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Back Clinic Health Team. The level of functional and metabolic efficiency of a living organism. In humans, it is the ability of individuals or communities to adapt and self-manage when facing physical, mental, psychological, and social changes in an environment. Dr.Alex Jimenez D.C., C.C.S.T, a clinical pain doctor who uses cutting-edge therapies and rehabilitation procedures focused on total health, strength training, and complete conditioning. We take a global functional fitness treatment approach to regain complete functional health.

Dr. Jimenez presents articles both from his own experience and from a variety of sources that pertain to a healthy lifestyle or general health issues. I have spent over 30+ years researching and testing methods with thousands of patients and understand what truly works. We strive to create fitness and better the body through researched methods and total health programs.

These programs and methods are natural and use the body’s own ability to achieve improvement goals, rather than introducing harmful chemicals, controversial hormone replacement, surgery, or addictive drugs. As a result, individuals live a fulfilled life with more energy, a positive attitude, better sleep, less pain, proper body weight, and education on maintaining this way of life.


The Effects of Low Laser Therapy on Repairing The Calcaneal Tendon | El Paso, TX

The Effects of Low Laser Therapy on Repairing The Calcaneal Tendon | El Paso, TX

The body is a well-working machine that can endure anything that is thrown in its way. However, when it gets an injury, the body’s natural healing process will ensure that the body can get back to its daily activities. The healing process of an injured muscle varies throughout the body. Depending on how severe the damage is and how long the healing process will take, the body can recover to a mere few days to a few months. One of the most gruelly healing processes that the body has to endure is a ruptured calcaneal tendon.

The Calcaneal Tendon

The calcaneal tendon or the Achilles tendon is a thick tendon that is located in the back of the leg. This muscle-tendon is what makes the body move while walking, running, or even jumping. Not only that, the calcaneal tendon is the strongest tendon in the body, and it connects the gastrocnemius and soleus muscles at the heel bone. When the calcaneal tendon is ruptured, the healing process can last from weeks to months until it is fully healed. 

 

 

The Healing Effects of Low Laser Therapy

One of the ways that can help the damaged calcaneal tendons’ healing process is low laser therapy. Studies have shown that low laser therapy can speed up the damaged tendon repair after a partial lesion. Not only that but the combination of ultrasound and low laser therapy has been studied to be the physical agents for treating tendon injuries. The studies showed that the combination of low laser therapy and ultrasound has beneficial properties during the recovery process of treating calcaneal tendon injuries.

 

 

The study found that when patients are being treated for their calcaneal tendons, their hydroxyproline levels around the treated area are significantly increased with ultrasound and low laser therapy. The body’s natural biochemical and biomechanical structures on the injured tendon increase, thus affecting the healing process. Another study has shown that low laser therapy can help reduce fibrosis and prevent oxidative stress in the traumatized calcaneal tendon. The study even showed that after the calcaneal tendon is traumatized, inflammation, angiogenesis, vasodilation, and the extracellular matrix are formed in the affected area. So when patients are being treated with low laser therapy for about fourteen to twenty-one days, their histological abnormalities are alleviated, reducing collagen concentration and fibrosis; preventing oxidative stress from increasing in the body.

 

Conclusion

Overall, it is said that the effects of low laser therapy can help speed up the healing process of repairing the calcaneal tendon. The promising results have been proven since low laser therapy can help repair the damaged tendon, reducing oxidative stress and preventing fibrosis from escalating, causing more problems on the injured tendon. And with the combination of ultrasound, the calcaneal tendon can recover faster so the body can continue its everyday activities without any prolonged injuries.

 

References:

Demir, Huseyin, et al. “Comparison of the Effects of Laser, Ultrasound, and Combined Laser + Ultrasound Treatments in Experimental Tendon Healing.” Lasers in Surgery and Medicine, U.S. National Library of Medicine, 2004, https://pubmed.ncbi.nlm.nih.gov/15278933/.

Fillipin, Lidiane Isabel, et al. “Low-Level Laser Therapy (LLLT) Prevents Oxidative Stress and Reduces Fibrosis in Rat Traumatized Achilles Tendon.” Lasers in Surgery and Medicine, U.S. National Library of Medicine, Oct. 2005, https://pubmed.ncbi.nlm.nih.gov/16196040/.

Oliveira, Fla’via Schlittler, et al. Effect of Low Level Laser Therapy (830 Nm … – Medical Laser. 2009, http://medical.summuslaser.com/data/files/86/1585171501_uLg8u2FrJP7ZHcA.pdf.

Wood, Viviane T, et al. “Collagen Changes and Realignment Induced by Low-Level Laser Therapy and Low-Intensity Ultrasound in the Calcaneal Tendon.” Lasers in Surgery and Medicine, U.S. National Library of Medicine, 2010, https://pubmed.ncbi.nlm.nih.gov/20662033/.

Low Laser Therapy Repairs Tissues | El Paso, TX

Low Laser Therapy Repairs Tissues | El Paso, TX

When dealing with any kind of pain, many types of remedies can help alleviate the source of the pain. Whether muscle pain or cardiac tissue pain, the effects can be long-term if not appropriately treated. Doctors have discovered that low laser therapy can help repair injured muscles that patients have experienced. With low laser therapy, the beneficial effects can help repair injuries that the bodies’ skeletal and cardiac muscles have endured. 

 

 

When the body gets injured, many people endure the pain later or during the accident. Sometimes the pain is short-termed or long-termed, depending on how severe the injury is. Short-term pain or “acute” pain can be simple, like a sprained joint; however, long-term pain or “chronic” pain, it’s more severe to the body and can have lasting effects. Chronic pain can hinder a person’s body from doing the most straightforward task. When people deal with chronic pain, it can drastically affect the body’s musculoskeletal system and even their cardiovascular system. 

When the body’s musculoskeletal system is damaged, many complications can start affecting the joints in many different parts of the body. Chronic pain can cause inflammation throughout the body, causing a person not to have the energy to do any task they planned for the day. Sometimes the pain can be excruciating where the body just completely shuts down. When doctors see their patients, they ask them, “Where does it hurt?” meaning where the pain feels more excruciating on the person’s body. The patient will always tell their physicians that the pain is on their joints or back. So doctors would recommend low laser therapy.

 

Low Laser Therapy

 

With low laser therapy or phototherapy, the effects from the treatment can alleviate the pain from the body. Studies show that the application of low laser therapy in injured muscles can significantly enhance muscle regeneration in multiple and frequent applications. Low laser therapy does target the injured muscles because it uses irradiation, which targets the affected muscle while increasing the body’s natural antioxidants and cytoprotective heat shock proteins (HSP-70i). Phototherapy can even help reduce muscle fatigue in athletes when they are in a post-exercise routine.

Studies have found that physical therapists use phototherapy as another form of recovery treatment for athletes. What the laser does is that when it is placed on the affected muscle and joint pain, the infrared wavelength penetrates the skin and starts to affect the targeted area. The infrared wavelengths cause therapeutic effects by decreasing oxidative stress accumulated by the body while also reactivating oxygen species production, improving the body’s mitochondrial function, etc. Another study also shows that phototherapy can also repair cardiac tissue. The study shows that when doctors use phototherapy, it directly affects the intracellular mechanisms in the heart while also activating heat-independent tissues without causing tissue damage to the heart. The study also shows that phototherapy can be effective in various complications, such as lymphoedema and muscular trauma. 

Conclusion

 

All in all, low laser therapy has beneficial properties in preventing muscle and cardiac muscle tissue damage. Its infrared radiation can help patients go about their day without the pain and suffering that their body endures. By reducing ventricular dilatation and preserving the body’s mitochondria while elevating the HSP-70i, the body can start on the road to recovery.

 

 

References:

Leal Junior, Ernesto Cesar Pinto, et al. “Effects of Low-Level Laser Therapy (LLLT) in the Development of Exercise-Induced Skeletal Muscle Fatigue and Changes in Biochemical Markers Related to Postexercise Recovery.” Journal of Orthopaedic & Sports Physical Therapy, Aug. 2010, https://www.jospt.org/doi/10.2519/jospt.2010.3294.

Kazemi Khoo, Nooshafarin, et al. “Application of Low-Level Laser Therapy Following Coronary Artery Bypass Grafting (CABG) Surgery.” Journal of Lasers in Medical Sciences, Laser Application in Medical Sciences Research Center, 2014, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4291821/.

Oron, Uri. “Photoengineering of Tissue Repair in … – Medical Laser.” Photoengineering of Tissue Repair in Skeletal and Cardiac Muscles, 2006, http://medical.summuslaser.com/data/files/91/1585172203_ls8S6pcJwigZfZQ.pdf.

Nervous System Health and Optimal Body Function

Nervous System Health and Optimal Body Function

Optimal nervous system health is the key to maximum body function and overall health. Individuals don’t really think about their nervous system until symptoms from injury, disease, or nerve problems present. The nervous system consists of billions of neurons that connect/network the brain with the rest of the body.

Nervous System Health and Optimal Body Function

Nervous System Health

All of the body’s systems, organs, and tissues have nerves attached to them. The brain engages with this network to control and coordinate bodily functions. Functions include:

  • Heart
  • Lungs
  • Immune system
  • Digestive system
  • Reproductive system

Every function the body performs requires brain-body communication through the nervous system. The brain communicates with the nervous system to regulate the body to the environment it is in. For example:

  • If it’s hot, the body sweats.
  • If it’s cold, the body shivers.
  • If there is danger, the fight or flight response activates.
  • All are directed by the brain transmitting signals and messages through the nervous system.

Body Function

Optimal body function means that all bodily functions are normal, active, and healthy. Everything is working as it should. When the body functions at less than 100%, it can develop into more serious problems little by little. Like a vehicle that starts making a little sound that seems like nothing, then after a few days, weeks, months, it becomes a massive popping, grinding, starting, stopping, emergency, when vital information that regulates function gets lost in transmission from the brain to the body, health declines.

Flowing Spinal Highway

The vital information/communication between the brain and the body flow through the spinal column. The super information highway/spinal cord travels down the spinal column. Branching off the spinal cord are spinal nerve roots that go to every system, organ, and tissue in the body. The spinal bones are lined up like an electrical conduit channel for the spinal cord. The vertebrae should be lined up and move properly, allowing optimal blood and nerve circulation without any obstruction or interference.

When the spine shifts out of place, creating misalignment, moving properly becomes hindered, causing discomfort and pain, along with the vital communication needed to regulate maximum function not able to get through. This leads to malfunction within the body and decreases health and well-being. Spinal misalignment that interferes with nerve message transmission is called a vertebral subluxation. Chiropractic healthcare professionals are trained to detect and correct spinal subluxations. They realign the spine’s bones to restore nervous system health and internal communication for proper body function.


Body Composition


Prebiotics Can Help With

Inflammation

Inflammation is a normal function of the immune system; however, chronic inflammation can cause damage to the body. Chronic inflammation is associated with:

  • Obesity
  • Heart disease
  • Cancer
  • Other diseases and conditions.

Having a balance of healthy gut microbiota helps decrease chronic inflammation and the risk of disease.

Gastrointestinal Diseases and Conditions

Prebiotics also ferment in the colon producing short-chain fatty acids. These provide energy for the colon’s epithelial cells that line and protect the colon. Prebiotics increase the protection provided by the epithelial cells, reducing the risk for gastrointestinal conditions like:

  • Irritable Bowel Syndrome – IBS
  • Crohn’s disease
  • Cancer.
  • Prebiotics can also reduce symptoms of gastrointestinal conditions.

Neurological System

The central nervous system is also known as the brain and spinal cord. However, many do not know about the enteric nervous system, which includes the gastrointestinal tract. The link between the enteric and central nervous systems involves cognitive and emotional functions. Prebiotics increase and promote healthy gut microbiota to help manage:

  • Mood
  • Learning
  • Memory
  • Certain psychological disorders
References

Cerdó, Tomás et al. “Probiotic, Prebiotic, and Brain Development.” Nutrients vol. 9,11 1247. 14 Nov. 2017, doi:10.3390/nu9111247

Chu, Eric Chun Pu, and Michelle Ng. “Long-term relief from tension-type headache and major depression following chiropractic treatment.” Journal of family medicine and primary care vol. 7,3 (2018): 629-631. doi:10.4103/jfmpc.jfmpc_68_18

Kiani, Aysha Karim et al. “Neurobiological basis of chiropractic manipulative treatment of the spine in the care of major depression.” Acta bio-medica : Atenei Parmensis vol. 91,13-S e2020006. 9 Nov. 2020, doi:10.23750/abm.v91i13-S.10536

Maltese, Paolo Enrico et al. “Molecular foundations of chiropractic therapy.” Acta bio-medica : Atenei Parmensis vol. 90,10-S 93-102. 30 Sep. 2019, doi:10.23750/abm.v90i10-S.8768

Wirth, Brigitte et al. “Neurophysiological Effects of High Velocity and Low Amplitude Spinal Manipulation in Symptomatic and Asymptomatic Humans: A Systematic Literature Review.” Spine vol. 44,15 (2019): E914-E926. doi:10.1097/BRS.0000000000003013

Drinking Tea For Inflammation and Back Pain

Drinking Tea For Inflammation and Back Pain

Individuals and doctors have praised the anti-inflammatory, pain-relieving properties of drinking tea. Inflammation is the body’s natural immune response when injury and infection present. This is good. However, it’s meant to be a temporary response that deactivates when there is no longer any danger. When the body is exposed to various irritants like industrial chemicals, inflammatory foods like sugar, refined carbohydrates, and autoimmune disorders can cause the immune system to go into overdrive. Chronic inflammation can develop, circulating powerful hormones and chemicals through the body, causing damage to the cells. One consequence of chronic inflammation is back pain. Besides standard backaches, some chronic conditions are directly tied to inflammation. These include forms of arthritis:

  • Ankylosing spondylitis
  • Rheumatoid arthritis
  • Transverse myelitis
  • Multiple sclerosis
  • These conditions involve inflammation of the central nervous system.
  • Drinking tea can help with back pain and pain in general.

