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Treatments

Back Clinic Treatments. There are various treatments for all types of injuries and conditions here at Injury Medical & Chiropractic Clinic. The main goal is to correct any misalignments in the spine through manual manipulation and placing misaligned vertebrae back in their proper place. Patients will be given a series of treatments, which are based on the diagnosis. This can include spinal manipulation, as well as other supportive treatments. And as chiropractic treatment has developed, so have its methods and techniques.

Why do chiropractors use one method/technique over another?

A common method of spinal adjustment is the toggle drop method. With this method, a chiropractor crosses their hands and pressed down firmly on an area of the spine. They will then adjust the area with a quick and precise thrust. This method has been used for years and is often used to help increase a patient’s mobility.

Another popular method takes place on a special drop table. The table has different sections, which can be moved up or down based on the body’s position. Patients lie face down on their back or side while the chiropractor applies quick thrusts throughout the spinal area as the table section drops. Many prefer this table adjustment, as this method is lighter and does not include twisting motions used in other methods.

Chiropractors also use specialized tools to assist in their adjustments, i.e., the activator. A chiropractor uses this spring-loaded tool to perform the adjustment/s instead of their hands. Many consider the activator method to be the most gentle of all.

Whichever adjustment method a chiropractor uses, they all offer great benefits to the spine and overall health and wellness. If there is a certain method that is preferred, talk to a chiropractor about it. If they do not perform a certain technique, they may recommend a colleague that does.


The Power of HIIT Workout: Unleash Beneficial Properties for Your Body

The Power of HIIT Workout: Unleash Beneficial Properties for Your Body

For individuals that are trying to change up their daily routine, can incorporating the beneficial properties of a HIIT workout reduce pain?

Introduction

When it comes to a person’s health and wellness, they need to exercise for at least 30 minutes. However, many individuals have hectic lifestyles, which correlates to a lack of time to work out, leading to various health conditions that can develop over time and lead to pain and discomfort. Around the world, many adults should get 150 to 300 minutes of exercise to reduce pain in their body system. This can include doing chores, exercising at home, or going to the gym. But people who want to get in a quick workout within their busy schedules can opt for a HIIT workout or high-intensity interval training.  In today’s article, we will look at what HIIT is, its beneficial effects on the body, and how important it is to incorporate a HIIT workout as part of a daily routine. We talk with certified associated medical providers who inform our patients to include a HIIT workout in their daily routine. While asking their associated medical provider intricate questions, we advise patients to formulate a customized treatment plan to help with chronic pain affecting their bodies through various exercise routines. Dr. Alex Jimenez, D.C., includes this information as an academic service. Disclaimer.

 

What is HIIT?

Do you experience any weight changes that cause difficulty maintaining your ideal weight? How often do you feel stressed and tired after a hectic day that you don’t have time for yourself? Or do you feel unusual aches and pains in your body that make you feel fatigued throughout the day? When it comes to individuals making small changes in their health and well-being, try to work out with the minimum time they have but also achieve the benefits of a full workout, can try HIIT. HIIT, or high-intensity interval training, is defined by exercise activities that target 80% of the individual’s max heart rate with alternative explosive bursts of full-throttle efforts with rest periods. (Coates et al., 2023)

 

 

Additionally, a HIIT workout usually involves cardio and resistance training as part of its sub-categories. This is generally incorporated into gyms and fitness centers and still requires both a warm-up, recovery intervals, and cool-down to ensure that the body is getting the full beneficial properties and effects from a HIIT workout. This is because a HIIT workout involves an active, high-intensity training session that is less than 15 minutes long and helps improve cardiometabolic health and cardiovascular endurance. (Atakan et al., 2021)

 


Optimize Your Wellness- Video


The Beneficial Properties of HIIT

Since HIIT has beneficial properties, many individuals experiencing low back pain from stress, excessive sitting or standing, or lifting heavy objects can utilize HIIT workouts as part of their exercise routine. HIIT workouts for lower back pain can help through general resistance and core strength training, which helps improve muscle strength and decrease the pain and deconditioning of the trunk muscles. (Verbrugghe et al., 2020) The other beneficial properties of HIIT are that it can help improve a person’s cardiorespiratory system or stamina. This helps maintain healthy endurance levels and causes them to increase the length or intensity of a HIIT workout while enjoying the health benefits it can provide. (Martin-Smith et al., 2020)

 

Since HIIT has beneficial properties, many individuals experiencing low back pain from stress, excessive sitting or standing, or lifting heavy objects can utilize HIIT workouts as part of their exercise routine. HIIT workouts for lower back pain can help through general resistance and core strength training, which helps improve muscle strength and decrease the pain and deconditioning of the trunk muscles. (Verbrugghe et al., 2020) The other beneficial properties of HIIT are that it can help improve a person’s cardiorespiratory system or stamina. This helps maintain healthy endurance levels and causes them to increase the length or intensity of a HIIT workout while enjoying the health benefits it can provide. (Martin-Smith et al., 2020)

 

Incorporating HIIT As Part of A Routine

Additionally, anyone who wants to do a HIIT workout routine can do it since it is perfect for a quick workout in a short amount of time. Individuals with busy schedules can complete a workout with alternating bursts of exercises and rest periods that can build up a person’s endurance. With a HIIT workout, many individuals will begin to notice that they have more energy throughout the day and start making changes to improve their lives.

 


References

Atakan, M. M., Li, Y., Kosar, S. N., Turnagol, H. H., & Yan, X. (2021). Evidence-Based Effects of High-Intensity Interval Training on Exercise Capacity and Health: A Review with Historical Perspective. Int J Environ Res Public Health, 18(13). doi.org/10.3390/ijerph18137201

Coates, A. M., Joyner, M. J., Little, J. P., Jones, A. M., & Gibala, M. J. (2023). A Perspective on High-Intensity Interval Training for Performance and Health. Sports Med, 53(Suppl 1), 85-96. doi.org/10.1007/s40279-023-01938-6

Gjellesvik, T. I., Becker, F., Tjonna, A. E., Indredavik, B., Lundgaard, E., Solbakken, H., Brurok, B., Torhaug, T., Lydersen, S., & Askim, T. (2021). Effects of High-Intensity Interval Training After Stroke (The HIIT Stroke Study) on Physical and Cognitive Function: A Multicenter Randomized Controlled Trial. Archives of Physical Medicine and Rehabilitation, 102(9), 1683-1691. doi.org/10.1016/j.apmr.2021.05.008

