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.
How do healthcare professionals provide a clinical approach to recognizing trafficking to individuals seeking a safe environment?
Introduction
Around the world, there is a phenomenon that local media and organizations are paying more attention to and that many people should be aware of. This is known as trafficking, and it can encompass a wide range of activities, from forced labor in various industries to sex work. While most individuals of trafficking are usually young women or children, it can affect many individuals of all ages and backgrounds. Many survivors of trafficking are compelled to live with the psychological and physical injuries they sustained from the mistreatment they endured at the hands of their traffickers. This course aims to give medical professionals and others in allied fields an understanding of the realities of human trafficking, as well as the kinds of resources and interventions that can be used to help many individuals trafficking in this two-part series. Today’s article overviews trafficking and how it can impact the individual. In part two, we will discuss the roles and protocols of how healthcare professionals can identify trafficking while providing a safe and positive space for the individual. We discuss with certified associated medical providers who consolidate our patients’ information to assess and identify trafficking in the clinic. We also inform and guide patients while asking their associated medical provider intricate questions to integrate a customized treatment plan for their pain and provide them with a safe and positive space. Dr. Jimenez, D.C., includes this information as an academic service. Disclaimer.
The Definition of Trafficking
It can be challenging to define trafficking since it frequently coexists with other problems like forced marriage, sexual assault, domestic abuse, and forced labor. (Hume & Sidun, 2017) As the United Nations stated, trafficking encompasses the following activities: “as recruitment, transportation, transfer, harboring, or receipt of many individuals using the threat or use of force to achieve the consent of a person having control over another person, for exploitation.” (United Nations Human Rights Office of the High Commissioner, n.d.) The following components of this definition include:
Act: This is a reference to the different forms of human trafficking, including the hiring, transferring, receiving, and harboring of individuals.
Means: Coercion, force, fraud, kidnapping, deception, abuse of power or weakness, or providing cash or other rewards to someone in a position of authority over the victim are typically used to carry out trafficking.
Purpose: Traffickers engage in forced labor, prostitution, sexual exploitation, forced servitude, slavery, and even organ harvesting to further their financial interests.
While the terms are occasionally used synonymously, human trafficking and people smuggling are not the same. Human smuggling is the transportation of a person into the nation by illicit means; it is voluntary, as the person smuggled usually offers compensation to another individual or party to achieve this purpose (Lusk & Lucas, 2009).
The broad term of human trafficking in the Trafficking Victims Protection Act includes both labor trafficking and sex trafficking. Sex trafficking is when someone is under the age of 18 and is obtained, patronized, or solicited for a commercial sex act by deception, force, or compulsion. The forced, coerced, or fraudulent submission of an individual to slavery, debt bondage, involuntary servitude, or peonage is considered labor trafficking. According to the U.S. Congress, the TVPA does not require that trafficking take place if a person is physically moved from one location to another.
The Statistics Of Trafficking
Determining the actual extent of the problem is challenging due to the complexity of the human trafficking issue and the fact that both the offenders and the victims frequently go unnoticed. A few published estimates from academics, researchers, and organizations and agencies responsible for recording and monitoring occurrences of human trafficking are as follows:
According to estimates from the International Labour Organization, there are over 40 million victims of human trafficking worldwide. (International Labour Organization, n.d.)
Over 51,000 complaints of cases of human trafficking have been received by the National Human Trafficking Hotline since 2007 (National Human Trafficking Hotline, n.d.).
The number of persons thought to be trafficked in the United States varies greatly from year to year, with estimates ranging from 40,000 to 50,000. (Weizter, 2007)
In 2017, the United States Department of Justice obtained 1,045 convictions for offenses related to human trafficking, a 78% increase from 2015. (International Labour Organization, n.d.).
According to the International Labour Organization, over 15 million people are in forced marriages, 4.8 million people are victimized by sex trafficking, and forced labor trafficking claims the lives of almost 25 million people globally. (International Labour Organization, 2017)
In the US, Florida is the third-most popular destination for victims of human trafficking. In 2018, there were 767 reports of human trafficking incidents in Florida and close to 1,900 contacts with the National Human Trafficking Hotline. There was almost 70% of sex trafficking, 16.5% of labor trafficking, and 7.5% of both sex and labor trafficking combined. Of the victims, 56% were adults, and 69% were female (National Human Trafficking Hotline, n.d.).
Data Collection Challenges
The current ICD-10-CM abuse codes could not adequately distinguish victims of human trafficking from other abuse victims, even though an increasing number of caregivers are trained to recognize and record individuals of different forms of human trafficking. Clinicians couldn’t properly identify a condition or arrange the resources needed to administer treatment without the right codes. Additionally, this made it impossible to critically monitor the existence and recurrence of human labor or sexual exploitation.
June 2018 saw the publication of the first ICD-10-CM codes for categorizing abuse related to human trafficking, as requested by the American Heart Association’s Hospitals Against Violence program. The proposal for the modification came from the AHA’s Central Office on ICD-10, which collaborated with Catholic Health Initiatives, the Human Trafficking Initiative at Massachusetts General Hospital, and the Freedom Clinic. With effect from FY 2019, certain ICD-10-CM codes can be used to collect data on adult or child forced labor or sexual exploitation, whether it is proven or suspected. These new codes may be issued in addition to other current ICD-10-CM codes for abuse, neglect, and other maltreatment. These codes received support from different hospitals and health systems. Furthermore, there exist novel codes that can be utilized to record an individual’s past labor or sexual exploitation history, examine, rule out, and observe instances of exploitation, and identify multiple, repeating perpetrators of maltreatment and neglect through an external cause of code (Macias-Konstantopoulos, 2018).
The ICD-10-CM provides specific abuse codes for a range of abuse experiences, such as physical abuse of an older adult, sexual abuse of a child, and violence against a spouse or partner. Similar to how disease diagnosis codes are used, tracking the frequency and trends of particular abuse types, their relationships to other injuries and illnesses, and the kinds of resources that might be needed to stop the abuse are all made feasible by recording abuse using the relevant ICD-10-CM code. Adopting prevention strategies, creating best practices for treatment, introducing new services and payment methods, and establishing new financing and research fields are all made possible by using these codes as the primary diagnosis (Macias-Konstantopoulos, 2018).
