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.
Individuals with ankylosing spondylitis have a new treatment option that was previously used for rheumatoid arthritis. It is a medication that belongs to a class known as JAK inhibitors. Ankylosing spondylitis combines joint pain with reduced mobility. Ankylosing spondylitis is different because in severe cases, the bones in the spine can fuse together, literally reducing mobility.
The disease typically begins with pain and stiffness in the back. This is usually after some time of inactivity. Symptoms start before the age of 45 and develop gradually. There is no cure for ankylosing spondylitis but there are treatments that can improve symptoms and put the condition into remission. Ankylosing spondylitis treatment is the most successful when addressed early before irreversible damage to the joints begins.
Janus Kinase Inhibitors
Janus kinase inhibitors have traditionally been used to treat:
Rheumatoid arthritis
Psoriatic arthritis
Ulcerative colitis
The medication works by decreasing the immune system�s activity. Janus kinase inhibitor drugs affect several cellular compounds that are important in the development and progression of ankylosing spondylitis. Currently, there are only three Janus kinase inhibitor medications available in the United States and FDA-approved to treat rheumatoid arthritis:
Xeljanz
Rinvoq
Olumiant
Each of the approved inhibitors targets specific enzymes
Current Ankylosing Spondylitis Treatments
Janus kinase inhibitors are not given to individuals right away. However, it could be an option if first and second-line treatments are not working. Treatments usually consist of:
First-Line Treatments
NSAIDs
Nonsteroidal anti-inflammatory medications are the most commonly used to treat ankylosing inflammation, pain, and stiffness.
Chiropractic
Chiropractic physical therapy is a major part of ankylosing spondylitis treatment keeping the spine flexible and as healthy as possible. A chiropractic/physical therapy team design and develop specific exercises to fit individual needs, which include:
Stretching and Range-of-motion exercises help maintain flexibility in the joints
Sleeping and walking posture adjustment exercises
Abdominal and spinal exercises to maintain a healthy posture
If nonsteroidal anti-inflammatory medications do not relieve symptoms, then biological medications could be prescribed. This class of medications includes:
Tumor necrosis factor blockers work by targeting cell protein that is part of the immune system, known as tumor necrosis alpha. This protein causes inflammation in the body, and the blockers suppress it.
Interleukin 17 Inhibitors
Interleukin 17 in the body’s immune system defends against infection. It uses an inflammatory response to fight infections. The IL-17 inhibitors suppress the inflammatory response and help reduce symptoms.
Other Treatment Options
Lifestyle Adjustments
Following a medical treatment plan is often combined with diet and lifestyle adjustments that are recommended to help with the condition, these include:
Most individuals with ankylosing spondylitis do not require surgery. However, a doctor could recommend surgery if there is joint damage, the hip-joint needs to be replaced, or if the pain is severe.
Inhibitor Potential
Studies are ongoing in the treatment of ankylosing spondylitis. The drug is currently in Phase 3 trials for the treatment of adults. The trial results have shown patients with active ankylosing spondylitis showed improvement in:
Fatigue
Inflammation
Back pain
The study enrolled adults with active ankylosing spondylitis who took at least two NSAIDs that were ineffective at treating symptoms. Most of the participants were men, average age of 41, and no prior usage of biologic disease-modifying antirheumatic drugs.
Janus kinase could become a standard treatment
There is still not enough research to make a prediction, but the data is promising. The inhibitors seem to be a safe option when used in a properly screened, well-matched setting that includes regular monitoring. The inhibitors appear to be effective and have the advantages of being taken orally and working fast.
Body Composition
Osteoarthritis and weight loss
Being obese has shown to be a high-risk factor for the development of osteoarthritis. This is not only from the effects of extra weight on the body’s joints but also as a result of the inflammatory effects of adipose tissue. The lower back, hips, and knees, bear the majority of the body’s weight.
An excess amount of adipose tissue on the body’s midsection and legs has been shown to negatively impact the weight-bearing joints. Promoting Lean Body Mass and encouraging weight loss lowers the risk of osteoarthritis and improves an individual’s quality of life. Exercise is regarded safe for individuals with osteoarthritis and should be incorporated to improve body composition, reduce Body Fat Mass, improve Lean Body Mass and maintain a healthy weight.
