the unwell individual may have different goals, challenges, or limitations than the lifestyle lens individual. So make sure you know who you are working with, and if you need more clarification, have a conversation with them to find out.
Let’s say you’ve gotten through that step, and now you’re in the actual conversation of, “Hey, let’s figure out how to get this exercise thing to create benefits in your life.” As you’re having the conversation, you might learn to use some aspects of motivational interviewing. So rolling with resistance, for example, sometimes people say, “Nope, I don’t want to exercise.” So in this example, you might say, “Okay, if you don’t want to exercise at a gym, what other options have you heard of that you might want to consider?” Let’s say that’s how you opened it up and remember that there’s always a way to roll with the resistance, and it’s focused on acknowledging the patient’s input. You’re responding to them by saying, “Okay, fine. You don’t want to work at a gym. I get that,” while expressing empathy. Many individuals have tried to work at a gym, and the machines tend to injure them when used incorrectly, intimidate them, or the equipment is not made for their size structure.
Emphasize With Your Patients
Dr. Alex Jimenez, D.C., presents: Many people want to avoid exercising; this is one of the many frustrating things because you feel the equipment needs to be made for you. So notice that you can empathize without judging and then roll with resistance and ensure they understand that you acknowledge their input about the situation. These things are common sense to you. Many of us may not employ these to the fullest potential to motivate our patients to implement exercise as part of their daily routines. The important and obvious thing is to refrain from arguing with your patient. Because all that will go to create for most people is more resistance, so if they say, “Hey, I don’t want to exercise right now,” you can say, “Would you be willing to talk about exercising as a goal in the future?”
And if they say, “Yeah, I need to make it through December,” you can reply with, “Okay, great, let’s have you follow up with me in January. Does that work for you?” So again, avoiding arguing and expressing empathy can put people’s minds at ease and prevent resistance. Another factor that many people often do when it comes to implementing exercise as part of their routine is by developing discrepancy. So sometimes, people say things that conflict with the daily habits that they already follow. So they might say, “Yeah, I want to exercise because I don’t want to take a statin medication, but I don’t have time to exercise.” So this is where you help them understand like you recognize that exercise is one of the key ways to reduce your need for a statin medication. And you get that if we leave this cholesterol the way it is, it will cause more risks for your patients. But at the same time, time is a factor. So you come up with some ideas to benefit your patients and incorporate exercise as a routine.
Develop A Plan
Dr. Alex Jimenez, D.C., presents: Remember that you don’t have to solve everything for someone. You could put things out like developing discrepancies for the patient and then let the patient generate solutions that work. So also support self-efficacy. This means that we are not going to change the behavior. The patient is the one who has to change the behavior, and their understanding of their capacity to change their behavior is essential. So whatever you can do to point out the positives, acknowledge whatever they’ve done, even if it’s like, “Hey, it’s wonderful that you bought sneakers. I understand that you didn’t do anything we discussed; life happened. I want to acknowledge you for getting the sneakers because that makes it much easier to start the plan now.” So support self-efficacy whenever possible. Now other more tangible obstacles keep someone from wanting to implement exercise.
Many times it’s either on a mental or physical plane. So here are some solutions that we’ve listed for some of the common mental obstacles we’ve seen. Some people don’t want to be out in public because of concerns about body image. So, they can often go to a special kind of gym if they want to go to a gym, or they can do at-home videos or a personal trainer. Sometimes it gets boring, and they would often moan and groan about it when they are exercising; however, if they are doing fun exercises like dancing or swimming, they will become more motivated and start to change their exercise regime throughout the week. You could do these things despite needing more knowledge or confidence about doing it correctly or on time.
Incorporate A Trainer Or A Health Coach
Dr. Alex Jimenez, D.C., presents: That’s when you might want to bring in a health coach or personal trainer, and with physical obstacles which may be related to a person hasn’t been exercising for a long time and assuming that you’ve cleared them to be able to initiate an exercise plan, maybe there are ways that you can say, “Okay listen, I want you to walk at a low intensity to start with, and you know, over the next month I’d like you to build up two 5,000 steps a day.” This can be a routine set for three days a week, four days a week, or whatever you decide with them and does that work for the patient. That might be one way to work on physical or perceived physical limitations. And then there may be people who have real-time constraints. So the two ways to handle this; is to optimize NEAT or HIIT workouts.
These can be simple activities we do throughout the day, like taking the stairs, parking further away, walking during your lunch break, and having walking appointments and meetings. While watching TV in the evening, you could pump some free weights in your bedroom or your living room. Or if they are more avid exercisers and are open to taking on some HIIT training, that could be a way to get some concentrated cardio and strength training signals in the body. Next, we want to discuss the different scenarios we may have regarding our office structures that support implementing exercise. A common scenario would be that you need a dedicated person in-house to help people implement the exercise prescription.
Use Resources
Dr. Alex Jimenez, D.C., presents: Okay, so if you are the provider, health coach, and personal trainer, we want you to consider using resources. You must recognize your boundaries in terms of not being able to be everything to everyone but using your resources effectively. Because we can’t create boundaries that are so tight that you’re not making the type of office that you want, meaning one that incorporates exercise prescriptions. So we’re going to talk about an office workout and exercise grid and how we will work with the local community, personal trainers, and gyms to refer out. And we have trained them to look at our exercise prescription as a guideline even though we are not legally partnered with them. They use these prescriptions as a way of communicating what our goals are. Here are some tools that we use that we are going to share out.