Documenting particular types of violence and abuse alone does not give a full picture of the abuse experience. Every abuse experience is a result of a complex interaction between several variables, including the physical surroundings, social and familial dynamics, and personal risks and vulnerabilities. Healthcare professionals can respond to illnesses and injuries connected to abuse as well as underlying health-related social and mental requirements more effectively when these aspects are assessed, documented, and coded using ICD-10-CM Z codes. Similarly, applying ICD-10-CM S, T, V, W, X, and Y codes to record and classify external causes of morbidity as well as the nature, purpose, and mechanism of injury can help shed light on how abuse and violence are committed and pave the way for further preventative measures (Macias-Konstantopoulos, 2018).
Required Actions
Coders should be aware of and start using the ICD-10-CM codes for forced labor and sexual exploitation as they examine a patient’s medical records to determine which ICD-10-CM codes to include.
Hospitals and health systems should inform those who need to know—doctors, nurses, other medical professionals, and coding specialists, among others—about the significance of gathering data on forced labor and sexual exploitation of people.
By keeping track of verified and suspected cases within the healthcare system, hospitals, and health systems can better monitor victim requirements and find ways to enhance community health.This practice also offers an additional means of gathering data to help the systemic creation of a service and resource infrastructure, as well as attempts to prevent harm and inform public policy.
The accompanying chart illustrates the distinction between focused and comprehensive assessment, documentation, and coding of abuse. It also highlights how these differences may affect medical professionals’ reactions to cases and their comprehension of the kinds of resources that may be required to help victims of human trafficking (Macias-Konstantopoulos, 2018).
Beyond the Surface: Understanding the Effects of Personal Injury- Video
Common Misconceptions of Trafficking
There is a misconception that trafficking entails the kidnapping and crossing of national or international borders for various activities to individuals. This misconception fails to acknowledge that individual trafficking can be of any ethnicity, gender, or country and that it can happen almost anywhere and in any sector of the economy. A handful of the widespread myths about human trafficking are as follows:
Myth: Physical violence is a common part of trafficking. Traffickers frequently employ nonviolent tactics, such as deception, manipulation, intimidation, and deceit, to coerce their victims into exploitative circumstances, even while physical violence plays a role in many of their crimes.
Myth: Sexual exploitation is a necessary component of trafficking. It’s likely the most well-known type of trafficking, but commercial sexual exploitation of victims is also a frequent practice. However, experts think that labor trafficking is more commonplace throughout the world.
Myth: Only undocumented foreign nationals are victims of trafficking.The Polaris Project operates the National Human Trafficking Hotline, which has handled thousands of cases of trafficking involving foreign nationals who are lawfully employed or residing in the United States.
Myth: Only illicit or covert sectors are involved in trafficking. Trafficking has been documented concerning several legitimate industries, including manufacturing, restaurants, cleaning services, and construction.
Myth: Transporting a person across state or national borders is a part of trafficking. Human smuggling is the illicit movement of persons across state or national borders. There can be trafficking even when there is no cross-border travel. A person may even become a victim of trafficking in their own house or hometown.
Myth: Trafficking is always a part of the commercial sex trade. Any commercial sex with kids is invariably seen as human trafficking. Adult commercial sex is only classified as trafficking when the victim is coerced, compelled, or deceived into doing it against their will.
Common Forms of Trafficking
There are many forms of trafficking as many individuals that were trafficked are categorized into the following:
Sex Trafficking
Bonded Labor/Forced Labor
Child Labor
Child Conscription
The Impact & Consequences of Trafficking on Individuals
For someone who has never experienced human trafficking, it might be challenging to understand why so many victims choose to remain silent or show such a strong willingness to cooperate with their traffickers (Johnson, 2012). According to Baldwin, Fehrenbacher, and Eisenman (2015), the victim’s compliance and quiet are influenced by the following elements, which the quiet Compliance Model explains:
Coercion: Traffickers use violence, intimidation, and depriving the individual of basic needs to force them into obedience. Traffickers may employ psychological strategies, including isolation, degrading treatment, and induced tiredness in addition to physical force. As a result, the individual experiences a distorted sense of reality and feels helpless.
Collusion: The victim’s cooperation with their traffickers in trafficking or other illicit activities may result from a combination of factors, including fear, loneliness, total dependence, and even a sense of identification with the trafficker.
Contrition: The victims’ guilt and regret for their acts, despite the coerced collaboration, only serve to guarantee their quiet (Johnson, 2013).
Trafficking individuals are susceptible to a wide range of health issues, including chronic illnesses brought on by inadequate working conditions or malnourishment, unwanted pregnancies, severe injuries, and STDs. It’s crucial to remember that emotional issues are often experienced as physical illnesses or sensations in certain cultures. For instance, depression, stress, or anxiety may manifest as symptoms of exhaustion, headaches, or gastrointestinal issues (Greenbaum, 2018; Zimmerman, Hossain, & Fun, 2008).
Conclusion
It is important to recognize the signs of trafficking in individuals who have been dealing with these issues. In part 2 of this series, we will look at how healthcare workers are identified and what procedures to take when a patient is trafficked. This allows the individual to know they are in a safe and positive environment to get the help they deserve.