 

Drinking Tea For Inflammation and Back Pain

Teas With Anti-Inflammatory Properties

Certain teas contain anti-inflammatory compounds. These compounds are called polyphenols and work to decrease the chemicals in the body responsible for pain and inflammation. There are varieties of teas that contain anti-inflammatory properties.

Certain Teas Reduce Inflammation

Drinking specific teas with more polyphenols can better decrease inflammation. For example, green tea is higher in polyphenols than black tea. Recent studies centered on individuals with rheumatoid arthritis over six months found significant improvement in symptoms in those who drank green tea. Green tea works best when part of an anti-inflammatory and nutritional lifestyle adjustment. This supports combating inflammation. Other teas that are believed to reduce inflammation include:

  • Turmeric
  • Holy basil
  • Ginger

Three Cups a Day

The amount of tea depends on the quality of the tea and how it is prepared. Doctors recommend around three cups a day for individuals with rheumatoid arthritis. However, these could contain caffeine. If this is an issue, there are decaffeinated versions with the same anti-inflammatory properties.

Drinking Tea Works Best When Combined with Other Treatments

If experiencing back pain or looking to combat a specific condition, it’s recommended to utilize various treatment approaches combined with drinking tea. This includes:

  • Chiropractic care
  • Physical therapy
  • Acupuncture
  • Mindfulness meditation
  • Yoga
  • Dietary supplements
  • Anti-inflammatory diet

Tea Is Not For All Types Of Pain

Certain back conditions benefit from drinking tea regularly; however, spine structural issues or fractures will not benefit from tea’s mild anti-inflammatory properties. It is vital for individuals with back pain that a spine specialist or chiropractor perform a proper and thorough examination, especially for Individuals that take medication that could directly interact with anti-inflammatory teas.

Drinking Tea for Back Pain

For most individuals, drinking tea is safe to help treat back pain conditions and added health benefits. For example, studies have found that green tea has mild anti-cancer, anti-diabetic properties and can help in maintaining a healthy weight. If tea helps reduce pain, it’s worth trying. Remember, pain is the body’s way to alert the individual that something is wrong.


Body Composition


Alcohol and Heart Health

According to the Mayo Clinic, consuming more than three alcoholic drinks in one sitting causes a temporary blood pressure elevation. Foods often served with alcohol are usually high in salt, which can also raise blood pressure. A few alcoholic beverages on a night out is fine, but heavy or binge drinking can lead to short-term spikes in blood pressure that could cause cardiac health problems. These are the short-term effects of alcohol on blood pressure. Heavy alcohol consumption can lead to long term health risks like:

  • Hypertension
  • Heart disease
  • Digestive issues
  • Liver disease
  • Stroke

It’s recommended that individuals incorporate regular exercise/physical activity and healthy diet changes and watch alcohol intake to improve heart health.

References

The Clinical Journal of Pain. (October 2019) “Nonspecific Low Back Pain:

Inflammatory Profiles of Patients With Acute and Chronic Pain” https://journals.lww.com/clinicalpain/fulltext/2019/10000/nonspecific_low_back_pain__inflammatory_profiles.2.aspx

Certain Teas Bring Down Inflammation More Than Others: Journal of Physical Therapy Science. (October 2016) “Green tea and exercise interventions as nondrug remedies in geriatric patients with rheumatoid arthritis” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5088134/

The Bottom Line: Proceeding of the Japan Academy, Series B Physical and Biological Sciences. (March 2012) “Health-promoting effects of green tea” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3365247/

Lifestyle Adjustments and Chiropractic Enhancements

Lifestyle Adjustments and Chiropractic Enhancements

Individuals are realizing the enhancements that chiropractic produces along with lifestyle adjustments. Chiropractic is about total body health. This includes:

  • Alleviating pain from injuries and musculoskeletal conditions
  • Reversing low energy levels
  • Healthy lifestyle adjustment support
  • Neck Pain
  • Back Pain
  • Chronic Pain
  • Herniated Disc/s
  • Headaches
  • Migraines
  • Sciatica
  • Sports Injuries

Healthy living and regular chiropractic adjustments will elevate the body’s health to new levels.

Chiropractic unlocks the body’s potential

Getting to the root cause of any symptoms that are presenting and addressing them is essential before the body can be at its optimum. A common root cause of pain, low energy, and various general health complaints is spinal misalignment. Poor spinal alignment leads to poor nerve energy flow and poor blood circulation. When the body and nervous system function incorrectly, there is interference with the body’s ability to process normal functions that leads to various forms of dysfunction. A chiropractor can recognize the smallest of changes in the spine that could be affecting the body’s health.

11860 Vista Del Sol, Ste. 128 Lifestyle Adjustments and Chiropractic Enhancements

Good Health to Optimal Health

Restoring spinal alignment is the first step in improving body health. If condition/s are present, first the pain will need to be reduced and under management, then the energy can be increased. A chiropractor will recommend lifestyle adjustments to start building a routine to take good health to optimal health. Recommendations include:

Physical Activity/Exercise

Regular physical activity/exercise for weight management, building muscle and maintaining balance. Specific exercises could be recommended for spinal alignment and core strength reinforcement.

Health Coaching/Diet

The nutrients consumed can have positive and negative effects on the body’s ability to function and heal. A health coach and nutritionist can recommend a nutrition plan that will elevate the body’s health to new levels, increasing energy and helping with weight loss if it is necessary.

11860 Vista Del Sol, Ste. 128 Lifestyle Adjustments and Chiropractic Enhancements

Stress management techniques

Stress is a major player when it comes to poor health. Chiropractic can help develop techniques and strategies to manage stress and reduce the strain on the body’s systems. This could include sleep hygiene, mindfulness, and more.

Neutral spine training

Healthy posture is highly neglected during daily activities, especially when sitting or lying down. A chiropractor will educate the individual on how to hold the spine and posture optimally to reduce awkward positions and unnecessary strain.

Consult a Chiropractic Provider

When making lifestyle changes, a vital component is learning how to incorporate the new adjustments consistently. This encourages the adjustment into becoming a healthy habit that can maintain optimal body health.

Body Composition

Reducing stress levels

There are various techniques that support relaxation, and help turn off the stress response. Here are a few science-backed options:

  1. Free-range eggs
  2. Nuts
  3. Seeds
  4. Shellfish
  5. Parsley
  6. Garlic

Stress-related eating is associated with an increased craving for calorie-dense and highly palatable/tasty usually unhealthy foods. When stress rises, food cravings rise triggering fat gain.

Disclaimer

The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, licensed physician, and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the musculoskeletal system’s injuries or disorders. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request. We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP, CIFM, CTG*
email: coach@elpasofunctionalmedicine.com
phone: 915-850-0900
Licensed in Texas & New Mexico

References

Hawk, Cheryl et al. “Best Practices for Chiropractic Management of Patients with Chronic Musculoskeletal Pain: A Clinical Practice Guideline.” Journal of alternative and complementary medicine (New York, N.Y.) vol. 26,10 (2020): 884-901. doi:10.1089/acm.2020.0181

Walsh, Roger. “Lifestyle and mental health.” The American psychologist vol. 66,7 (2011): 579-92. doi:10.1037/a0021769

Stonerock, Gregory L, and James A Blumenthal. “Role of Counseling to Promote Adherence in Healthy Lifestyle Medicine: Strategies to Improve Exercise Adherence and Enhance Physical Activity.” Progress in cardiovascular diseases vol. 59,5 (2017): 455-462. doi:10.1016/j.pcad.2016.09.003

Texas Supreme Court’s Decision in “Texas Board of Chiropractic Examiners et al v. Texas Medical Association” Case

Texas Supreme Court’s Decision in “Texas Board of Chiropractic Examiners et al v. Texas Medical Association” Case

After all of these years, I am happy to announce that the Texas Supreme Court has finally made a decision regarding the Texas Board of Chiropractic Examiners et al v. Texas Medical Association case on January 29th, 2021. With great honor and gratitude, I’d like to continue to extend sincere thanks to everyone who worked hard on this case and whose tremendous efforts resulted in the decision. Thanks to the Supreme Court’s decision, chiropractors in Texas can now carry on their jobs accordingly. Below, I have provided a letter from Board President, Mark R. Bronson, D.C., F.I.A.N.M. on behalf of the Texas Board of Chiropractic Examiners stating the Texas Supreme Court’s decision in the Texas Board of Chiropractic Examiners et al v. Texas Medical Association case on January 29th, 2021. – Dr. Alex Jimenez D.C., C.C.S.T.

 


 

February 1, 2021

 

On behalf of the Texas Board of Chiropractic Examiners, I extend our sincere thanks and appreciation to everyone whose efforts resulted in the Texas Supreme Court’s decision in Texas Board of Chiropractic Examiners et al v. Texas Medical Association on January 29, 2021. Special thanks are due to all the attorneys at the Office of the Attorney General who worked on this case over these years.

 

The decision properly affirmed the validity of the Board’s scope of practice rule, which the court clearly said does not exceed our statutory scope of chiropractic practice. The court unequivocally held that the Board�s rules do not violate Occupations Code Chapter 201 or run counter to the chapter’s objectives set by the Texas Legislature, and in fact, carefully observe the statutory boundary between the medical and chiropractic professions. This decision, which recognizes the common sense and long-standing inclusion of associated nerves in chiropractic diagnosis and treatment, preserves and strengthens the essence of chiropractic.

 

Thanks to the court’s decision, our licensees can now fulfill their duties as vital portal-of-entry healthcare providers in Texas without fear. The court’s decision reaffirms the principles of economic freedom that have made Texas the best state in the nation to be a chiropractor.

 

Sincerely,

 

Mark R. Bronson, D.C., F.I.A.N.M. Board President
Texas Board of Chiropractic Examiners

 

Supreme-Court-Decision

 


 

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*

 

Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas & New Mexico*

 

The Health of The Spine and Chiropractic For Optimal Body Performance

The Health of The Spine and Chiropractic For Optimal Body Performance

The health of the spine and optimal body performance go hand in hand. When thinking about chiropractic treatment thoughts of cracking, popping, or fixing spinal kinks are what usually come to mind. This is true, however, chiropractic goes much deeper than just adjustments. Regular chiropractic will help maintain overall/optimal health and prevent: Learn more about the treatment options and benefits that chiropractic can provide.  
11860 Vista Del Sol, Ste. 128 The Health of The Spine and Chiropractic For Optimal Body Performance
 

How Chiropractic Supports The Health Of The Spine

The main focus of chiropractic is on the health of the spine. This is because the spine’s health is the base for all other aspects of the body’s health. When the spine is properly aligned, nerve energy/communication and blood circulation are optimized to support the body’s function. When the body is in proper form the health benefits are numerous. These include:
  • Pain alleviation
  • Increased energy
  • Increased productivity
  • Clear thinking
  • Improved biomechanics movement
  • Improved mood
The chiropractic approach is science-based and is highly recommended for achieving positive health results.  
11860 Vista Del Sol, Ste. 128 The Health of The Spine and Chiropractic For Optimal Body Performance
 

Treatment Options

Chiropractic builds-up the body’s nervous system, immune system, and strengthens the musculoskeletal system. What to expect from treatment sessions depends on each individual’s specific conditions, needs, and goals. Treatment can include:

Spinal adjusting

  • Spinal adjustments combined with other treatment techniques are needed to maintain the body’s health long term.

Health Coaching

  • Understanding the causes of ill health/conditions will help manage and prevent issues. A chiropractor and a health coach can discuss positive lifestyle modification factors that will help like:
  • Posture education
  • Exercise tips
  • Stress management techniques
  • Sleep modification
  • Developing healthy diet habits

Deep/Soft tissue massage

  • Soreness, stiffness, and connective tissue flexibility problems are common with misalignment. Addressing these areas with physical therapeutic massage will help reinforce proper body alignment.

Prescribed exercise program

  • A chiropractic practitioner will recommend exercises for strengthening and stretching muscles, tendons will provide support for optimal body alignment and overall health.
 

Health Potential

Seeking treatment options for improved health, consider a chiropractic provider. They will address the root cause to help bring out the best on every level. Chiropractic providers are in high demand and will get the body back to its full potential. See what the possibilities can be.

Body Composition Benefits


 

Best Diet for Weight Loss

Life is about balance and is important to remember that all macronutrients are needed to function properly. Protein does not just affect muscle, it also acts on hormones, enzymes, and antibodies. Carbs are an energy source that the red blood cells use, and without enough fat in the diet, an individual can gain weight by eating more filler foods. The body is a well-refined machine that does not function on fad diets. The function is obtained through balance and variety in a healthy diet. The best diet for weight loss is not complicated or high-tech. The focus should be on whole unrefined foods, reduced red meat consumption, and plenty of vegetables. But, the food does not have to taste bad or have no taste at all. A too rigid diet can make individuals more likely to revert back into unhealthy eating habits. Try a salad with leafy greens, brown rice, sweet potatoes, avocado, black beans, and cilantro lime dressing. It may be a surprise, how healthy eating can taste amazing.