And then, especially in certain times like we’re having right now, we also referred to online resources. So this office workout prescription was created by our team, and we handed out this resource to our patients. We encourage them to find a buddy in their office or home because it is generally more fun. There are data to suggest that when you exercise in a social format, Like participating in team sports, it creates more benefits than doing an individual sport or being at the gym with your AirPods centered only on yourself. So there is this association where having a social element to your exercise regimen increases the benefits. Set up reminders on your phone when you’re at the office to do these hourly five-minute exercises.
And then we also have an online link where our trainers and health coaches demonstrate proper form and modifications for these office workouts. And then, of course, once you give any resource, whether it’s this office workout prescription or any other help, determine with the patient what we want to do about this. We don’t want to give out this prescription and say we hope it works. The main question is that do you want to have accountability? “Hey, can you come back to see us in a month, and let’s see where you are with it?” Or, “Hey, can you consider taking it to this next level after a month if you feel good and come back to see us in two months?” Or, “Hey, once you’re done with this, why don’t we talk in two months to recheck your lipids and know if you made a bump in your LDL particle number so that we can lower the dose of your statin or get you off the statin.”
So we don’t recommend just doing the exercise prescription and leaving it open-ended in terms of follow-up; make it like any other prescription; if you were to put someone on a statin, you would follow up with them. So just like that, you would follow up with someone you prescribe an exercise prescription. Again, it’s really practical. It can be done whether you work in an office, a home office, or you don’t work at an office but work in the house. So it’s in your IFM toolkit. And it has a Monday through Friday, an eight-to-five grid of what you do throughout the week. So it diversifies exercises and makes it, so all your muscle groups are incorporated using the stuff you have in an office or a typical home.
Delegate With Your Patients
Dr. Alex Jimenez, D.C., presents: So it is beautiful for the “I don’t know what to do” people, and it’s a great start for sedentary people. Then you can also consider any technology that is of interest to you. Here are some that our health coach and personal trainer have suggested based on what the patient’s goals are. They may be trying to run a 5k, then find an app that might work for them there. Or they may incorporate yoga to work on their mind-body access or flexibility. You can personalize it to the type of workout if they’re interested in HIIT, yoga, or Pilates. Again, find technologies you enjoy, and check them out yourself. Or you can make a little cheat sheet that can be given out or put as a template. Here’s something important that we want you to consider if you still need to do it.
It’s called delegation. This can not be done alone; this is a group effort to allow the individual to have a team to back them up and help improve their health and wellness journey. Now, this is done in healthcare all over the place. For respiratory therapists, many people will do delegated work from the healthcare provider. So it’s just a transfer of responsibility for the performance of patient care. Now, remember that it’s still done under the provider’s responsibility. You should consider that different states and insurance contracts may have little nuances on how they would want you to do delegation. Still, we know habits have changed, and we need help to keep up with them to meet the requirement.
So how would we delegate a patient? We would go through a thorough examination, like taking their BMIS/BIAs with the Inbody Machine, and then go through a series of functional medicine tests to determine what issues or overlapping risk profiles are affecting them. Then the doctor and their associated medical providers will develop a personalized treatment plan for that patient that incorporates a healthy diet and exercise regime for them to follow.
Conclusion
Dr. Alex Jimenez, D.C., presents: Making these small changes is beneficial in the long haul regarding a person’s health and wellness journey. It may take a while to get accustomed to the routine, and sometimes it can be frustrating. However, finding what works and doesn’t work with the patient and making these changes can result in a better solution that benefits the person.
When everyday factors affect how many of us function, our back muscles begin to suffer. The back muscles in the cervical, thoracic, and lumbar section surround the spine and spinal cord, which helps the body stay upright and promotes good posture. The muscles allow the upper portions of the body to bend down and twist without pain while providing stability to the lower parts of the body. However, when the body ages or everyday activities cause issues, it can develop low back pain associated with weak back muscles. There are many ways to prevent these issues from escalating with various hyperextension exercises for low back pain. This 2-part series examines how low back pain affects the body and how different hyperextension exercises can help strengthen the back. Part 1 examines how hyperextension affects the body and how it is associated with low back pain. We mention our patients to certified medical providers that provide available therapy treatments for individuals suffering from chronic low back pain. We encourage each patient when it is appropriate by referring them to associated medical providers based on their diagnosis or needs. We understand and accept that education is a marvelous way when asking our providers’ crucial questions at the patient’s request and acknowledgment. Dr. Jimenez, D.C., makes use of this information as an educational service. Disclaimer
Low Back Pain Affecting The Body
Have you been dealing with aches and pains when bending down? Do you feel stiffness in your torso when twisting? Or have you experienced limited mobility in your hips? Many of these symptoms correlate with low back pain. Studies reveal that back pain is one of the most common issues in the emergency room. Low back pain is associated with many factors that put pressure on the various muscles in the back and can lead to underlying conditions that can cause symptoms to make the body dysfunctional. Additional studies have revealed that chronic low back pain can have influenced overlapping risk profiles, which include:
Stress
Dietary habits
Lifting heavy objects
Musculoskeletal disorders
When these factors affect the back, many individuals will be in constant pain and take medication to relieve their pain. However, medicine can only go so far as it only masks the pain, but there are other ways to reduce low back pain and help strengthen the various muscles surrounding the low back.