Guimaraes, G. V., Ciolac, E. G., Carvalho, V. O., D’Avila, V. M., Bortolotto, L. A., & Bocchi, E. A. (2010). Effects of continuous vs. interval exercise training on blood pressure and arterial stiffness in treated hypertension. Hypertens Res, 33(6), 627-632. doi.org/10.1038/hr.2010.42

Martin-Smith, R., Cox, A., Buchan, D. S., Baker, J. S., Grace, F., & Sculthorpe, N. (2020). High Intensity Interval Training (HIIT) Improves Cardiorespiratory Fitness (CRF) in Healthy, Overweight and Obese Adolescents: A Systematic Review and Meta-Analysis of Controlled Studies. Int J Environ Res Public Health, 17(8). doi.org/10.3390/ijerph17082955

Verbrugghe, J., Agten, A., Stevens, S., Hansen, D., Demoulin, C., Eijnde, B. O., Vandenabeele, F., & Timmermans, A. (2020). High Intensity Training to Treat Chronic Nonspecific Low Back Pain: Effectiveness of Various Exercise Modes. J Clin Med, 9(8). doi.org/10.3390/jcm9082401

 

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Relieve Low Back Leg Pain: Effective Treatment Methods

Relieve Low Back Leg Pain: Effective Treatment Methods

Lower back leg pain depends on specific symptoms and their duration. Can having a better idea of symptoms help individuals inform their medical providers to develop an effective treatment plan?

Relieve Low Back Leg Pain: Effective Treatment Methods

Low Back Leg Pain

Lower back leg pain, sciatica, and weakness of the lower-extremity muscles are often diagnosed as a herniated (compressed or ruptured) disc. Nerves surrounding the spine are sensitive to irritation and pressure caused by a disc shifting out of position or physical damage to the disc and surrounding area, ranging from mild to severe. This is why it is important to be evaluated by a healthcare provider. Treatment depends on the type of spinal disc herniation and the severity, but getting an early medical evaluation helps ensure optimal outcomes. Non-surgical conservative treatments are often effective, but some cases may require more aggressive treatment, especially if the pain persists.

Spine and Nerves

Spinal discs are the shock absorbers between vertebrae. They consist of a tough outer layer, annulus fibrosis, covering a soft gel core, nucleus pulposus. When a disc is damaged, it can bulge and irritate surrounding nerves. In more severe cases, the annulus fibrosis can weaken and tear, allowing the material to leak and compress the spinal cord or nerves. As the nerves are not functioning properly, abnormal signals may be sent to and from the brain. The most common lower back herniations occur in the lumbar region, where five vertebrae near the base of the spine are classified from top to bottom as L1 through L5. (Dydyk A.M. et al., 2023) Pain resulting from an injury to this part of the spine can be debilitating because it may involve sciatic nerve irritation. Herniated disc causes are generally a combination of age-related degeneration, being overweight/obese, trauma, a sedentary lifestyle, and overloading of the spine. (Cleveland Clinic, 2021)

Symptoms

The most common symptoms include: 

Back Pain

  • Caused by nerve irritation, muscle spasms, and inflammation.

Radiculopathy

  • Abnormal signaling of the nerves.

Electrical Shooting Pain

  • Nerve pressure can cause abnormal sensations, commonly experienced as electric shooting pains.
  • For low back herniations, the shocks go down one or both legs.

Tingling – Numbness

  • There are often abnormal sensations such as tingling, numbness, or pins and needles down one or both legs.

Muscle Weakness

Bowel – Bladder Symptoms

  • These symptoms may signal cauda equina syndrome, a rare condition resulting from a herniated disc between the L5 vertebrae and the first vertebrae of the sacrum.

Diagnosis

Diagnosing a herniated disc as the cause of low back leg pain involves testing sensation, muscle strength, and reflexes. MRI also aids this process (American Association of Neurological Surgeons, 2024). MRIs can often show herniated discs and other abnormalities, especially in older patients.

Treatment

A herniated disc treatment plan is based on patient symptoms, physical examination findings, and imaging results. Most herniated disc symptoms resolve themselves in four to six weeks. Lower back pain is generally treated conservatively through:

  • Topical pain ointments or creams for muscle spasms.
  • Non-surgical decompression relieves pressure, activates healing, and restores circulation and nutrients.
  • Chiropractic adjustments realign the spine and musculoskeletal system.
  • Massage loosens the muscles and maintains their relaxation.
  • NSAIDs to reduce inflammation. (Cleveland Clinic, 2021)
  • Total rest is never recommended, even if movement is challenging,
  • Exercise and stretching help avoid muscle degeneration and strengthen the muscles.
  • Relaxation techniques and other natural pain therapies can help manage symptoms and restore overall health.
  • Pain-blocking injections which can include anesthetics or corticosteroids at the source (Cleveland Clinic, 2021)
  • Surgery is recommended only when conservative treatments are ineffective after six weeks, if there is significant muscle weakness from nerve damage, or if motor functions are compromised. (American Association of Neurological Surgeons, 2024)

Injury Medical Chiropractic and Functional Medicine Clinic

Chiropractic therapy is among the more conservative treatment options and may be tried first before proceeding with surgery. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other associated medical professionals to integrate a treatment plan to improve the body’s flexibility and mobility and resolve musculoskeletal issues.


Disc Herniation


References

Dydyk AM, Ngnitewe Massa R, Mesfin FB. Disc Herniation. [Updated 2023 Jan 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: www.ncbi.nlm.nih.gov/books/NBK441822/

Cleveland Clinic. (2021). Herniated disc. my.clevelandclinic.org/health/diseases/12768-herniated-disk

American Association of Neurological Surgeons. (2024). Herniated disc. www.aans.org/patients/conditions-treatments/herniated-disc/

The Benefits of a Ketogenic Diet: Achieving Optimal Health

The Benefits of a Ketogenic Diet: Achieving Optimal Health

Can individuals dealing with pain and inflammation in their bodies can incorporate a ketogenic diet and have beneficial results?