Dr. Alex Jimenez�s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*
References
Meeker, William C, and Scott Haldeman. �Chiropractic: a profession at the crossroads of mainstream and alternative medicine.��Annals of internal medicine�vol. 136,3 (2002): 216-27. doi:10.7326/0003-4819-136-3-200202050-00010
Chiropractic Alignment For Increased Well Being and Positivity

Chiropractic Alignment For Increased Well Being and Positivity

Chiropractic alignment is often the go-to option when injured or experiencing various types of pain. And for good reason, because it works. However, chiropractic medicine goes beyond injuries, and pain conditions. Individuals can reap the benefits of regular chiropractic for increased well being and maintaining optimal health. Chiropractors understand the importance of balancing all areas of the body’s health. This is done through a combination of spinal adjustments and educating individuals on how to develop healthy lifestyle habits. Chiropractic care can increase positivity, overall life, and well-being.  
11860 Vista Del Sol, Ste. 128 Chiropractic Alignment For Increased Well Being and Positivity
 

Regular Chiropractic Alignment Benefits

Being able to enjoy a full and healthy life is more than just being free of pain or injury. It means all of the body’s functions are operating properly and cleanly. Understanding what helps the body thrive can take an individual’s quality of life to another level. Chiropractic can help guide individuals to feel their best with recommendations and regular spinal monitoring and alignment. The benefits of chiropractic include:
  • Energy levels increase
  • Anxiety, stress, and depression are reduced
  • Sleep quality improves
  • Pain reduces and alleviates
  • The body�s natural healing abilities are activated
  • Mood and positivity increases
  • Muscle strength increases and physical performance improves
  • Inflammation is reduced
11860 Vista Del Sol, Ste. 128 Chiropractic Alignment For Increased Well Being and Positivity
 

Spinal Alignment and Increased Positivity

The science behind chiropractic is based on the health of the nervous system. A well-balanced nervous system keeps the body functioning at an optimal level. The primary focus of chiropractic is making sure the spine is in proper alignment. Once a balance has been achieved further recommendations and treatment options can be incorporated into a full maintenance regimen. Spine misalignment occurs with the regular stress placed on the body. Poor posture, too much sitting, and developing injury are a few reasons the spine slips out of alignment. These misalignments are hard to detect without the help of a trained professional chiropractor. Spinal misalignment causes the neural tissues and energy to become compromised and progresses little by little to health degradation.  
11860 Vista Del Sol, Ste. 128 Chiropractic Alignment For Increased Well Being and Positivity
 

Health to the Next Level

Chiropractic medicine specializes in the best possible spinal alignment treatment. An in-depth science-based approach focuses on whole-body results to help an individual feel their best. Get in touch with a chiropractor to see how they can help boost health.

Migraine Treatment

 
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Dr. Alex Jimenez�s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*
References
Ernst, Edzard. �Chiropractic: a critical evaluation.��Journal of Pain and symptom management�vol. 35,5 (2008): 544-62. doi:10.1016/j.jpainsymman.2007.07.004
Strengthening The Immune System With Chiropractic Support

Strengthening The Immune System With Chiropractic Support

The immune system is made up of a network of cells and proteins that defend the body against infection/s. It is made up of specialized organs, and chemicals that fight microorganisms, specifically that are bacterial and can cause infection/disease. The system keeps a record of every germ so it can recognize and destroy any microbes if they enter the body again. Immune system abnormalities can lead to:
 

The Immune System

Protection from viruses and bacterias requires a long term solution/s for building and strengthening immunity. Chiropractic adjustments along with health coaching can help. The main organs of the immune system are:
11860 Vista Del Sol, Ste. 128 Strengthening The Immune System With Chiropractic Support
 

The Microbiome

The health and variety of bacteria in the gastrointestinal tract have been shown to have significant effects on overall health, including immunity. When gut health is optimized, it helps the body�s natural processes for detecting and fighting microorganisms. Simple ways to strengthen gut health include:

Diet

A healthy diet rich in a variety of whole foods and vegetables will promote diversity in the gut.  

Supplements

Probiotics can significantly help strengthen gastrointestinal health.

Get Out In the Sun

Being outside provides the microbiome vitamin D which helps fight inflammation and strengthens the sense of well-being.

Nerve Signal Optimization

The central nervous system has a primary role in gastrointestinal motility and overall balance. Proper spinal alignment will help blood and nerve synapse circulation.  
11860 Vista Del Sol, Ste. 128 Strengthening The Immune System With Chiropractic Support
 

Maintaining Body Balance

A strengthened immune system is about maintaining whole-body balance. The body is a complicated system that operates/functions in top form when tuned up and in proper alignment.

Spinal Alignment

Chiropractic can provide expert treatment to restore spinal misalignment/s. This keeps the body functioning at an optimal level.

Exercise

A moving body is a healthy body. Regular exercise will benefit the immune system and keep it strong.

Stress Management

A high level of stress can compromise the immune system’s health. Regular physical activity/exercise, chiropractic, being aware of any health issues can help manage stress. Chiropractic immune system management will help promote a healthy gastrointestinal tract, help manage stress, get in more physical activity, and stay pain-free. Chiropractic can help kick in the body’s natural immune response and keep the flow going. Call today to see how we can help build a healthy immune system.

Lower Back Pain Chiropractic Treatment


 

Dr. Alex Jimenez�s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*
Reference
Colombi, Andrea, and Marco Testa. �The Effects Induced by Spinal Manipulative Therapy on the Immune and Endocrine Systems.��Medicina (Kaunas, Lithuania)�vol. 55,8 448. 7 Aug. 2019, doi:10.3390/medicina55080448
Prescriptions-Understanding What They Say and Mean

Prescriptions-Understanding What They Say and Mean

Prescription medications are used for treating various types of pain and their causes like inflammation and muscle spasms. Medication can be an important component of a multi-approach treatment plan. Today they are computer-generated and transmitted electronically to a local pharmacy. This article is to help understand what they say and what they mean.  
11860 Vista Del Sol, Ste. 128 Prescriptions-Understanding What They Say and Mean
 
Prescription Shorthand example could be something like – Medication Name 250 mg PO bid x 5 days.
  • The first part is the medication name, which can be a brand name or have a generic name.
  • The second part is 250 mg. This refers to how strong the medication is. In this case, it is 250 milligrams.
  • PO means the medication is taken by mouth.
  • The bid means twice a day.
  • The x 5 days means that this prescription is to be taken for 5 days.
Most of us know the Rx to mean prescription. This is true, with Rx being the abbreviation for the Latin word that means to receive. Prescription abbreviations come from Latin terminology. Here are some common ones used today.  
Abbreviation Translation Latin Terminology
ac before meals ante cibum
bid twice a day bis in die
cap capsule capsula
gt drop guuta
hs at bedtime hora somni
od right eye oculus dexter
os left eye oculus sinister
po by mouth per os
pc after meals post cibum
pil pill pilula
prn as needed pro re nata
q2h every 2 hours quaque 2 hora
qd every day quaque die
qh every hour quaque hora
qid 4 times a day quater in die
tab tablet tabella
tid 3 times a day ter in die
  Understanding what a prescription says is more than just getting it filled at the pharmacy. Remember medications are not without risk. Here are a few guidelines designed to help individuals at the doctor�s office, pharmacy, and at the house.

Doctor Discussions

  • Make sure the doctor knows the entire medical history. Include past reactions to medications like rashes, indigestion, dizziness, and loss of appetite even if only a minor reaction.
  • If taking vitamins, supplements, and herbal compounds a doctor needs to know what is being taken, how much, and how often. This is because certain supplements are known to react with certain medications.
  • Over-the-counter medications can be purchased without a prescription but that does not mean not without risk. Tell the doctor precisely what is being taken, the dosage, frequency, and the reason for taking these medicines.
  • Ask the doctor for the full name of the medication that is being prescribed.
  • Discuss the use of the medication
  • The proper dosage
  • How often to be taken
  • If a dose is missed
  • Possible interactions with other medications including over-the-counter
  • Reaction/s to the medication
  • How it’s supposed to work
  • Side effects
  • Activity level affects
  • Can it be taken with coffee, alcohol, supplements, etc
  • Take notes to help remember the information.
  • Ask for available written material/information about the medication.

The Pharmacy

  • The pharmacy and the patient’s profile is needed for the information included in the records like surgeries, allergies, and other medications being taken. This is to prevent a medication/s interaction complication.
  • Tamper-resistant caps will be provided if children or young adults are present.
  • Ask the pharmacist to include what the medication is used for on the label or if it is too long then a printout.
  • Not remembering how to take the prescription happens. Contact the pharmacy/pharmacist and do not guess.
  • For many, the doctor will telephone, or have a direct line with a pharmacy/s to send prescriptions instantly. However, it is a good idea to review the dose and frequency with the doctor or pharmacist to be completely sure.
  • If a new medication has been prescribed, the pharmacist can fill only half the prescription. This is in case a reaction or side effect presents and can help in saving on the cost.
  • Traveling to a different state/city/climate could require modifications, as some medications will not work properly if there is exposure to sun or other elements.
  • Certain large pills or tablets can be difficult to swallow, so before crushing or splitting, check with the pharmacist. Some medications have alternative forms of ingestion.

At Home Medication Safety

  • With children in the house don�t keep the medication in the nightstand or on the bathroom counter or cabinet. Always keep medications in a secure area.
  • Keep an antidote like Syrup of Ipecac. This is to induce vomiting if poison or harmful chemical is swallowed. Learn the dosing directions and precautions before an emergency.
  • Keep the phone numbers for poison control center and EMS.
  • Reaction or any side effects, call the doctor immediately.
  • Do not mix medications with other medicines along with their bottles. Keep medications in the bottles they came in. Mixing medications in one bottle can alter stability.
  • Keep medications in a dark, dry, and cool (non-refrigerated unless indicated) place. Heat, light, and humidity can affect medication potency and stability.
  • Take medications as directed by the doctor. Medications that are strong enough to heal can also cause damage/injury if taken incorrectly.
  • Never share or take another person’s medication.
  • Only give children medication when fully awake and alert.
  • Some prescriptions and over-the-counter medications come with a dosing cup. Cups can be different sizes along with the dosing measurements. Do not use a cup from another product.
  • When the prescription expires, destroy the unused medication and bottle or take them to a drug disposal site. Some pharmacies offer this service.
  • Keep a list including medical history and medications being taken on a regular basis along with the dose and frequency in a wallet or purse. This information can help during a medical emergency.
Understanding the medication is the key to treating the condition. These recommendations could help to be healthy and safe.

Chiropractor for Auto Injuries


 

Dr. Alex Jimenez�s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*
Certain Medications Increase Risk for Osteoporosis and Spinal Fractures

Certain Medications Increase Risk for Osteoporosis and Spinal Fractures

Medications can be lifesavers when it comes to the treatment of various conditions. But they can also open the door to other serious conditions. Medications fall into pharmacological drug classes. Certain medications can interfere with bone health, and induce bone density loss. Users of these medications could put them at risk for osteoporosis and possible spinal fracture/s. Medications that can potentially weaken bones and how to protect yourself is the focus. Not all of the medications listed are for treating spinal disorders or neck and back pain.  
11860 Vista Del Sol, Ste. 128 Certain Medications Increase Risk for Osteoporosis and Spinal Fractures
 

Steroids

Steroids taken by mouth are commonly prescribed for spinal conditions. This includes:
  • Low back pain
  • Neck pain
  • Spinal inflammatory arthritis
These medications carry anti-inflammatory compounds that are pretty powerful. These help the pain but can cause bone loss with long-term use. These types of steroids put the bones at risk because of how they slow down the osteoblasts, which are bone-building cells. As the osteoblasts are slowed, the work of the osteoclasts, which are bone-absorbing cells gets increased straining the system and ultimately leading to bone loss.

Examples of steroids:

  • Dexamethasone
  • Methylprednisolone
  • Prednisone
Daily doses of more than 5 mg pose the biggest threat to the skeletal system. Ask a doctor about a short-term low-dose regimen, especially, if there is a heightened risk for osteoporosis or spinal fracture.

Selective Serotonin Receptor Uptake Inhibitor

Selective serotonin receptor uptake inhibitors help those with neck and low back pain in a variety of ways. These include reducing the mental and emotional effects of chronic pain. But, selective serotonin receptor uptake inhibitors can boost the fracture risk. This type of medication can cause bone loss in older women and reduced bone density in men and children.

Examples of selective serotonin receptor uptake inhibitors:

Ask a doctor for another type of selective serotonin receptor uptake inhibitor. Possibilities include serotonin and norepinephrine reuptake inhibitors, that can achieve the same results without bone loss and fracture risks.

Certain Anticonvulsants

Anticonvulsants are used to control seizures. However, they have been found to help individuals with spinal nerve pain. But there are some types of anticonvulsants that can increase the liver�s vitamin D metabolism. This lowers the blood�s vitamin D levels. Vitamin D is essential to the body�s ability to absorb calcium. That means that lower vitamin D levels can cause bone loss.

Examples of anticonvulsants:

Talk to a doctor, chiropractor, or health coach about taking a vitamin D supplement/s to boost vitamin D levels.

Certain Diabetic Medications

There are two types of diabetic medications that can increase the risk of fracture. Thiazolidinediones known as TZD’s and sodium-glucose cotransporter 2 inhibitors. The TZD’s increase the fat cells in the bone marrow, and lower the bone-building cells. The sodium-glucose cotransporter 2 inhibitors can reduce bone density.

Examples of TZD’s:

If there is a high risk of fracture, ask a doctor if an alternative medication to a TZD can be taken.

Examples of sodium-glucose cotransporter 2 inhibitors:

  • Canagliflozin
  • Dapagliflozin
  • Empagliflozin
If there is a greater risk of falls, ask a doctor if an alternative to taking a sodium-glucose cotransporter 2 inhibitor can be taken.

Hormone Medications

Medications that reduce estrogen or androgen levels in the body also increase the bone’s absorbing cell activity. And this can lead to bone density loss.

Examples of hormone medications:

  • Anastrozole
  • Exemestane
  • Leuprolide
  • Goserelin
  • Medroxyprogesterone acetate
If there is an increased risk for osteoporosis or fracture, talk to a doctor about ways to protect the bones while taking these medications.