An Overview Of Hyperextension (Part 2)
Biomedical physiologist Alex Jimenez explains how there are a couple of different variations that you can do to prevent low back pain. The first one is the elbows in front. The second one is the elbows in front while pointing them forward and keeping them pointed forward throughout the entire movement. The third one is the hands behind the head. And then the fourth variation is putting weight behind your back once you work up to this level. And then using that weight to put more stress on a pivot point. You can also hold the weight to your chest, but putting it behind your head gives you a further pivot point or a further point on the fulcrum, which are your hips putting more stress on your spinal rectors. The repetitions and frequency should be performed at the beginning of most workouts, before or after your abdominal exercises on leg days. You can use this exercise as a warmup before deadlifting or squatting. I’ll remember you don’t have to go as much weight or as many reps when you’re doing this on leg days. So we recommend starting with four sets of 20 reps and slowly working up to four sets of 40 reps. This seems like a lot, but it will be beneficial in the end.
Various Hyperextension Exercises For The Back
When it comes to low back pain, the various muscles are weak, which can lead to multiple symptoms affecting a person’s mobility. Luckily making small changes in a daily structure, like incorporating exercises that target the back, can be beneficial. Studies reveal that exercises targeting the back muscles can help strengthen the targeted muscles to have mobility and stability in the back. As a bonus, exercises combined with chiropractic treatments can help restore the body and allow the spine to be realigned. When it comes to back exercises, hyperextension exercises can help prevent low back symptoms from reoccurring and strengthen weak back muscles. Here are some of the various hyperextension exercises that benefit the back.
Reverse Flys
There are different variations of how to do reverse flys. You can pick a moderate or lightweight dumbbell or a resistance band. This exercise is great for the upper back muscles and rear deltoids.
Sit in a chair where the dumbbells are in front of you. *For resistance bands, make sure the bands are under your feet.
Pick up the dumbbells/resistance bands with the palms of your hands and bend forward.
Squeeze the shoulder blades together, lift the arms to shoulder level with slightly bent elbows, and lower them.
Repeat for three sets of 12 reps and rest in between.
Hip Thrust
Different variations to this exercise can help with the posterior muscles in the lower back. You can use barbells, dumbbells, resistance bands, or your body weight to strengthen your core back muscles.
Lean against a bench with the knees bent and the feet flat on the floor.
Rest the shoulder blades on the bench for support and have the weight placed near your core.
Raise your body slightly by pushing your heels down to the floor and walking out slowly beyond your knees.
Push through your heels to have your hips at shoulder level, hold for a second, and lower your hips back down.
Repeat for three sets of 12 reps and rest in between.
Supermans
This exercise has two different variations and makes you aware of your back muscles. This exercise helps improve muscle mobility in all three sections of the back.
Lay on the mat face down with your arms in front and your legs straight.
Keep the head in a neutral position and raise both the arms and legs off the mat. This allows the body to be in a banana shape in a comfortable position. *If you want more challenge, lift the opposite arms and legs simultaneously.
Hold for a couple of seconds for the upper and lower back and hamstrings to maintain their positions.
Lower down with control.
Repeat for three sets of 12 reps and rest in between.
Fire Hydrants
This exercise helps the lower back and glute muscles reduce the effects of low back pain and make it more challenging to use a resistance band.
Be in a cat/cow position on your mat, allowing the wrist to be aligned under the shoulders and the knees to be aligned under the hips.
Maintain a neutral spine while engaging the core.
Squeeze the glutes and lift your right leg off the mat, keeping the knee at 90 degrees. *The hips should be the only ones moving to keep the core and pelvis stable.
Lower the right leg down with control.
Repeat for three sets of 12 reps and rest before repeating the motion on the left leg.
Conclusion
All in all, having low back pain doesn’t mean your life is over. Incorporating hyperextension exercises as part of your daily routine can help strengthen your back muscles and ensure that you won’t have reoccurring symptoms from low back pain. Making these small changes can lead to beneficial results in the long run for your health and wellness journey.
References
Allegri, Massimo, et al. “Mechanisms of Low Back Pain: A Guide for Diagnosis and Therapy.” F1000Research, U.S. National Library of Medicine, 28 June 2016, www.ncbi.nlm.nih.gov/pmc/articles/PMC4926733/.
Casiano, Vincent E, et al. “Back Pain – Statpearls – NCBI Bookshelf.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 4 Sept. 2022, www.ncbi.nlm.nih.gov/books/NBK538173/.
Koes, B W, et al. “Diagnosis and Treatment of Low Back Pain.” BMJ (Clinical Research Ed.), U.S. National Library of Medicine, 17 June 2006, www.ncbi.nlm.nih.gov/pmc/articles/PMC1479671/.
Having and maintaining flexibility in the joints depends on the connective tissues surrounding the muscles. Proper lubrication in the connective tissues enables the fibers to slide over one another easily. Naturally occurring proteins collagen and elastin are key components of connective tissue that provide strength and elasticity. The more elastic the connective tissue, the more flexibility around the joint. If it is becoming difficult to stretch out or there is chronic stiffness and tightness, there are foods that help maintain flexibility and enhance overall health.
Foods That Help Maintain Flexibility
Joint flexibility means functioning connective tissues that join the skeleton and muscles and the ability of different body parts to extend and complete motions. Connecting tissues assists with movement and stabilization. These issues include:
Ligaments
Ligamentscan be band-shaped or string-shaped collagen fibers that connect bones.
Tendons
Tendonsare similar to ligaments and are band or string shaped but connect muscles to the bones.