References
Baldwin, S. B., Fehrenbacher, A. E., & Eisenman, D. P. (2015). Psychological Coercion in Human Trafficking. Qualitative Health Research, 25(9), 1171-1181. doi.org/10.1177/1049732314557087
Greenbaum, V. J. (2017). Child sex trafficking in the United States: Challenges for the healthcare provider. PLoS Med, 14(11), e1002439. doi.org/10.1371/journal.pmed.1002439
Hume, D. L., & Sidun, N. M. (2017). Human Trafficking of Women and Girls: Characteristics, Commonalities, and Complexities. Women & Therapy, 40(1-2), 7-11. doi.org/10.1080/02703149.2016.1205904
Lusk, M., & Lucas, F. (2008). The challenge of human trafficking and contemporary slavery. Journal of Comparative Social Welfare, 25(1), 49–57. doi.org/10.1080/17486830802514049
Macias-Konstantopoulos, W. L. (2018). Diagnosis Codes for Human Trafficking Can Help Assess Incidence, Risk Factors, and Comorbid Illness and Injury. AMA J Ethics, 20(12), E1143-1151. doi.org/10.1001/amajethics.2018.1143
Parreñas, R. S., Hwang, M. C., & Lee, H. R. (2012). What Is Human Trafficking? A Review Essay. Signs: Journal of Women in Culture and Society, 37(4), 1015–1029. doi.org/10.1086/664472
Saiz Echezarreta, V., Alvarado, C., & Gómez-Lorenzini, P. (2018). Advocacy of trafficking campaigns: A controversy story. Comunicar, 26(55), 29–38. doi.org/10.3916/c55-2018-03
Weitzer, R. (2007). The Social Construction of Sex Trafficking: Ideology and Institutionalization of a Moral Crusade. Politics & Society, 35(3), 447-475. doi.org/10.1177/0032329207304319
Zimmerman, C., Hossain, M., Yun, K., Gajdadziev, V., Guzun, N., Tchomarova, M., Ciarrocchi, R. A., Johansson, A., Kefurtova, A., Scodanibbio, S., Motus, M. N., Roche, B., Morison, L., & Watts, C. (2008). The health of trafficked women: a survey of women entering posttrafficking services in Europe. Am J Public Health, 98(1), 55-59. doi.org/10.2105/AJPH.2006.108357
How do healthcare professionals provide a clinical approach to recognizing HIV for individuals in pain and providing relief?
Introduction
The human body has dealt with various environmental factors, injuries, and pathogens that can cause issues to the body system. As many individuals are always on the go from one location to another, being healthy is extremely important. Making time to make an appointment for a person’s health and well-being is extremely important, as many people have experienced comorbidities and overlapping risk profiles that are causing them pain. When individuals experience onset issues of fatigue, muscle and joint pain, or immune disorders, many healthcare professionals must assess the situation and ask the individuals when they experienced these overlapping risk profiles and how they affect their daily activities. One of the overlapping risk profiles that seems to affect the body is a viral infection known as Human Immunodeficiency Virus or HIV. This can get many healthcare professionals to come up with a personalized treatment plan to reduce these overlapping risk profiles and educate the individual on what to do to manage HIV symptoms. Today’s article looks at how HIV can impact a person, their symptoms, and non-surgical treatments to manage HIV. We discuss with certified associated medical providers who consolidate our patients’ information to assess the effects of HIV and its associated symptoms. We also inform and guide patients on how to be aware of the impact of HIV and ask their associated medical providers intricate questions to integrate a customized treatment plan to incorporate multiple non-surgical therapies to manage the symptoms. Dr. Jimenez, D.C., includes this information as an academic service. Disclaimer.
What Is HIV?
Do you constantly feel tired even after taking a good night’s rest? Do you feel your throat being sore without the flu symptoms? Or are you experiencing muscle and joint pain in different locations of your body? Worldwide, many individuals have often experienced these symptoms from a viral infection known as Human Immunodeficiency Virus or HIV. HIV belongs to the retroviridae family, which targets the body’s immune system, especially the CD4+ T cells. The CD4+T cells play an important role in the body’s immune response, but when HIV starts to deplete the receptors and terminate the host cells. (Masenga et al., 2023) This causes individuals to have acute stages of HIV and, if not treated immediately, can lead to the progression of severe stages. However, how do individuals contract HIV? Well, the most common mode is through unprotected sexual intercourse, sharing needles, or through maternal-infant exposure, which diminishes the T-helper cell population and, over time, can increasingly weaken the immune system. (van Heuvel et al., 2022) This causes many individuals to develop various symptoms from HIV that can vary, depending on the severity and the progression stages of the virus.
The Symptoms
Now, for the progression of HIV to infect the body’s immune system and cause various symptoms to affect the individual, many healthcare professionals have to look at the process of the host’s exosomes and their correlation role with HIV. The generational process of exosomes causes overlapping risk profiles with the viral assembly of HIV as exosomes can transport the virus from the infected cells to the uninfected cells of the body by helping it regulate the host’s immune response to the virus infection. (Chen et al., 2021) To that point, it can lead to the progression of several stages of HIV and its associated symptoms. When a person is dealing with an HIV infection in its acute stages, the symptoms can be mild and easily mistaken for a common viral infection. Some of the symptoms can include:
Muscle aches
Joint pain
Difficulty falling asleep
Fatigue
Neuropathy
Shortness of breath
Swollen glands
This is because the inflammatory cytokines from the immune system are heightened and influenced by HIV. When inflammatory cytokines become associated with HIV, symptoms have a huge impact on an individual’s life, causing them to be miserable. (Schnall et al., 2020) Additionally, when HIV is in a clinical latency stage, the virus is less active but can still replicate without exhibiting any symptoms in the body. However, when HIV progresses to its severe stage, it can lead to the development of AIDS. Luckily, treatment advancements to treat HIV from its acute stages can help manage the associated symptoms.
The Non-Surgical Approach To Wellness- Video
Non-Surgical Treatments For HIV
When it comes to treating HIV, non-surgical treatments can help manage its associated symptoms while dramatically improving the life expectancy and quality of life of the individual who is affected by the virus. For non-surgical treatments, the main goal is to diagnose HIV as early as possible and to assess the situation by coming up with new and innovative HIV testing initiatives to increase the frequency and prevention of HIV in both clinical and non-clinical settings. (Delaney & DiNenno, 2021) Below are some non-surgical treatments to manage HIV.
Antiretroviral Treatments
Now, some of the non-surgical treatments to manage HIV is by taking antiretroviral therapy. This allows the individual with HIV to be more mindful of taking antiretroviral medications daily, which then helps improve sustained viral suppression of HIV and provides effective strategies of therapeutic approaches to enhance antiretroviral activities. (Huerta, 2020) Additionally, the primary goal of antiretroviral therapy is to reduce the HIV load to an undetectable level, keep the immune system functioning, and prevent the progression development of AIDS.
Lifestyle Adjustments
While living with HIV today is vastly different from decades past, thanks to significant medical advancements. Many individuals can go to their healthcare providers for an early diagnosis and effective treatment to live long and healthy lives. Awareness, education, and staying proactive with health checks remain key in the fight against HIV and its progression. Additionally, proper nutrition, regular exercise, and mental health support are also crucial for people living with HIV, helping to boost the immune system and manage symptoms. At the same time, regular visits to a healthcare provider for blood tests are essential to monitor the effectiveness of ART and adjust the treatment regimen as needed to live a healthier life.