Antacids

Antacids both over-the-counter and prescription that contain aluminum help to neutralize stomach acid. There are other medications called H2-blockers also known as proton-pump inhibitors. These reduce how much acid the stomach produces. While these aid in reducing heartburn, stomach pain, etc, long-term use can reduce the body�s ability to absorb calcium and thus increase the risk for fracture.

Examples of these types of antacids:

Examples of Proton-Pump Inhibitors:

  • Omeprazole
  • Esomeprazole
  • Lansoprazole
Ask a doctor if a different H2-blocker can achieve the same results. Additionally, a doctor, nutritionist, or health coach could recommend dietary changes/adjustments to help reduce stomach acid.

Blood Thinners and Anticoagulants

These medications help reduce the risk of stroke, can interfere with the body�s ability to absorb calcium. They reduce the activity of the bone-building cells. This causes bone loss and increases the risk of fracture.

Examples of anticoagulants or blood thinners:

  • Enoxaparin sodium
  • Warfarin
Talk to a doctor about a possible alternative anticoagulant. A change in medication has been shown to put the bones at less risk.

Diuretics

Loop diuretics work by reducing inflammation/swelling along with water retention by increasing the kidneys urine production. These medications can cause the kidneys to remove key nutrients like calcium, potassium, and magnesium to help increase bone production. Reduction in all of these increases the risk of bone loss and a spinal fracture.

Examples of loop diuretics:

  • Furosemide
  • Ethacrynic acid
  • Bumetanide
Talk to a doctor about an alternative known as a thiazide diuretic. These encourage the kidneys to retain calcium, thus increasing bone density.

Reduce The Risk

Protecting bone health is the objective. A bone mineral density test could help along with taking bone-boosting supplements. Learning about the risks of taking these medications can help prevent osteoporosis and spinal fractures. Keep track of all medications over-the-counter, prescription, holistic, all-natural, etc, and make sure all doctors, specialists understand what is being taken. A spine specialist or endocrinologist might not what the other doctor has prescribed, so keep everyone informed.
 

Rehabilitation for Cerebral Palsy

 
 

Dr. Alex Jimenez�s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*
Healthy Aging of the Body’s Muscles

Healthy Aging of the Body’s Muscles

Healthy aging is not the easiest to do. The muscle aging process breaks down faster than they get repaired as the body ages. This makes it difficult to participate and carry out regular activities. For healthy aging to be achieved exercise is a must. Specifically, strength training helps to regain muscle loss from aging/inactivity. Strength training reduces the difficulty of daily tasks, enhances the body’s energy, and composition. Strength training combined with vitamin D supplementation will slow down muscle loss, help regain muscle mass/strength, maintain healthy blood sugar levels, and prevent falls. New health problems, new aches, pains, and new fragility caused by muscle loss. What steps can be taken to promote healthy aging and staying healthy and fit? The science of aging, and what can be done to age gracefully and maintain optimal health.  
11860 Vista Del Sol, Ste. 128 Healthy Aging of the Body's Muscles
 

The body and aging

The body’s muscles are constantly going breaking down and repairing themselves. As the muscles are used throughout the day, tiny microscopic tears happen from wear and tear. This is where the tears need to be rebuilt with protein. As the body gets older, it stops rebuilding muscle as efficiently and with time, there is a reduction in overall muscle mass and strength. This loss can be from a combination of factors including:
  • Hormone changes – increasing/decreasing levels
  • Physical inactivity
  • Underlying conditions like cardiovascular disease, diabetes, cancer
This reduction in muscle mass does not just happen to the seniors and the elderly. Body development and strength are at their optimal in an individual’s twenties and start to plateau in the thirties. A decrease in strength usually leads to being less active, and routine activities start to become more difficult. Less activity leads to:
  • Less to no calories burned
  • Minimal muscle development
  • Negative changes to body composition
  • Muscle loss
  • Increase in body fat
At some point in an individual’s thirties, the body begins to progressively lose muscle each year. At fifty an individual could have lost around ten percent of the body’s muscle. Then an additional 15% by sixty and another 15% by seventy. Then overall functionality is lost and the ability to enjoy life to the fullest decreases.

Muscle loss factors

Sarcopenia

Sarcopenia is a significant loss of muscle mass and strength. It focuses on diet changes and physical activity that cause progressive loss of muscle mass.
  • Balance issues
  • Change in walking ability
  • Decreased ability to perform daily activities
It was once believed that muscle loss and the effects that came with it were inevitable. However, with the advancements in science and musculoskeletal health, along with continuing to stay active and keeping track of body composition, there are ways to combat loss of muscle mass and strength. Causes include:
  • Age
  • Improper nutrition – decreased protein intake
  • Hormonal changes
  • Increase in pro-inflammatory proteins that the body makes, not the type that is eaten
  • Decreased physical activity
  • Vascular disease/s

Malnutrition

Malnutrition is a lack of nutritional intake, which can affect body composition. Malnutrition can create complications that not only affect diet and exercise but how the body responds to diet and exercise. Elderly individuals tend not to get enough protein, which is essential for healthy muscle repair. This is often because they have trouble chewing, food-costs, and trouble cooking limit their access to getting protein on a regular basis. Inadequate protein intake can lead to sarcopenia. Protein requirements for older individuals are higher than for the younger population. This is brought on by age-related changes like a decreased response to protein intake. This means that older individuals need to consume more protein to achieve the same anabolic effect. Micronutrient deficiency means a lack of nutrients. These are minerals and vitamins, that support body processes like cell regeneration, immune system health, and eyesight. Examples are iron or calcium deficiencies. This deficiency has the highest impact on normal physiological functions/processes and can happen with a protein-energy deficiency. This is because most micronutrients are obtained from food.  
 

Body composition and age

Proper lean muscle mass is essential for healthy aging. A lack of enough muscle can result in:

Difficulty moving

This is when regular movements are no longer regular but now take massive amounts of strength and energy. Examples include taking the elevator becoming a necessity and getting in and out of a car is just as challenging. Loss of function and independence are common as muscle loss progresses. Nineteen percent of women and ten percent of men aged 65 or older no longer have the ability to kneel.

Weight gain

The muscles are linked with the body’s metabolism, so once muscles begin to diminish, so does the metabolism. This is referred to as the body’s metabolism slowing down. What is actually happening is a loss of muscle, meaning the body needs fewer calories to function. When the body needs fewer calories and an individual continues eating the same amount of calories, this is when body fat starts to accumulate. This can happen with no significant changes to individual weight. As muscle loss progresses, it is replaced by fat. Body-weight can remain unchanged, but changes in body composition are unseen, which often leads to an array of health problems associated with obesity.

New healthy aging problems

Studies show that weight gain at a steady rate can lead to adult-onset diabetes. This is due to more body fat and muscle loss. Skeletal muscle mass loss has been linked with insulin resistance. This means the less muscle, the less insulin sensitive an individual becomes. As insulin sensitivity decreases and becomes more resistant, the risk factors for type 2 diabetes increases. Loss of muscle can cause other problems with age. One damaging condition is osteoporosis. A few ways to prevent muscle loss.
  • Eat a proper amount of protein throughout the day. Space out protein across several meals rather than trying to eat it all at once. This will ensure the proper amount daily.
  • Monitor body composition regularly. Try to keep muscle mass loss and fat mass gain at a minimum.
  • Begin a strength training routine.
11860 Vista Del Sol, Ste. 128 Healthy Aging of the Body's Muscles
 

Focus on building muscle

Muscle loss and weakness has been shown to not be a part of aging, but rather as a result of chronic inactivity. Muscle mass is lost with age but it is not the aging process itself that causes muscle atrophy. It is because individuals tend to become more inactive. Physical inactivity is really what causes muscle loss and weakness. However, something can be done about inactivity. For example, there was a study on postmenopausal women that revealed that regular resistance training increased muscle strength by about 19% after one year. Scientific researchers believed this training increased bone mineral density, which defends against brittle bones. This along with related studies also confirmed that bone frailty can be reduced. Muscle strength relative to muscle mass can also be improved with resistance/strength training. The idea is that physical aging can be slowed down with physical activity. This is to keep the muscles from losing function.

DNA damaged cells

Telomeres are caps at the end of DNA strands that protect the chromosomes. They can be thought of as the plastic ends on shoelaces. If those shoelaces lose the plastic ends the laces become frayed until they unravel and can no longer do their job. The same can be said of telomeres, the DNA strands become damaged and the cells cannot do their job. A shortening of the Telomere is a hallmark of cellular aging. Cells with shortened telomeres tend to malfunction and secrete hormones that trigger an inflammatory response and tumor formation. A study found that individuals that exercise regularly have longer telomeres. This does not mean that an individual has to spend the entire day at the gym. Only moderate, not heavy strength training was found to be effective.  
 

Maintain muscle

Older individuals can still be reluctant to try improving their fitness level. Many believe that years of inactivity has done its damage and that they are too old to train. However, anyone can set goals to improve body composition that will improve energy levels and maintain activity. Functional fitness refers to the ability to move comfortably throughout daily life. It not only benefits physical activity but contributes to improved body composition. The aging process does reduce metabolic rate and often leads to increased body fat. Lean Body Mass contributes to the overall Basal Metabolic Rate also known as metabolism. This is the number of calories the body needs to support its essential functions. Engaging in strength training or resistance exercises can regain some of the muscle loss brought on from aging and inactivity. This can lead to an increase in lean body mass, which increases Basal Metabolic Rate. This all helps prevent:
  • Bone loss
  • Heart disease
  • Obesity
  • Age-related falls
With age and the loss of lean muscle mass, balance and agility follow. Tendencies to fall increase and the injuries from those falls can be detrimental to overall health and quality of life. Fractures caused by falling are higher in elder women. A study of all-women over the age of fifty spent 12 weeks using bands as the chosen form of resistance, as opposed to dumbbells or seated machines, saw a significant increase in strength. None of the participants reported injuries. This could be important for those that are worried that exercise could cause too much strain on the body.

It is never too late

Six percent of adults in the United States engage in resistance training or some form of weight training at least twice a week. There are misconceptions that weight training has an age limit. This is not true. The benefits from lifting weights, whether dumbbells, bodyweight exercises, bands, machines, etc are for everyone young and old. This does not mean training at high-intensity. Older adults should look to resistance training to increase energy levels and decrease body fat. A study in Sports Medicine focused on the effects of strength training for older adults found:
  • Increased power
  • Reduced difficulty to perform daily tasks
  • Enhanced energy
  • Improved body composition
  • Participation in spontaneous physical activity
There are several key changes for older adults to increase their healthy aging. They are:
  • Eating sufficient nutrients
  • Monitoring body composition
  • Strength/resistance training
Both strength training and proper nutrition are vital for maintaining or achieving ideal body composition.
 

Vitamin D

Vitamin D is a nutrient that can be acquired in several ways. It supports the normal physiologic functions that include the absorption of minerals like calcium and zinc. This nutrient can be acquired through food consumption, supplemental form, and exposure to the sun. Most foods in a regular diet provide a relatively small amount with the exception of fatty-fish. Examples of natural food sources include:
  • Salmon
  • Swordfish
  • Egg yolks
  • Fortified foods like milk, orange juice, and yogurt
Once Vitamin D enters the body, it goes through the liver, kidneys and gets converted into an active form, known as a prohormone. It is then circulated into the blood. A prohormone is essential to normal physiological function and support of the skeletal muscle system.

Building muscle

Vitamin D plays an important role in bone health. More recently it has been reported to contribute to muscle quality. Skeletal Muscle Mass decreases with age, primarily from decreased activity. Treatment includes proper nutrition, exercise, and vitamin D naturally or in supplementation form. It was found to slow down muscle loss, help regain muscle mass and strength.

On your feet

Falls are the number-one cause of fatal and nonfatal injury/s. Low vitamin D levels could be partly to blame. There is strong evidence that vitamin D deficiency can increase the risk of a fall in older adults. The connection has to do with the effects of muscle strength and function. Around 250 older adults participated in a trial of taking vitamin D daily plus calcium supplementation improved:
  • Quadriceps strength
  • Postural control
  • Daily functions
  • Standing up
  • Walking
After a year falls were found to decrease by over 25%. Compared with patients that only received calcium, and improved by almost 40% after 20 months. Supplements helped these individuals counter the effects of aging and inactivity on their muscles, and was important in preventing potential falls that could result in injury. Getting enough vitamin D is a step to take to supplement exercise, strength training, and maintain muscle health.

Blood sugar check

Vitamin D benefits for muscle health have been linked with muscle mass and blood sugar. Insulin is a hormone that allows blood sugar into the muscles. Individuals with sufficient blood vitamin D levels have a significantly lower risk of hyperglycemia than those with below-recommended levels. Research shows that daily vitamin D supplements in combination with calcium slow down the long-term rise in blood sugar in individuals with prediabetes. Research has shown that supplementation is beneficial for those who are classified as having a deficiency.

Vitamin D Supplements

For individuals with vitamin deficiencies, supplementation can help prevent loss of muscle, strength, falling, and the progression of hyperglycemia. Aging can be accomplished strength training, aerobic exercise, a healthy diet, and the regular monitoring of body composition.

Healthy aging

Maintaining optimal health and aging the way we were supposed to is possible. It does get harder to maintain ideal body composition. The muscles have a harder time rebuilding/repairing and can experience sarcopenia and malnutrition. It is not about getting a flawless physique, but about being able to participate in activities and maintain a healthy lifestyle. Achieving functional fitness through:
  • Observation
  • Diet evaluation
  • Dietary supplementation
  • Twice a week strength training
  • Five-time a week moderate cardiovascular fitness
It is never too late to start on the journey towards optimal health and healthy aging.