Introduction

When it comes to a person’s health and wellness journey, many people often wonder where to start making changes in their bodies. Many people begin exercising not only to reduce stress levels in the musculoskeletal system but also to help clear their minds. This is a great cause, as any form of physical activity can help reduce muscle fatigue and weakness and strengthen the extremities and quadrants in the musculoskeletal system. However, even though exercising is part of the health and wellness journey, another component plays a crucial part in the health and wellness journey: eating nutritional foods and dieting. Now, dieting can be scary for some newcomers who are just entering their health and wellness journey, but when people start making small changes to their eating habits, like incorporating more vegetables and fruits in their meals, making more meals at home, and doing portion control to eat enough till they are full can provide beneficial results. These small changes can empower individuals to take control of their health and wellness journey. Dieting and changing eating habits can give useful results for people dealing with chronic issues correlated with environmental factors. In today’s article, we will look at a particular diet known as the ketogenic diet, its beneficial properties, and how to incorporate it to reduce chronic conditions affecting the body. We talk with certified associated medical providers who provide our patients’ information to assess how incorporating the ketogenic diet can help reduce chronic conditions. We also inform patients while asking their associated medical provider intricate questions to formulate customized treatment plans to help with chronic conditions by incorporating the ketogenic diet along with physical activities. Dr. Alex Jimenez, D.C., includes this information as an academic service. Disclaimer.

 

What Is the Ketogenic Diet?

Do you often feel extremely thirsty throughout the day, and do you chug at least a couple of gallons of water daily? Do you feel heat or see redness in various locations around your body that seem tender when touched? Or do your joints become stiff in the mornings when you wake up and feel better throughout the entire day? Often, people have a love-hate relationship with food. However, it all depends on what the person is eating and what environmental factors correlate with their food. So, when a person has chronic conditions that cause pain and inflammation in their joints, muscles, and organs, the negative side effects are that the food they consume can induce the inflammatory effects. In contrast, the positive impact of food can help individuals dampen the pain and inflammation in the body. (Fifi & Holton, 2020) Many individuals dealing with inflammation and pain in their bodies can incorporate a ketogenic diet to reduce the inflammatory effects.

 

 

Now, what is the ketogenic diet? The ketogenic diet is where carbohydrates are low, and various levels of lean proteins and healthy fats induce ketosis. (McGaugh & Barthel, 2022) This, in turn, helps with alternating the metabolic pathways to induce weight loss, improve health conditions like lipid profile improvements, and reduce hyperglycemia. When environmental factors like obesity, sedentary lifestyles, or physical inactivity can cause chronic issues like lipedema, the body will cause overlapping risk profiles to induce inflammation. When the body is dealing with lipedema, it can cause the body to be in a constant inflammatory state that induces cell damage and cell death through apoptosis. Hence, when a person is going to do a ketogenic diet, it can help reduce the inflammatory effects while alleviating pain symptoms. (Verde et al., 2023)

 


Eating Right To Feel Better-Video


The Beneficial Properties Of A Ketogenic Diet

One of the beneficial properties that a person can take with a ketogenic diet is that it can help reduce cardiovascular diseases with its anti-inflammatory properties. Since a ketogenic diet helps place the body in a state of nutritional ketosis, incorporating omega-3 fatty acids can help the body exert systemic anti-inflammatory effects and begin healing. (Dynka et al., 2023) At the same time, the ketogenic diet can help individuals who are suffering from chronic conditions like epilepsy, diabetes, or obesity to not only induce weight loss but also help improve body composition. (Sjodin et al., 2020) This is because when individuals get a customized treatment plan incorporating the ketogenic diet, it must include physical activities that help strengthen muscles in the body’s quadrants. In contrast, the ketogenic diet helps slow down muscle glycogen depletion. Additionally, the ketogenic diet is beneficial by:

  • Reducing glucose levels so individuals with diabetes don’t need insulin.
  • Restrict carbohydrate intake
  • Moderate protein consumption
  • Increasing fat consumption for calories (Dowis & Banga, 2021)

 

Ketogenic Diet Reducing Chronic Conditions

When it comes to the ketogenic diet, many individuals have dealt with chronic conditions like epilepsy, diabetes, or cardiovascular conditions. Understand that incorporating a healthy diet filled with healthy fats, lean protein, plenty of fruits and vegetables, and physical activity can benefit many individuals in the long run. The ketogenic diet can help the liver by producing more ketone bodies to help with the production of ATPs and reduce ROS (reactive oxygen species); this, in turn, helps improve a person’s quality of life. (Abboud et al., 2021) Informing individuals who are dealing with chronic conditions that they must make small changes to their routines. This can be incorporated into their customized treatment plan and help reduce the pain-like effects from the person’s chronic conditions correlating to the inflammatory effects. The ketogenic diet can be a stepping stone to a person’s health and wellness and help them be motivated to see positive results.

 


References

Abboud, M., AlAnouti, F., Georgaki, E., & Papandreou, D. (2021). Effect of Ketogenic Diet on Quality of Life in Adults with Chronic Disease: A Systematic Review of Randomized Controlled Trials. Nutrients, 13(12). doi.org/10.3390/nu13124463

Dowis, K., & Banga, S. (2021). The Potential Health Benefits of the Ketogenic Diet: A Narrative Review. Nutrients, 13(5), 1654. doi.org/10.3390/nu13051654

Dynka, D., Kowalcze, K., Charuta, A., & Paziewska, A. (2023). The Ketogenic Diet and Cardiovascular Diseases. Nutrients, 15(15). doi.org/10.3390/nu15153368

Fifi, A. C., & Holton, K. F. (2020). Food in Chronic Pain: Friend or Foe? Nutrients, 12(8). doi.org/10.3390/nu12082473

McGaugh, E., & Barthel, B. (2022). A Review of Ketogenic Diet and Lifestyle. Mo Med, 119(1), 84-88. www.ncbi.nlm.nih.gov/pubmed/36033148

www.ncbi.nlm.nih.gov/pmc/articles/PMC9312449/pdf/ms119_p0084.pdf

Sjodin, A., Hellstrom, F., Sehlstedt, E., Svensson, M., & Buren, J. (2020). Effects of a Ketogenic Diet on Muscle Fatigue in Healthy, Young, Normal-Weight Women: A Randomized Controlled Feeding Trial. Nutrients, 12(4). doi.org/10.3390/nu12040955

Verde, L., Camajani, E., Annunziata, G., Sojat, A., Marina, L. V., Colao, A., Caprio, M., Muscogiuri, G., & Barrea, L. (2023). Ketogenic Diet: A Nutritional Therapeutic Tool for Lipedema? Curr Obes Rep, 12(4), 529-543. doi.org/10.1007/s13679-023-00536-x

 

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The Best 7 Exercises to Incorporate for a Healthy Spine

The Best 7 Exercises to Incorporate for a Healthy Spine

Can incorporating these 7 exercises help individuals dealing with back pain help promote a healthy spine and functionality?

