Abstract: When hormone levels decline with age or menopause, bioidentical hormone replacement therapy (BHRT) can help compensate by easing tight joints, safeguarding bone density, and bolstering muscular strength. Those changes can support better mobility and flexibility. BHRT will not magically make a person more flexible. It may help by lowering joint inflammation, supporting cartilage health, and easing muscle stiffness that often comes with low estrogen or testosterone. Integrative chiropractic care can amplify those advantages by restoring joint motion, reducing nervous-system stress, and improving movement mechanics. This article explains how hormones affect movement, what BHRT can and cannot do, and how a medical doctor and chiropractor work together in El Paso.
Start With What People Usually Feel
Many people notice the same shift. The body feels tighter than it used to. The first steps in the morning take longer. Bending to tie shoes, turning to check a blind spot, or reaching into a high cabinet does not feel as easy.
Some of that comes from less activity, old injuries, or weaker muscles. Hormones also play a role. Estrogen and testosterone do more than affect mood, sleep, and energy. They also affect joints, bones, cartilage, and muscle.
When those hormone levels fall, joints can feel tighter. Bones can lose density. Muscles may not support movement as well. That is why the question isn’t only, “Do I need to stretch more?” It is also “What is happening inside the body that makes stretching harder?”
How Hormone Decline Changes Joints, Bones, and Muscles
Estrogen helps keep joints quieter. It can lower inflammatory signals and help cartilage stay healthier and better lubricated. After menopause, estrogen drops. Joints may then become more prone to swelling and stiffness. The fluid that helps joints glide can decrease. Bone density often declines at the same time, which puts extra stress on the joints (Mobility Bone & Joint Institute, 2025).
Testosterone supports collagen and muscle mass. Collagen is a building block of cartilage, tendons, and ligaments. Muscle acts like a natural brace around a joint. When testosterone is low, repair can slow, muscles can weaken, and joints can feel less stable (BodyLogicMD, 2025; Sota Wellness, n.d.).
People may notice:
Tight hips, shoulders, neck, or knees
Longer morning stiffness
Less energy for walking or exercise
Weaker support around the joints
A higher chance of bone loss
These changes can feed on each other. Pain reduces activity. Less activity weakens muscle. Weaker muscle loads the joints more. Hormone balance may help interrupt that cycle, but movement still has to be restored.
What Bioidentical Hormone Therapy Is
BHRT uses hormones that match the ones the body makes. They are often made from plant sources and then chemically altered to match human estradiol, progesterone, or testosterone.
A clinician usually reviews symptoms and lab work before choosing a plan. Forms can include creams, patches, pellets, or other methods. The dose is meant to be personal, not one-size-fits-all.
It is important to stay careful. Mayo Clinic notes that bioidentical hormones are not proven safer or more effective than standard hormone therapy. Compounded products can also vary in quality (Mayo Clinic, 2024). Hormone therapy is a medical decision. It should be supervised, monitored, and based on a person’s health history. It is not right for everyone.
How BHRT May Support Mobility and Flexibility
BHRT does not stretch a tight muscle or unlock a restricted joint. It can help compensate for hormone decline in ways that make movement easier.
It may ease tight joints. Restoring estrogen and testosterone can reduce inflammatory activity that makes joints ache and feel stiff (BodyLogicMD, 2025; Renew Health & Wellness, 2021).
It may safeguard bone density. Stronger bones provide a more stable base for joints and can lower fracture risk (Balance Hormone Center, n.d.; Desert Sands Aesthetics, n.d.).
It may bolster muscular strength. Better muscle support can make daily movement safer and more controlled (Charleston Pain Relief Center, n.d.; Sota Wellness, n.d.).
It may support cartilage health. Estrogen helps joint lubrication and may slow some cartilage wear. Testosterone can support collagen (BodyLogicMD, 2025).
It may raise energy for activity. When fatigue eases, people can walk, stretch, and train more often. That extra movement can improve flexibility.
Some reports show less joint pain in people using hormone therapy. A few studies have linked estrogen therapy with slower osteoarthritis progression in some groups. Other evidence is mixed. Medical groups do not list joint pain as a main reason to start hormone therapy (Maven Clinic, n.d.). Results vary from person to person.
Why BHRT Will Not Magically Make You More Flexible
Flexibility is the ability of a muscle and joint to move through a useful range. Mobility is a bigger idea. It is flexibility plus strength, control, and healthy connective tissue (Essentrics, 2026).
Hormones can make that range more comfortable. They cannot create it by themselves. People still need:
Regular movement through the full range
Strength around the hips, spine, shoulders, and knees
Better posture and joint mechanics
Enough sleep and recovery
Care for old injuries that never fully resolved
If someone only uses hormone therapy and never addresses stiff joints or weak muscles, flexibility often stays limited. BHRT may lower the background tightness. The body still has to relearn easier movement.
How Integrative Chiropractic Care Fits Into This Treatment
This is where integrative chiropractic care becomes useful. Chiropractic care does not replace estrogen, progesterone, or testosterone. It does not change hormone levels on its own. It can restore the motion that stiffness and poor mechanics have taken away.
Gentle adjustments and soft-tissue work can help joints move again. Better joint motion often means less guarding and less pain. That can lower nervous-system stress. Pain and poor sleep raise cortisol. High cortisol can increase inflammation and make recovery harder (Nightlight Chiropractic, 2025).
Integrative chiropractic care can:
Restore motion in stiff spinal and extremity joints
Reduce muscle tightness around painful areas
Improve posture so joints are not loaded in a crooked way
Lower physical stress on the nervous system
Make walking, stretching, and rehab more comfortable
When joints move better, people can use the muscle and bone support that BHRT may provide. Hormone therapy works on the internal environment. Chiropractic care works on movement mechanics. Together, they can amplify results more than either one alone (Wellness Doctor RX, 2026).
Functional Medicine, Rehabilitation, and Injury Care
Hormone changes are not isolated. Sleep, stress, nutrition, weight, and old injuries all affect how stiff a person feels. Functional medicine looks at those layers. Rehabilitation rebuilds strength and range of motion. Personal injury care addresses the extra tightness that can follow a car accident or work strain.
A useful plan often includes:
A review of symptoms, injury history, and labs
Medical oversight when hormone therapy is being considered
Chiropractic care to restore joint motion
Rehab to build strength through the new range
Nutrition and lifestyle support for bone, muscle, and inflammation
The goal is not to stack random treatments. The goal is to help the body move with less pain and more control.
A Team Approach at Injury Medical Clinic PA
At Injury Medical Clinic PA in El Paso, Texas, this kind of layered care is built into the clinic model. Dr. Maria Guadalupe Cardenas, MD, is board-certified in internal medicine. She has more than 40 years of experience as an internist (NPI #1164426749, Texas MD License #J2933). Serves as medical director and collaborative physician. Provides medical evaluation, diagnosis, and oversight, including review of hormone-related concerns.
Dr. Alexander Jimenez, DC, APRN, FNP-BC, CCST, CFMP, IFMCP, ATN, provides chiropractic care and integrative clinical support. He is a chiropractor and board-certified family nurse practitioner. His work includes spinal care, functional medicine, personal injury rehabilitation, and wellness protocols.
This setup is common in integrative and injury-care clinics. An MD provides medical direction. A chiropractor restores joint motion and movement mechanics. The same team can also include functional medicine, rehabilitation, and related services. When appropriate, hormone optimization is paired with alignment work, soft-tissue care, and guided activity so patients can regain motion more safely.
Clinical Observations From Dr. Jimenez
Dr. Jimenez’s clinical observations point to the same idea. Hormone health and musculoskeletal care work better together. Integrative chiropractic care can restore spinal and pelvic alignment, reduce muscle tightness, and improve autonomic balance. That may help patients sleep better, stay more active, and tolerate other therapies more easily (Jimenez, n.d.).
He has noted that pelvic and low-back care can improve hip mechanics. Better hip motion often makes walking and daily tasks feel less restricted. Movement then supports bone health, insulin sensitivity, and mood. In practice, care isn’t just about a single adjustment or a single hormone prescription. It looks at inflammation, nutrition, sleep, alignment, and how the person actually moves (El Paso Back Clinic, n.d.; Jimenez, n.d.).
Patients often do best with a stepwise plan. First, reduce pain and stiffness. Next, restore joint motion. Then build strength and control through that new range.
What to Keep in Mind Before Starting
BHRT is one possible tool, not a flexibility program. A careful clinician will review risks, benefits, labs, and medical history. People with certain health conditions may not be appropriate candidates. Stretching, strength work, and chiropractic care still matter even if hormone levels improve.
A practical next step is a full evaluation. That means looking at how the joints move, how strong the supporting muscles are, and whether hormone changes are part of the picture. From there, the plan can be personal.
The Bottom Line
Can bioidentical hormone therapy help with mobility and flexibility? It can help compensate for hormone decline by easing tight joints, safeguarding bone density, and bolstering muscular strength. It may also lower inflammation, support cartilage, and ease muscle stiffness. It will not magically make someone more flexible.
Integrative chiropractic care can amplify those advantages. It restores joint motion, reduces nervous-system tension, and improves movement mechanics. Together, the two approaches address both the body’s internal chemistry and how it moves.
In El Paso, Injury Medical Clinic PA offers a multidisciplinary model in which Dr. Cardenas provides medical direction, and Dr. Jimenez provides chiropractic and integrative care. That combination is designed to help people move with more comfort, strength, and control.