References
Chen, J., Li, C., Li, R., Chen, H., Chen, D., & Li, W. (2021). Exosomes in HIV infection. Curr Opin HIV AIDS, 16(5), 262-270. doi.org/10.1097/COH.0000000000000694
Delaney, K. P., & DiNenno, E. A. (2021). HIV Testing Strategies for Health Departments to End the Epidemic in the U.S. Am J Prev Med, 61(5 Suppl 1), S6-S15. doi.org/10.1016/j.amepre.2021.06.002
Huerta, L. (2020). Editorial: Anti-infective 2020: HIV-From pathogenesis to treatment. Curr Opin Pharmacol, 54, x-xii. doi.org/10.1016/j.coph.2020.12.001
Masenga, S. K., Mweene, B. C., Luwaya, E., Muchaili, L., Chona, M., & Kirabo, A. (2023). HIV-Host Cell Interactions. Cells, 12(10). doi.org/10.3390/cells12101351
Schnall, R., Jia, H., & Reame, N. (2020). Association Between HIV Symptom Burden and Inflammatory Cytokines: An Analysis by Sex and Menopause Stage. J Womens Health (Larchmt), 29(1), 119-127. doi.org/10.1089/jwh.2019.7749
van Heuvel, Y., Schatz, S., Rosengarten, J. F., & Stitz, J. (2022). Infectious RNA: Human Immunodeficiency Virus (HIV) Biology, Therapeutic Intervention, and the Quest for a Vaccine. Toxins (Basel), 14(2). doi.org/10.3390/toxins14020138
Can various stretches can help relieve individuals with plantar fasciitis to reduce foot pain and restore gait function?
Introduction
As human beings, we are constantly on the move, and our feet are the ones that take a toll after a long day. The feet have various muscles, ligaments, tendons, and soft tissues that help protect the joints and provide stability. The feet are part of the lower body extremities that aid in mobility and strength of the upper body. When many individuals are constantly on their feet, the muscles and ligaments become overworked and can develop into pain-like issues. Most of the time, it is just muscle aches and pain; however, when repetitive motions start to cause more problems on the feet, it can lead to micro tears in the foot’s fascia. This, in turn, can lead to the development of plantar fasciitis, affecting a person’s gait ability. Today’s article looks at how plantar fasciitis affects gait function and how various stretches can help alleviate plantar fasciitis. We discuss with certified associated medical providers who consolidate our patients’ information to assess plantar fasciitis and its associated comorbidities. We also inform and guide patients on various stretches for plantar fasciitis and ask their associated medical providers intricate questions to integrate a customized treatment plan to incorporate multiple stretches to reduce the pain-like symptoms correlated with it. Dr. Jimenez, D.C., includes this information as an academic service. Disclaimer.
How Plantar Fasciitis Affects Gait Function
Do you feel like you are walking crooked from one location to another? Do you feel a stabbing pain when you take your first steps? Or do you feel constant pain in your feet while you are resting? As stated earlier, many individuals are constantly on their feet and have dealt with some pain that can affect their quality of life. Since the feet are part of the lower body extremities, a person experiencing a lot of pain in their heels can lead to a chronic musculoskeletal condition known as plantar fasciitis. The plantar fascia plays a huge part in the human body as it helps with the normal biomechanics of the foot, supports the arch, and provides shock absorption when a person is stepping. (Buchanan et al., 2024) When a person has been doing repetitive motions on their feet, it can lead to the development of plantar fasciitis. Plantar fasciitis is a common musculoskeletal disease that causes chronic degenerative changes in the plantar fascia. This musculoskeletal disease is also associated with mechanical factors such as repetitive stress and weight bearing that can lead to microtears in the muscle fibers. (Tseng et al., 2023) That point causes many individuals to have gait issues and other comorbidities.
Some risk factors correlated with plantar fasciitis are decreased ROM in plantarflexion and increased tensile load, which can cause many individuals to have gait issues while walking. (Hamstra-Wright et al., 2021) Since many individuals rely on walking and are experiencing pain from plantar fasciitis, not only their gait function is being affected, butthe surrounding muscles in the legs are also affected. Pain symptoms like intrinsic muscle weakness, reduced muscle strength on the legs and dorsiflexion, leg length discrepancy, and arch deformity can increase the chances of plantar fasciitis developing. (Khammas et al., 2023) This can cause many individuals to have gait dysfunction since the pain can be unbearable. Additionally, when people deal with plantar fasciitis, they shift their weight to one side of their bodies to reduce the pain and allow their secondary muscles to take on the unnecessary weight load. Luckily, there are ways to minimize the pain-like effects of plantar fasciitis and help restore a person’s gait function.
What is Plantar Fasciitis?-Video
Effective Stretches To Alleviate Plantar Fasciitis
When it comes to reducing plantar fasciitis, many individuals seek various treatments to reduce the pain-like symptoms causing their gait dysfunction. Many individuals seek non-surgical and surgical treatments to find the right solution for their plantar fasciitis. Depending on the severity of the pain affecting their feet, the main objective is to reduce tissue compressive load and provide a personalized treatment plan to educate and treat plantar fasciitis. (Morrissey et al., 2021) One of the best ways to reduce the pain from plantar fasciitis is by incorporating various stretches. Various stretches for plantar fasciitis can be effective as they can help relieve pain and enhance muscle strength in the extrinsic and intrinsic foot muscles. (Boonchum et al., 2020) Below are some stretches that many people dealing with plantar fasciitis can do at home to relieve the pain.
Towel Stretch
This simple stretch is perfect for the morning, especially before taking your first steps.
How to do it:
Sit alongside the bed with your legs straight in front of you.
Loop a towel around the ball of the feet and hold each end with your hands.
Pull the towel towards you while trying to keep the knees straight until you feel a stretch along the bottom of your foot and calf.
Hold the position for 15 to 30 seconds.
Repeat 2-3 times for each foot.
Calf Stretches
Tight calf muscles can exacerbate plantar fasciitis. Stretching your calves can relieve the pressure on your plantar fascia.
How to do it:
Stand near a wall with one foot back and one foot in front of you.
Keep your back heel on the ground and bend your front knee until you feel a stretch in the back leg’s calf muscle.
Hold for about 30 seconds and switch.