Introduction

Many individuals have dealt with back pain in their body’s upper, middle, and lower portions, which can correlate with other issues in the upper and lower body extremities. This is due to how many environmental factors affect a person’s daily routine. From stressful days that impact a person’s day to physical inactivity or even spinal issues that have developed over time can cause back pain. When individuals decide to make changes in their health and wellness journey to not only reduce back pain but also improve how they present themselves. Many individuals can start with exercises to reduce back pain and help their spinal health by making sure that they are doing it correctly to prevent injuries. Today’s article looks at how spinal issues correlate with back pain and how these seven simple exercises and stretches can help reduce lower back pain and help you have a healthy spine. We talk with certified associated medical providers who provide our patients’ information to assess back pain correlated with their spine. We also inform patients while asking their associated medical provider intricate questions to formulate customized treatment plans to reduce back pain by integrating exercises to help reduce the pain and promote wellness. Dr. Alex Jimenez, D.C., includes this information as an academic service. Disclaimer.

 

Spinal Issues Correlating To Back Pain

Do you feel stiffness or muscle aches in your back’s upper, middle, or lower areas? Have you noticed that your posture is hunched more than normal when looking at the phone or being on the computer for an extended period? Or does your back ache from lifting a heavy object or sleeping incorrectly? More often than not, these pain-related scenarios are associated with back pain combined with spinal issues. As one of the leading causes of disability, loss of productivity, and more visits to a health clinic, back pain can impact the body and cause individuals to be miserable. (Bang et al., 2021) Back pain can be specific or non-specific and can cause a person’s spine to degenerate through the spinal disc. The spinal disc provides stability, flexibility, and mobility to the spine, which then helps keep the host upright. However, as the body ages, so does the spine, as lower back pain is multifactorial. When the spinal disc degenerates, the spine has a reduced capacity for intrinsic self-repair within the tissues. (Mohd Isa et al., 2022)

 

 

At the same time, when many individuals are dealing with low back pain, depending on the severity of the issue, they will often change their gait mechanics by adapting different strategies to mitigate the loading on the primary muscles associated with the locomotion that protects the pain-producing tissues. (Smith et al., 2022) When that happens, the pain from the lower back muscles can aggravate the spine further and lead to more chronic issues; however, there are ways to reduce the effects of lower back pain and to help keep the spine healthy.

 



The 7  Exercises To Incorporate For Back Pain

When it comes to making sure that lower back pain can be reduced and to help with keeping a healthy spine, many people often seek out physical therapy to reduce the pain. Since low back pain is costly in a clinical approach, physical therapy is cost-effective, non-invasive, and can help individuals get a kick start in their health journey. Physical therapy involves whole-body movement that emphasizes breathing coordination, reducing pain from the lower back, and helping stabilize the lumbar spine to improve physical function. (Li et al., 2023) By going through a treatment plan that incorporates physical therapy, many individuals will begin to notice their pain is improving and their quality of life is getting better. (Fischer et al., 2021) Additionally, stretching and core stability exercises can activate the deep and superficial spinal muscles by strengthening them and help stretch out sore muscles affected by low back pain to help many individuals recover. (Calatayud et al., 2019) Below are seven exercises that can help reduce back pain and, when done correctly and consecutively, can help many individuals have a healthier spine while being more mindful of their bodies.

 

Knee-To-Chest Exercise

This knee-to-chest exercise can help stretch the lower back muscles and can be done in the morning or evening.

  • Lying on your back with knees bent and feet flat for stability.
  • Pull one knee up with both hands and press it towards your chest.
  • Keep the stomach muscles tight while pressing your spine to the floor, holding for at least 30 seconds before returning to position.
  • Repeat with the other knee and do each stretch 2-3 times.

 

Lower Back Rotational Stretch (On the Floor)

This lower back rotational stretch can help stretch tight muscles in the lower back.

  • Laying on the mat, ensure you are on your back with knees bent and feet flat.
  • Make sure the shoulders are firmly on the floor, and slowly roll the knees to one side until 45 degrees.
  • Hold that position for 30 seconds before slowly rotating the knees back to the starting position.
  • Repeat on the other side and do each stretch 2-3 times.

 

Lower Back Flexibility Exercise

This lower back flexibility will help stretch and strengthen the lower back and core muscles.

  • Lay flat on the mat. For stability, make sure that the knees are bent with feet are flat on the floor.
  • Tighten the stomach muscles so the lower back can be pulled away from the floor.
  • Hold the position for 5 seconds and relax, slowly lowering to the floor.
  • Flatten the back as your belly button starts to go towards the floor, and hold the position for 5 seconds before relaxing.
  • Do five repetitions a day to slowly work up to 30 reps.

 

Bridge Exercise

The bridge exercise can help with core stability and help strengthen core muscles.

  • Laying flat on your back on the floor, with knees bent and feet flat. Make sure that your shoulders and head are relaxed.
  • Tighten the core and glute muscles while slowly raising from the hips to form a straight line from the knees to the shoulders.
  • Stay in that position for 30 seconds while taking deep breaths.
  • Slowly go down to the floor and relax.
  • Do five repetitions a day to slowly work up to 30 reps.

 

Cat-To-Cow Stretch

The cat-to-cow stretch helps with shoulders, upper back, and lower back muscles.

  • On your hands and knees, hip-width apart on the mat, be in a neutral spine position.
  • Slowly arch your back by pulling your belly towards the ceiling and your head down for 30 seconds.
  • Then, slowly let the back and belly sag towards the floor as the head rises for 30 seconds.
  • Return to the neutral spine position and repeat about 3-5 times twice daily.

 

Lower Back Rotational Stretch (Seated)

This lower back rotational stretch is seated if the floor is uncomfortable for individuals with severe back pain.

  • Sitting in an armless chair or stool in a seated upright position, cross one leg over the other.
  • Then, place the left elbow against the outside of the right knee and twist and stretch the side.
  • Hold the postion for 10 seconds before slowly returning to a seated position.
  • Repeat the stretch on the opposite side.
  • Do this stretch 3-5 times on each side to stretch tight back muscles about twice daily.