Dr. Alex Jimenez�s Blog Post Disclaimer
The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*
Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*
References
Hammitzsch A, Lorenz G, Moog P. Impact of Janus Kinase Inhibition on the Treatment of Axial Spondyloarthropathies. Frontiers in Immunology 11:2488, Oct 2020; doi 10.3389/fimmu.2020.591176.�www.frontiersin.org/article/10.3389/fimmu.2020.591176, accessed Jan 21, 2021.
van der Heijde D, Baraliakos X, Gensler LS, et al. Efficacy and safety of filgotinib, a selective Janus kinase 1 inhibitor, in patients with active ankylosing spondylitis (TORTUGA): results from a randomized, placebo-controlled, phase 2 trial.�Lancet.�2018 Dec 1;392(10162):2378-2387. doi: 10.1016/S0140-6736(18)32463-2. Epub 2018 Oct 22. PMID: 30360970.�pubmed.ncbi.nlm.nih.gov/30360970/�accessed Jan 19, 2021.
When lower back pain presents many want to retreat to the couch, bed and just lay down, but doctors, chiropractors, physical therapists, and spine specialists do not recommend this course of action. What they do recommend, other than treatment, is to engage in the easiest forms of exercise on the spine and back muscles. �
Staying sedentary is one of the worst things an individual can do to their back. When the back is aching exercise can usually help. This is because the muscles, ligaments, tendons are being stretched and not just staying still, which lets inflammation build up and swell. Moving keeps the blood flowing, allowing for broader healing and recovery.
However, back pain relief can be a challenge. Various treatment options exist because there are a variety of causes. The key is figuring out which type is best for each individual and their specific condition. An individual needs to know the cause of their type of back pain, as this determines which exercises should or should not be doing. The Pain and Therapy journal evaluated some of the best exercises for lower back pain. �
Physical Therapy Exercises
The McKenzie method can be very effective for acute disc herniation pain and sciatica. This type of exercise is to figure out if there is a specific position that helps the pain become centralized, correct any motion restrictions, and take the pressure off the region that is compressed or inflamed. Physical therapists incorporate McKenzie exercises as part of regular treatment. The strength-building moves are designed to help support the spine and consist of range-of-movement work and sustained positions. �
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Home and Studio Workouts
Pilates is one of the easiest exercises for individuals with chronic low-back pain. Like McKenzie exercises, it utilizes sustained positions that strengthen the trunk/core muscles. The muscles are strengthened using small movements. Using the machine called a reformer, has built-in support for the spine. This is considered a low-key, muscle-toning workout that can ease chronic back pain. �
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Water Exercise
Water exercises lessen the body’s weight, taking pressure/stress off the spine. Deep-water running with the water at shoulder-height can significantly improve low-back pain. In a study, a group of overweight/obese women worked out twice a week for an hour-long exercise session. After 12 weeks, improvements in pain intensity, personal care, sitting, standing, and sleeping were reported. �
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Easiest Office Exercise
One of the easiest exercises is walking. It is great for the body. But the key is to walk more than usual around the office, or wherever work is. This is not about getting the heart rate up. It is about not staying in the same position for too long. When sitting and focused, an individual can stay in an uncomfortable position for some time and just push through it in an attempt to finish up the work.
Using a timer or an application that alerts every hour to get up and stretch is highly beneficial. Walk correctly to the bathroom, or just get up and walk around for a bit gets the blood pumping through the body and the muscles in motion stretching and contracting. �
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Stabilization Exercise
Strengthening workouts can be done at home.
Stretch while standing against the wall bringing the arms up and down.
Pull the elbows down into the back, which stops the hyperactive trapezius from tensing up.
Knee to the chest motion while lying on the back
Abdominal crunches while balance on an exercise ball
Push the head back into the headrest while driving. This helps avoid the forward head posture.
Contact a doctor, chiropractor, or physical therapist that can recommend the best stabilization exercises for the specific pain/condition. �
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Tai Chi and Qigong
Tai Chi and Qigong are gentle exercises where an individual performs slow, controlled movements emphasizing balance and focus. Both can reduce pain, disability, and other symptoms associated with lower back pain. �
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Body Composition Testimonial
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Exercise After Childbirth
Physical activity for pregnant and post-birth, the American Congress of Obstetricians and Gynecologists recommends the following. The easiest exercise routines can be resumed gradually after pregnancy, once a doctor confirms it is medically safe, depending on the delivery, and the presence or absence of medical complications.