Repeat 2-3 times for each leg.
Plantar Fascia Stretch
Directly stretching the plantar fascia can help alleviate pain and improve foot function.
How to do it:
Sit with your affected foot and place it over the opposite side.
Use your hand to pull your toes back towards the shin until you feel a stretch along the arch of your foot.
Hold the stretch for at least 15 seconds and repeat the stretch three times.
Achilles Tendon Stretch
This stretch helps both the calf muscles and the plantar fascia.
How to do it:
Stand with your affected foot behind you.
Keep your heel down and bend your knee slightly.
Hold the position for 15-20 seconds, then relax.
Repeat 2-3 times for each leg.
Marble Pickup
Strengthening the muscles around your foot can also support the healing process.
How to do it:
Sit in a chair
Then, place 20 marbles and a bowl on the floor before your feet.
Use your toes to pick up one marble and place it into a bowl one at a time.
Repeat until you have all the marbles in the bowl.
References
Boonchum, H., Bovonsunthonchai, S., Sinsurin, K., & Kunanusornchai, W. (2020). Effect of a home-based stretching exercise on multi-segmental foot motion and clinical outcomes in patients with plantar fasciitis. J Musculoskelet Neuronal Interact, 20(3), 411-420. www.ncbi.nlm.nih.gov/pubmed/32877978
Hamstra-Wright, K. L., Huxel Bliven, K. C., Bay, R. C., & Aydemir, B. (2021). Risk Factors for Plantar Fasciitis in Physically Active Individuals: A Systematic Review and Meta-analysis. Sports Health, 13(3), 296-303. doi.org/10.1177/1941738120970976
Khammas, A. S. A., Mahmud, R., Hassan, H. A., Ibrahim, I., & Mohammed, S. S. (2023). An assessment of plantar fascia with ultrasound findings in patients with plantar fasciitis: a systematic review. J Ultrasound, 26(1), 13-38. doi.org/10.1007/s40477-022-00712-0
Morrissey, D., Cotchett, M., Said J’Bari, A., Prior, T., Griffiths, I. B., Rathleff, M. S., Gulle, H., Vicenzino, B., & Barton, C. J. (2021). Management of plantar heel pain: a best practice guide informed by a systematic review, expert clinical reasoning and patient values. Br J Sports Med, 55(19), 1106-1118. doi.org/10.1136/bjsports-2019-101970
Tseng, W. C., Chen, Y. C., Lee, T. M., & Chen, W. S. (2023). Plantar Fasciitis: An Updated Review. J Med Ultrasound, 31(4), 268-274. doi.org/10.4103/jmu.jmu_2_23
Can various stretches provide beneficial results for individuals experiencing TMJ pain by providing relief to the jaw?
Introduction
Many individuals use their jaws to communicate with one another, eat delicious food, and express themselves. The jaw is part of the upper extremities as it has five muscles that allow it to function when the mouth is opening or closing, chewing, and moving from side to side. When common motor functions like yawning, chewing, or speaking produce loud pops or clicks, it can become very painful and more often lead to temporomandibular joint dysfunction or TMJ. TMJ is a joint disorder that can affect a person’s ability to use their jaws properly and can lead to visceral-somatic disorders that can affect the upper extremities, causing them to be miserable. Luckily, many individuals can incorporate various stretches to reduce the impact of TMJ and help relax the stiff muscles around the jaw. Today’s article looks at the effects of TMJ, how various stretches can effectively reduce TMJ, and how additional non-surgical treatments can relieve TMJ pain. We discuss with certified associated medical providers who consolidate our patients’ information to assess pain-like issues associated with TMJ. We also inform and guide patients on various stretches for TMJ and ask their associated medical providers intricate questions to integrate a customized treatment plan to reduce the pain-like issues affecting their jaws. Dr. Jimenez, D.C., includes this information as an academic service. Disclaimer.
The Effects of TMJ
Do you feel stiffness in your jaw after clenching for an extended period? Do you hear excessive loud clicks when opening or closing your jaw? Or do you think your jaw is locking up constantly, making it difficult to open or close your mouth? When many individuals start to feel pain around their jaws excessively, many would often think that it could be tooth pain, but in actuality, it is the temporomandibular joint that is causing the issues. Temporomandibular joint disorder, or TMJ, can be developed through various causes that can impact a person’s jaw and can lead to pain and discomfort. Mechanical factors like jaw injuries, arthritis, teeth clenching, and grinding can cause excessive or unbalanced joint loading to the jaw, which can progress the development of TMJ. (Cardoneanu et al., 2022) When dealing with TMJ, pain can lead to symptoms of tenderness around the joint area of the jaw, difficulty chewing, ear pain, and stiffness.
At the same time, the effects of TMJ pain are often characterized by localized discomfort, as TMJ is a multifactorial musculoskeletal and neuromuscular disorder that can be difficult to diagnose. (Alolayan et al., 2022) This is because of how many individuals chew their foods on one side, which can lead to its development. When the masseter muscles of the jaw begin to overload on the TMJ, it can initiate remodeling on the non-working side of the jaw and cause the pain to flourish over time. (Santana-Mora et al., 2013) However, when dealing with TMJ pain, many individuals can seek out various treatment options that can reduce muscular impairment and disc displacement from the jaw and help improve the mandibular range of motion. (Brighenti et al., 2023)
The Science of Motion-Video
Why Stretching Helps With TMJ
When it comes to reducing TMJ pain, many individuals can seek out non-surgical treatments to reduce the overlapping pain symptoms and restore jaw function. Some of the main objectives that many pain specialists can take into account when dealing with TMJ pain are reducing reflex masticatory muscle pain and helping increase TMJ function through various treatments that can have a positive impact on the jaw. (Ferrillo et al., 2022) Some non-surgical treatments include multiple stretches to help relax the surrounding muscles and jaw and alleviate the tension and discomfort associated with TMJ.
Effective Stretches For TMJ Relief
Stretching can be part of a person’s personalized treatment plan to reduce TMJ pain and its associated comorbidities. Stretching and strengthening exercises can positively affect pain while improving the range of TMJ movement and helping many individuals restore their jaw motor function (Byra et al., 2020). Below are some of the stretches that can help reduce TMJ pain and relax the jaw muscles.