Fascia
Fascia is a densely woven mesh that wraps around the blood vessels, bones, muscles, organs, and nerves.
Flexibility keeps the muscles active and mobile as they are necessary for daily physical activities. When these tissues become stiff from inactivity or an unhealthy diet, it limits the body’s range of movement and increases the risk of injury. Stretching improves flexibility, and adding foods to a nutrition plan will help maintain limberness.
Nutrition
A nutrition plan full of vitamins, minerals, and antioxidants will nourish connecting tissues and cells and increase collagen production. Foods rich in essential fatty acids/EFAs, vitamin C, sulfur, and water will promote healthy connective tissue for enhanced flexibility.
Fatty Acids
Essential fatty acids include omega-3 and omega-6, primarily found in fish, flax seeds, and liquid oils.
These fatty acids are essential because they cannot be made in the body.
Foods likefatty fish, flax seeds, walnuts, or supplements, can help achieve the proper ratio.
For individuals not too keen on fish, consider omega-3 supplements.
Collagen
Collagen is the main protein from connective tissue, and vitamin C is essential for collagen production.
Vitamin C-rich foods – oranges, bell peppers, broccoli, strawberries, tomatoes, leafy green vegetables, raspberries, pineapple, cruciferous vegetables, parsley, and watermelon.
Make various smoothie recipes for breakfast or an afternoon snack.
Sulfur helps maintain the flexible bonds in connective tissues.
Animal proteins that provide sulfur include fish, poultry, beef, and eggs.
Vegetable sources include Brussels sprouts, cabbage, broccoli, cauliflower, onions, and garlic.
Hydration
Water is not considered food as it contains no calories, but it is vital as it makes up 76 percent of the muscles. A high percentage of water content is the key to muscle elasticity. When the body is dehydrated, it holds onto water, causing fluid retention and stiffness. The more the muscles stay dehydrated, the more they have trouble recovering from physical activities, fatigue levels increase, the range of motion decreases, and the risk of injury increases. Don’t wait until you are thirsty. Stay hydrated throughout the day to keep the joints lubricated and energy levels high.
Fruits high in water include:
Strawberries
Watermelon
Cantaloupe
Peaches
Grapefruit
Pineapple
Apples
Pears
Vegetables high in water include:
Cucumber
Lettuce
Zucchini
Celery
Eggplant
Limit Salt and Sugar Intake
Processed foods tend to have a high salt content.
Too much salt causes the joints to swell as the body retains fluid.
Keeping sugar intake low is important in enhancing flexibility.
This is because sugar breaks down the collagen in the skin and connective tissues.
This means avoiding processed foods, ready meals, and junk food.
Flexibility can be improved by eliminating foods that destroy collagen, focusing on foods that reduce insulin spikes, and maintaining hydration in the connective tissues. A nutritionist can develop a personalized nutrition plan for optimal neuromusculoskeletal health.
Foods That Help Maintain Flexibility
References
Beba, Mohammad et al. “The effect of curcumin supplementation on delayed-onset muscle soreness, inflammation, muscle strength, and joint flexibility: A systematic review and dose-response meta-analysis of randomized controlled trials.” Phytotherapy research: PTR vol. 36,7 (2022): 2767-2778. doi:10.1002/ptr.7477
Kviatkovsky, Shiloah A et al. “Collagen peptide supplementation for pain and function: is it effective?.” Current opinion in clinical nutrition and metabolic care vol. 25,6 (2022): 401-406. doi:10.1097/MCO.0000000000000870
MacKay, Douglas, and Alan L Miller. “Nutritional support for wound healing.” Alternative medicine review: a journal of clinical therapeutic vol. 8,4 (2003): 359-77.
Shaw, Gregory, et al. “Vitamin C-enriched gelatin supplementation before intermittent activity augments collagen synthesis.” The American journal of clinical nutrition vol. 105,1 (2017): 136-143. doi:10.3945/ajcn.116.138594
Zdzieblik, Denise, et al. “Improvement of activity-related knee joint discomfort following supplementation of specific collagen peptides.” Applied physiology, nutrition, and metabolism = Physiologie applique, nutrition et metabolism vol. 42,6 (2017): 588-595. doi:10.1139/apnm-2016-0390
Stretching Objective: The body needs to be flexible to maintain a full range of motion. Stretching keeps the muscles supple, strong, and healthy; without it, the muscles shorten and become stiff and tight. Then, when the muscles are needed, they are weak and unable to extend fully. This increases the risk of joint pain, strains, injuries, and muscle damage. For example, sitting in a chair for a long time results in tight glute muscles and hamstrings, which leads to back discomfort symptoms and inhibits walking. Injury Medical Chiropractic and Functional Medicine Clinic can help individuals develop a personalized stretching program to maintain smooth mobility, flexibility, and function.
Stretching Objective
Benefits
The body needs to be flexible to maintain mobility, balance, and independence. The benefits of regularly stretching include:
When the muscles are stretched, so are the muscle spindles. The spindle records the change in length and speed and transmits the signals through the spinal cord, which conveys the information. This triggers the stretch reflex, which tries to resist the change by causing the stretched muscle to contract. Muscle spindle function helps maintain muscle tone and protects the body from injury. One of the reasons for holding a stretch for a specific amount of time is because, as the muscle stays in a stretched position, the spindle acclimates to the new condition and reduces its resistance signaling, gradually training the stretch receptors to allow greater lengthening of the muscles.