Weight Loss Techniques – Push Fitness Center

 
 

Dr. Alex Jimenez�s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*
Podcast: Dynamic Heel Regulator Genesis & What it is

Podcast: Dynamic Heel Regulator Genesis & What it is

 

PODCAST: In this podcast, Dr. Alex Jimenez, a chiropractor in El Paso, presents UTEP’s Engineering Program and Dr. Sarkodie’s team, Juan Corona and Valeria Altamirano, to discuss the genesis of the new dynamic Foot Heel Regulator and what it is. Leg length discrepancy is a health issue characterized as a significant difference in the lengths of an individual’s legs which can ultimately cause a variety of other health issues, including low back pain and sciatica, among others. Juan Corona and Valeria Altamirano describe why they started their leg length regulator product and how they’re planning to bring it to the public to help people with this health issue improve the overall quality of their lives. – Podcast Insight

 


 

[00:00:02] Today, we’re going to be presenting an amazing young group of individuals where we’re going to be discussing really what’s special in El Paso. We’ve got a lot of talent here in this town. And one of the things that we’re gonna be talking about is the actual professionalism. And the science actually what the college engineering does. Dr. Natalicia is an amazing, dynamic principal who’s left a legacy of engineering in the school of UTEP. And one of the things that we have is we have an amazing desire for our youth to want to stay. Now, I’ve been here for 30 years and I’ve been practicing for quite a bit of a long time. And what I’ve noticed is that when I first came to El Paso in 1991, a lot of the young individuals wanted to leave. It was a very common desire that if you lived out here, you wanted to leave. You wanted to go to Washington State. Washington. Harvard. But you didn’t wanna come back. Today, we have a school that is recognized around the world. And the science department is one of the most amazing departments and well respected. And it’s always in the top 10 with M.I.T. and in schools that are very high in engineering values. So I’ve met a lot of the students out here over the years and specifically engineering students and the amazing minds that they have and how intelligent they are. It doesn’t stop to baffle me. It makes me very proud as an individual, as a parent, as a community individual to present certain talents. And today we’re gonna be presenting a group of individuals that have begun a new process, a new endeavor in their lives, and a new beginning. [00:01:38][96.4]

 

[00:01:39] This beginning is one that is full of mystery, wonder, and amazing science endeavors. [00:01:45][6.1]

 

[00:01:46] The program that we’re gonna be discussing focuses on leg length regulations or what they call the leg length regulator. That’s the idea. One, Dr. Sara Cody, Dr. Thomas Sarkoty, who is their teacher, is one of the lead individuals and the one that is spearheading this program. And now I have the privilege of having these two young individuals. I have Juan Corona and Valeria. And tell me how you pronounce your last name. Altamirano. OK, so she’s got a really strong voice, so she will have no problem with introductory. So today I want to do is I want to talk to you guys about these two individuals and specifically about the leg length regulator. This leg length regulator is a new dynamic that is their baby. These guys are master students. That means they’ve gone through a long level education and they are in pre Ph.D. programs, which if they choose to, they can become the future in this new design. So I want to present it to you guys. I’m going to talk first with Mrs. Valeria, and she’s going to go ahead and tell me a little bit about this program as she’s one of the leads. And then the second chair is Juan. I want to be able to go over these things and to discuss what it is that this new product that is being actually genesis or begun here in El Paso is about so Valeria talk to me. Hello, how are you doing? [00:03:13][87.3]

 

[00:03:14] I’m doing really well. Thank you for having me here. [00:03:16][2.2]

 

[00:03:17] So you guys have started a new product and it’s this leg length regulator. Tell me a little bit about what it is, because I think El Paso wants to know what we’re doing in the engineering department. What is it? [00:03:26][8.9]

 

[00:03:26] So the leg length regulator is a new device that we’re trying to develop. And it’s to focus on patients that have leg length discrepancy. And what that is, is when your lower limbs are of unequal size. So a lot of people don’t really know that they have this kind of illness until they notice that they have a lot of back pain. It’s hard for them to stand right. It’s hard for them to walk. And they just experience a lot of uneasiness when they’re doing things. So for a class project, we were assigned to do research and make a device that of our choosing. And Dr. Sarkody had mentioned if we wanted to look into leg length discrepancy. So I went ahead and looked into it and I noticed that a lot of people are affected by it, especially children and elderly patients. So we went ahead and decided, okay, let’s build something for this cause. And that’s how it came to be the leg length regulator. So what it does is we’re trying to use an LVDT, which is a linear variable differential transformer, and it uses that along with a PD controller and programed into an Arduino. And it’ll help regulate the amount of pressure that’s being put on to the foot to help lift it back up to where it’s supposed to be so that the patient doesn’t feel pain. That’s the main goal here, is for that to eliminate pain. And so that children and adults can go on with their everyday lives without having this issue. [00:05:05][98.8]

 

[00:05:06] This is very much amazing. I want to ask Juan in a second here specifically about the idea and how he’s also perceived the beginning of this idea. But as a practicing physician over the last 30 years, I can assure you that leg length discrepancy is a huge problem. It totally throws and alters body mechanics. And one of the things that I can assure you is that when I evaluate each one of my patients, I actually measure for leg length discrepancy, whether it’s just a qualitative look or even a quantitative approach through x rays or different linear methods by measuring femur, hips and knees, tibias and all the good nuts. But we can figure these things out and we can look at the effects. And I will tell you this, that having an altered foot mechanics really throws off the human locomotion, the ambulation of the foot. So I’d like to know a little bit about Juan. Juan. Tell me. And your last name is Corona. Right. And you’re an El Pasoan. And tell me a little bit about the story behind you and this project. [00:06:11][65.4]

 

[00:06:13] I have an undergrad in mechanical engineering. So I’ve always been interested in the biomechanics field. I volunteered in some labs before and I approached Dr. Sarkody as part of my job for him to be my thesis advisor for my project. And as Valeria mentioned, we were in one class where we were asked to find what kind of problem and come up with some kind of a solution in a case. In our case, it was this leg length regulator then we would, that was the class. Then we had another class, which was it was more like a workshop. It’s called ICorps. And basically what they do is tell you and teach you how to sell your product and to see if it’s actually needed for a different kind of population. So, what we want to do, as Valeria mentioned, come up with a device that regulates the different lengths in your legs and to help people reduce their pain, their back pain, their knee pain, and all these different biomechanical issues that come with having this discrepancy. [00:07:23][70.6]

 

[00:07:24] You know, one of the things when you said biomechanical discrepancies, I have to think back to the years when smoking was real bad. It’s been one of the killers of the Americas and people in families through the nineteen hundreds. [00:07:38][14.0]

 

[00:07:40] One of the things is the surgeon general really fought hard and the system fought hard to put these little emblems on to smoking packages, which was smoking is hazardous for your health. Right. And everyone knew it was common sense but they took years to produce this one sentence. Later on, they went off and they put another sentence in there, says it could be also deleterious to pregnant individuals. Right. So this took a long time. It literally it’s sad to believe that it actually took to the 80s to put that statement on. Now, one of the things that I noticed is, is that the surgeon general has recently, and we’re talking about the last decade, has determined that arthritis is a disorder of biomechanical imbalance. Right. So now we know that biomechanical imbalance is one of the major causes of arthritis. When the body’s out of calibration, the body actually forms a level of imbalance. And the body responds, it’s just like when you work out, everyone who works out with their hands. They eventually get calluses on their hands and fingers. This is a normal process. Well, that’s because the body is under stress. The tissues are stressed. The body responds. Well, guess what happens when the body’s out of mechanics? Well, the bones in a process that is delineated by wolf’s law, which is a process of which accelerated mobilization of the osteoblasts, which are they work together, the osteoclasts and osteoblasts you ultimately form arthritis in the direction where the load is imbalancely placed. This is the way the body protects you. So one of the things is that if your body’s out of whack or your foot is not put in the right position, you will actually cause early degenerative changes not only in your foot, ankle, hip, knee, and pretty much the spine in different areas. Right. One of the things that people don’t know is that when we have, let’s say, a person who’s got arthritis in their back and they got a bad hip. Where do you begin? Which one do you fix first? And the smartest and the most astute surgeons will realize that you’ve got to first fix the hip first, because how can you fix a spine with a base all misaligned. Right. It’s almost like you’re building a house on an even floor. So you’ve got to fix the pelvis in this situation. We’re fixing it from the ground up. Once we fix the issue from the ground up, we can actually place a situation where now the body’s in the proper mechanics and then we can deal with the back problem. It’s very hard to fix, a little back problem with a body that has a base that is offset. [00:10:05][145.4]

 

[00:10:06] So let me ask you this in terms of this new product because I’m really excited about this product for you guys as I’m a stand buyer in this really mumbo jumbo to me engineering process and all these linears and vectors that they kind of develop in the neato stuff that they do. I want them to tell us a little bit about what was their beginning, how did they do their research? How did you guys do your research? Either of you guys can answer, how did you do the research in terms of beginning the process? [00:10:32][26.2]

 

[00:10:38] So in order for us to… first Dr. Sarkody, he mentioned about this problem and he said that it was affecting some people, though, in order for us to double-check that we had to carry out some different kind of interviews with people that had. Well, we first interviewed different clinicians and patients that have this condition in order for us to see if it’s actually something that was present among the people here in El Paso. And it is actually pretty common. Very common. Yeah. So we started doing more research and then we started some reading some peer-reviewed articles, you know, to see what our main effects and why… And if I may. [00:11:18][39.9]

 

[00:11:18] … [00:12:58][0.0]

 

[00:12:58] Yeah, it has like 500 people in it. And everyone that’s in that group has been affected either by a family member or they personally have been affected by it. And so I messaged the group admin and I said, hey, I’m doing research. Can I join your group? I don’t have any relation to leg length discrepancy, but I’m trying to build a product to help patients that really need it. And she got back to me and she told me, yeah, definitely. Go ahead, like I’ll post it and see if people are interested. And so, yeah, I was able to get in and I got interviews and that’s kind of how I saw that a lot of patients are actually affected by it. And I didn’t know to what extreme until they were telling me their stories that they have to preorder their shoes, they have to send their shoes to a company to get them back. One little girl told me that she only has one pair of shoes because it’s the only one that works. So she’s sad because she can’t really be that little 12-year-old girl that wants to wear every single shoe out there. [00:14:05][66.8]

 

[00:14:06] Yes. Is that true? Is that true? I have women here watching in the background. Is it true? They all say yes. It’s very true. OK. You know what? Let me ask you particularly because now we’re entering the human component of actually leg length discrepancy. I don’t think anyone’s written the story about the humanity of it, or at least I don’t see them as much. But there is a humanity, a feeling, an empathy to it. What did you sense as you were hearing these stories from these individuals? [00:14:31][25.5]

 

[00:14:33] I was shocked because I didn’t know how bad it was for a person to go through this, because, I mean, you know, my legs are even. I would hope that they are. And it never occurred to me like, oh, I have to go by a different shoe because I need a wider heel to even out my body. And some patients told me that they are active, but it’s hard because when they want to work out, it causes more pain because of the back problem. And then they have to go to rehab and then they want hip surgeries so that they can fix everything. But then it happens again. And then some patients told me that they don’t have the funds to afford a hip surgery and just to go through all that struggle of trying to find something that’ll make them feel good about themselves and not stand out. But at the same time, make it work. Because that was one issue that I noticed. A lot of people do not like the extra heel insert because it’s so bulky and so big and so noticeable and people will stare and be like, why do you have a different shoe size? Like, it looks weird. So it makes them feel really uncomfortable and they don’t want to go out because of this. And so they just stick with regular shoes because they don’t want to be standing out and have people pointing like, hey, you have a problem and they rather take in the pain than fix it. So that really hurt me a lot. Knowing that there’s not something that can help them improve and be able to live their lives daily without having this in the back of their mind. [00:16:14][101.3]

 

[00:16:15] One of the things that you mentioned is and I don’t know if you guys are old enough to have. Well, probably not. But, you know, many people started realizing that the word why became the most important word, probably about a good decade ago. You guys were in middle school. The why that you have in order to do this project. What means a lot to me is that your compassion to it, it hurts you. What else did you feel? And I’m going to talk. I’m gonna ask Juan how he felt after he did his research. What did you feel when you did your research about the individuals and their plight to try to feel good? Valeria, go ahead. [00:16:54][38.9]

 

[00:16:54] Um, well, for me. What made me want to keep on going was asking them questions, like I asked them, what do you want? What is out in the market that you would buy? And they told me what it was. So with the information that they gave me, I started looking into different like redesigning our initial design so that it can fit their criteria so that it can help then and ask them questions about telemedicine. If a component was available, would you prefer that? And would you like to reduce the number of times you visit the doctors and they told me? Yes. And they were just really I was just basically trying to get what they wanted. So I can try to figure out how to put everything that they’re looking for into one design. [00:17:39][44.3]

 

[00:17:39] That’s amazing. Juan, what was the why that’s driving you in this project? Because you got to do you know, one of the things is, engineering is one thing? Right. Right. And that’s the math. That’s the lines, the physics, all the cool stuff that is, you know, the Oppenheimer stuff. For me, when we get to the humanity of it. How do you feel this project has empowered you? [00:18:01][21.6]

 

[00:18:23] And of course I’ve had some knee pain or back pain or my foot hurt sometimes after running. Depends on how much you run and everything. How often. And then it’s I think it’s pretty easy for a person to not relate. For example, I think when people say that they just have two legs with differing lengths, you might not think how much it affects them and how much it impacts their life. And really like in a more personal way, like, for example, someone that likes a certain sport. If they walk, how much they cause in order for them to get a different shoe that is able to help them reduce all these pain. So I think all these pretty small issues when it translates to their experience. I think that’s the thing that impacted me the most. Because you might not know how much this condition is actually affecting their life until you ask them and they tell you. You know, many people that have these types of conditions are prevented of doing some activity that they might like. In my case, it would be running. And I don’t know what I would do if I were not able to run, you know, because there’s a difference between not doing something because you don’t want to then not doing something because you can’t. That’s a big, big difference. Yeah. So like that you get taken away that choice. I think that’s something that really impacted me. So that’s why we really want to keep working on this device to improve it and to make it accessible because there are solutions right now, but there might not be as accessible and affordable for different people. [00:19:59][95.3]