Relaxed Jaw Exercise
How to Do It: Place the tongue gently on the roof of the mouth behind the upper front teeth. This allows the teeth to come apart while relaxing the jaw muscles.
Benefits: This exercise helps relax the jaw and ease muscle tension.
Partial Goldfish Exercises
How to Do It: Place the tongue gently on the roof of the mouth and one finger in front of the ear where the TMJ is located. Place your middle finger on your chin. Drop your lower jaw halfway and close. Perform this exercise six times in one set.
Benefits: This stretch helps target the jaw’s range of motion and reduce joint stiffness.
Full Goldfish Exercises
How to Do It: Similar to the partial opening, but open your mouth fully this time.
Benefits: This stretch helps enhance the full range of motion and reduce joint stiffness.
Chin Tucks
How to Do It: Sitting upright in a chair, pulling your chin straight back, creating a “double chin.” Hold for three seconds, and then release.
Benefits: This exercise helps strengthen the neck muscles, improves posture, and reduces strain on the jaw.
Additional Tips To Reduce TMJ
Along with these stretches, additional tips for managing and reducing TMJ by avoiding excessive jaw movements and applying hot/cold packs to reduce any residual inflammation correlating with TMJ. When people with TMJ start incorporating non-surgical treatments and stretches to relieve the pain, it can help increase the mandibular active range of motion and provide beneficial relief. (Urbanski et al., 2021) This, in turn, allows many people with TMJ pain to be more mindful of the body and make small changes in their health and well-being.
References
Alolayan, A., Alsayed, S. S., Salamah, R. M., Ali, K. M., Alsousi, M., & Elsayed, S. (2022). Temporomandibular joint (TMJ) disorders prevalence and awareness of appropriate clinical practices, among Al-Madinah community in Saudi Arabia. F1000Res, 11, 395. doi.org/10.12688/f1000research.104272.2
Brighenti, N., Battaglino, A., Sinatti, P., Abuin-Porras, V., Sanchez Romero, E. A., Pedersini, P., & Villafane, J. H. (2023). Effects of an Interdisciplinary Approach in the Management of Temporomandibular Disorders: A Scoping Review. Int J Environ Res Public Health, 20(4). doi.org/10.3390/ijerph20042777
Byra, J., Kulesa-Mrowiecka, M., & Pihut, M. (2020). Physiotherapy in hypomobility of temporomandibular joints. Folia Med Cracov, 60(2), 123-134. www.ncbi.nlm.nih.gov/pubmed/33252600
Cardoneanu, A., Macovei, L. A., Burlui, A. M., Mihai, I. R., Bratoiu, I., Rezus, II, Richter, P., Tamba, B. I., & Rezus, E. (2022). Temporomandibular Joint Osteoarthritis: Pathogenic Mechanisms Involving the Cartilage and Subchondral Bone, and Potential Therapeutic Strategies for Joint Regeneration. Int J Mol Sci, 24(1). doi.org/10.3390/ijms24010171
Ferrillo, M., Giudice, A., Marotta, N., Fortunato, F., Di Venere, D., Ammendolia, A., Fiore, P., & de Sire, A. (2022). Pain Management and Rehabilitation for Central Sensitization in Temporomandibular Disorders: A Comprehensive Review. Int J Mol Sci, 23(20). doi.org/10.3390/ijms232012164
Santana-Mora, U., Lopez-Cedrun, J., Mora, M. J., Otero, X. L., & Santana-Penin, U. (2013). Temporomandibular disorders: the habitual chewing side syndrome. PLOS ONE, 8(4), e59980. doi.org/10.1371/journal.pone.0059980
Urbanski, P., Trybulec, B., & Pihut, M. (2021). The Application of Manual Techniques in Masticatory Muscles Relaxation as Adjunctive Therapy in the Treatment of Temporomandibular Joint Disorders. Int J Environ Res Public Health, 18(24). doi.org/10.3390/ijerph182412970
Can incorporating electrical muscle stimulation help control pain, strengthen muscles, increase physical function, retrain lost movements, and/or manage inflammation for individuals experiencing neck and back pain?
Female doctor placing myostimulation physical therapy equipment on patient’s back
Electric Muscle Stimulation
Electrical muscle stimulation or E-stim is a physical therapy used to reactivate the muscles’ ability to contract. E-stim uses devices that transmit electrical impulses through the skin to target nerves and/or muscles. The most common forms include
Transcutaneous electric nerve stimulation, or TENS, is the most well-known type of electrical stimulation that offers devices that can be used at home or on the go.
Electrical muscle stimulation or EMS.
In physical therapy, E-stim stimulates muscles to contract, strengthening them and encouraging blood circulation.
Blood circulation can directly affect the condition of muscle tissue.
Electrical muscle stimulation is also used in spinal cord injury and other neuromuscular conditions. (Ho, C. H. et al., 2014)
E-stim
During treatment, electrodes are hooked to an electric stimulation machine and placed around the affected neck or back area.
The electrodes will be placed on the skin for most neck or back injuries.
The placement of the electrodes depends on the reason for treatment and the depth or superficiality of the electrical stimulation.
The electrodes are often placed near a motor point of a muscle to ensure the correct contraction.
The therapist will adjust the controls of the stimulation machine to achieve thorough muscle contraction with minimal discomfort.
Stimulation can last 5 – 15 minutes, depending on the treatment plan and injury severity.
Spinal Joint Stabilization
Activation of the muscles may help increase spinal joint stability, improving problems with spinal instability. (Ho, C. H. et al., 2014) Electric muscle stimulation is thought to enhance the exercise program a therapist prescribes to help maintain joint stability. Electrical stimulation may also help build muscle strength and endurance. (Veldman, M. P. et al., 2016) Muscle endurance is the repetitions a muscle can contract before it fatigues.
Healing and Pain Management
Electric muscle stimulation therapy can enhance tissue healing and help manage inflammation by reducing swelling and increasing circulation. It can reduce pain sensations by blocking nerve transmission at the spinal cord. (Johnson, M. I. et al., 2019) A healthcare professional may suggest a TENS or take-home electric stimulation unit to manage symptoms. (Johnson, M. I. et al., 2019)
Treatment
Interdisciplinary therapies tailored to an individual’s specific back or neck pain have been found to provide positive results. Exercise, yoga, short-term cognitive behavioral therapy, biofeedback, progressive relaxation, massage, manual therapy, and acupuncture are recommended for neck or back pain. (Chou, R. et al., 2018) Taking non-steroidal anti-inflammatory medications may also help. Electrical muscle stimulation could be an effective neck or back treatment.