Bioidentical hormone replacement therapy, or BHRT, uses hormones that match the ones your body makes. People often take estrogen, progesterone, or testosterone to ease low energy, poor sleep, mood changes, or weight gain. There is no single official diet for this therapy. Dietitians and doctors often suggest a Mediterranean-style diet or another whole-food, anti-inflammatory plan to support metabolism, liver cleansing, and steady energy while on bioidentical hormone replacement therapy (BHRT). Integrative chiropractic care lowers nervous-system tension. That can help control cortisol and support how the body uses hormones. This article explains what BHRT is, why food matters, which foods help most, extra daily habits, and how a team in El Paso combines chiropractic and medical care.
What Bioidentical Hormone Replacement Therapy Involves
BHRT replaces hormones that drop with age or other changes. These hormones act as messengers. They help control sleep, mood, energy, bone strength, and how the body uses food. Estrogen is often used for hot flashes and dryness. Progesterone can protect the uterus and support sleep. Testosterone may help with energy and muscle. Some products are FDA-approved. Others are mixed by a pharmacist for one person.
Many people notice milder symptoms in a few weeks. Stronger results often appear after about three months. Doctors watch labs and symptoms so the dose stays as low as needed. BHRT works best when the rest of the body is supported, including how you eat and how well your nervous system handles stress.
Why Nutrition Matters During BHRT
Food gives the body the building blocks for hormones and the tools to use them well. Hormones are made from fats and proteins. The liver breaks down excess hormones so they don’t build up. Fiber and certain plants help the gut move those leftovers out. Blood-sugar swings can raise insulin and cortisol, which can work against the hormones you are taking. An anti-inflammatory pattern lowers that extra stress.
Dietitians and doctors often suggest a Mediterranean-style diet or another whole-food, anti-inflammatory plan to support metabolism, liver cleansing, and steady energy while on bioidentical hormone replacement therapy (BHRT). The Mediterranean diet, which emphasizes healthy fats, lean proteins, and fiber, is a particularly effective example of a complete, anti-inflammatory diet that patients undergoing estrogen, progesterone, or testosterone bioidentical hormone replacement therapy (BHRT) follow. As a result of reducing stress and tension in the nervous system, which in turn helps control cortisol and optimizes metabolic and endocrine function, integrative chiropractic therapy lends credence to this idea.
The Mediterranean-Style Eating Pattern
Think of your plate in simple parts. Fill half with colorful vegetables and some fruit. Add a quarter of lean protein, such as fish, chicken, or beans. Use the last quarter for whole grains or starchy vegetables. Finish with a source of healthy fat like olive oil, avocado, or nuts.
This pattern supplies fiber for the gut, omega-3 fats that calm inflammation, and antioxidants that protect cells. It also gives the liver the nutrients it needs to process hormones. People on BHRT often feel more stable energy and fewer crashes when they follow this style.
Key habits include:
Eat mostly plants, fish, nuts, seeds, and olive oil.
Choose whole grains like quinoa, brown rice, or oats instead of white bread.
Limit processed snacks, sugary drinks, and extra alcohol.
Drink enough water to help the body move hormones through the liver and kidneys.
Foods That Support Estrogen, Progesterone, and Testosterone
Certain foods stand out because they supply specific nutrients. Here are six that specialists often highlight.
Fatty fish such as salmon and tuna. These give vitamin D, which can support testosterone, and omega-3 fats that reduce inflammation.
High-fiber grains like quinoa, brown rice, and oats. Fiber feeds good gut bacteria and supplies B vitamins that help the nervous system and hormones.
Flaxseeds. They contain lignans that help the body handle extra estrogen by binding it in the gut so it can leave the body.
Fresh herbs and spices such as turmeric, garlic, and fennel. These have compounds that support liver function and lower inflammation.
Berries and cherries. They supply antioxidants and can help raise melatonin for better sleep.
Lean protein, such as chicken breast, is also important. Protein helps regulate hunger hormones and supports muscle, which matters when testosterone is part of the plan.
Other helpful choices include leafy greens, avocados, nuts, olive oil, and fermented foods like yogurt. These add more fiber, healthy fats, and gut-friendly bacteria. Gut health matters because the microbiome helps break down estrogen.
A sample day might look like this: oatmeal with berries and flax for breakfast, a salad with chicken, olive oil, and vegetables for lunch, and baked salmon with quinoa and greens for dinner. Snacks can be nuts, fruit, or yogurt.
Lifestyle Steps That Work With Your Nutrition Plan
Food is the base, but other daily habits make BHRT more effective. Sleeping seven to nine hours lets the body repair and reset hormones. Regular movement, such as walking or strength work, improves both insulin sensitivity and mood. Stress management through breathing or light stretching keeps cortisol from rising too high.
Limit extra caffeine and alcohol, because they can disrupt sleep and liver function. Stay at a healthy weight, since extra body fat can change how hormones work. These steps are simple and work well with the eating pattern.
How Integrative Chiropractic Care Supports BHRT
The nervous system and hormones communicate all day. High stress raises cortisol, which can block the effects of estrogen, progesterone, or testosterone. Chiropractic care uses gentle adjustments and soft-tissue work to ease tension in the spine and muscles. This can lower sympathetic (fight-or-flight) activity and help the body stay in a more balanced state.
When the spine and pelvis move well, the body often sleeps better and feels less pain. Better sleep and lower pain reduce cortisol. The result can be improved energy and a more stable hormone response. Chiropractic care also supports movement, which helps bones and muscles stay strong while on hormone therapy. It does not replace the hormones. It helps the whole system work more smoothly.
A Collaborative Team in El Paso
In El Paso, Texas, Injury Medical Clinic PA brings medical and chiropractic care together. Dr. Alexander Jimenez, DC, APRN, FNP-BC, CCST, CFMP, IFMCP, ATN, leads the practice. He uses chiropractic adjustments, functional medicine, nutrition, and rehabilitation. His clinical observations show that whole-food, low-glycemic eating plus gut support and spinal care can improve sleep, mood, and how patients feel on hormone plans.
Dr. Maria Guadalupe Cardenas, MD (board-certified in internal medicine) (NPI #1164426749, Texas MD License #J2933), with over 40 years of experience as an internist, works with Dr. Alex Jimenez, DC, and serves as the medical director and collaborative physician at his practice, Injury Medical Clinic PA, in El Paso, Texas. This multidisciplinary setup is common in integrative or injury care clinics, where an MD provides medical direction alongside a chiropractor.
The team integrates chiropractic care (Dr. Jimenez) with medical oversight by Dr. Cardenas (internal medicine), as well as functional medicine, personal injury care, rehabilitation, and related services. Patients receive coordinated plans that cover diet, movement, stress, and hormone support. This approach treats the whole person, not one symptom at a time.
Putting It All Together
Start with a simple Mediterranean-style plate most days. Add the key foods listed above. Pair eating with sleep, movement, and stress reduction. If you choose integrative care, chiropractic work can help the nervous system stay calmer so the hormones you take can do their job more easily. Work with your doctor to check labs and adjust as needed. No single food or adjustment is a cure, but together they create a stronger foundation.
This way of eating and living is sustainable for most people. It uses foods you can find at a regular grocery store and habits that fit into daily life. The goal is steady energy, better sleep, and a body that uses BHRT well.
Many adults notice extra weight creeping on, especially around the middle, even when they try to eat better and stay active. Hormone changes over time often play a quiet but powerful role in how the body stores fat, burns energy, and controls hunger. Bioidentical hormone replacement therapy (BHRT) offers a way to bring those internal messengers back into better balance. It is not a quick weight-loss fix or a magic pill. Instead, it helps remove some of the metabolic roadblocks that make diet and lifestyle efforts harder to sustain.
When hormone levels are optimized, many people find it easier to manage cravings, keep steady energy, and support lean muscle. This article explains how BHRT, and specifically the EvexiPEL method from Evexias Health Solutions, can work alongside smart eating and daily habits for longer-lasting results.
What Bioidentical Hormones Actually Do in the Body
Hormones act like chemical messengers. They tell the body when to store fat, when to burn it, how hungry to feel, and how well muscles can grow. Key players include estrogen, testosterone, insulin, cortisol, and thyroid hormones. When these get out of balance—often from aging, stress, or other life changes—metabolism can slow, fat can gather more easily around the belly, and cravings for sweets can grow stronger.
Bioidentical hormones are made to match the exact structure of the ones the human body produces naturally. They usually come from plant sources and are customized for each person after lab testing. The goal is to restore balance rather than force rapid change. Because they more closely match the body’s own chemistry, many patients experience smoother effects than with synthetic options.
How Balanced Hormones Help with Weight and Fat Control
Balanced hormones support weight management in several practical ways:
Fewer intense sugar cravings: When estrogen, progesterone, and cortisol signals stabilize, the brain’s hunger cues become easier to manage. People often report a less urgent desire for processed sweets or snacks.
Better insulin sensitivity: Improved insulin function helps the body use blood sugar for energy rather than store it as fat. This makes it easier to maintain a steady weight over time.
More consistent daily energy: Steady hormone levels reduce afternoon slumps. With more energy, it becomes easier to go for a walk, prepare a healthy meal, or stick to an exercise plan.
Support for lean muscle: Testosterone and other hormones help maintain or build muscle. Muscle tissue burns more calories even at rest, which supports a higher everyday metabolism.
Less stubborn abdominal fat: Hormone balance can influence where the body prefers to store fat. Many notice gradual improvement in midsection fat when levels are optimized alongside healthy habits.
These changes do not happen overnight. They create an internal environment where diet and movement efforts can finally show clearer results.
EvexiPEL Pellet Therapy: Steady Delivery Without the Roller Coaster
Evexias Health Solutions developed the EvexiPEL method as a form of BHRT that uses tiny, custom-made pellets. A trained provider places the pellets just under the skin during a short office visit. The pellets then release a steady, consistent dose of bioidentical hormones—such as testosterone or estradiol—over several months, usually three to six.