Chiropractic Stretch Training
However, stretching once won’t generate maximum flexibility. Tight muscles may have taken months or years to develop; therefore, it will take time to achieve flexibility and must be continually worked on to maintain it. Chiropractors and physical therapists are body movement experts and can assess individual muscle strength and develop a customized stretching program.
Muscle Spindle Activation
References
Bhattacharyya, Kalyan B. “The stretch reflex and the contributions of C David Marsden.” Annals of Indian Academy of Neurology vol. 20,1 (2017): 1-4. doi:10.4103/0972-2327.199906
Behm, David G et al. “Acute effects of muscle stretching on physical performance, range of motion, and injury incidence in healthy active individuals: a systematic review.” Applied physiology, nutrition, and metabolism = Physiologie applique, nutrition et metabolism vol. 41,1 (2016): 1-11. doi:10.1139/apnm-2015-0235
Berg, K. Stretching fundamentals. In: Prescriptive Stretching. 2nd ed. Kindle edition. Human Kinetics; 2020.
da Costa, Bruno R, and Edgar Ramos Vieira. “Stretching to reduce work-related musculoskeletal disorders: a systematic review.” Journal of rehabilitation medicine vol. 40,5 (2008): 321-8. doi:10.2340/16501977-0204
Page, Phil. “Current concepts in muscle stretching for exercise and rehabilitation.” International journal of sports physical therapy vol. 7,1 (2012): 109-19.
Witvrouw, Erik, et al. “Stretching and injury prevention: an obscure relationship.” Sports medicine (Auckland, N.Z.) vol. 34,7 (2004): 443-9. doi:10.2165/00007256-200434070-00003
The legs are important for standing and motion. Various problems can affect any part, including the bones, tendons, joints, blood vessels, and connective tissues of the entire leg, foot, ankle, knee, or hip. Common problems include unbalanced/unevenness, muscle sprains and strains, joint dislocations, nerve compression, and fractures. These issues can benefit from chiropractic leg adjustments to relieve the symptoms, realign the body, restore mobility, strengthen the muscles, and prevent further complications.
Leg Adjustments
The legs are composed of two major sections: upper and lower. The ball-and-socket hip joint connects the upper portion, with only one bone comprising the upper leg, the femur, the largest bone in the body. The lower leg goes from the knee to the ankle and is composed of two bones, the fibula, and the tibia.
The tibia makes up the knee together with the base of the femur.
The fibula starts from the knee joint and is connected to the tibia.
Muscles
The leg muscles support standing and sitting, carry the body’s weight, and provide movement. Several muscles in the upper and lower legs work together to enable walking, running, jumping, flexing, and pointing the toes.
Upper Leg
The upper leg muscles support the body’s weight and movement. Their jobs include:
Anterior muscles: These muscles stabilize the body and help with balance. They also allow:
Bending and extension of the knees.
Flexion of the thigh at the hip joints.
Rotation of the legs at the hips.
Medial muscles assist in hip adduction – moving the leg toward the body’s center. They also allow flexion, extension, and rotation of the thigh.
Posterior muscles help move the leg from front to back and rotate at the hip socket.
Lower Leg
Anterior muscles are in the front/anterior part of the lower leg and help lift and lower the foot and toe extension.
Lateral muscles run outside the lower leg and stabilize the foot when walking or running. They also allow side-to-side movement.
Posterior muscles: These muscles are in the back of the lower leg. Some are superficial (close to the skin surface), and some sit deeper inside the leg. They help:
Flex and point the toes.
Jump, run and push off.
Lock and unlock the knee.
Maintain a healthy posture by stabilizing the legs.
Stand up straight by supporting the arch of the feet.
Causes
There are different causes of leg discomfort symptoms. Age, work, physical activity, sports, and misalignments can all cause leg issues to develop.
Musculoskeletal
Musculoskeletal system injuries, conditions, and disorders are related to the bones, muscles, tendons, and ligaments. This includes bruising, tendonitis, muscle strain, overuse, and fractures can all lead to musculoskeletal issues.
Neurological
Neurological symptoms are related to a problem with the nerves and the nervous system. Damaged and pinched nerves can contribute to leg issues.
Vascular
If there are blood vessel issues, it can also lead to leg symptoms. Depending on the cause, leg symptoms can vary from moderate to severe and may be non-stop or come and go.
Chiropractic care is a proven way of reducing swelling and discomfort throughout the body. Chiropractic leg adjustments help release restrictions and misalignments. This results in increased mobility of the joints, decreased inflammation, and improved function. A chiropractic adjustment on the leg is known as a long-axis distraction adjustment. This adjustment is designed to open the affected joint in the direction the chiropractor pulls. They can adjust their contact to open the femur from the acetabulum of the pelvis, the knee joint, the ankle joints, and the low back. This encourages proper joint space and motion in the affected areas, promoting healthy movement and space and allowing more nutrient flow and pressure removal from the surrounding nerves to help with symptom relief.
Hip Long Axis Distraction
References
Binstead JT, Munjal A, Varacallo M. Anatomy, Bony Pelvis, and Lower Limb, Calf. (www.ncbi.nlm.nih.gov/books/NBK459362/) [Updated 2020 Aug 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Accessed 12/29/2021.