Individuals unsure whether they need or would benefit from electrical should discuss symptoms and conditions with a primary physician, healthcare provider, or specialist to guide them in the right direction and determine the best treatment. Injury Medical Chiropractic and Functional Medicine Clinic focuses on what works for the patient and strives to better the body through researched methods and total wellness programs. Using an integrated approach, we treat injuries and chronic pain syndromes through personalized care plans that improve ability through flexibility, mobility, and agility programs personalized to the individual to relieve pain. If other treatment is needed, Dr. Jimenez has teamed up with the top surgeons, clinical specialists, medical researchers, and premier rehabilitation providers to provide the most effective treatments.
Thoracic Spine Pain
References
Ho, C. H., Triolo, R. J., Elias, A. L., Kilgore, K. L., DiMarco, A. F., Bogie, K., Vette, A. H., Audu, M. L., Kobetic, R., Chang, S. R., Chan, K. M., Dukelow, S., Bourbeau, D. J., Brose, S. W., Gustafson, K. J., Kiss, Z. H., & Mushahwar, V. K. (2014). Functional electrical stimulation and spinal cord injury. Physical medicine and rehabilitation clinics of North America, 25(3), 631–ix. doi.org/10.1016/j.pmr.2014.05.001
Veldman, M. P., Gondin, J., Place, N., & Maffiuletti, N. A. (2016). Effects of Neuromuscular Electrical Stimulation Training on Endurance Performance. Frontiers in physiology, 7, 544. doi.org/10.3389/fphys.2016.00544
Johnson, M. I., Jones, G., Paley, C. A., & Wittkopf, P. G. (2019). The clinical efficacy of transcutaneous electrical nerve stimulation (TENS) for acute and chronic pain: a protocol for a meta-analysis of randomised controlled trials (RCTs). BMJ open, 9(10), e029999. doi.org/10.1136/bmjopen-2019-029999
Chou, R., Côté, P., Randhawa, K., Torres, P., Yu, H., Nordin, M., Hurwitz, E. L., Haldeman, S., & Cedraschi, C. (2018). The Global Spine Care Initiative: applying evidence-based guidelines on the non-invasive management of back and neck pain to low- and middle-income communities. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 27(Suppl 6), 851–860. doi.org/10.1007/s00586-017-5433-8
Can individuals dealing with musculoskeletal trigger points seek non-surgical treatments to reduce pain in their extremities?
Introduction
The musculoskeletal system has various muscles, tendons, ligaments, and soft tissues that allow the lower and upper extremities to function in multiple tasks that the person is doing. From physical activities to relaxing or just doing errands, the musculoskeletal system has a wonderful relationship with all the various body systems. It helps protect the vital organs from environmental factors and injuries. However, when environmental factors or injuries affect the body, many overlapping risk profiles affect the upper and lower quadrants, thus affecting the muscles and the soft tissues. When the musculoskeletal system starts to feel symptoms of pain and discomfort, it can cause visceral-somatic referred pain in different body locations and cause the development of trigger points in the muscle tissues. This causes the individual to be in excruciating pain and discomfort and is seeking treatment to reduce the pain-like symptoms. Today’s article gives us an understanding of musculoskeletal trigger points and how various non-surgical treatments can alleviate musculoskeletal trigger points in the body. We discuss with certified associated medical providers who consolidate our patients’ information to assess pain-like issues affecting their musculoskeletal system that are correlating to trigger point pain. We also inform and guide patients on various non-surgical treatments and ask their associated medical providers intricate questions to integrate a customized treatment plan to reduce musculoskeletal trigger point pain. Dr. Jimenez, D.C., includes this information as an academic service. Disclaimer.
Understanding Musculoskeletal Trigger Points
Do you often experience pain in your legs, arms, hands, and feet throughout the day? How often do you experience symptoms of stiffness and discomfort in your neck, shoulder, or back? Or do you feel tingling and numbing sensations in your hands and feet? More often than not, many people who are experiencing these overlapping pain issues in their musculoskeletal system might have trigger points in their muscle fibers. Trigger points are part of a painful musculoskeletal condition known as myofascial pain syndrome. This painful musculoskeletal condition constitutes a hyperirritable spot within the taut band of the musculoskeletal system, causing pain when being compressed. (Lavelle et al., 2007) When a person is dealing with musculoskeletal trigger points, they will often experience referred pain and discomfort, motor dysfunction, and autonomic issues. This is because when many individuals experience pain in the upper or lower muscle quadrants, they deal with referred pain from the affected muscles. When the affected muscles have abnormal tender muscle regions, it can lead to impaired movements associated with the affected muscles in any joint area. (Macdonald, 1980)
Additionally, musculoskeletal trigger points can be identified as latent or active based on the development of where the pain originates from within the musculoskeletal system. To that point, when environmental factors or injuries develop trigger points, pain-like symptoms like muscle stiffness, dysfunction, and restricted range of motion show up when a pain specialist is assessing a person. (Shah et al., 2015) Fortunately, musculoskeletal trigger points are not difficult to treat once the pain source is located in the musculoskeletal system. This is because non-surgical treatments help manage the pain-like symptoms by inactivating the trigger points and restoring the affected resistant muscles to their full range of motion. (Rubin, 1981)
The Non-Surgical Approach To Wellness-Video
Non-Surgical Treatments For Musculoskeletal Trigger Points
When it comes to treating musculoskeletal trigger points, many individuals seek out various treatments to reduce pain-like symptoms. Since musculoskeletal trigger points can range from mild discomfort to severe pain, it can affect a person’s daily activities and cause them to be miserable. Luckily, musculoskeletal trigger points can be reduced through non-surgical treatments. Non-surgical treatments can vary depending on the pain severity of the trigger points in the musculoskeletal system. At the same time, many individuals can have numerous non-surgical therapies as they are customizable, cost-effective, and personalized for the person’s treatment. Below are some non-surgical treatments that can help alleviate musculoskeletal trigger points.