This steady release mimics the body’s natural rhythm far better than daily creams, gels, pills, or weekly shots. Many patients describe avoiding the ups and downs, or “roller coaster,” that can come with other delivery methods. Consistent levels often translate into more reliable energy, steadier moods, and fewer hormone-driven cravings throughout the day.
Because the delivery stays even, people can focus on building healthy routines instead of managing daily symptom swings. EvexiPEL is always paired with lab testing and a full wellness plan; it is never used alone.
Why Nutrition Matters Even More with BHRT
BHRT works best when paired with a diet built around fresh, whole foods. Think plenty of vegetables, quality proteins, healthy fats from avocados and nuts, and fiber-rich choices. These foods provide the body with the raw materials it needs for hormone production, detoxification, and stable blood sugar.
Cutting back on processed carbohydrates and added sugars helps too. These foods can spike blood sugar and work against the improvements in insulin sensitivity that BHRT supports. Many people find that once hormones stabilize, choosing whole foods feels more natural because energy stays higher and cravings quiet down.
Evexia’s providers often combine pellet therapy with targeted nutraceuticals—high-quality supplements designed to support metabolism, gut health, and mitochondrial energy. This root-cause approach to care addresses multiple systems at once rather than focusing on calories alone.
The Advantage of Multidisciplinary Integrative Care
Hormone balance does not exist in a vacuum. The nervous system, gut health, sleep, stress, and physical structure all influence how well hormones work. That is why care from a coordinated team often produces stronger, longer-lasting outcomes.
A clear example is the collaborative model at Injury Medical Clinic PA in El Paso, Texas. Dr. Alexander Jimenez, DC, APRN, FNP-BC, CFMP, IFMCP, ATN, CCST, brings chiropractic expertise, functional medicine insights, and advanced wellness protocols. He works directly with Medical Director Dr. Maria Guadalupe Cardenas, MD, a board-certified internal medicine physician with more than 40 years of experience (NPI #1164426749, Texas MD License #J2933).
In this setup:
Chiropractic care from Dr. Jimenez helps optimize nervous system function, posture, and mobility, so patients can move more comfortably and handle daily stress more effectively.
Dr. Cardenas provides medical oversight, reviews lab results, manages internal medicine needs, and ensures safe, appropriate hormone monitoring.
Functional medicine and nutrition support address gut health, inflammation, and lifestyle factors that affect metabolism.
Rehabilitation and personal injury services remove physical barriers that might otherwise limit activity and exercise.
Dr. Jimenez’s clinical observations in integrative settings show that patients achieve better metabolic and energy improvements when hormone optimization is combined with whole-person care. The spine and nervous system directly influence hormone signaling and stress responses. When both are supported, the body becomes more efficient at using the benefits of balanced hormones for weight and overall wellness.
This team approach makes BHRT one component of a larger, personalized strategy rather than an isolated treatment.
What Results Typically Look Like
People who combine EvexiPEL BHRT with whole-food nutrition and team-based support often describe:
More stable energy that lasts through the afternoon without relying on caffeine or sugar.
Reduced cravings that once derailed healthy eating plans.
Gradual improvements in body composition—less fat, better muscle tone—as insulin sensitivity and metabolism improve.
Easier adherence to daily movement because joints and energy feel better supported.
These changes build over weeks and months. The steady hormone delivery helps patients stay consistent long enough for new habits to stick. BHRT does not replace the need for healthy food choices and regular activity; it makes those efforts more effective by clearing hormonal interference.
Sample Report
Taking the Next Step Toward Balanced Health
If stubborn weight, low energy, or strong cravings have been ongoing challenges despite sincere efforts, checking hormone levels can be a useful step. A provider trained in EvexiPEL or similar BHRT methods will review full lab results, health history, and lifestyle before recommending a plan. Results vary, and therapy must always occur under proper medical supervision.
Clinics that blend chiropractic care, internal medicine oversight, functional nutrition, and regenerative approaches—like the model with Dr. Jimenez and Dr. Cardenas—can offer the coordinated support many people need. By addressing hormones, nervous system health, nutrition, and daily habits together, patients often move from frustration to steady, inside-out progress.
Balanced hormones alone will not create lasting change. But when they work in harmony with smart daily choices and a supportive care team, weight management becomes less of a constant struggle and more of a natural outcome of a body that is finally working with you instead of against you.
A Modern, Integrative Approach to Musculoskeletal Health and Healing
Abstract
Hello, I’m Dr. Alexander Jimenez. In my years of practice integrating chiropractic care with advanced functional medicine at the El Paso Back Clinic, I’ve seen firsthand how systemic health, including hormonal balance, profoundly impacts musculoskeletal well-being. This educational post will guide you through the intricate landscape of modern patient care, exploring an innovative, atraumatic technique that, while often used in other medical contexts, offers powerful lessons for promoting tissue health and minimizing trauma—principles at the very core of chiropractic and physical therapy. We will explore how precise anatomical landmarking, gentle procedural finesse, and a deep understanding of physiology can be applied to enhance recovery and reduce pain. Most importantly, I will connect these concepts back to my core practice, explaining how restoring the body’s foundational health creates a powerful synergy with integrative chiropractic care, helping patients with chronic conditions like back pain and sciatica not just regain mobility, but achieve a vibrant, active life. We will explore how a collaborative, evidence-based approach, combined with foundational pillars like diet and exercise, empowers patients to move from recovery to true wellness.
Understanding the Importance of Minimizing Tissue Trauma
As a clinician dedicated to helping my patients recover from injury and achieve optimal function, a central principle of my practice is to “first, do no harm.” This means every technique, whether it’s a spinal adjustment or a soft-tissue therapy, must be performed with the goal of facilitating healing rather than causing further injury. Recently, I have been studying the work of leading researchers who are revolutionizing procedural medicine with what is known as an atraumatic technique. This approach is a significant departure from older, more aggressive methods and is designed specifically to decrease tissue trauma.
The core of this method is the use of specialized instruments, such as a trocar with a conical tip instead of a sharp, cutting one. A conical tip is designed to gently separate and weave through tissue fibers rather than severing them. Think of it as carefully parting the threads of a fabric with a dull needle, rather than slicing through them with a blade.
Physiological Impact of Cutting vs. Separating: When tissue, including skin, fascia, and underlying fat, is cut, it triggers a significant inflammatory cascade. The body’s immediate response is to send a rush of inflammatory cells and fluids to the area to begin the repair process, a phenomenon detailed in research on wound healing (Guo & DiPietro, 2010). This leads to swelling, pain, bruising, and a greater risk of scar tissue formation.
Benefits of an Atraumatic Approach: By gently separating the tissue, we create a pathway with minimal disruption to blood vessels and nerve endings. This results in significantly less inflammation, less post-procedural pain, and a cleaner healing environment. This is a significant improvement because it allows the body to focus its energy on healing the intended area rather than on repairing collateral damage caused by the procedure itself.
In my practice, I observe a similar principle. When a patient has a subluxation or soft tissue injury, aggressive, forceful manipulation can sometimes exacerbate inflammation. Instead, our goal with chiropractic adjustments and physical therapy is to use precise, controlled force to restore motion and function, working with the body’s tissues rather than against them. This modern, atraumatic philosophy aligns perfectly with the foundational principles of chiropractic care, which aim to reduce physical stress and improve nerve function, thereby enhancing the body’s innate healing capacity.
The Art and Science of Precise Placement: A Chiropractic Parallel
Just as a surgeon must be precise, so must a chiropractor. The success of any therapeutic intervention hinges on accurate placement and targeting the correct anatomical structures. In the atraumatic procedure I’ve been studying, “Goldilocks” placement—not too high, not too low, but just right—is critical for both efficacy and patient comfort.
Let’s explore the landmarks for a procedure in the upper gluteal region, and see how these principles translate to our work.
Critical Anatomical Landmarks:
A thorough understanding of anatomy, such as that detailed in Clinically Oriented Anatomy (Moore et al., 2018), is non-negotiable for safe practice.
Inside the Tan Line: Keeping an incision site within a patient’s typical tan line is a practical aesthetic consideration, but it also serves as a general guide to stay within the upper gluteal area.
Away from the Coccyx: The area near the coccyx (tailbone) and the gluteal cleft is prone to moisture and friction, creating an environment that is poor for healing. We avoid this area to reduce the risk of infection and irritation.
Avoiding the Iliotibial (IT) Band: The IT band is a thick, fibrous fascial band that runs along the outside of the thigh. Placing any implant or performing any deep work directly over this band can cause significant inflammation and lateral hip and thigh pain that can be long-lasting. This is a structure we frequently address in physical therapy for runners and athletes, so we are intimately familiar with how sensitive it can become.
Targeting Fatty Tissue: The ideal location is the well-vascularized fatty tissue of the upper-outer gluteal quadrant. This area provides cushioning and has a good blood supply, which is essential for healing.
A Precision Measurement Technique
To ensure perfect placement, a simple yet brilliant technique is used: the lidocaine syringe and needle serve as a measuring tool. Because the needle is the same length as the therapeutic instrument (the trocar), it can be used to map the treatment’s final destination.
Identify the Target: First, I palpate the area to find the “sweet spot”—the thickest part of the subcutaneous fatty tissue, well away from the bony prominences of the hip and spine.
Map the Trajectory: I place the needle tip at the desired endpoint.
Mark the Entry Point: I then lay the needle down along the planned insertion path. The needle hub now indicates the perfect spot for the initial incision or entry.
This method removes all guesswork. It’s a physical, tangible way to ensure the procedure is executed exactly as planned. This level of precision is something we strive for every day at El Paso Back Clinic. Whether we are identifying the specific vertebral level for an adjustment, locating a trigger point for dry needling, or applying therapeutic ultrasound, anatomical precision is the key to a successful outcome.