 

Shoulder Blade Squeeze

This shoulder blade squeeze helps individuals properly posture while stretching and strengthening tight upper back and shoulder muscles.

  • Start in a seated upright position on an armless chair or stool.
  • Slowly pull the shoulder blades together in the upright position and hold for 5-30 seconds.
  • Relax, return to the upright position, and repeat 3-5 times twice daily.

 


References

Bang, A. A., Bhojraj, S. Y., & Bang, A. T. (2021). Back pain and musculoskeletal pain as public health problems: Rural communities await solution. J Glob Health, 11, 01007. doi.org/10.7189/jogh.11.01007

Calatayud, J., Escriche-Escuder, A., Cruz-Montecinos, C., Andersen, L. L., Perez-Alenda, S., Aiguade, R., & Casana, J. (2019). Tolerability and Muscle Activity of Core Muscle Exercises in Chronic Low-back Pain. Int J Environ Res Public Health, 16(19). doi.org/10.3390/ijerph16193509

Fischer, S. C., Calley, D. Q., & Hollman, J. H. (2021). Effect of an Exercise Program That Includes Deadlifts on Low Back Pain. J Sport Rehabil, 30(4), 672-675. doi.org/10.1123/jsr.2020-0324

Li, Y., Yan, L., Hou, L., Zhang, X., Zhao, H., Yan, C., Li, X., Li, Y., Chen, X., & Ding, X. (2023). Exercise intervention for patients with chronic low back pain: a systematic review and network meta-analysis. Front Public Health, 11, 1155225. doi.org/10.3389/fpubh.2023.1155225

Mohd Isa, I. L., Teoh, S. L., Mohd Nor, N. H., & Mokhtar, S. A. (2022). Discogenic Low Back Pain: Anatomy, Pathophysiology and Treatments of Intervertebral Disc Degeneration. Int J Mol Sci, 24(1). doi.org/10.3390/ijms24010208

Smith, J. A., Stabbert, H., Bagwell, J. J., Teng, H. L., Wade, V., & Lee, S. P. (2022). Do people with low back pain walk differently? A systematic review and meta-analysis. J Sport Health Sci, 11(4), 450-465. doi.org/10.1016/j.jshs.2022.02.001

 

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Reducing Stress for Improved Gut Health: A Practical Approach

Reducing Stress for Improved Gut Health: A Practical Approach

Can individuals reduce stress affecting their daily routine through treatments to restore their gut health?

Introduction

Everybody in the entire world has dealt with stress at some point in their lives and has experienced general aches and pains in their bodies. This is due to the hormone cortisol, which helps regulate the entire body’s response. Stress has two forms, acute and chronic, and depending on the scenario a person is under, it correlates with stress and can even impact the major body systems. When dealing with acute stress, the muscles start to tense up at the stressor and go into a fight-or-flight mode until the stressor is gone and the individual can begin to relax. However, if the individual is dealing with chronic stress, it can cause numerous overlapping issues that can lead to digestive issues affecting the gut system. When the gut system is acting up from the cortisol hormone in its chronic form, many people will begin to notice small changes that are affecting their health and well-being. Today’s article examines why gut issues induce stress, how individuals can reduce stress naturally, and how people can restore their gut health. We talk with certified associated medical providers who provide our patients’ information to assess gut issues associated with stress that is affecting their health and wellness. We also inform patients while asking their associated medical provider intricate questions to formulate customized treatment plans to reduce the effects of stress correlating to gut health. Dr. Alex Jimenez, D.C., includes this information as an academic service. Disclaimer.

 

Why Gut Issues Induced Oxidative Stress?

How often does your body tense up and slowly relax after a stressful situation? Do you experience general aches or pains in your muscles and joints? Or do you feel tenderness and discomfort in your gut? When people are experiencing chronic oxidative stress in their bodies, they sometimes don’t realize that their gut also plays a part. This is because the gut is known as “the second brain” and helps regulate the immune response while protecting the body from unwanted pathogens. However, dealing with a large amount of stress from environmental factors can cause alterations in the immune system’s response and disrupt the delicate balance between the individual and the gut microbiota. (Sharifa et al., 2023) Since gut issues can vary from person to person, it is important to note that when environmental factors cause overlapping risk profiles, it can modify or change the gut microbiota composition of the host.

 

 

The gut system, which harbors a large number of beneficial microbial cells, plays a crucial role in the human body. These cells help stimulate the immune system’s maturity and play a role in cognitive performance and stress tolerance. (Marttinen et al., 2020) However, when a person has a poor diet, not physically active, or leads a stressful lifestyle due to their jobs, these environmental factors can cause the development of gut issues over time and contribute to the increase of oxidative stress in the body. (Vasquez et al., 2019) Additionally, many people dealing with chronic stress will often notice their skin feeling a bit warmer, they feel bloated, they will often experience fatigue throughout the day, and experience weight changes. So when the gut system is experiencing high levels of stress from environmental factors, the intestinal epithelial permeability will begin to activate the T-cells that will destroy the immunosuppressive cytokines which leads to systemic inflammation to the body. (Ni et al., 2022) However, there are numerous ways to reduce stress and to help restore gut health naturally.

 


Fighting Inflammation Naturally- Video


How To Reduce Stress Naturally

When it comes to reducing stress naturally, the first step is to recognize the stressors. Many individuals can start off small by making small changes to their health and wellness. Incorporating meditation, journalling, chiropractic care, acupuncture, massage therapy, and exercise can help relax the mind, reduce stress from the body, and alleviate musculoskeletal issues that are correlated with the gut and stress. These treatments can help reduce the tension from the muscles being affected by stress, while stretching and relaxing them. Additionally, these therapies are non-surgical, customized to the patient, and help realign the spine to promote healing. By recognizing the stressor, many individuals can make the small changes they need to reduce their stress and prevent them from returning.