 

[00:19:59] … [00:24:30][78.6]

 

[00:24:31] And no matter what kind of individual, the human foot was designed to last 100 years at least. OK, so there’s nothing in our lives that lasts 100 years. Nothing. No car, no computer, no house without constant maintenance. [00:24:43][11.8]

 

[00:24:43] So imagine the majesty of the foot dynamics. This thing was created for all has like a bunch of bones, all with an arc on it. Two trends, late forces. The whole thing is covered in curves so that it dissipates forces and translates energy and dissipates energy in the most amazing way. One of the things that the feet does have is that as you strike the foot, the first hip is called the heel strike. [00:25:08][24.8]

 

[00:25:08] The heel strike is the moment at which your heel strikes it. At that point, the whole body has to adapt to the opposite. The contralateral, the mechanics, the muscles on the opposite side of the body engage. They know that you have struck the floor. You know this because when you ever missed the heel strike on the stairs, you look like some sort of crazed animal trying to figure out where that foot’s going to land. Right. Your body jumps. So from the heel strike. So as the body goes forward, then it goes to the foot, the stance phase, the stance phases the next phase on the final phase, which is probably the next phase, not the final phase, which is basically the toe-off or the toe land and the toe-off the first metatarsal, which is the big toe. It actually translates to energy, but it was being guided by the heel strike. So all this matters. Okay. Now, based on how the body translates that energy and that foot, we can actually see what actually occurs to the body. Now, guess who’s adjusting to this foot? Heel stands and toe-off stage, the low back is the knees are the cushion mechanism. The meniscus is, the mortise joint in the ankle. These things are all adapting. The beautiful thing of the tibia and the fibula also adapting. So in this magical motion thing. Yeah. You know what? Sadly to say, but we could talk the story when we were young kids, that toe bone connected to the ankle bone, the ankle bone connected to the hip bone all the way to the neck bone, and we sing that song, but it’s very true. So this design is very important to me as an individual to look forward to what it has now. Let’s get into the dynamics and the science of it. Okay, what did you guys do? And by the way. I can only get into it as far as they want to get into it because it’s very unique and it’s very still in the developmental stage. What were the things that you were considering in designing the product? [00:26:51][103.3]

 

[00:26:56] Yes. So when we were in the design process, I actually drew up some sketches and I sent them out and said, hey, does this look okay? And we all came to an agreement to do kind of like a shoe insert because we saw that the shoe insert was available. And then the addition heel part of the shoes, so we all said like, OK? We want to get rid of the whole oh. It looks weird kind of aspect. So our first initial design was focus on the shoe insert. And then we started looking into different material, like for foam that’ll help do the adjustment. And then I looked into different electrical components because my background is in electrical engineering. So I went ahead. [00:27:45][48.8]

 

[00:27:45] … [00:32:17][34.2]

 

[00:32:37] Yes. So I did do research on it about what the program is. And it’s ICorps. And what they do is they help engineers or anyone in the science field to build different technology that could be needed out in the world. And you present what you have to this group and they determine if, kind of like, if you’re worthy or not to have to bring your idea to life because a lot of people, what I’ve learned from the regional ICorps program was that a lot of people think that they have a million-dollar idea. But when they present it and they do research and they do customer discovery, they start to realize that maybe no one really needs it. They just thought it was a cool idea. [00:33:24][46.3]

 

[00:33:25] Yeah. So there’s stages. And so you said there’s regional and there’s what is there national. OK, there’s regional. National. [00:33:30][5.3]

 

[00:33:32] Yes. So when we went out and at first I was like, I don’t know, like to be honest, I told myself, I don’t know if there’s an actual need for this kind of thing. So it was cool having to go out and find people that have this type of issue. And I’m glad that I did because now I know a lot of people do have this issue and they don’t realize that they have this issue till they’re about the mid 20s, higher 30s, and it’s kind of too late for them to figure out, like what to do and help adjust their posture and fix it. Compared to kids who are born with it, they have to deal with all this and then go through different appointments to help fix it. And then they can qualify for surgery, which can take time. So when I saw that, I realized that what we’re trying to do and what we’re trying to make, it has an impact and can help all these people so they don’t have to be like, OK. [00:34:31][58.5]

 

[00:34:31] I have limited options. What can I do? Either hip surgery or get a shoe that’s going to make me stand out. And so this device that we’re trying to develop shows that it can go above and beyond and help a ton of people. [00:34:46][14.5]

 

[00:34:47] Let me ask you this Juan. Obviously, this is first a great product, but then you’re going to throw your baby out to competition. Right. So tell me how you feel about that and how ready are you and what are the things that you’re gonna be doing to get ready for this competition? [00:35:03][16.4]

 

[00:35:04] Um, so, yeah, um, basically as Valeria mentioned, the ICorps program they teach us if our idea is actually, if there’s actually a need for people to get it and if people are willing to pay for a device, essentially know if we’re actually able to commercialize it. So in this competition, we have different of course people and people have a different device and we all think there are devices that most needed one but we actually have to prove that people need it and that it’s actually going to help their lives. So I think in the original part, we already, that part is already finished. But we’re looking to go for the nationals. I’m pretty sure it’s going to be tough. I mean, I’m pretty sure that like not everyone gets it gets there, but we are very confident. And how much is the device needed and how much these people would get their life improved if they actually get us through it? [00:36:05][61.4]

 

[00:36:06] I think we have it in our thoughts. And as you guys develop this, you guys are thinking of like which was your avatar, who really wants the product. I would assure you this, that as a parent if I see my son having an issue, I’m the avatar, I’m the dad because you’re selling the product to me because I’m the one that’s going to identify my little boy. My little girl has an issue. Right. [00:36:30][23.8]

 

[00:36:30] So I got to tell you, the way you package this stuff in the way you’re explaining it to me excites me to be able to help my son, my daughter in whatever situation is. So that’s very exciting to see. Now, in terms of getting it on with the competition, let’s talk about getting it on with the competition because we’re gonna get it on. Right. So as we do the process, have you guys thought that process out in and how we’re going to present that at the regional? I think first it had to go to regional correct or has it been not we’re not past regionals or we are past regionals. [00:37:03][32.2]

 

[00:37:21] I have, um, I saw that it was a seven-week program and they told us that the first four days are heavy because you have to go to seminars and it can be from 8:00 in the morning all the way to 6:00 in the afternoon. So you need a lot of time. And then another thing that they told me was if we do want to do this for the regional, we had to contact 25 or conduct 25 interviews. And at the national level, you have to do 100 interviews. So it’s four times greater than what it is at regional. [00:37:59][38.1]

 

[00:38:16] And then we can also use LinkedIn to go for more of the doctors and people that actually focus and specialize in like leg length discrepancy. But it’s good to know for the customer segment of who’s actually going to be purchasing this because that’s where our money is going to be coming from. Yes. You know, it’s gonna be a lot of work, but we’re committed. And I’ve already looked at my schedule and I’m like, OK, this day is gonna be dedicated just to do this and things like that. And I’ve been pushing things around so that way I have the time to do what is needed and to get it done efficiently and successfully. [00:38:56][39.6]

 

[00:38:57] You know, full disclosure, I’ve been invited to be part of the mentor program along with Dr. Sarkody in different responsibilities. I look forward to working with these individuals and knowing the entire team to be able to bring the product to whatever it is that it’s supposed to be. It’s already written. But we’ve got to make it happen. Right. So we’ve got to propel this product. So I was brought in by Juan. He found me out. I was you know, I was bouncing around and I think Kenna also bumped in and we kind of crisscrossed and we got e-mails and they told me about this product. I thought it was an awesome idea because I have seen the effects. I can tell you that if I had an option like this, it would be unbelievable or a great choice for individuals that have from scoliosis to back problems to hip problems. Because we live in a world where when I started practicing, there was no such thing as the Internet. Now, as far as whether it is and did indicate that it’s a fast thing, my daughter, she was able to do things, you know, do a whole project by just getting on social media and doing things in minutes. That took me years to do. The people out there are highly educated. And now with the Internet and the resources that they’re out there, this is gonna be a big thing. I do believe. I believe in their vision. I believe in their why. [00:40:18][81.4]

 

[00:40:20] … [00:45:45][68.6]

 

[00:45:50] Well, you know, I can see you’re holding your cards to your vest there. Well, I tell you, I’m very impressed with you guys I’m fans of you guys. And I look forward to having you guys back into doing the podcast and discussing different avenues. Now, each one of these we did a lot of general talking. We didn’t get too deep into the subject matter for that. And that is by design. By the way, until we are able to really present this product, we won’t want to give the competition any of the ideas. Because then you guys, you know, you see the leg length regulator 2 and you’re gonna be really upset. Right. So as we do this kind of ideas today, we’re gonna be filling in some of the videos in the background. That’s gonna be just basic and generic. But I look forward to assisting you guys. And in the ability to push you guys out there and make it happen, because we’re gonna get it on right. Guys, we’re gonna get it on. We’re gonna get it. We’re going to take on these I.T. technical individuals and we’re going to bring it home because we have a stronger why. Right. And that’s what I want to make sure that as we encompass these new dynamics, I look forward to seeing my cohort, Dr. Sarkodie, in this process. And we’re gonna be bringing him into the next podcast and discussing, you know, the insights, the genesis in this product, and the reasons why the developmental process from his point of view, what he sees into his design, along with his personal experiences in moving biomechanical dynamic apparatuses that he has had. Because as I understand, Dr. Sarkodie has had a vast amount of experience in body and mechanical dynamics, specifically when we’re dealing with gait dynamics. [00:47:31][101.0]

 

[00:47:33] So UTEP, you know, has brought in a lot of great order around the world and is attracting great scientists from around the world. And what we need to do is we need to support our teams and our individuals. So. Enough said and we look forward to seeing you guys into the future. So God bless. And again, we had Juan Corona and Valeria Altamirano. [00:47:54][21.8]

 

[00:47:55] All right. Sounds good. All right. Thank you so much, guys. [00:48:00][5.2]

 

[00:48:01] Thank you. [00:48:01][0.0]

 

[2792.1]

 

Chiropractic and The Benefits for Children’s Health and Wellness

Chiropractic and The Benefits for Children’s Health and Wellness

Chiropractic adjustments for children’s health is nothing new, but it could be something new for parents. Do children really need chiropractic adjustments? Chiropractic physicians, also known as DC’s provide techniques and treatments that pediatricians don’t offer.

Chiropractors offer non-invasive options, before referring an individual to a pain specialist that might only prescribe medication/s and surgery. The body’s central nervous system controls everything. Birth itself can be physically traumatic for some infants. Therefore, receiving an adjustment can improve neurological input and correction, allowing for healthy development. �

11860 Vista Del Sol Ste. 128 Chiropractic and The Benefits for Children�s Health and Wellness

If involved in sports or some type of physical activity, chiropractic helps recovery from injuries progress faster and is less traumatic than disruptive therapies like pain-meds or surgery. Chiropractic medicine takes into account the entire person when there is an adjustment/correction in one area, it supports and corrects the other areas.

Depending on the chiropractor, other techniques and specialties like acupuncture, craniosacral, nutrition, and more could be incorporated into a patient’s treatment plan. Here are a few ways chiropractic can benefit children’s health.

Non-invasive

Chiropractic treatment is holistic and non-invasive. For children’s health, adjustments help with proper growth and development by removing or limiting digestive issues like:

  • Nursing
  • Re-flux
  • Colic
  • Constipation

Other issues for where pediatric chiropractic care can be utilized include:

  • Allergies
  • Asthma
  • Bed-wetting
  • Colds
  • Ear infections
  • Attention deficit disorder
  • Attention deficit hyperactivity disorder
  • Autism
11860 Vista Del Sol Ste. 128 Chiropractic and The Benefits for Children�s Health and Wellness

However, unlike adults, children, and especially infants, chiropractic medicine focuses on mobilization that places a lower amount of pressure on the area, rather than manipulation associated with chiropractic for adult treatment that places more pressure on the area being adjusted.

Nutrition

Parents who are considering chiropractic treatment for their children’s health and wellness should also expect nutritional health coaching for optimal health. Chiropractors go through extensive training in nutrition and are qualified to offer nutritional plans that are part of the treatment.

Proper nutrition is important for everyone�s health. But for children who are growing and developing, it is essential that they get the nutrients they need for optimal spine health and development. Some foods and food additives can cause behavioral issues. These foods include:

  • Dairy
  • Artificial colors
  • Sugar
  • Preservatives
  • Other food allergens

Chiropractors can help parents and caregivers by testing and identifying behavioral triggers whose root cause could be nutritional that is improper or deficient for children’s health. �

Wellness Philosophy

Educating parents and families about the benefits of proper nutrition and fitness are essential for children’s health and wellness. Families need to follow the principles of:

  • Eating whole foods
  • Junk food minimalization
  • Electronic device limits
  • Playing/exercising regularly

These are strategies that will reduce childhood obesity that is causing a range of problems for health care like Type 2 diabetes, high cholesterol, and high blood pressure. Excess weight in young children and if it goes on for a long time creates a higher chance of earlier death in adulthood. From a psychological perspective, it is important to understand that during childhood kids can develop a negative body image, leading to low self-esteem, and causing depression. This can lead to serious mental health issues.

Safe

Overall, chiropractic care for children is safe and highly effective. Children typically have a positive response or no response. If you�re considering chiropractic for your child, there are many resources to help make an informed decision. For more information, visit the International Chiropractic Pediatric Association to find a chiropractor.