Eid K, Tafas E, Mylonas K, Angelopoulos P, Tsepis E, Fousekis K. Treatment of the trunk and lower extremities with Ergon® IASTM technique can increase hamstrings flexibility in amateur athletes: A randomized control study. Phys Ther Sport. 2017;28:e12. doi:10.1016/J.PTSP.2017.08.038
Jeno SH, Schindler GS. Anatomy, Bony Pelvis, and Lower Limb, Thigh Adductor Magnus Muscles. (www.ncbi.nlm.nih.gov/books/NBK534842/) [Updated 2020 Aug 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Accessed 12/29/2021.
McGee S. Stance and gait. In: McGee S. Evidence-Based Physical Diagnosis. 3rd ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 6.
Ransom AL, Sinkler MA, Nallamothu SV. Anatomy, Bony Pelvis, and Lower Limb, Femoral Muscles. (www.ncbi.nlm.nih.gov/books/NBK500008/) [Updated 2020 Oct 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Accessed 12/29/2021.
The hips in the lower portions of the body allow the legs to move the host from one location to another and provide stability to support the upper body’s weight. The hips will enable the torso to twist and turn without feeling pain. This is due to the various muscles and ligaments surrounding the pelvic bone and hip joint socket that allow the motion to be possible. However, when various injuries or factors start to affect the multiple muscles surrounding the pelvis or there is a chronic condition like osteoarthritis that causes wear and tear on the hip joints can cause underlying symptoms associated with the hips and cause many individuals to have difficulty when moving around. Luckily there are ways to improve hip mobility and the surrounding muscles in the hip and pelvic region of the body. Today’s article looks at the causes of the development of tight hips in the body and how different stretches can release tight hip flexor muscles. We refer our patients to certified providers that incorporate techniques and multiple therapies for many individuals suffering from hip pain and its correlating symptoms that can affect the musculoskeletal system in the hips, legs, and lumbar region of the spine. We encourage and appreciate each patient by referring them to associated medical providers based on their diagnosis when it is appropriate. We understand that education is a fantastic way when asking our providers intricated questions at the patient’s request and understanding. Dr. Jimenez, D.C., only utilizes this information as an educational service. Disclaimer
What Causes The Body To Develop Tight Hips?
Have you been dealing with hip mobility issues? When you sit, do you feel uncomfortable, and your hip muscles become tight? Or do you have a decreased range of motion when moving your hips? It could correlate with your hips if you have been experiencing muscle pain issues in the lower extremities. The hips help stabilize the upper and lower portions of the body while providing the full leg’s range of motion. When a person begins to sit for long periods or twist their body in a weird position, it can cause the muscles that surround the hips to become shortened. Other issues, like chronic conditions, can play a role in developing tight hip flexors. Studies reveal that various pathologies affecting the hips, lumbar spine, and lower extremities could strongly correlate with restricted hip mobility that can cause harmful effects that can affect the hips. To that point, some of the symptoms associated with tight hip flexors include:
Instability
Hypermobility
Limited range of motion
Reduce muscle strength in the groin
Muscle cramps
Sharp, sudden pain in the hips, pelvis, or groin
Low back pain
Piriformis syndrome
Other research studies mentioned that hypermobility disorders could affect the hip joints. Hypermobility disorders like EDS (Ehlers-Danlos syndrome) could cause micro or macro-trauma on the hip joint and affect the ligaments surrounding the hip joint. To that point, it can cause the hip flexor muscles to become tense and potentially affect how a person moves, which then causes soft tissue injuries and chronic pain.
Hip Flexor Stretches-Video
Do you feel tight along your hips? Do you see yourself hobbling around when walking? Or do you feel aches or strains when stretching? Many of these issues correlate with tight hip flexors that could result from hip pain in the lower extremities. When a person has tight hip flexors, it could be due to them constantly sitting down, causing the hip muscles to be shortened, or chronic conditions that can affect the hip joint and muscles. However, there are various ways to prevent tight hip flexors and regain mobility back to the hips. Studies reveal that stretching combined with core stabilization can help improve the hip’s range of motion while ensuring core endurance exercises can help strengthen the surrounding muscles in the hip area. The video above shows stretches targeting the hip flexor muscles and helps improve hip mobility.
Different Stretches To Release Tight Hip Flexors
Studies have shown that the hip flexor muscles are the main contributors to lumbar spine stability when releasing tight hip flexor muscles. So when there are tight hip flexors, it can cause overlapping risk profiles to the lumbar spine, which leads to pain and impairment in performance. The best way to reduce the pain-like symptoms associated with tight hip flexors is by stretching the lower half of the body to reduce muscle strain and tightness in the hip flexors. Additional studies have found that stretching combined with exercises targeting the low back can reduce the pain caused in the low back and help improve stability and strengthen the surrounding muscles located in the hips. Now it is important to remember that stretching for at least 5-10 minutes before and after working out allows the muscles to warm up and improve flexibility. Below are some different stretches that can release tight hip flexors.
High Crescent Lunge
While standing on the mat, take a step forward to allow your right foot to be in a staggard stance *Think in a lunge position.
Bend the front knee gently while keeping the back leg straight, as this allows the heel in the back leg to be lifted off the mat; the bent front knee enables the thigh to be parallel to the floor, and the right foot is pressed flat on the mat.
Square up the hips, so they face toward the mat’s front.
Extend the arm up towards the ceiling to stretch upwards while pressing into the mat to feel the hips stretch
Hold for five breaths before slowly rising out of the lunge position and repeating on the other side.
This stretch helps release tension in the hip flexors and quads while warming up the muscles and increasing blood flow to the legs.