The Procedure: A Step-by-Step Guide to Minimizing Discomfort
Executing a procedure with an atraumatic philosophy requires meticulous attention to detail at every stage.
Step 1: Skin Preparation and Numbing
Aseptic Technique: We begin by thoroughly cleaning the skin. While alcohol is common, we prefer a chlorhexidine gluconate (CHG) solution. Based on guidance from wound care specialists and studies like the one published in the New England Journal of Medicine (Darouiche et al., 2010), CHG provides a more robust and longer-lasting antimicrobial effect, creating a cleaner field.
The Importance of the Wheal: Effective numbing is paramount for patient comfort. The technique involves creating a “wheal”—a small, raised bubble of lidocaine just beneath the skin’s surface. After creating the wheal, the needle is advanced along the pre-planned track at approximately a 45-degree angle. Lidocaine is injected as the needle moves forward and as it is withdrawn, bathing the entire pathway in anesthetic.
Step 2: The Atraumatic Incision and Insertion
The Incision: Using a sharp, sterile blade, a very small, precise incision is made—just enough to break the skin.
Trocar Insertion: The conical tip of the trocar is then placed into the incision. With the skin and underlying tissue held firmly, the trocar is gently advanced, weaving through the tissue rather than cutting.
Anchoring Technique: Once the trocar is in place, the therapeutic agent is placed inside. Here is the most critical distinction from older methods: I hold the inner part (obturator) firmly in place, anchoring the therapeutic agent at the desired location. Then, I retract the outer sheath (the trocar) over the stationary obturator. This action gently lays the agent down in a neat line within the created channel, without additional force or trauma.
The result is a clean procedure with minimal oozing or leakage, a stark contrast to the trauma-induced effusion seen with older techniques. This translates directly into a more comfortable patient experience and a faster, cleaner healing process.
The Foundational Role of Chiropractic and Physical Therapy
One of our clinic’s unique strengths is our deep roots in chiropractic care and physical therapy. This provides us with a constant stream of patients who come to us for musculoskeletal issues—back pain, neck pain, joint problems, and injuries. They trust us to help them regain function and live without pain.
It’s in these conversations that we often uncover deeper systemic issues that go beyond the spine or a sore joint. A patient’s inability to move due to conditions like sciatica or severe back pain can lead to a sedentary lifestyle. This creates a vicious cycle of muscle atrophy (sarcopenia), weight gain, deconditioning, and worsening health.
The Synergy of Foundational Health and Integrative Chiropractic Care
Here at the El Paso Back Clinic, we see the whole person. We empower our patients with the tools they need for a better life, which go far beyond a spinal adjustment. This is where the integration of advanced therapies with foundational care becomes a game-changer.
Enhanced Muscle Repair and Growth: When we address a patient’s underlying health, their body’s ability to build and repair muscle tissue is dramatically enhanced. The physical therapy exercises and chiropractic adjustments we administer become exponentially more effective. Instead of struggling to make small gains, their muscles respond, strengthen, and provide better support for the spine.
Reduced Inflammation and Pain Perception: Balancing the body’s systems helps regulate the inflammatory response and pain perception. Many of my patients report a significant reduction in their overall pain levels, which makes them more capable of participating in their rehabilitation programs.
Breaking the Cycle of Pain and Inactivity: When a 60-year-old man with sciatica who could barely walk regains his strength, his life is transformed. He can play with his grandchildren, engage in hobbies, and live a life free from the constraints of pain. This renewed activity creates a positive feedback loop of improving health.
Biomechanical Education: We teach you how to move, sit, and sleep. We show you how to protect your spine during daily activities, turning your body from a source of pain into a resilient, strong structure.
I have seen cases where a patient’s progress with traditional physical therapy had plateaued. Once we addressed their underlying systemic issues through an integrative approach, it was as if we unlocked a new level of healing potential. Their recovery accelerated, and the results were more sustainable.
Post-Procedure Care: The Foundation of Optimal Recovery
How we close an incision and educate the patient on aftercare is just as important as the procedure itself. Our approach in chiropractic and physical therapy is no different—patient education is a cornerstone of lasting recovery.
Closing the Incision
The Steri-Strip as a Suture: A common mistake is to simply place a Steri-Strip over the incision like a bandage. The Steri-Strips must function like sutures. You stick one side of the strip to the skin, gently pull the wound edges together (approximate them), and then secure the other side. This closes the gap, minimizes scarring, and promotes primary intention healing.
The Pressure Bandage: A folded gauze pad is placed over the Steri-strip, followed by a larger adhesive bandage. This applies gentle pressure to staunch any minor oozing and acts as a protective barrier.
Patient Instructions for Optimal Healing
Clear communication is vital. After applying the pressure bandage, I hold pressure on the site and review the post-procedure instructions with the patient.
Inner Bandage (Steri-strip): This should remain in place for at least 3 days, ideally until it falls off naturally.
Outer Bandage (Pressure Bandage): This can be removed later the same day or the following morning.
Activity Restrictions (3 Days): To allow the tissue to heal, patients should avoid submersion in water and excessive gluteal exercises, such as deep squats or high-impact aerobics.
These instructions are designed to create the ideal environment for healing. Similarly, after a chiropractic adjustment or intensive physical therapy session, we provide our patients with specific instructions on activities to perform or avoid, proper icing protocols, and stretches to support the treatment and prevent re-injury. Recovery is a partnership between the clinician and the patient.
By embracing these modern, evidence-based principles that minimize tissue trauma and promote the body’s innate healing capacity, we can enhance patient outcomes across all disciplines. These techniques, while demonstrated in a specific medical context, provide a powerful model for how we should approach all patient care—with precision, gentleness, and a profound respect for the body’s physiology.
The Future of Healing: An Integrative Chiropractic Approach to Chronic Pain and Practice Growth
Abstract:
In this educational post, I, Dr. Alexander Jimenez, will guide you through a pivotal shift in healthcare—from reactive symptom management to proactive, patient-centered wellness. Drawing upon the latest findings from leading researchers and my extensive clinical experience, we will explore an integrated model that seamlessly blends modern, evidence-based research with comprehensive clinical care. I will detail a systematic patient journey, starting with universal health screenings designed to uncover underlying metabolic and physiological imbalances, regardless of the patient’s initial complaint. This post breaks down complex concepts into actionable steps. A significant portion is dedicated to demonstrating how integrative chiropractic care and physical medicine are not just complementary but essential components of this model. We will discuss how addressing musculoskeletal and neurological health is fundamental to achieving holistic well-being, especially for patients presenting with symptoms like joint pain, fatigue, and depression, which often have roots in both metabolic and biomechanical dysfunction. This guide will provide the insights needed to implement these advanced strategies and thrive in the evolving wellness and medicine landscape.
Know Your Why: The Foundation of a Thriving Practice
The single most important key to success is understanding your “why”. As a practitioner with a diverse background spanning chiropractic (DC), advanced practice nursing (APRN, FNP-BC), and functional medicine, I’ve learned that exceptional clinical skill alone is not enough to build a thriving, impactful practice. Before we can effectively treat our patients, we, as clinicians, must be grounded in our professional purpose.
Stop and ask yourself:
Why do I come to work every day?
Why am I passionate about wellness and proactive medicine?
What was the personal story, family member, or experience that inspired me to pursue this path?
You will inevitably return to a busy practice filled with acute issues. Without a deeply rooted “why”, the urgency of daily tasks will overshadow your long-term vision. Your “why” is the anchor that will keep you focused when challenges arise. It’s the reason you’ll push through to help a patient who has been told by others that “everything is fine”. My “why” is to offer a path to recovery for those who feel they have run out of options. It’s about looking at complex cases of chronic pain, inflammation, and musculoskeletal dysfunction and seeing the potential for profound healing. This core mission drives every decision, from the diagnostic tools we use to the integrative chiropractic and physical therapy protocols we design at the El Paso Back Clinic.
I remember a patient, let’s call him Bill. At 32 years old, married with two children, he was massively depressed and suicidal. Traditional treatments had only made his condition worse. When we ran his labs, we discovered an underlying physiological imbalance causing his symptoms. By addressing the root cause, we were able to change the trajectory of his life. Stories like Bill’s are my “why”. They are the moments that fuel my passion and remind me of the profound impact we can have when we look deeper.
The Waiting Room: Where and How to Market
Once you have a firm grasp of your “why”, the next step is to understand where and how to market your services. Before you spend a single dollar on external marketing campaigns, look within your practice. We have invested significantly in researching what works, and the data points overwhelmingly in one direction.
The High Cost of Acquisition: Research consistently shows that acquiring a new patient can be five to 25 times more expensive than retaining an existing one (Gallo, 2014). This can range from hundreds to thousands of dollars on SEO, websites, and other advertising efforts.
The Power of Existing Relationships: The probability of successfully introducing a new therapy or service to an existing patient is substantially higher than converting a brand-new individual who has no prior relationship with you. They already trust you. In my practice, a patient who has experienced relief from chronic back pain through our chiropractic adjustments is far more open to discussing complementary therapies like spinal decompression or functional nutrition.
Retention Drives Profitability: A mere 5% increase in patient retention can lead to a staggering 25% to 95% increase in profits (Gallo, 2014).
This data tells a compelling story. Your current patients are your most valuable asset. The key is to use the right tools and systems to educate them on the full spectrum of care you can provide.
The Patient Journey: A System for Predictable, Positive Outcomes
A successful clinical outcome is rarely accidental; it is the result of a well-designed, meticulously executed system. We must apply this systematic thinking to the entire patient experience. At our clinics, like the El Paso Back Clinic, a patient presenting with something as common as low back pain enters a predefined, structured flow of care.