 

How To Restore Gut Health

Restoring gut health is crucial to prevent inflammatory issues from reoccurring in the body. The gut microbiota, which contains trillions of bacteria aiding in digestion and nutrient transport, needs to be replenished with good bacteria and reduced bad bacteria to dampen the inflammatory effects caused by stress. One effective way to restore gut health in the body is by incorporating probiotic-rich foods into your diet. These include yogurt, kefir, sauerkraut, and kimchi. These dietary modifications can influence the gut bacteria and restore the gut structure. (Madison & Kiecolt-Glaser, 2019)

 

 

At the same time, probiotics can help stabilize stress cortisol levels and boost the good bacterial microbiota to improve body function by lowering the inflammatory cytokines. (Madabushi et al., 2023) This, in turn, helps restore the gut flora to the gut system. At the same time, when individuals incorporating a healthy diet filled with anti-inflammatory foods and pro/prebiotics can help not only reduce oxidative stress correlated with gut issues but also implement management techniques for stress and exercises that can help improve a person’s quality of life, reduce inflammation from the gut and body, and help enhance the immune response. (Jawhara, 2024) When individuals start to think about their health and well-being, making small changes can lead to positive results and help make sure that no gut issues associated with stress can reoccur. Figuring out what stressors are impacting the gut and making these changes can help prevent them from returning in the future and help that individual live a healthier lifestyle.

 


References

Jawhara, S. (2024). How Do Polyphenol-Rich Foods Prevent Oxidative Stress and Maintain Gut Health? Microorganisms, 12(8). doi.org/10.3390/microorganisms12081570

Madabushi, J. S., Khurana, P., Gupta, N., & Gupta, M. (2023). Gut Biome and Mental Health: Do Probiotics Work? Cureus, 15(6), e40293. doi.org/10.7759/cureus.40293

Madison, A., & Kiecolt-Glaser, J. K. (2019). Stress, depression, diet, and the gut microbiota: human-bacteria interactions at the core of psychoneuroimmunology and nutrition. Curr Opin Behav Sci, 28, 105-110. doi.org/10.1016/j.cobeha.2019.01.011

Marttinen, M., Ala-Jaakkola, R., Laitila, A., & Lehtinen, M. J. (2020). Gut Microbiota, Probiotics and Physical Performance in Athletes and Physically Active Individuals. Nutrients, 12(10). doi.org/10.3390/nu12102936

Ni, Q., Zhang, P., Li, Q., & Han, Z. (2022). Oxidative Stress and Gut Microbiome in Inflammatory Skin Diseases. Front Cell Dev Biol, 10, 849985. doi.org/10.3389/fcell.2022.849985

Sharifa, M., Ghosh, T., Daher, O. A., Bhusal, P., Alaameri, Y. A., Naz, J., Ekhator, C., Bellegarde, S. B., Bisharat, P., Vaghani, V., & Hussain, A. (2023). Unraveling the Gut-Brain Axis in Multiple Sclerosis: Exploring Dysbiosis, Oxidative Stress, and Therapeutic Insights. Cureus, 15(10), e47058. doi.org/10.7759/cureus.47058

Vasquez, E. C., Pereira, T. M. C., Campos-Toimil, M., Baldo, M. P., & Peotta, V. A. (2019). Gut Microbiota, Diet, and Chronic Diseases: The Role Played by Oxidative Stress. Oxid Med Cell Longev, 2019, 7092032. doi.org/10.1155/2019/7092032

 

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Managing Back Pain with SIBO: The Gut Health Connection

Managing Back Pain with SIBO: The Gut Health Connection

Can individuals dealing with back pain find treatment to reduce gut pain associated with SIBO to improve body health?

Introduction

Many individuals have noticed that when it comes to improving their health and well-being, many will incorporate small changes into their daily routines. From exercising for at least 30 minutes to incorporating healthy nutritional foods into their diet, many people don’t realize that the best way to have a healthy style starts with the gut. The gut system helps the body digest food and nutrients to be transported to the body, helps regulate growth and metabolism, and provides immune support to all the organ systems. However, when harmful pathogens and environmental factors start to impact the gut, it can cause the development of harmful pathogens inside the gut system and, over time, cause overlapping risk profiles in the body. This leads to gut dysfunction and musculoskeletal issues in the individual and can cause pain and discomfort if not treated right away. Luckily, numerous ways exist to improve gut health and reduce musculoskeletal issues. Today’s article focuses on a gut issue known as SIBO, how SIBO is correlated with back pain, and what treatments can help reduce SIBO. We talk with certified associated medical providers who provide our patients’ information to assess and identify how SIBO is correlated with back pain. We also inform patients while asking their associated medical provider intricate questions to formulate customized treatment plans to reduce the effects of SIBO and help restore gut health. Dr. Alex Jimenez, D.C., includes this information as an academic service. Disclaimer.

 

What is SIBO?

How often do you feel general aches or pain in your gut or around your lower back? Do you constantly feel tired throughout the day, even after a full night’s rest? Or have you been constantly feeling constipated or bloated after eating a meal? Many of these scenarios are associated with a gut issue known as SIBO or small intestinal bacterial overgrowth. Before diving into what SIBO is, it is important to see the gut’s main function to the body. Known as the second brain of the body, the gut system is home to trillions of good bacteria that help with food digestion and protect the body from bad bacteria. When environmental factors like poor dieting, physical inactivity, or inflammatory effects affect the body, the gut’s delicate ecosystem is also affected. This can cause gut dysfunction to the body and, over time, when it is not being treated, lead to SIBO.

 

SIBO is the presence of excess bad bacteria in the small intestines, which causes protective barriers that help the small intestines weaken. (Sorathia et al., 2024) Additionally, SIBO can correlate with conditions as it can accompany other gut issues by stimulating the immune system. (Banaszak et al., 2023) When the immune system becomes hyperactively stimulated by SIBO, it can cause the inflammatory cytokines to mass produce and cause a ripple effect on the entire body. Since inflammation is the body’s natural response to remove harmful pathogens that cause issues, mass production of inflammatory cytokines in the gut can cause toxins and bad bacteria to enter the bloodstream and travel to different body areas to cause pain. At the same time, SIBO can disrupt the gut-brain axis, which leads to intestinal motility changes and secretion, thus causing overlapping risk profiles like back pain to affect the body. (Carter et al., 2023)

 


Eating Right to Feel Better- Video


How Does Back Pain Correlate With SIBO?