Regular aerobic exercise in lactating women has been shown to improve cardiovascular fitness without affecting milk production, composition, or infant growth.
Nursing women should consider feeding their infants before exercising in order to avoid exercise discomfort.
Nursing women also should ensure proper hydration before engaging in physical activity.
Take it slow.
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Dr. Alex Jimenez�s Blog Post Disclaimer
The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*
Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*
Scar tissue if left untreated/unmanaged could lead to mobility and chronic pain issues. Individuals that are recovering from a traumatic injury often have issues brought on from scar tissue. Scar tissue build-up is part of the healing process but in some cases, the tissue build-up can create another set of health issues. Restricted mobility and range of motion and lack of flexibility can worsen over time.
Chiropractors are taught to consider the presence of scar tissue when performing adjustments. This is especially true for patients recovering from a traumatic injury. If left untreated it could affect:
Recovery progress
Treatment approaches
The capability of the individual to handle the treatment
The planning and execution for a chiropractic recovery strategy
Scar Tissue Breakdown
Scar tissue can be broken up, managed, and kept loose/relaxed through various chiropractic/physical therapy techniques, stretches, exercises, and diet adjustments. Breaking up scar tissue and keeping it relaxed is necessary to restore full movement and range of motion. A certain degree of scar tissue will remain to mark the wound, but the pliability and softness of these tissues can be treated. Chiropractors can implement several techniques to break down scar tissue.
Graston Technique
The Graston technique uses instrumentation for addressing scarring in soft-tissue areas like the legs, neck, and lower back. A chiropractor targets the thicker scar tissue areas gently breaking them down.
Instrument Adjustment
Using a pulsating instrument, chiropractors can target specific areas of scar tissue buildup. The instrument massages the areas to improve flexibility and reduce stress in the tissue.
Assisted Manipulation
The assisted manipulation technique soothes the area before performing manual adjustments. A chiropractor could use light oil for heat, transcutaneous electrical nerve stimulation to loosen tension, or numbing gel/cream to soften any sensitivity.
Trigger point therapy
This therapy focuses on heavily scarred tissue areas, where there is substantial buildup. A chiropractor breaks down the scar tissue while continually testing the motion.
Therapeutic massage
Therapeutic massage is necessary with widespread scar tissue. It improves blood flow and gently stimulates scar tissue to improve movement and alleviate pain. These techniques and how they are applied depending on the individual and the amount of tissue build-up. For example, certain techniques work better for different situations like:
The Graston technique could help after surgery
Trigger point therapy can help when muscle spasms, and knots present
Therapeutic massage could be best suited for soft tissue scarrings, like whiplash or muscle strains
Adjustment Attention
Recent injuries that produce scar tissue can usually be felt while a chiropractor palpates the area, while radiological imaging shows scar tissue from past injuries. A chiropractor will take note of these areas when developing a treatment plan. Severe scar tissue will need special focus, which could mean a longer recovery. This is because the body could take longer to adjust to the adjustments being made. A thorough consultation and investigation will be performed/examined before any adjustments begin.
Chiropractic Massage Rehabilitation
References
Shin, Thuzar M, and Jeremy S Bordeaux. The role of massage in scar management: a literature review. Dermatologic surgery: official publication for American Society for Dermatologic Surgery [et al.] vol. 38,3 (2012): 414-23. doi:10.1111/j.1524-4725.2011.02201.x
Shoulder and arm pain can be debilitating, especially when there is no obvious cause or injury that needs to be treated. A rare condition known as brachial neuritiscan cause spasms along with pain down the arm, followed by numbness, tingling, and weakness. If not diagnosed and treated early, the symptoms can worsen with time. The pain experienced can be described as sharp, searing, and shooting. Brachial neuritis can be intense and disabling when it presents for hours and even days.
Utilizing a chiropractic approach, shoulder and spinal adjustments can provide relief and a faster healing/recovery from the inflammatory condition. Individuals experiencing shoulder, arm, and possible hand pain should consult with a chiropractor about a potential home and clinic treatment plan to improve their condition.