Knee-To Chest Stretch
Lie on the mat with both legs extended out and feet flexed.
Pull on the left knee to the chest while keeping the right leg straight, and the lumbar portion of the back is pressed into the mat.
Hold the position while taking deep breaths for 30 seconds to 2 minutes.
Release slowly and repeat on the right leg *You can lift both knees to your chest and rock slowly from side to side to relieve low back tension as an alternative.
This stretch is extremely helpful for tight hamstrings and allows the tense muscles on the hips and lower back to relax while increasing blood flow back to the muscles.
Piriformis Stretch
On the mat, sit with both legs extended out.
Cross the right leg over the left and place the other flat on the floor while the left foot is flexed
Place the right hand behind the body while the left elbow is on the right knee.
On inhale, press the right leg to the left while allowing the torso to twist on the right.
Take five breaths for a deeper stretch and switch sides to repeat the action with the left hand *If you have low back pain issues, the modified version allows you to use your left hand to pull the right quad in and out to the left and vice versa.
This stretch helps loosen tight muscles in the lower back, hips, and glutes. If you have sciatic nerve pain associated with piriformis syndrome, this stretch helps release muscle tension from the piriformis muscle aggravating the sciatic nerve.
Happy Baby Pose
Lie on the mat with both knees bent and feet on the ground.
On inhale, lift the feet off the ground and grab the outer sections of the feet with your hands.
Then gently pull the feet towards the chest and allow the knees to lower to the ground, on either side of the body, while keeping the back flat on exhale.
Hold the position for at least five breaths.
This stretch helps with the inner thigh muscles or hip adductors and helps them become loose and mobile without feeling any strain or tension.
Bridge Pose
On the mat, lie on your back and sides, and extend your arms while your feet are flat on the floor with your knees bent.
Press with your heels to lift the hips and allow the feet to walk a few steps toward the body. *Keep the feet and knees hip-width apart.
Clasp hands together underneath the body and press them into the mat
Hold the position for five breaths.
This stretch helps take the pressure off the hip muscles while strengthening the glutes and abdominal muscles.
Conclusion
When it comes to releasing tight hip flexors after sitting for a long time or having hip issues affecting your low back or pelvis, Doing different stretches that target the hips can reduce the pain and release tight muscles associated with other conditions that can affect the body. The hips are important to take care of since they provide mobility and stability to the upper and lower portions of the body. They support the upper body’s weight while providing a huge range of motion to the legs. Incorporating these different stretches can reduce the pain that they have been under and help warm up the other muscles that surround the lower extremities.
References
Lee, Sang Wk, and Suhn Yeop Kim. “Effects of Hip Exercises for Chronic Low-Back Pain Patients with Lumbar Instability.” Journal of Physical Therapy Science, U.S. National Library of Medicine, Feb. 2015, www.ncbi.nlm.nih.gov/pmc/articles/PMC4339134/.
Moreside, Janice M, and Stuart M McGill. “Hip Joint Range of Motion Improvements Using Three Different Interventions.” Journal of Strength and Conditioning Research, U.S. National Library of Medicine, May 2012, pubmed.ncbi.nlm.nih.gov/22344062/.
Reiman, Michael P, and J W Matheson. “Restricted Hip Mobility: Clinical Suggestions for Self-Mobilization and Muscle Re-Education.” International Journal of Sports Physical Therapy, U.S. National Library of Medicine, Oct. 2013, www.ncbi.nlm.nih.gov/pmc/articles/PMC3811738/.
When exercising, it is very important to warm each muscle group to prevent injuries from occurring when working out. Stretching the arms, legs, and back can loosen up stiff muscles and increase blood flow to allow each muscle fiber to warm up and allow maximum power when each set is performed. One of the best ways to reduce muscle fatigue or stiffness before working out is to foam roll each muscle group for at least 1-2 minutes max to provide optimal functionality. Foam rolling allows the muscles to warm up before an extensive workout session. Still, it can also offer many benefits when combined with other therapies to reduce pain-like symptoms like trigger point pain from causing further injuries from reoccurring in the body. Today’s article focuses on the benefits of foam rolling, how it reduces trigger point pain, and how it is combined with chiropractic care to achieve optimal health and wellness. We refer patients to certified providers incorporating techniques and therapies for individuals dealing with trigger point pain affecting different body areas. By locating where the trigger points are coming from, many pain specialists utilize a treatment plan to reduce the effects that trigger points are causing on the body while suggesting different tools, like using a foam roller to reduce pain in the other muscle groups. We encourage and appreciate each patient by referring them to associated medical providers based on their diagnosis when it is appropriate. We understand that education is a terrific way when asking our providers intricated questions at the patient’s request and understanding. Dr. Jimenez, D.C., only utilizes this information as an educational service. Disclaimer
The Benefits Of Foam Rolling
Have you been dealing with pain-like symptoms in different parts of your body? Do you feel stiffness in your muscles? Or have you been feeling exhausted throughout the entire day? Many people often feel stressed, overworked, and exhausted after a long day and need to find different ways to relieve stress. Whether going to the gym to work out or yoga class, many people should warm up for about 5-10 minutes to work out each muscle group to reduce muscle fatigue and stiffness. One of the tools that people should utilize is using a foam roller. Studies reveal that foam rolling before working out can improve muscle performance and flexibility and, at the same time, alleviate muscle fatigue and soreness.