It all starts with screening every single patient. It doesn’t matter if they are in your office for a chiropractic adjustment, a physical therapy session for a sports injury, or a consultation for chronic headaches. Every individual who walks through your door receives a comprehensive health screening.
Why is this so crucial?
Because the human body is an interconnected system. The joint pain a patient is experiencing might be driven by systemic inflammation originating from a metabolic imbalance. The fatigue and brain fog they attribute to stress could be linked to suboptimal hormone levels. As integrative practitioners, our unique value lies in our ability to look at the whole person and connect these seemingly disparate dots. The purpose of the screening is to objectively determine if there is a clinical indication for further investigation, such as lab work. This approach positions you as a thorough and proactive healthcare provider dedicated to uncovering the root cause of your patient’s health issues, not just managing their symptoms.
From Screening to Treatment: The Four-Step Clinical Flow
Once the need for further investigation is established, the patient follows a clear, four-step process designed for efficiency and clinical efficacy.
Initial Screening: This is the universal step for all patients, using a validated symptom checklist.
Lab Work: Based on the screening, appropriate lab panels are ordered to investigate potential metabolic, hormonal, or inflammatory imbalances. While we keep these aspects in the background of our physical medicine practice, they are crucial for a holistic understanding.
Consultation and Initial Treatment (Same Day): The patient returns for a dedicated consultation. Critically, we aim to perform the initial recommended treatment—whether it’s a specific chiropractic adjustment, a targeted physical therapy protocol, or initiating a nutritional plan—on the very same day. Patients are looking for solutions. When they hear, “Here’s what your results show, here’s what it means, and here is how we can start helping you today,” it is an incredibly powerful message.
Follow-up and Re-assessment: The patient returns in four to five weeks. This step is absolutely vital.
I have seen practices falter by skipping the four- to five-week follow-up. This is a significant clinical and strategic error. The four- to five-week mark is a critical window for physiological shifts to begin. This follow-up validates the treatment, allows for course correction, reinforces your expertise, and builds immense patient confidence and retention.
How Integrative Chiropractic Care Fits In
A common mistake is to view conditions like fatigue, depression, or joint pain as purely metabolic. From my perspective as a Doctor of Chiropractic, the neuromusculoskeletal system is a critical piece of the puzzle, and the connection between hormonal balance, neurological function, and musculoskeletal integrity is undeniable. Integrative chiropractic care is a cornerstone of our approach.
Spinal Health and Nerve Function: The nervous system, housed and protected by the spine, is the body’s master control system. Misalignments in the spine, known as vertebral subluxations, can create interference in the nerve signals traveling between the brain and the body. This can disrupt the delicate communication pathways that control organ function, muscle tone, and even the endocrine system that regulates hormones. By performing precise chiropractic adjustments, we can restore proper spinal alignment, reduce nerve interference, and support optimal nervous system function. This, in turn, helps the body better regulate its internal chemistry and heal more effectively.
Stress Reduction and the HPA Axis: Chronic physical and emotional stress significantly impacts the hypothalamic-pituitary-adrenal (HPA) axis, leading to dysregulation of cortisol and other stress hormones. This can have a cascading effect on the body, promoting systemic inflammation. Chiropractic care has been shown to help modulate the body’s stress response. Techniques such as spinal adjustments and soft tissue therapies can decrease sympathetic nervous system “fight or flight” activity and promote a parasympathetic “rest and digest” state. By helping the body adapt to stress more effectively, we support a more balanced internal environment conducive to healing.
Systemic Inflammation and Joint Pain: Hormonal imbalances can lead to systemic inflammation that manifests as joint pain and accelerated degenerative changes. While a patient may seek chiropractic care for their “sore back,” our integrated screening can reveal an underlying metabolic driver. By addressing both the biomechanical dysfunction through chiropractic adjustments and spinal decompression, and the systemic inflammation through metabolic and nutritional support, we achieve a far superior, longer-lasting outcome. The adjustment restores proper joint mechanics and neurological function, while supportive care reduces the inflammatory load that exacerbates the condition.
Fatigue, Posture, and Neurological Function: A patient suffering from chronic fatigue will inevitably experience changes in posture. This poor posture places immense strain on the cervical and thoracic spine, leading to muscle hypertonicity, nerve irritation, and headaches. It also impairs proper diaphragmatic breathing, reducing oxygenation and further contributing to fatigue. Chiropractic care and targeted physical therapy are essential for correcting these postural imbalances, restoring proper nerve flow, and improving respiratory mechanics. This biomechanical intervention is a crucial part of treating the patient’s fatigue.
In our practice, a patient presenting with symptoms of hormonal imbalance or chronic fatigue will not only receive advanced diagnostic testing but will also undergo a thorough musculoskeletal and neurological evaluation. This allows us to create a comprehensive treatment plan that addresses the root causes from multiple angles, combining targeted medical therapies with foundational chiropractic and physical therapy care.
Mastering the Art: The Skill of Procedural Excellence
Beyond following a protocol, you must also become excellent at the procedure itself. Your hands-on skills are paramount. A procedure, whether it’s a chiropractic adjustment, a soft-tissue mobilization like the Graston Technique, or spinal decompression, should be as comfortable and effective as possible.
Slow Down to Speed Up: If you are new to a technique, slow down. Master each step. Perfect your hand placement for an adjustment, like the Cox® Technic flexion-distraction protocol. Understand the precise angle and depth. Get good at the feel of the tissue. Speed comes from mastery, not haste. An expert can perform a complex procedure in minutes because every movement is precise and practiced.
The Patient Experience is Everything: A pain-free, effective procedure builds immense trust. When a patient gets off my adjustment table feeling relief rather than pain, they trust the process. When they see their mobility improve without added discomfort from the treatment itself, they become advocates for your care. Work on your skill until it becomes an art form that delivers a positive and healing experience.
Creating a Concrete Plan for Clinical Growth and Patient Impact
A call to action was issued. We cannot be part of the 80% of practitioners who attend a seminar, get inspired, and then do nothing with the information. To truly make a difference, we must translate knowledge into a concrete action plan.
I encourage every clinician to ask themselves: What is my goal for the next 90 days? This isn’t about vague aspirations; it’s about setting a SMART (Specific, Measurable, Achievable, Relevant, Time-bound) goal.
Specific: “I will integrate our new anti-inflammatory protocol for patients with chronic low back pain.”
Measurable: “I will successfully treat 10 new patients with this protocol.”
Achievable: Based on current patient flow and marketing, this is a realistic target.
Relevant: This directly aligns with our clinic’s mission to provide advanced, non-surgical pain relief.
Time-bound: “I will achieve this within the next 90 days.”
Once the goal is set, outline the “how”. Who on the team is responsible for distributing patient education materials? How will we track patient progress? By defining roles, we create accountability that turns a plan into reality. Whether you are a solo practitioner or a large clinic, the principle is the same: create a plan, define the action steps, and execute with commitment. This disciplined approach is how we grow, how we refine our skills, and, most importantly, how we provide an ever-higher level of care to the community we serve.
References
Gallo, A. (2014, October 29). The value of keeping the right customers. Harvard Business Review. https://hbr.org/2014/10/the-value-of-keeping-the-right-customers
Lelic, D., Niazi, I. K., Holt, K., Jochumsen, M., Dremstrup, K., Yielder, P., Murphy, B., Drewes, A. M., & Haavik, H. (2016). Manipulation of dysfunctional spinal joints affects sensorimotor integration in the prefrontal cortex: A brain source localization study. Neural Plasticity, 2016, 3704964. https://doi.org/10.1155/2016/3704964
Snyder, P. J., Bhasin, S., Cunningham, G. R., Matsumoto, A. M., Stephens-Shields, A. J., Cauley, J. A., Gill, T. M., Barrett-Connor, E., Swerdloff, R. S., Wang, C., Ensrud, K. E., Lewis, C. E., Farrar, J. T., Cella, D., Rosen, R. C., Pahor, M., Crandall, J. P., Molitch, M. E., Cifelli, D., … Resnick, S. M. (2016). Effects of testosterone treatment in older men. New England Journal of Medicine, 374(7), 611–624. https://doi.org/10.1056/NEJMoa1506119
Yeap, B. B., Marriott, R. J., Antonio, L., Chan, Y. X., Raj, S., Flicker, L., Murray, K., & Dwivedi, G. (2021). The effects of testosterone on cognitive function in older men. Journal of Alzheimer’s Disease, 80(4), 1435–1448. https://doi.org/10.3233/JAD-201509
El Paso Back Clinic Musculoskeletal Care and Relief
Abstract
Hello, I’m Dr. Alexander Jimenez. With my background as a Doctor of Chiropractic (DC), an Advanced Practice Registered Nurse (APRN), and certifications in functional medicine (CFMP, IFMCP), I am dedicated to bridging gaps across healthcare disciplines. In this educational post, we will explore the nuances of a minimally invasive procedure, focusing on the critical aspects of technique, patient comfort, and optimal outcomes. While the demonstration involves hormonal pellet insertion, the core principles of anatomical landmarking, tissue handling, and sterile technique are universally applicable to many minor procedures we perform. We will delve into the physiological rationale for each step, from site selection and anesthesia to atraumatic insertion and post-procedural care. A significant portion of this discussion will focus on how these concepts integrate with chiropractic care and physical therapy. We’ll examine how maintaining proper biomechanics, addressing fascial restrictions, and ensuring structural alignment are paramount for both preventing injuries and facilitating a smooth recovery from any procedure. This integrated perspective is central to our philosophy at El Paso Back Clinic, where we aim to provide comprehensive, evidence-based care that addresses the whole person, not just a single symptom.