Now, many people are wondering how back pain is correlated with SIBO. Since SIBO causes the immune system to be hyperactive and mass-produce inflammatory cytokines to reduce the integrity and function of the gastrointestinal barrier, it can cause chronic inflammation and induce pain, which includes musculoskeletal conditions like back pain. (Hui et al., 2023) Additionally, the gut-brain axis being over-runed by SIBO and chronic inflammation being an overlapping risk factor can cause negative influences on the gut microbiome composition, and how the individual reacts to the changes can lead to abnormal bone growth and reabsorption due to the excess bacteria. (Geng et al., 2023) The excess bacteria produced by SIBO can affect intervertebral disc homeostasis and, when combined with environmental factors, can further enhance the inflammatory damage to the back muscles. (Yao et al., 2023) However, there are ways to not only reduce the back pain but also treat SIBO from causing more issues in the gut.

 

Treatments To Reduce SIBO

When it comes to treating SIBO, it depends on what treatment a person will be combined. The main goals for creating a treatment plan for SIBO are:

  • Reducing the bad bacteria
  • Bio-transform the gut
  • Preventing a relapse

Additionally, many individuals can make small changes in their routine by making dietary changes that can modify the intestinal microbiota. (Souza et al., 2022) This, in turn, helps promote gut health and replenish the nutrients while restoring the good bacteria to the gut. Regarding back pain associated with SIBO, chiropractic care can help individuals decrease or alleviate musculoskeletal symptoms by realigning the spine while massaging the muscles. This can help increase circulation while soothing the inflammatory effects caused by SIBO. Chiropractic care can be implemented as part of a person’s customizable treatment plan through a whole body approach by incorporating lifestyle changes and restoring gut health. By making these small changes with the right treatments to manage the overlapping symptoms caused by SIBO, many individuals can make these small changes to their routine to prevent SIBO from reappearing and causing issues in the body.

 


References

Banaszak, M., Gorna, I., Wozniak, D., Przyslawski, J., & Drzymala-Czyz, S. (2023). Association between Gut Dysbiosis and the Occurrence of SIBO, LIBO, SIFO and IMO. Microorganisms, 11(3). doi.org/10.3390/microorganisms11030573

Carter, J., Bettag, J., Morfin, S., Manithody, C., Nagarapu, A., Jain, A., Nazzal, H., Prem, S., Unes, M., McHale, M., Lin, C. J., Hutchinson, C., Trello, G., Jain, A., Portz, E., Verma, A., Swiderska-Syn, M., Goldenberg, D., & Kurashima, K. (2023). Gut Microbiota Modulation of Short Bowel Syndrome and the Gut-Brain Axis. Nutrients, 15(11). doi.org/10.3390/nu15112581

Geng, Z., Wang, J., Chen, G., Liu, J., Lan, J., Zhang, Z., & Miao, J. (2023). Gut microbiota and intervertebral disc degeneration: a bidirectional two-sample Mendelian randomization study. J Orthop Surg Res, 18(1), 601. doi.org/10.1186/s13018-023-04081-0

Hui, J., Chen, Y., Li, C., Gou, Y., Liu, Y., Zhou, R., Kang, M., Liu, C., Wang, B., Shi, P., Cheng, S., Yang, X., Pan, C., Jia, Y., Cheng, B., Liu, H., Wen, Y., & Zhang, F. (2023). Insight into the Causal Relationship between Gut Microbiota and Back Pain: A Two Sample Bidirectional Mendelian Randomization Study. Adv Genet (Hoboken), 4(4), 2300192. doi.org/10.1002/ggn2.202300192

Sorathia, S. J., Chippa, V., & Rivas, J. M. (2024). Small Intestinal Bacterial Overgrowth. In StatPearls. www.ncbi.nlm.nih.gov/pubmed/31536241

Souza, C., Rocha, R., & Cotrim, H. P. (2022). Diet and intestinal bacterial overgrowth: Is there evidence? World J Clin Cases, 10(15), 4713-4716. doi.org/10.12998/wjcc.v10.i15.4713

Yao, B., Cai, Y., Wang, W., Deng, J., Zhao, L., Han, Z., & Wan, L. (2023). The Effect of Gut Microbiota on the Progression of Intervertebral Disc Degeneration. Orthopaedic Surgery, 15(3), 858-867. doi.org/10.1111/os.13626

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Taking Action against Trafficking: Implementing a Heart-Clinical Approach

Taking Action against Trafficking: Implementing a Heart-Clinical Approach

Can healthcare professionals implement H.E.A.R.T. protocols for trafficked individuals while providing a safe space?

Introduction

Across the world, many local media and organizations are paying close attention to a phenomenon that many people should be aware of. This phenomenon is known as trafficking, and it can be associated with numerous activities, from forced labor to sex labor, and can affect a person’s sense of self-worth. While many people will correlate that trafficking affects many women and children, it can affect many individuals regardless of age, gender, and background. While many survivors of trafficking are dealing with the psychological and physical injuries that they obtain from their traffickers, many medical professionals can implement protocols and roles through the implementation of H.E.A.R.T. to provide a safe space for individuals suffering from trafficking. Today’s article focuses on the definition of trafficking, what H.E.A.R.T. is, and how it is used in a clinical setting. We discuss with certified associated medical providers who consolidate our patients’ information to assess and identify trafficking in a clinical approach while providing a safe space. We also inform and guide patients while asking their associated medical provider intricate questions to formulate customized treatment plans for their pain and provide them with a safe space and positive experience. Dr. Jimenez, D.C., includes this information as an academic service. Disclaimer.

 

The Definition Of Trafficking

 

When it comes to defining trafficking, it can be challenging as it is frequently associated with other issues. However, the main definition for trafficking is “recruiting, transporting, transferring, or harboring many individuals or a person that are threatened or forced to achieve the consent of a person having control of the individuals for exploitation.” With human trafficking being a pressing public concern that affects all races, social classes, demographics, and genders, it can impact society and the individual who is being trafficked. (Toney-Butler et al., 2024) Additionally, many people often mistake trafficking and smuggling as they are completely different. Smuggling requires a person to be transported into a nation through voluntary illicit means. While trafficking can come in two forms, which are labor and commercial sex, it can happen within the person’s own home. (Rambhatla et al., 2021) This is because many survivors who are going to get healthcare services will feel various emotions of fear or shame that can prevent them from asking for help due to what they have been through with their trafficker. However, when many individuals who are trafficking survivors are suffering from significant physical, mental, and social health problems and are seeking healthcare services, many healthcare professionals play an important role by creating a safe and responsive space for them. (The Lancet Regional Health-Western, 2022)

 


Beyond the Surface: Understanding the Effects of Personal Injury- Video


What is H.E.A.R.T In A Clinical Setting

When it comes to creating a safe and positive space in a clinical setting, many healthcare professionals often miss the signs of trafficking due to a lack of training or confidence to identify and treat patients who are trafficking victims. (Lee et al., 2021) However, healthcare protocols should be implemented, and H.E.A.R.T. should be incorporated into a clinical approach to assess and develop a customized treatment plan for the patient. Healthcare professionals can engage with the patient in a one-on-one discussion away from their trafficker and can offer important medical and psychological care resources. (Exeni McAmis et al., 2022) By incorporating H.E.A.R.T. protocols in a healthcare clinic, many doctors and medical professionals can help many patients be in a safe environment. Below is what H.E.A.R.T. stands for.