Incorporating foam rolling as part of your warm-up can prevent issues like trigger point pain from causing more problems in the affected muscle group and causing more harm. Foam rolling has been known as a self-myofascial release (SMR) tool for many athletic people to relieve delay-onset muscle soreness (DOMS) and can help the recovery process for muscular performance. Studies show that when athletes have DOMS, their muscles are tender and stiff that which causes restricted movement. By foam rolling, each sore muscle group can get rolled out on a dense foam roll from the person’s body weight to apply pressure on the soft tissue. When performed correctly, the body’s range of motion will increase, and soft tissue restriction is prevented.
Foam Rolling To Reduce Trigger Point Pain
When the body has been overworked, the muscle fibers will start to overstretch and cause various issues in different body parts. When this happens, tiny, hard nodules form over time and cause referred pain to other body locations in each muscle group. This is known as myofascial pain syndrome or trigger points. Studies reveal that trigger point pain is when the affected muscles are either acute or chronic and cause pain in the surrounding connective tissues. Dr. Travell, M.D.’s book, “Myofascial Pain and Dysfunction,” mentioned that myofascial pain could cause somato-visceral dysfunction in the body as the affected muscles and nerves are correlated with the corresponding vital organs. This means that if someone is dealing with back pain, it could be an issue with their gut system. Now how does foam rolling help prevent trigger point pain? As mentioned earlier, foam rolling each muscle group can alleviate muscle soreness and improve blood circulation. Studies reveal that foam rolling on the muscle group affected by trigger point pain can increase blood flow to the affected muscle and reduce fascial inflammation in the body.
What Foam Rolling Does To The Body- Video
Have you been dealing with muscle soreness? Do you feel like you are constantly bending over or shuffling your feet? Or have you been experiencing constant aches and pains when stretching? If you have been dealing with these musculoskeletal issues, why not incorporate foam rolling as part of your routine? Many individuals have some pain that is affecting their muscles that is causing them pain. Regarding reducing pain, incorporating foam rolling on the affected muscles can increase blood flow to the muscle and reduce any symptoms associated with chronic conditions. Studies reveal that the combination of foam rolling and stretching before working out can provide these amazing benefits, which include the following:
Ease muscle pain
Increase range of motion
Reduce cellulite
Relieve back pain
Relive trigger points in muscles
The video above gives an excellent explanation of what foam rolling does to the body and why it provides relief to those different muscle groups. When people merge foam rolling with other treatments, it can benefit their health and wellness.
Foam Rolling & Chiropractic Care
As stated earlier, other various treatments can combine foam rolling to promote a healthy body. One of the treatments is chiropractic care. Chiropractic care incorporates mechanical and manual manipulation of the spine, especially in subluxation or spinal misalignment. When the spine is misaligned, it can cause muscle strain and mobility issues that can affect the body over time. So how does foam rolling play a part in chiropractic care? Well, a chiropractor or doctor of chiropractic can develop a plan to help manage the pain while treating the condition affecting the body. Since foam rolling is utilized in a warm-up session in association with physical therapy, many individuals who work with a personal trainer can incorporate foam rolling as part of their warm-up to loosen up stiff muscles and go to regular chiropractic treatments to improve muscle strength, mobility, and flexibility.
Conclusion
There are many beneficial properties that foam rolling can provide to the body. Foam rolling can allow blood circulation to the muscles while reducing muscle fatigue and soreness. Incorporating foam rolling as part of a daily warm-up can also prevent trigger points from forming in the muscle groups and can work out the tight knots that the muscle has occurred. At the same time, treatments like chiropractic care and physical therapy can combine foam rolling to promote health and wellness in the body and prevent muscle pain.
References
Konrad A, Nakamura M, Bernsteiner D, Tilp M. The Accumulated Effects of Foam Rolling Combined with Stretching on Range of Motion and Physical Performance: A Systematic Review and Meta-Analysis. J Sports Sci Med. 2021 Jul 1;20(3):535-545. doi: 10.52082/jssm.2021.535. PMID: 34267594; PMCID: PMC8256518.
Pagaduan, Jeffrey Cayaban, et al. “Chronic Effects of Foam Rolling on Flexibility and Performance: A Systematic Review of Randomized Controlled Trials.” International Journal of Environmental Research and Public Health, U.S. National Library of Medicine, 4 Apr. 2022, www.ncbi.nlm.nih.gov/pmc/articles/PMC8998857/.
Pearcey, Gregory E P, et al. “Foam Rolling for Delayed-Onset Muscle Soreness and Recovery of Dynamic Performance Measures.” Journal of Athletic Training, U.S. National Library of Medicine, Jan. 2015, www.ncbi.nlm.nih.gov/pmc/articles/PMC4299735/.
Shah, Jay P, et al. “Myofascial Trigger Points Then and Now: A Historical and Scientific Perspective.” PM & R : the Journal of Injury, Function, and Rehabilitation, U.S. National Library of Medicine, July 2015, www.ncbi.nlm.nih.gov/pmc/articles/PMC4508225/.
Travell, J. G., et al. Myofascial Pain and Dysfunction: The Trigger Point Manual: Vol. 2:the Lower Extremities. Williams & Wilkins, 1999.
Wiewelhove, Thimo, et al. “A Meta-Analysis of the Effects of Foam Rolling on Performance and Recovery.” Frontiers in Physiology, U.S. National Library of Medicine, 9 Apr. 2019, www.ncbi.nlm.nih.gov/pmc/articles/PMC6465761/.
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
Stretching Objective
Leg Adjustments