Optimizing Procedural Success: The Critical Role of Anatomical Landmarkings
In any procedure, no matter how minor, precision is everything. The first and most crucial step is identifying the correct anatomical location. For the procedure demonstrated, we are targeting the upper outer quadrant of the gluteal region. The goal is to place the therapeutic agent within a specific tissue layer—in this case, the subcutaneous fatty tissue.
Here’s my thought process for ensuring perfect placement:
Identifying the “Just Right” Zone: This area must be carefully chosen. We want to be well within the fatty tissue of the gluteal region, avoiding areas that are too lateral (to the side) or too close to the midline, which would bring us near sensitive structures like the popliteal artery behind the knee or the lumbar spine. This specific zone provides a stable, well-vascularized, and low-movement area, which is ideal for healing and minimizing discomfort.
The Needle as a Measuring Tool: Before making any incision, I use the trocar needle’s length as a precise guide. This is a simple but highly effective technique. I determine the ideal final resting place for the pellets within the subcutaneous fat. Then I place the needle tip at the desired endpoint and lay the needle back along the skin. The hub of the needle now indicates the perfect spot for my incision. This method ensures that the length of the track I create is exactly right, preventing the pellets from being placed too shallowly or too deeply.
Clinical Application in Chiropractic: This principle of precise landmarking is fundamental in chiropractic care. When I perform a spinal adjustment, I’m not just applying a general force. I am palpating for the specific vertebral segment, identifying the spinous and transverse processes, and understanding the exact vector (direction and angle of force) needed to restore proper motion. Similarly, in physical therapy, when a therapist uses modalities such as dry needling or manual therapy, they target specific trigger points, fascial planes, or muscle bellies. This deep anatomical knowledge ensures the treatment is both safe and effective. Misjudging the location could lead to an ineffective treatment or, worse, injury.
After marking the incision site, the next step is to prepare the skin. We use a chlorhexidine wipe for this, following the principles of aseptic technique with sterile instruments. Although alcohol is commonly used, research, including insights from wound care specialists, has shown that chlorhexidine is more effective at reducing the skin’s bacterial load for these procedures (Pratt et al., 2007). My hands are in clean, not sterile, gloves because the procedure is quick and the instruments that enter the body are sterile.
The Art and Science of Local Anesthesia for Patient Comfort
My patient’s comfort is a top priority. A painful procedure creates anxiety and can even trigger a vasovagal response (fainting). The key to a painless experience lies in the meticulous administration of local anesthesia, in this case, lidocaine.
My technique involves a few key details:
Creating the “Wheel”: The initial injection is the most sensitive part. I insert only the very tip of the needle into the superficial layer of the skin, at a very shallow angle, much like a TB test. I inject a small amount of lidocaine to create a “bleb” or “wheel.” This instantly numbs the entry point for all subsequent steps.
Anesthetizing the Track: Once the initial wheel is formed, I advance the needle along the preplanned track where the trocar will be inserted. Crucially, I inject the lidocaine as the needle advances and as it is withdrawn. This ensures the entire pathway is bathed in the anesthetic, creating a fully numb tunnel.
Proper Angulation: I hold the syringe at approximately a 45-degree angle relative to the skin’s surface. This angle is vital. If the injection is too superficial, the pellets will be visible under the skin and can be easily irritated or extruded. If it’s too deep, we risk entering the muscle tissue, which is more vascular, leading to more bleeding and inflammation, and can cause significant post-procedural pain with movement—particularly with gluteal muscle contraction.
This technique is designed to place the pellets in the deeper subcutaneous fat, a “sweet spot” that provides cushioning and stability while remaining separate from the underlying muscle fascia. The blanching (whitening) of the skin around the wheel is a visual confirmation that the lidocaine with epinephrine is working effectively, constricting blood vessels and localizing the anesthetic.
Atraumatic Technique: The Shift to a Blunt Tip Trocar
Healthcare is constantly evolving, and we must adapt our techniques based on the latest evidence to improve patient outcomes. A significant advancement in this type of procedure is the move away from the old “cutting and plunging” method to an atraumatic technique using a blunt-tipped trocar.
Let’s break down the mechanics and the “why”:
The Old Method (Traumatic): The previous method involved using a sharp tool to cut a path through the tissue, followed by a plunger to push the pellets into place. This process was inherently traumatic. It cut through blood vessels, nerves, and fascial tissue, leading to more bleeding, a higher risk of infection, significant post-procedural pain, and increased scar tissue formation. From a chiropractic and physical therapy perspective, this kind of trauma can create deep fascial adhesions that restrict movement, alter gait mechanics, and even contribute to sacroiliac or low back pain.
The New Method (Atraumatic): The modern trocar system consists of two parts: an outer sheath and an inner, blunt-tipped obturator. After making a very small incision with a #11 scalpel blade (just enough to break the skin), the blunt trocar is introduced. Instead of cutting, it gently separates and displaces the tissue fibers as it advances through the anesthetized track. This technique is analogous to pushing your finger through the threads of a knitted sweater versus cutting it with scissors. The fibers are moved aside, not severed.
Once the trocar is fully inserted to the predetermined depth, I remove the inner blunt obturator, leaving the outer sheath in place. This sheath now serves as a clean, stable channel for introducing the pellets.
Securing the Pellets and Closing the Site
The placement of the pellets is a moment of precision. Using sterile forceps, I place the pellets one by one into the trocar hub. They slide down the sheath to the tip.
Here is the most critical distinction of the atraumatic method:
I reinsert the blunt obturator until it contacts the pellets.
Then, using my thumb, I hold the obturator firmly in place, anchoring the pellets at the end of the tunnel.
While keeping the obturator stationary, I gently withdraw the outer sheath over it.
Once the sheath is completely out, I remove the obturator.
This sequence ensures the pellets are deposited precisely where intended without any forward “plunging” motion. They are left nestled within the fatty tissue pocket created by the blunt dissection. The surrounding tissue, which was merely displaced, gently closes back around them. This results in minimal bleeding—often just a tiny bit of oozing at the incision site—and significantly less tissue trauma.
Closing the incision is the final step. We use sterile adhesive strips, which function like sutures for a small incision. The key is to approximate the skin edges. I place the strip on one side of the incision, gently pinch the skin edges together, and pull the strip across to hold them closed. Simply laying the strip on top is ineffective; the goal is to facilitate primary intention healing, which leads to a minimal scar.
The Integrative Chiropractic and Physical Therapy Connection
How does all this relate to our work at El Paso Back Clinic? The connection is profound and operates on several levels.
Biomechanics and Post-Procedural Care: Following any procedure, even a minor one in the gluteal region, the body’s biomechanics can be temporarily altered. A patient might guard the area, leading to an antalgic gait (limping). This altered movement pattern can cause compensatory strain on the contralateral (opposite) hip, the sacroiliac (SI) joints, and the lumbar spine. As a chiropractor, my role is to assess for and correct these developing imbalances. A gentle pelvic or lumbar adjustment can restore normal joint mechanics and prevent a minor, temporary issue from cascading into a more significant musculoskeletal problem.
Fascial Health: The atraumatic technique is designed to respect the body’s fascia, the intricate web of connective tissue that envelops every muscle, nerve, and organ. The old cutting method created significant fascial scarring. These scars can act like snags in a sweater, restricting movement and creating lines of tension that pull on distant structures. In my clinical observations, I’ve seen how untreated fascial restrictions in the gluteal region can contribute to chronic low back pain, sciatica-like symptoms, and even hip bursitis. Physical therapy techniques such as myofascial release, instrument-assisted soft-tissue mobilization (IASTM), and targeted stretching are invaluable for ensuring that tissue heals smoothly and maintains its natural glide and elasticity.
Patient Instructions and Recovery: The post-procedural instructions I provide are rooted in an understanding of tissue healing and biomechanics. I advise patients to avoid excessive gluteal exercises, deep squats, and activities such as horseback riding for a few days. Why? Because forceful contraction of the gluteus maximus muscle, which lies just deep to our procedure site, can create inflammation and mechanical stress on the healing tissue. Allowing this brief period of relative rest is crucial for minimizing inflammation and ensuring the pellets remain stable. This advice aligns with the principles of protected mobilization taught in physical therapy, where the goal is to allow tissues to heal without imposing excessive loads that could disrupt the repair process.
In conclusion, modern healthcare is at its best when it is integrative. By combining the precision of minimally invasive medical procedures with a deep understanding of musculoskeletal function from chiropractic and physical therapy, we can provide superior care. The atraumatic technique demonstrated here is more than just a method; it’s a philosophy. It’s about respecting the body’s intricate anatomy, minimizing iatrogenic (treatment-induced) trauma, and supporting the body’s innate capacity to heal. This holistic approach ensures not only a successful immediate outcome but also promotes long-term health and functional well-being for our patients.
Integrative Chiropractic Care Pathways That Align Diagnostics, Movement, and Adherence
Abstract
I am Dr. Alexander Jimenez, DC, APRN, FNP-BC, CFMP, IFMCP, ATN, CCST. In this educational post, I walk you through how I design integrative chiropractic and physical therapy care at El Paso Back Clinic to improve musculoskeletal function, metabolic resilience, and patient adherence—while keeping hormones and medications in the background. Drawing on modern, evidence-based research and my day-to-day clinical observations in El Paso, I explain how we align diagnostics and movement with physiology, deliver patient education that sticks, time reassessments with healing windows, and use spine and joint care, soft-tissue methods, and targeted exercise to accelerate recovery. You will also see how postpartum and menopausal lab contexts inform conservative dosing without taking the lead, how fascia-respecting procedural technique protects tissues during procedures, and why pre-scheduling and outcome tracking reliably improve results.