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The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*

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What is Degenerative Disc Disease (DDD)?: An Overview

What is Degenerative Disc Disease (DDD)?: An Overview

Degenerative Disc Disease is a general term for a condition in which the damaged intervertebral disc causes chronic pain, which could be either low back pain in the lumbar spine or neck pain in the cervical spine. It is not a �disease� per se, but actually a breakdown of an intervertebral disc of the spine. The intervertebral disc is a structure that has a lot of attention being focused on recently, due to its clinical implications. The pathological changes that can occur in disc degeneration include fibrosis, narrowing, and disc desiccation. Various anatomical defects can also occur in the intervertebral disc such as sclerosis of the endplates, fissuring and mucinous degeneration of the annulus, and the formation of osteophytes.

 

Low back pain and neck pain are major epidemiological problems, which are thought to be related to degenerative changes in the disk. Back pain is the second leading cause of the visit to the clinician in the USA. It is estimated that about 80% of US adults suffer from low back pain at least once during their lifetime. (Modic, Michael T., and Jeffrey S. Ross) Therefore, a thorough understanding of degenerative disc disease is needed for managing this common condition.

 

Anatomy of Related Structures

 

Anatomy of the Spine

 

The spine is the main structure, which maintains the posture and gives rise to various problems with disease processes. The spine is composed of seven cervical vertebrae, twelve thoracic vertebrae, five lumbar vertebrae, and fused sacral and coccygeal vertebrae. The stability of the spine is maintained by three columns.

 

The anterior column is formed by anterior longitudinal ligament and the anterior part of the vertebral body. The middle column is formed by the posterior part of the vertebral body and the posterior longitudinal ligament. The posterior column consists of a posterior body arch that has transverse processes, laminae, facets, and spinous processes. (�Degenerative Disk Disease: Background, Anatomy, Pathophysiology�)

 

Anatomy of the Intervertebral Disc

 

Intervertebral disc lies between two adjacent vertebral bodies in the vertebral column. About one-quarter of the total length of the spinal column is formed by intervertebral discs. This disc forms a fibrocartilaginous joint, also called a symphysis joint. It allows a slight movement in the vertebrae and holds the vertebrae together. Intervertebral disc is characterized by its tension resisting and compression resisting qualities. An intervertebral disc is composed of mainly three parts; inner gelatinous nucleus pulposus, outer annulus fibrosus, and cartilage endplates that are located superiorly and inferiorly at the junction of vertebral bodies.

 

Nucleus pulposus is the inner part that is gelatinous. It consists of proteoglycan and water gel held together by type II Collagen and elastin fibers arranged loosely and irregularly. Aggrecan is the major proteoglycan found in the nucleus pulposus. It comprises approximately 70% of the nucleus pulposus and nearly 25% of the annulus fibrosus. It can retain water and provides the osmotic properties, which are needed to resist compression and act as a shock absorber. This high amount of aggrecan in a normal disc allows the tissue to support compressions without collapsing and the loads are distributed equally to annulus fibrosus and vertebral body during movements of the spine. (Wheater, Paul R, et al.)

 

The outer part is called annulus fibrosus, which has abundant type I collagen fibers arranged as a circular layer. The collagen fibers run in an oblique fashion between lamellae of the annulus in alternating directions giving it the ability to resist tensile strength. Circumferential ligaments reinforce the annulus fibrosus peripherally. On the anterior aspect, a thick ligament further reinforces annulus fibrosus and a thinner ligament reinforces the posterior side. (Choi, Yong-Soo)

 

Usually, there is one disc between every pair of vertebrae except between atlas and axis, which are first and second cervical vertebrae in the body. These discs can move about 6? in all the axes of movement and rotation around each axis. But this freedom of movement varies between different parts of the vertebral column. The cervical vertebrae have the greatest range of movement because the intervertebral discs are larger and there is a wide concave lower and convex upper vertebral body surfaces. They also have transversely aligned facet joints. Thoracic vertebrae have the minimum range of movement in flexion, extension, and rotation, but have free lateral flexion as they are attached to the rib cage. The lumbar vertebrae have good flexion and extension, again, because their intervertebral discs are large and spinous processes are posteriorly located. However, lateral lumbar rotation is limited because the facet joints are located sagittally. (�Degenerative Disk Disease: Background, Anatomy, Pathophysiology�)

 

Blood Supply

 

The intervertebral disc is one of the largest avascular structures in the body with capillaries terminating at the endplates. The tissues derive nutrients from vessels in the subchondral bone which lie adjacent to the hyaline cartilage at the endplate. These nutrients such as oxygen and glucose are carried to the intervertebral disc through simple diffusion. (�Intervertebral Disc � Spine � Orthobullets.Com�)

 

Nerve Supply

 

Sensory innervation of intervertebral discs is complex and varies according to the location in the spinal column. Sensory transmission is thought to be mediated by substance P, calcitonin, VIP, and CPON. Sinu vertebral nerve, which arises from the dorsal root ganglion, innervates the superficial fibers of the annulus. Nerve fibers don�t extend beyond the superficial fibers.

 

Lumbar intervertebral discs are additionally supplied on the posterolateral aspect with branches from ventral primary rami and from the grey rami communicantes near their junction with the ventral primary rami. The lateral aspects of the discs are supplied by branches from rami communicantes. Some of the rami communicantes may cross the intervertebral discs and become embedded in the connective tissue, which lies deep to the origin of the psoas. (Palmgren, Tove, et al.)

 

The cervical intervertebral discs are additionally supplied on the lateral aspect by branches of the vertebral nerve. The cervical sinu vertebral nerves were also found to be having an upward course in the vertebral canal supplying the disc at their point of entry and the one above. (BOGDUK, NIKOLAI, et al.)

 

Pathophysiology of Degenerative Disc Disease

 

Approximately 25% of people before the age of 40 years show disc degenerative changes at some level. Over 40 years of age, MRI evidence shows changes in more than 60% of people. (Suthar, Pokhraj) Therefore, it is important to study the degenerative process of the intervertebral discs as it has been found to degenerate faster than any other connective tissue in the body, leading to back and neck pain. The changes in three intervertebral discs are associated with changes in the vertebral body and joints suggesting a progressive and dynamic process.

 

Degeneration Phase

 

The degenerative process of the intervertebral discs has been divided into three stages, according to Kirkaldy-Willis and Bernard, called ��degenerative cascade��. These stages can overlap and can occur over the course of decades. However, identifying these stages clinically is not possible due to the overlap of symptoms and signs.

 

Stage 1 (Degeneration Phase)

 

This stage is characterized by degeneration. There are histological changes, which show circumferential tears and fissures in the annulus fibrosus. These circumferential tears may turn into radial tears and because the annulus pulposus is well innervated, these tears can cause back pain or neck pain, which is localized and with painful movements. Due to repeated trauma in the discs, endplates can separate leading to disruption of the blood supply to the disc and therefore, depriving it of its nutrient supply and removal of waste. The annulus may contain micro-fractures in the collagen fibrils, which can be seen on electron microscopy and an MRI scan may reveal desiccation, bulging of the disc, and a high-intensity zone in the annulus. Facet joints may show a synovial reaction and it may cause severe pain with associated synovitis and inability to move the joint in the zygapophyseal joints. These changes may not necessarily occur in every person. (Gupta, Vijay Kumar, et al.)

 

The nucleus pulposus is also involved in this process as its water imbibing capacity is reduced due to the accumulation of biochemically changed proteoglycans. These changes are brought on mainly by two enzymes called matrix metalloproteinase-3 (MMP-3) and tissue inhibitor of metalloproteinase-1 (TIMP-1). (Bhatnagar, Sushma, and Maynak Gupta) Their imbalance leads to the destruction of proteoglycans. The reduced capacity to absorb water leads to a reduction of hydrostatic pressure in the nucleus pulposus and causes the annular lamellae to buckle. This can increase the mobility of that segment resulting in shear stress to the annular wall. All these changes can lead to a process called annular delamination and fissuring in the annulus fibrosus. These are two separate pathological processes and both can lead to pain, local tenderness, hypomobility, contracted muscles, painful joint movements. However, the neurological examination at this stage is usually normal.

 

Stage 2 (Phase of Instability)

 

The stage of dysfunction is followed by a stage of instability, which may result from the progressive deterioration of the mechanical integrity of the joint complex. There may be several changes encountered at this stage, including disc disruption and resorption, which can lead to a loss of disc space height. Multiple annular tears may also occur at this stage with concurrent changes in the zagopophyseal joints. They may include degeneration of the cartilage and facet capsular laxity leading to subluxation. These biomechanical changes result in instability of the affected segment.

 

The symptoms seen in this phase are similar to those seen in the dysfunction phase such as �giving way� of the back, pain when standing for prolonged periods, and a �catch� in the back with movements. They are accompanied by signs such as abnormal movements in the joints during palpation and observing that the spine sways or shifts to a side after standing erect for sometime after flexion. (Gupta, Vijay Kumar et al.)

 

Stage 3 (Re-Stabilization Phase)

 

In this third and final stage, the progressive degeneration leads to disc space narrowing with fibrosis and osteophyte formation and transdiscal bridging. The pain arising from these changes is severe compared to the previous two stages, but these can vary between individuals. This disc space narrowing can have several implications on the spine. This can cause the intervertebral canal to narrow in the superior-inferior direction with the approximation of the adjacent pedicles. Longitudinal ligaments, which support the vertebral column, may also become deficient in some areas leading to laxity and spinal instability. The spinal movements can cause the ligamentum flavum to bulge and can cause superior aricular process subluxation. This ultimately leads to a reduction of diameter in the anteroposterior direction of the intervertebral space and stenosis of upper nerve root canals.

 

Formation of osteophytes and hypertrophy of facets can occur due to the alteration in axial load on the spine and vertebral bodies. These can form on both superior and inferior articular processes and osteophytes can protrude to the intervertebral canal while the hypertrophied facets can protrude to the central canal. Osteophytes are thought to be made from the proliferation of articular cartilage at the periosteum after which they undergo endochondral calcification and ossification. The osteophytes are also formed due to the changes in oxygen tension and due to changes in fluid pressure in addition to load distribution defects. The osteophytes and periarticular fibrosis can result in stiff joints. The articular processes may also orient in an oblique direction causing retrospondylolisthesis leading to the narrowing of the intervertebral canal, nerve root canal, and the spinal canal. (KIRKALDY-WILLIS, W H et al.)

 

All of these changes lead to low back pain, which decreases with severity. Other symptoms like reduced movement, muscle tenderness, stiffness, and scoliosis can occur. The synovial stem cells and macrophages are involved in this process by releasing growth factors and extracellular matrix molecules, which act as mediators. The release of cytokines has been found to be associated with every stage and may have therapeutic implications in future treatment development.

 

Etiology of the Risk Factors of Degenerative Disc Disease

 

Aging and Degeneration

 

It is difficult to differentiate aging from degenerative changes. Pearce et al have suggested that aging and degeneration is representing successive stages within a single process that occur in all individuals but at different rates. Disc degeneration, however, occurs most often at a faster rate than aging. Therefore, it is encountered even in patients of working age.

 

There appears to be a relationship between aging and degeneration, but no distinct cause has yet been established. Many studies have been conducted regarding nutrition, cell death, and accumulation of degraded matrix products and the failure of the nucleus. The water content of the intervertebral disc decreases with the increasing age. Nucleus pulposus can get fissures that can extend into the annulus fibrosus. The start of this process is termed chondrosis inter vertebralis, which can mark the beginning of the degenerative destruction of the intervertebral disc, the endplates, and the vertebral bodies. This process causes complex changes in the molecular composition of the disc and has biomechanical and clinical sequelae that can often result in substantial impairment in the affected individual.

 

The cell concentration in the annulus decreases with increasing age. This is mainly because the cells in the disc are subjected to senescence and they lose the ability to proliferate. Other related causes of age-specific degeneration of intervertebral discs include cell loss, reduced nutrition, post-translational modification of matrix proteins, accumulation of products of degraded matrix molecules, and fatigue failure of the matrix. Decreasing nutrition to the central disc, which allows the accumulation of cell waste products and degraded matrix molecules seems to be the most important change out of all these changes. This impairs nutrition and causes a fall in the pH level, which can further compromise cell function and may lead to cell death. Increased catabolism and decreased anabolism of senescent cells may promote degeneration. (Buckwalter, Joseph A.) According to one study, there were more senescence cells in the nucleus pulposus compared to annulus fibrosus and herniated discs had a higher chance of cell senescence.� (Roberts, S. et al.)

 

When the aging process goes on for some time, the concentrations of chondroitin 4 sulfate and chondroitin 5 sulfate, which is strongly hydrophilic, gets decreased while the keratin sulfate to chondroitin sulfate ratio gets increased. Keratan sulfate is mildly hydrophilic and it also has a minor tendency to form stable aggregates with hyaluronic acid. As aggrecan is fragmented, and its molecular weight and numbers are decreased, the viscosity and hydrophilicity of the nucleus pulposus decrease. Degenerative changes to the intervertebral discs are accelerated by the reduced hydrostatic pressure of the nucleus pulposus and the decreased supply of nutrients by diffusion. When the water content of the extracellular matrix is decreased, intervertebral disc height will also be decreased. The resistance of the disc to an axial load will also be reduced. Because the axial load is then transferred directly to the annulus fibrosus, annulus clefts can get torn easily.

 

All these mechanisms lead to structural changes seen in degenerative disc disease. Due to the reduced water content in the annulus fibrosus and associated loss of compliance, the axial load can get redistributed to the posterior aspect of facets instead of the normal anterior and middle part of facets. This can cause facet arthritis, hypertrophy of the adjacent vertebral bodies, and bony spurs or bony overgrowths, known as osteophytes, as a result of degenerative discs. (Choi, Yong-Soo)

 

Genetics and Degeneration

 

The genetic component has been found to be a dominant factor in degenerative disc disease. Twin studies, and studies involving mice, have shown that genes play a role in disc degeneration. (Boyd, Lawrence M., et al.) Genes that code for collagen I, IX, and XI, interleukin 1, aggrecan, vitamin D receptor, matrix metalloproteinase 3 (MMP � 3), and other proteins are among the genes that are suggested to be involved in degenerative disc disease. Polymorphisms in 5 A and 6 A alleles occurring in the promoter region of genes that regulate MMP 3 production are found to be a major factor for the increased lumbar disc degeneration in the elderly population. Interactions among these various genes contribute significantly to intervertebral disc degeneration disease as a whole.