Medical History and Examination
The process of diagnosing brachial neuritis involves an individual’s medical history and physical exam. More complicated cases could require imaging studies and electrodiagnostic tests. The first steps in diagnosing the cause of shoulder and/or arm pain include:
Medical history
Information will be collected on an individual’s:
Medical history
Family history
Underlying conditions
Recent illnesses or injuries
Lifestyle habits
How and when symptoms began
Current symptoms
Physical examination
A chiropractor will palpate or inspect by feeling the neck, shoulder, and arm for irregularities. Then they will examine the range of motion, strength, and reflexes. If the individual’s history and physical exam suggest that the cause could be brachial neuritis or other condition involving the nerves, imaging studies, and diagnostic tests could be required to evaluate further.
Symptoms of Brachial Neuritis
The condition is also known as Parsonage-Turner Syndrome. It affects the brachial plexus, a set of nerves that run from the neck and upper back to the shoulders. The condition usually affects only one side of the body and presents randomly.
What happens is the nerves become inflamed.
Inflammation can be triggered through an autoimmune response. This is often the result of an infection, surgical procedure, or other internal stressors. The inflammation can lead to severe debilitating shoulder pain over a few days.
This also leads to long-term numbness, weakness in the shoulder and arm.
The pain becomes worse with movement.
Typically, the pain goes away on its own within a few days.
Numbness, weakness, or tingling in the shoulder or arm continues.
Over time the symptoms begin to worsen and, if left untreated, could lead to muscular atrophy of the arm.
The pain and weakness can make it difficult to move the arm, leading to decreased strength.
Symptoms can last up to a year or more.
This is why individuals have to find ways to strengthen their shoulder/arm despite the condition.
Chiropractic Relief
Treatment requires a pain management program until the pain subsides. Once the pain is manageable, chiropractic, physical therapy, exercises, and stretches could improve mobility and strength. Chiropractic can provide relief and tools necessary to prevent the worsening of symptoms. Chiropractic helps to:
Reduces pain
Improves mobility
Restores strength
Chiropractic manipulation will ensure that the nerves near the brachial plexus do not become compressed, but if they are, then chiropractic can be utilized to decompress/release them. In addition, trigger point release and massage can help alleviate the tension in the surrounding tissues of the arm and shoulder.
A chiropractor will educate the individuals on effective pain management techniques for home, including ice/heat therapy and stretching exercises. These techniques will help restore the proper alignment and flow of the spinal vertebrae, nerves, and muscle tissues, allowing the body to heal quickly, naturally, and more effectively.
Chiropractic Shoulder Pain Treatment
References
Feinberg, Joseph H, and Jeffrey Radecki. Parsonage-turner syndrome. HSS journal: the musculoskeletal journal of Hospital for Special Surgery vol. 6,2 (2010): 199-205. doi:10.1007/s11420-010-9176-x
PODCAST: Dr. Alex Jimenez, Kenna Vaughn, Lizette Ortiz, and Daniel “Danny” Alvarado discuss nutrition and fitness during these times. During quarantine, people have become more interested in improving their overall health and wellness by following a proper diet and participating in exercise. The panel of experts in the following podcast offers a variety of tips and tricks on how you can improve your well-being. Moreover, Lizette Ortiz and Danny Alvarado discuss how they’ve been helping their clients achieve their optimal well-being during these COVID times. From eating fruits, vegetables, lean meats, good fats, and complex carbohydrates to avoiding sugars and simple carbohydrates like white pasta and bread, following a proper diet and participating in exercise and physical activity is a great way to continue to promote your overall health and wellness. – Podcast Insight
If you have enjoyed this video and/or we have helped you in any way
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Thank You & God Bless.
Dr. Alex Jimenez RN, DC, MSACP, CCST
PODCAST: Dr. Alex Jimenez and Dr. Marius Ruja discuss the importance of personalized medicine genetics and micronutrients for overall health and wellness. Following a proper diet and participating in exercise alone isn’t enough to make sure that the human body is functioning properly, especially in the case of athletes. Fortunately, there are a variety of tests available that can help people determine if they have any nutritional deficiencies that may be affecting their cells and tissues. Vitamin and mineral supplements can also ultimately help improve an individual’s overall health and wellness. While we may not be able to change certain aspects of our genes, Dr. Alex Jimenez and Dr. Marius Ruja discuss that following a proper diet and participating in exercise while taking the proper supplements, can benefit our genes and promote well-being. – Podcast Insight
If you have enjoyed this video and/or we have helped you in any way
please feel free to subscribe and share us.
Thank You & God Bless.
Dr. Alex Jimenez RN, DC, MSACP, CCST
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