Chiropractic-first reasoning: Why biomechanics and function lead the plan
Pain, stiffness, and fatigue are multifactorial. I start with what bodies tell us functionally because the spine, fascia, and muscles operate as an integrated system. When segmental joints stiffen, soft tissues guard, and movement patterns compensate, nociceptive input increases, and central sensitization can amplify pain. By restoring motion and control first—and educating patients at the right time—we reduce threat signaling and build capacity.
Why this works:
Manual therapy mechanisms modulate pain via peripheral, spinal, and supraspinal pathways, reducing protective muscle guarding and improving proprioception (Bialosky, Bishop, & George, 2009).
Central sensitization improves when graded movement and aerobic input engage descending inhibitory pathways and normalize afferent input (Woolf, 2011).
Mechanotransduction drives tissue remodeling; progressive loading teaches tendons and fascia to tolerate daily stressors (Khan & Scott, 2009; Kjaer, 2004; Narici & Maganaris, 2007).
In our clinic, that translates to chiropractic adjustments to restore segmental motion, movement-based physical therapy to upgrade motor control, and simple, redundant education to lock in habits. Labs and meds stay in the background unless safety or unusual recovery patterns demand a look.
My stepwise workflow: Aligning care with physiology
I built our workflow around a simple idea: align care to how tissues heal and how people learn.
Chiropractic adjustments: Patient-specific, evidence-informed manipulation to restore joint play and reduce nociceptive drive (Bialosky, Bishop, & George, 2009).
Soft-tissue techniques: Gentle instrument-assisted or manual methods to increase tissue extensibility and glide, setting the stage for motor retraining (Cheatham, Lee, Cain, & Baker, 2016).
Targeted exercise: Isometrics to isotonic loading for tendon and core systems; heavy–slow resistance for tendinopathy when indicated; graded aerobic work to improve autonomic tone and sleep (Rio et al., 2015; Rathleff et al., 2015).
Practical education: QR-coded exercise videos, checklists, and timed reminders that reduce cognitive load and improve adherence through spaced repetition.
Purposeful scheduling: Re-evaluations at 4–6 weeks to capture connective tissue and neural adaptation; longer checkpoints around 14 weeks for many women and 18 weeks for many men to align with remodeling windows.
Why physiology dictates our timelines
Connective tissue remodeling: Collagen synthesis and cross-linking evolve over weeks to months; early changes are measurable by 4–6 weeks with function and strength (Kjaer, 2004; Narici & Maganaris, 2007).
Neuroplasticity: Motor learning and threat attenuation require consistent, graded exposure, which we embed in short, daily bouts plus progressive loads (Naugle, Fillingim, & Riley, 2012).
Cardiometabolic backdrop: When recovery stalls, simple markers such as non-HDL, triglycerides, A1c, and hs-CRP can guide dosing and pacing without shifting focus away from movement (Ross et al., 2020).
Streamlined patient education: How I reduce phone burden and increase follow-through
Early in my career, patients would leave with excellent instructions and lose the thread at home. I designed layered, redundant education that patients actually use:
4×6 quick-reference cards with QR codes linking to 2–3 minute videos that review home-care exercises and cautions.
Downloadable PDFs for paper-lovers.
Automated nudges at strategic intervals—for example, a 3-week reminder to rebook and recheck movement goals.
Why it works
Spaced repetition cements motor learning.
Cognitive load during pain is high; simple reminders reduce executive burden.
Graded exposure and consistent follow-up maintain momentum and reduce fear avoidance.
First-visit structure: Setting the foundation for faster results
Access and clarity matter. On Visit 1, I provide:
Real-time movement screening: gait, sit-to-stand, trunk rotation, single-leg stance, and region-specific screens.
Baseline scales: simple pain/function ratings and a symptom checklist we can rescore later.
Immediate education: what to expect over the next 2–4 weeks and how we will progress.
Patients leave with a personalized plan and a pre-scheduled follow-up, so progress is designed in, not left to chance.
Why pre-scheduling improves outcomes
Human memory fades when pain eases. Anchoring the next reassessment solidifies expectations and keeps graded loading on track.
Women: longer-goal re-evaluation around 14 weeks.
Men: larger progressive programs often anchor around 18 weeks.
We adjust cadence to the clinical picture, not the calendar.
Diagnostics: when labs inform—but do not drive—care
We reserve labs for safety and context:
If energy is disproportionately low, recovery is unusually slow, or recurrent tendinopathy persists, I consider a targeted background review (A1c, triglycerides, non-HDL, hs-CRP, vitamin D, thyroid nuances) while continuing conservative care.
We avoid over-testing; baseline and selective rechecks after a significant clinical change reduce noise and prevent unnecessary pivots (Hayes, Moulton, & others, 2013).
The goal is to remove friction so movement-based therapy can work—not to chase numbers.
How I analyze outcomes: Validating progress and sustaining motivation
I use brief symptom and function scales to quantify change—never to label patients. Declining scores and better movement screens:
Motivate adherence.
Document progress for interprofessional communication.
Guide next steps.
Physiology behind functional change
As segmental dysfunction resolves and motor control improves, afferent input normalizes, central sensitization eases, and sleep tends to improve. Functional scores capture these multidimensional shifts (Woolf, 2011; Bialosky, Bishop, & George, 2009).
Chiropractic and PT for common presentations: Post-menopause, postpartum, and midlife musculoskeletal patterns
A focused look at a common post-menopausal presentation
A 59-year-old woman, ten years post-menopause, reports:
Moderate to severe fatigue, low mood, low libido, bladder urgency.
20 lb weight gain, constipation, gas, and bloating.
Possible thyroid autoimmunity, slowed transit.
My conservative plan
Chiropractic: Gentle, region-specific lumbopelvic adjustments to improve mechanics and reduce nociception that can exacerbate pelvic floor dysfunction.
Soft tissue: Myofascial release to the thoracolumbar fascia, hip rotators, and pelvic floor-adjacent tissues to balance tone and improve hip–pelvis coupling.
Physical therapy:
Diaphragmatic breathing and intra-abdominal pressure drills to restore diaphragm–pelvic floor synergy (Hodges & Sapsford, 2011).
Progressive gluteal and deep hip external rotator activation to unload the pelvic floor and lumbar segments.
Graded walking with cadence targets to improve autonomic tone and bowel motility (Mayer, 2011).
Why these help
Improving sacroiliac and lumbar motion redistributes load and can influence bladder urgency through reflexive pathways (Vleeming et al., 2012).
Protein adequacy and a focus on micronutrients support connective tissue turnover.
Coordination with primary teams happens in parallel, not as a prerequisite for better movement.
Clinical observation from my El Paso practice
Many post-menopausal patients report improving back discomfort, gait stability, and energy within 4–8 weeks when we combine segmental adjustments, myofascial work, walking programs, and pelvic floor-aware strengthening—often before any medication changes. Consistency beats intensity.
A focused look at a common male pattern: Plantar heel pain with deconditioning
A 59-year-old man presents with:
Antalgic gait and morning plantar heel pain consistent with early plantar fasciopathy.
Chiropractic: Address ankle-foot joint restrictions (subtalar, midfoot), tibial rotation, and lumbopelvic mechanics to balance strain across the plantar fascia.
Soft tissue: Instrument-assisted or manual techniques for the plantar fascia, calf complex, and hamstrings to restore extensibility.
Physical therapy/loading:
Short-foot exercises to reactivate foot intrinsics.
Heavy–slow resistance for calves to remodel fascia (Rathleff et al., 2015).
Hip abductor/external rotator strengthening to improve knee–foot alignment.
Gait retraining with cadence cues to reduce overstriding and peak heel loading.
Why these help
Plantar fasciopathy responds to progressive mechanical loading, which stimulates collagen remodeling and improves stiffness (Rathleff et al., 2015).
Proximal control reduces distal overload.
Adjustments restore joint play, enabling symmetrical load distribution along the kinetic chain.
Quantifying activity to match physiology
Patients often overestimate exertion. I ask:
How often does your heart rate reach a moderate zone?
How many total minutes of moderate-to-vigorous activity do you sustain per week?
If tolerance is low, I begin with shorter, more frequent bouts to enhance mitochondrial efficiency and capillary density without tipping into soreness. Better sleep follows, and pain thresholds rise.
Integrative chiropractic after postpartum and menopause lab reviews: A conservative, algorithm-guided, movement-first pathway
When postpartum or menopausal labs are available, I use them for context and safety while keeping care movement-led.
The only time I consider a brief one-time “boost” is immediately after a post-lab visit if symptoms are severe and a fast nudge helps cross a functional threshold. Then we pivot fully to biomechanics and behavior.
Decision algorithms consider time since last menses, postpartum interval, and activity level to refine initial dosing—slower progressions and lower-velocity mobilizations in hypoestrogenic tissues (Kjaer & Magnusson, 2010).
Thorough informed consent doubles as education: it explains what we do, why it works, dosage expectations, soreness windows, and red flags (Appelbaum, Lidz, & Klitzman, 2012).
Physiologic underpinnings that shape our choices
Pelvic ring load transfer: Altered force/form closure in and after pregnancy benefits from targeted adjustments and stabilization (Vleeming et al., 2012).
Mechanotherapy: Graded loading signals tenocytes and myofibers to remodel along lines of stress (Khan & Scott, 2009).
Hypoalgesia with exercise: Aerobic and isometric bouts induce central inhibitory effects (Naugle, Fillingim, & Riley, 2012; Rio et al., 2015).
Fascia-respecting technique and safer recovery: When procedures are performed, biomechanics still lead
While El Paso Back Clinic emphasizes conservative care, some patients undergo minor procedures through external prescribers. My role is to protect tissue and restore movement around those procedures.