Chiropractic Care
Chiropractic care utilizes mechanical and manual manipulation of the musculoskeletal system and can help reduce the overlapping effects of musculoskeletal trigger points. Chiropractors incorporate various techniques and ischemic pressure to relieve the pain and provide relief. (Vernon & Schneider, 2009) Additionally, chiropractors can locate the trigger points by pressing on the muscle tissue or manipulating the muscle fibers. Chiropractors can also combine massage therapy to relieve trigger points and associated pain symptoms to restore the body to optimal function. This combination can incorporate various techniques to increase blood circulation to the affected muscle, help break down the inflexible scar tissue, and help restore muscle function to the extremities.
Acupuncture
Another form of non-surgical treatment to reduce musculoskeletal trigger points is acupuncture. Acupuncture incorporates solid, thin needles placed on various acupoints in the body by a professional. What acupuncture does is that when the needles are placed in the acupoints of the affected muscle, it can help stimulate the nervous system and help facilitate the body’s natural pain-relieving chemicals to kick-start the healing process. Additionally, when people incorporate acupuncture to reduce musculoskeletal trigger points, the sensory input that is causing them pain is reduced and can provide prolonged relief. (Melzack, 1981)
Lifestyle Adjustments
When it comes to reducing trigger points and combining non-surgical treatments, many individuals dealing with overlapping pain profiles from musculoskeletal trigger points can make lifestyle adjustments to prevent its development. Making small adjustments to a person’s work and living environments can reduce stress from being a co-factor to developing trigger points in the muscle fibers. Other small adjustments like improving posture and employing relaxation techniques like yoga, meditation, or deep breathing exercises can help reduce muscle stress and strain from everyday life. Incorporating non-surgical treatments to reduce and manage musculoskeletal triggers can provide a positive, beneficial result to improve muscle function and allow individuals to live healthier lives.
References
Lavelle, E. D., Lavelle, W., & Smith, H. S. (2007). Myofascial trigger points. Anesthesiol Clin, 25(4), 841-851, vii-iii. doi.org/10.1016/j.anclin.2007.07.003
Macdonald, A. J. R. (1980). Abnormally tender muscle regions and associated painful movements. Pain, 8(2), 197-205. doi.org/10.1016/0304-3959(88)90007-3
Melzack, R. (1981). Myofascial trigger points: relation to acupuncture and mechanisms of pain. Archives of Physical Medicine and Rehabilitation, 62(3), 114-117. www.ncbi.nlm.nih.gov/pubmed/6972204
Rubin, D. (1981). Myofascial trigger point syndromes: an approach to management. Archives of Physical Medicine and Rehabilitation, 62(3), 107-110. www.ncbi.nlm.nih.gov/pubmed/6453568
Shah, J. P., Thaker, N., Heimur, J., Aredo, J. V., Sikdar, S., & Gerber, L. (2015). Myofascial Trigger Points Then and Now: A Historical and Scientific Perspective. PM R, 7(7), 746-761. doi.org/10.1016/j.pmrj.2015.01.024
Vernon, H., & Schneider, M. (2009). Chiropractic management of myofascial trigger points and myofascial pain syndrome: a systematic review of the literature. J Manipulative Physiol Ther, 32(1), 14-24. doi.org/10.1016/j.jmpt.2008.06.012
For individuals who are having difficulty moving around due to pain, loss of range of motion, and/or decreased strength, can incorporating working with a physical therapist help relieve pain and restore function?
A woman with orthosis working with a physical therapist
Physical Therapy Benefits
Many wonder if they are candidates for physical therapy or if physical therapy can help their injury, ailment, or condition. The answer is yes; most individuals can benefit from physical therapy, whether their condition is a simple ankle sprain or a complex neurological disorder. Physical therapists can help develop pain management treatment strategies and injury prevention. Physical therapy can benefit individuals even if they are not injured; as movement experts, physical therapists can train individuals to help prevent injury and maintain flexibility.
Body Mechanics
Physical therapists work in various settings, including hospitals, nursing homes, sports, and chiropractic clinics. If necessary, they can come to your house after an injury. They work with individuals from all walks of life as a conservative treatment approach to managing, healing, and preventing injuries and disabilities. Physical therapy uses non-invasive tools to help improve total body function. Physical therapy focuses on:
Relieving pain
Promoting healing
Restoring function
Restoring movement
Facilitation and adaptation for a specific injury.
Therapy also focuses on body mechanic training, fitness, and wellness. (Hon, S. et al., 2021)
Regardless of age, individuals who have problems with flexibility and mobility may benefit from working with a physical therapist to help them return to optimal function.
Conditions Physical Therapy Can Help Treat
Muscle sprains and strains.
Work-related injuries.
Repetitive motion injuries.
Sports-related injuries.
Neck pain.
Lower back pain.
Neuro-rehabilitation – post-stroke and spinal cord or head injury.
Shoulder, arm, hand, and wrist injuries and problems.
Fractures.
Slip and fall accidents and other traumas.
Orthopedic conditions.
Chronic fatigue.
Chronic weakness.
Pre and post-surgical conditioning and strengthening.
Wound care like diabetic wounds and non-healing traumatic or post-surgical wounds.
Pre – during pregnancy and post-partum programs.
Fitness and wellness education.
Poor cardiovascular endurance.
Cardiac rehabilitation.
Respiratory problems.
Bowel or bladder incontinence.
Cancer recovery.
Individuals unsure whether they need or would benefit from physical therapy should discuss their options with a primary physician, healthcare provider, or specialist to guide them in the right direction. Injury Medical Chiropractic and Functional Medicine Clinic focuses on what works for you and strives to better the body through researched methods and total wellness programs. Using an integrated approach, we treat patients’ injuries and chronic pain syndromes through personalized care plans that improve ability through flexibility, mobility, and agility programs personalized to the individual to relieve pain. If other treatment is needed, Dr. Jimenez has teamed up with the top surgeons, clinical specialists, medical researchers, and premier rehabilitation providers to provide the most effective treatments.
Unlocking Vitality
References
Hon, S., Ritter, R., & Allen, D. D. (2021). Cost-Effectiveness and Outcomes of Direct Access to Physical Therapy for Musculoskeletal Disorders Compared to Physician-First Access in the United States: Systematic Review and Meta-Analysis. Physical therapy, 101(1), pzaa201. doi.org/10.1093/ptj/pzaa201
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