 

H-Hearing

The “H” in H.E.A.R.T. is for hearing as many medical professionals not only to hear but to see what is going on in the clinic and to establish environmental awareness. This is due to looking at the patient and who is accompanied by them. With healthcare providers being at the front, they interact with patients and may not know what health concerns are affecting them. This could be due to the following:

  • Language or cultural barriers
  • Fear of criminal repercussions
  • Fear of the trafficker
  • Distrust of the healthcare provider (Gutfraind et al., 2023)

By incorporating the hearing aspect in H.E.A.R.T., many healthcare professionals can provide a safe, thoughtful, and engaging approach to the patient and know what to look for when a patient is coming in for treatment.

 

E-Evaluating

The “E in H.E.A.R.T. is used to evaluate its importance in enhancing patient interactions in a trauma-informed care facility. This is highly important because the individual is seeking health care. For the patients being trafficked, it is important to notice the red flags the individual is experiencing. Some of the red flags that many healthcare providers should look for are:

  • Physical health
  • Behavioral Health
  • The patient is with a controlling person
  • The patient does not have possession of their I.D.

Additionally, it is always important to show compassion, be sensitive to the individual while addressing their needs and concerns, and use a non-judgmental approach during the interview process. This helps the individual ensure they are in a safe environment when discussing sensitive topics. At the same time, it is important not to let the patient be re-traumatized while avoiding the impulse to rescue and overpromise the patient to mental health as we want them to have their self-worth. At the same time, it is best to remember the four “Rs when doing a trauma-informed approach; they are:

  • Realize: Understanding how trauma can affect people.
  • Recognize: Recognizing the signs of trauma.
  • Respond: Have all staff trained, use evidence-based practices, and provide a safe environment.
  • Resist Re-trauma: Recognizing how some practices may trigger painful memories while avoiding re-traumatizing the patient.

By implementing the four “Rs and the “E in H.E.A.R.T., many healthcare professionals can provide valuable resources to trafficking survivors with a strong support system.

 

A-Activating

The “A in H.E.A.R.T. stands for activating, where healthcare professionals must have proper protocols to engage all employees. This allows the healthcare providers to understand how beneficial it is to develop a protocol for a person who is being trafficked, understand their state and federal reporting laws, and list key elements of effective trauma-informed screening procedures when assessing the patient. This allows a foundational structure to support a response for suspected patients who are being trafficked. At the same time, by following HIPAA laws and organization policies, many healthcare providers must explain the reporting process to the right officials. Additionally, the benefits of developing a protocol for trafficking are by:

  • Clarifying procedures
  • Enhance staff training
  • Optimize the interactions with the trafficking patients
  • Improve staff confidence
  • Prepare for any threatening situations
  • Maximizing preparedness to aid trafficking patients
  • Optimize support for patients
  • Develop collaborative outside resources

 

R-Resourcing

The “R in H.E.A.R.T. stands for resourcing, as many healthcare providers must identify the referral systems. This allows healthcare professionals to understand the important message to convey when assessing trafficking victims and the importance of responding to safety, emergency, and reporting requirements. When assessing and interviewing the patient, many will have to recognize that their patient may be a possible victim of trafficking, what their immediate needs are, and what long-term resources can help.

 

T-Training

The “T” in H.E.A.R.T. stands for training, as it is important that many healthcare providers continuously train to spot trafficking; this provides confidence to many healthcare workers and can help save a person’s life. By implementing H.E.A.R.T. protocols, the “T” allows the doctor to respect the individual’s decision to want help, providing a positive support system while encouraging them to come back, offering to help with a safety plan, and building a resource network. This is because if the patient is accompanied by someone who is controlling and answering for the patient, handing out information discreetly can provide a bit of hope to the individual to make the move. At the same time, providing local and immediate assistance resources can help the individual in the long run. This allows healthcare providers to build a trusting relationship and even help individuals to have a safe and positive experience on their health and wellness journey.

 


References

Exeni McAmis, N. E., Mirabella, A. C., McCarthy, E. M., Cama, C. A., Fogarasi, M. C., Thomas, L. A., Feinn, R. S., & Rivera-Godreau, I. (2022). Assessing healthcare provider knowledge of human trafficking. PLOS ONE, 17(3), e0264338. doi.org/10.1371/journal.pone.0264338

Gutfraind, A., Yagci Sokat, K., Muscioni, G., Alahmadi, S., Hudlow, J., Hershow, R., & Norgeot, B. (2023). Victims of human trafficking and exploitation in the healthcare system: a retrospective study using a large multi-state dataset and ICD-10 codes. Front Public Health, 11, 1243413. doi.org/10.3389/fpubh.2023.1243413

Lee, H., Geynisman-Tan, J., Hofer, S., Anderson, E., Caravan, S., & Titchen, K. (2021). The Impact of Human Trafficking Training on Healthcare Professionals’ Knowledge and Attitudes. J Med Educ Curric Dev, 8, 23821205211016523. doi.org/10.1177/23821205211016523

Rambhatla, R., Jamgochian, M., Ricco, C., Shah, R., Ghani, H., Silence, C., Rao, B., & Kourosh, A. S. (2021). Identification of skin signs in human-trafficking survivors. Int J Womens Dermatol, 7(5Part B), 677-682. doi.org/10.1016/j.ijwd.2021.09.011

The Lancet Regional Health-Western, P. (2022). Human trafficking is more than a crime. Lancet Reg Health West Pac, 20, 100444. doi.org/10.1016/j.lanwpc.2022.100444

Toney-Butler, T. J., Ladd, M., & Mittel, O. (2024). Human Trafficking. In StatPearls. www.ncbi.nlm.nih.gov/pubmed/28613660

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