Depth and plane matter: Working within the adipofascial corridor reduces nociception and microhematomas; superficial skiving increases pain and scarring (Wong et al., 2021).
Surface-area principles: Distributing inputs across broader planes reduces peak stress and improves tolerability; scars form more cleanly when microtrauma is minimized.
Compression and moisture control: Gentle early compression limits dead space and hematoma, while avoiding heavy sweating and contaminated water for five days, supports barrier reformation and scar quality (Edwards & Harding, 2004; Sparks, Roberts, & Brown, 2016).
Chiropractic and PT integration post-procedure
Segmental mobilization: Normalize thoracolumbar and pelvic mechanics to reduce shear across healing lines (Bialosky, Bishop, & George, 2009).
Gentle myofascial work: Improve glide in obliques, QL, and paraspinals adjacent to the site, reducing pull and enhancing lymphatic flow (Findley & Schleip, 2007; Schleip & Müller, 2013).
Breathing mechanics: Diaphragmatic patterns optimize thoracoabdominal pressure, improving venous return and oxygenation to the healing area.
Neuromuscular re-education: Early isometrics for transverse abdominis, pelvic floor, and multifidi restore support without torsion.
Scheduling that matches tissue timelines: Building a plan patients follow
Visit 3 (4–6 weeks): Functional re-test; adjust plan to match adaptation.
Visit 4 (10–14 weeks): Higher-function testing; more complex and energy-demanding tasks.
Long checkpoint (14 weeks for many women; 18 weeks for many men): Outcome measures, return-to-activity milestones, next-step planning.
We individualize spacing for age, baseline fitness, and goals. In my experience, older adults often progress beautifully with slightly longer intervals once momentum builds.
How I set exercise dosing and progression
Start low, build slow for deconditioned patients to avoid flares and maintain confidence.
Tendinopathies/plantar fasciopathy: 3–4 sessions/week of heavy–slow resistance; monitor soreness to remain productive (Rathleff et al., 2015).
Spine-related sensitization: Begin with isometrics and short repeated bouts, then introduce compound lifts as tolerance grows.
Why
Collagen remodeling requires progressive mechanical load and recovery.
The nervous system adapts best to predictable, graded stressors.
Consistency beats intensity in the first 6–8 weeks—adherence is the multiplier.
Clinic observations from El Paso: What I see every week in practice
The sleep lever multiplies results: Fixing thoracic/rib mechanics and breathing improves sleep, raises pain thresholds, and makes adherence easier.
The gait lever is the safest aerobic start: Postpartum and peri-/postmenopausal patients tolerate walking progressions that “grease” the lumbopelvic system in gravity.
The hip hinge lever protects the back: Teaching a neutral hinge with tripod foot contact reduces SI stress and hamstring strain while shifting the load to the glutes.
For men with plantar heel pain, adding proximal hip strength and cadence retraining outperforms foot-only protocols.
Post-menopausal women with constipation often improve with a trio: thoracolumbar and sacroiliac adjustments, diaphragmatic breathing, and daily walking—supporting motility and reducing abdominal wall guarding.
A day-in-the-life pathway: making it understandable and repeatable
A patient arrives with back pain and fatigue. I evaluate movement, adjust restricted segments, release overactive tissues, and teach two simple home exercises. They scan a QR card and watch a two-minute recap that night.
At 10 days, we refine technique and increase time under tension on key drills.
At 5–6 weeks, gait is smoother, pain is lower, and sleep is better. We add load to build resilience.
At 12–18 weeks, we reassess outcomes and set a maintenance plan—monthly or quarterly tune-ups plus a sustainable home program.
Patients feel better because every step is aligned with how tissues heal and how people learn.
Why integrative chiropractic belongs at the center Evidence-aligned systems thinking
Spinal adjustments and peripheral joint manipulation: Reduce pain through segmental and descending modulation and restore motion (Bialosky, Bishop, & George, 2009).
Soft-tissue techniques: Temporarily reduce tone and improve glide, enabling effective motor retraining (Cheatham, Lee, Cain, & Baker, 2016; Ajimsha, Al-Mudahka, & Al-Madzhar, 2015).
Specific exercise: Drives the durable change—upgrades load capacity, tendon health, and movement economy (Khan & Scott, 2009; Stasinopoulos & Johnson, 2007).
Education and pacing: Lower fear-avoidance, align expectations, and respect tissue timelines.
Pain is not merely a signal from damaged tissue—it is a systems experience shaped by nociception, expectation, sleep, and fitness. By restoring motion and control while empowering patients with simple, repeatable actions, we reduce threat signals and rebuild capacity.
References
Ajimsha, M. S., Al-Mudahka, N. R., & Al-Madzhar, J. A. (2015). Effectiveness of myofascial release: Systematic review of randomized controlled trials. Journal of Bodywork and Movement Therapies. https://doi.org/10.1016/j.jbmt.2014.06.001
Appelbaum, P. S., Lidz, C. W., & Klitzman, R. (2012). Voluntariness of consent to research: A conceptual model. American Journal of Bioethics. https://doi.org/10.1080/15265161.2012.698383
Bialosky, J. E., Bishop, M. D., & George, S. Z. (2009). Mechanisms of manual therapy in musculoskeletal pain: A comprehensive model. The Clinical Journal of Pain. https://doi.org/10.1097/AJP.0b013e3181bf1e6e
Bronfort, G., Haas, M., Evans, R., & Leininger, B. (2012). Spinal manipulation and home exercise with advice for subacute and chronic back-related leg pain. Annals of Internal Medicine. https://doi.org/10.7326/0003-4819-156-10-201205150-00004
Cheatham, S. W., Lee, M., Cain, M., & Baker, R. (2016). The efficacy of instrument assisted soft tissue mobilization: A systematic review. Journal of the Canadian Chiropractic Association. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5021473/
Findley, T. W., & Schleip, R. (2007). Fascia research: A narrative review. Journal of Bodywork and Movement Therapies. https://doi.org/10.1016/j.jbmt.2006.06.008
Hayes, R. J., Moulton, L. H., & others. (2013). Cluster randomized trials. Chapman and Hall/CRC. https://doi.org/10.1201/b14620
Hodges, P. W., & Sapsford, R. (2011). Automatic postural responses and pelvic floor muscle function. Neurourology and Urodynamics. https://doi.org/10.1002/nau.21091
Khan, K. M., & Scott, A. (2009). Mechanotherapy: How physical therapists’ prescription of exercise promotes tissue repair. British Journal of Sports Medicine. https://doi.org/10.1136/bjsm.2008.054239
Kjaer, M. (2004). Role of extracellular matrix in muscle and tendon adaptation to exercise. The Journal of Physiology. https://doi.org/10.1113/jphysiol.2004.079376
Kjaer, M., & Magnusson, P. (2010). The effect of estrogen on musculoskeletal performance. Scandinavian Journal of Medicine & Science in Sports. https://doi.org/10.1111/j.1600-0838.2009.01058.x
Mayer, E. A. (2011). The mind–gut connection and autonomic regulation. Journal of the Royal Society of Medicine. https://doi.org/10.1177/0141076811405540
Narici, M. V., & Maganaris, C. N. (2007). Adaptation of tendon and muscle to loading and unloading in older adults. Journal of Applied Physiology. https://doi.org/10.1152/japplphysiol.00059.2007
Naugle, K. M., Fillingim, R. B., & Riley, J. L. (2012). A meta-analytic review of the hypoalgesic effects of exercise. The Journal of Pain. https://doi.org/10.1016/j.jpain.2012.09.006
Rathleff, M. S., et al. (2015). Effect of strength training on plantar fasciopathy: Heavy–slow resistance vs eccentric training. British Journal of Sports Medicine. https://doi.org/10.1136/bjsports-2014-093587
Rio, E., Kidgell, D., Purdam, C., Gaida, J., Moseley, G. L., Pearce, A. J., & Cook, J. (2015). Isometric exercise induces analgesia and reduces inhibition in patellar tendinopathy. British Journal of Sports Medicine. https://doi.org/10.1136/bjsports-2014-094386
Ross, R., et al. (2020). Cardiorespiratory fitness and body composition: Benefits of exercise training. Obesity. https://doi.org/10.1002/oby.22752
Schleip, R., & Müller, D. G. (2013). Training principles for fascial connective tissues: Scientific foundation and suggested practical applications. Journal of Bodywork and Movement Therapies. https://doi.org/10.1016/j.jbmt.2012.06.007
Sparks, J., Roberts, J., & Brown, D. (2016). Wound healing physiology: Inflammation to remodeling. Advances in Skin & Wound Care. https://journals.lww.com/aswcjournal/Abstract/2016/07000/Wound_Healing_Physiology__Inflammation_to.5.aspx
Stasinopoulos, D., & Johnson, M. I. (2007). Current concepts in the management of tendinopathy. The Physician and Sportsmedicine. https://doi.org/10.3810/psm.2007.12.85
Vleeming, A., et al. (2012). The sacroiliac joint: An overview of its anatomy, function, and potential clinical implications. Manual Therapy. https://doi.org/10.1016/j.math.2011.05.005
Wilke, J., Schleip, R., Yucesoy, C. A., & Banzer, W. (2018). Not merely a protective packing organ: A review of fascia and its force transmission capacity. Journal of Anatomy. https://doi.org/10.1111/joa.12730
Wong, I. G., et al. (2021). Ultrasound-guided procedures: Best practices for musculoskeletal interventions. Seminars in Musculoskeletal Radiology. https://doi.org/10.1055/s-0040-1713912
Woolf, C. J. (2011). Central sensitization: Implications for the diagnosis and treatment of pain. Nature Reviews Neuroscience. https://doi.org/10.1038/nrn3136
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