 

Nutrition and Degeneration

 

Disc degeneration is also believed to occur due to the failure of nutritional supply to the intervertebral disc cells. Apart from the normal aging process, the nutritional deficiency of the disc cells is adversely affected by endplate calcification, smoking, and the overall nutritional status. Nutritional deficiency can lead to the formation of lactic acid together with the associated low oxygen pressure. The resulting low pH can affect the ability of disc cells to form and maintain the extracellular matrix of the discs and causes intervertebral disc degeneration. The degenerated discs lack the ability to respond normally to the external force and may lead to disruptions even from the slightest back strain. (Taher, Fadi, et al.)

 

Growth factors stimulate the chondrocytes and fibroblasts to produce more amount of extracellular matrix. It also inhibits the synthesis of matrix metalloproteinases. Example of these growth factors includes transforming growth factor, insulin-like growth factor, and basic fibroblast growth factor. The degraded matrix is repaired by an increased level of transforming growth factor and basic fibroblast growth factor.

 

Environment and Degeneration

 

Even though all the discs are of the same age, discs found in the lower lumbar segments are more vulnerable to degenerative changes than the discs found in the upper segment. This suggests that not only aging but, also mechanical loading, is a causative factor. The association between degenerative disc disease and environmental factors has been defined in a comprehensive manner by Williams and Sambrook in 2011. (Williams, F.M.K., and P.N. Sambrook) The heavy physical loading associated with your occupation is a risk factor that has some contribution to disc degenerative disease. There is also a possibility of chemicals causing disc degeneration, such as smoking, according to some studies. (Batti�, Michele C.) Nicotine has been implicated in twin studies to cause impaired blood flow to the intervertebral disc, leading to disc degeneration. (BATTI�, MICHELE C., et al.) Moreover, an association has been found among atherosclerotic lesions in the aorta and the low back pain citing a link between atherosclerosis and degenerative disc disease. (Kauppila, L.I.) The disc degeneration severity was implicated in overweight, obesity, metabolic syndrome, and increased body mass index in some studies. (�A Population-Based Study Of Juvenile Disc Degeneration And Its Association With Overweight And Obesity, Low Back Pain, And Diminished Functional Status. Samartzis D, Karppinen J, Mok F, Fong DY, Luk KD, Cheung KM. J Bone Joint Surg Am 2011;93(7):662�70�)

 

Pain in Disc Degeneration (Discogenic Pain)

 

Discogenic pain, which is a type of nociceptive pain, arises from the nociceptors in the annulus fibrosus when the nervous system is affected by the degenerative disc disease. Annulus fibrosus contains immune reactive nerve fibers in the outer layer of the disc with other chemicals such as a vasoactive intestinal polypeptide, calcitonin gene-related peptide, and substance P. (KONTTINEN, YRJ� T., et al.) When degenerative changes in the intervertebral discs occur, normal structure and mechanical load are changed leading to abnormal movements. These disc nociceptors can get abnormally sensitized to mechanical stimuli. The pain can also be provoked by the low pH environment caused by the presence of lactic acid, causing increased production of pain mediators.

 

Pain from degenerative disc disease may arise from multiple origins. It may occur due to the structural damage, pressure, and irritation on the nerves in the spine. The disc itself contains only a few nerve fibers, but any injury can sensitize these nerves, or those in the posterior longitudinal ligament, to cause pain. Micro movements in the vertebrae can occur, which may cause painful reflex muscle spasms because the disc is damaged and worn down with the loss of tension and height. The painful movements arise because the nerves supplying the area are compressed or irritated by the facet joints and ligaments in the foramen leading to leg and back pain. This pain may be aggravated by the release of inflammatory proteins that act on nerves in the foramen or descending nerves in the spinal canal.

 

Pathological specimens of the degenerative discs, when observed under the microscope, reveals that there are vascularized granulation tissue and extensive innervations found in the fissures of the outer layer of the annulus fibrosus extending into the nucleus pulposus. The granulation tissue area is infiltrated by abundant mast cells and they invariably contribute to the pathological processes that ultimately lead to discogenic pain. These include neovascularisation, intervertebral disc degeneration, disc tissue inflammation, and the formation of fibrosis. Mast cells also release substances, such as tumor necrosis factor and interleukins, which might signal for the activation of some pathways which play a role in causing back pain. Other substances that can trigger these pathways include phospholipase A2, which is produced from the arachidonic acid cascade. It is found in increased concentrations in the outer third of the annulus of the degenerative disc and is thought to stimulate the nociceptors located there to release inflammatory substances to trigger pain. These substances bring about axonal injury, intraneural edema, and demyelination. (Brisby, Helena)

 

The back pain is thought to arise from the intervertebral disc itself. Hence why the pain will decrease gradually over time when the degenerating disc stops inflicting pain. However, the pain actually arises from the disc itself only in 11% of patients according to endoscopy studies. The actual cause of back pain seems to be due to the stimulation of the medial border of the nerve and referred pain along the arm or leg seems to arise due to the stimulation of the core of the nerve. The treatment for disc degeneration should mainly focus on pain relief to reduce the suffering of the patient because it is the most disabling symptom that disrupts a patient�s lives. Therefore, it is important to establish the mechanism of pain because it occurs not only due to the structural changes in the intervertebral discs but also due to other factors such as the release of chemicals and understanding these mechanisms can lead to effective pain relief. (Choi, Yong-Soo)

 

Clinical Presentation of Degenerative Disc Disease

 

Patients with degenerative disc disease face a myriad of symptoms depending on the site of the disease. Those who have lumbar disc degeneration get low back pain, radicular symptoms, and weakness. Those who have cervical disc degeneration have neck pain and shoulder pain.

 

Low back pain can get exacerbated by the movements and the position. Usually, the symptoms are worsened by the flexion, while the extension often relieves them. Minor twisting injuries, even from swinging a golf club, can trigger the symptoms. The pain is usually observed to be less when walking or running, when changing the position frequently and when lying down. However, the pain is usually subjective and in many cases, it varies considerably from person to person and most people will suffer from a low level of chronic pain of the lower back region continuously while occasionally suffering from the groin, hip, and leg pain. The intensity of the pain will increase from time to time and will last for a few days and then subside gradually. This �flare-up� is an acute episode and needs to be treated with potent analgesics. Worse pain is experienced in the seated position and is exacerbated while bending, lifting, and twisting movements frequently. The severity of the pain can vary considerably with some having occasional nagging pain to others having severe and disabling pain intermittently.� (Jason M. Highsmith, MD)

 

The localized pain and tenderness in the axial spine usually arises from the nociceptors found within the intervertebral discs, facet joints, sacroiliac joints, dura mater of the nerve roots, and the myofascial structures found within the axial spine. As mentioned in the previous sections, the degenerative anatomical changes may result in a narrowing of the spinal canal called spinal stenosis, overgrowth of spinal processes called osteophytes, hypertrophy of the inferior and superior articular processes, spondylolisthesis, bulging of the ligamentum flavum and disc herniation. These changes result in a collection of symptoms that is known as neurogenic claudication. There may be symptoms such as low back pain and leg pain together with numbness or tingling in the legs, muscle weakness, and foot drop. Loss of bowel or bladder control may suggest spinal cord impingement and prompt medical attention is needed to prevent permanent disabilities. These symptoms can vary in severity and may present to varying extents in different individuals.

 

The pain can also radiate to other parts of the body due to the fact that the spinal cord gives off several branches to two different sites of the body. Therefore, when the degenerated disc presses on a spinal nerve root, the pain can also be experienced in the leg to which the nerve ultimately innervates. This phenomenon, called radiculopathy, can occur from many sources arising, due to the process of degeneration. The bulging disc, if protrudes centrally, can affect descending rootlets of the cauda equina, if it bulges posterolaterally, it might affect the nerve roots exiting at the next lower intervertebral canal and the spinal nerve within its ventral ramus can get affected when the disc protrudes laterally. Similarly, the osteophytes protruding along the upper and lower margins of the posterior aspect of vertebral bodies can impinge on the same nervous tissues causing the same symptoms. Superior articular process hypertrophy may also impinge upon nerve roots depending on their projection. The nerves may include nerve roots prior to exiting from the next lower intervertebral canal and nerve roots within the upper nerve root canal and dural sac. These symptoms, due to the nerve impingement, have been proven by cadaver studies. Neural compromise is thought to occur when the neuro foraminal diameter is critically occluded with a 70% reduction. Furthermore, neural compromise can be produced when the posterior disc is compressed less than 4 millimeters in height, or when the foraminal height is reduced to less than 15 millimeters leading to foraminal stenosis and nerve impingement. (Taher, Fadi, et al.)

 

Diagnostic Approach

 

Patients are initially evaluated with an accurate history and thorough physical examination and appropriate investigations and provocative testing. However, history is often vague due to the chronic pain which cannot be localized properly and the difficulty in determining the exact anatomical location during provocative testing due to the influence of the neighboring anatomical structures.

 

Through the patient�s history, the cause of low back pain can be identified as arising from the nociceptors in the intervertebral discs. Patients may also give a history of the chronic nature of the symptoms and associated gluteal region numbness, tingling as well as stiffness in the spine which usually worsens with activity. Tenderness may be elicited by palpating over the spine. Due to the nature of the disease being chronic and painful, most patients may be suffering from mood and anxiety disorders. Depression is thought to be contributing negatively to the disease burden. However, no clear relationship between disease severity and mood or anxiety disorders. It is good to be vigilant about these mental health conditions as well. In order to exclude other serious pathologies, questions must be asked regarding fatigue, weight loss, fever, and chills, which might indicate some other diseases. (Jason M. Highsmith, MD)

 

Another etiology for the low back pain has to be excluded when examining the patient for degenerative disc disease. Abdominal pathologies, which can give rise to back pain such as aortic aneurysm, renal calculi, and pancreatic disease, have to be excluded.

 

Degenerative disc disease has several differential diagnoses to be considered when a patient presents with back pain. These include; idiopathic low back pain, zygapophyseal joint degeneration, myelopathy, lumbar stenosis, spondylosis, osteoarthritis, and lumbar radiculopathy. (�Degenerative Disc Disease � Physiopedia�)

 

Investigations

 

Investigations are used to confirm the diagnosis of degenerative disc disease. These can be divided into laboratory studies, imaging studies, nerve conduction tests, and diagnostic procedures.

 

Imaging Studies

 

The imaging in degenerative disc disease is mainly used to describe anatomical relations and morphological features of the affected discs, which has a great therapeutic value in future decision making for treatment options. Any imaging method, like plain radiography, CT, or MRI, can provide useful information. However, an underlying cause can only be found in 15% of the patients as no clear radiological changes are visible in degenerative disc disease in the absence of disc herniation and neurological deficit. Moreover, there is no correlation between the anatomical changes seen on imaging and the severity of the symptoms, although there are correlations between the number of osteophytes and the severity of back pain. Degenerative changes in radiography can also be seen in asymptomatic people leading to difficulty in conforming clinical relevance and when to start treatment. (�Degenerative Disc Disease � Physiopedia�)

 

Plain Radiography

 

This inexpensive and widely available plain cervical radiography can give important information on deformities, alignment, and degenerative bony changes. In order to determine the presence of spinal instability and sagittal balance, dynamic flexion, or extension studies have to be performed.

 

Magnetic Resonance Imaging (MRI)

 

MRI is the most commonly used method to diagnose degenerative changes in the intervertebral disc accurately, reliably, and most comprehensively. It is used in the initial evaluation of patients with neck pain after plain radiography. It can provide non-invasive images in multiple plains and gives excellent quality images of the disc. MRI can show disc hydration and morphology-based on the proton density, chemical environment, and the water content. Clinical picture and history of the patient have to be considered when interpreting MRI reports as it has been shown that as much as 25% of radiologists change their report when the clinical data are available. Fonar produced the first open MRI scanner with the ability of the patient to be scanned in different positions such as standing, sitting, and bending. Because of these unique features, this open MRI scanner can be used for scanning patients in weight-bearing postures and stand up postures to detect underlying pathological changes which are usually overlooked in conventional MRI scan such as lumbar degenerative disc disease with herniation. This machine is also good for claustrophobic patients, as they get to watch a large television screen during the scanning process. (�Degenerative Disk Disease: Background, Anatomy, Pathophysiology.�)

 

Nucleus pulposus and annulus fibrosus of the disc can usually be identified on MRI, leading to the detection of disc herniation as contained and non contained. As MRI can also show annular tears and the posterior longitudinal ligament, it can be used to classify herniation. This can be simple annular bulging to free fragment disc herniations. This information can describe the pathologic discs such as extruded disc, protruded discs, and migrated discs.

 

There are several grading systems based on MRI signal intensity, disc height, the distinction between nucleus and annulus, and the disc structure. The method, by Pfirrmann et al, has been widely applied and clinically accepted. According to the modified system, there are 8 grades for lumbar disc degenerative disease. Grade 1 represents normal intervertebral disc and grade 8 corresponds to the end stage of degeneration, depicting the progression of the disc disease. There are corresponding images to aid the diagnosis. As they provide good tissue differentiation and detailed description of the disc structure, sagittal T2 weighted images are used for the classification purpose. (Pfirrmann, Christian W. A., et al.)

 

Modic has described the changes occurring in the vertebral bodies adjacent to the degenerating discs as Type 1 and Type 2 changes. In Modic 1 changes, there is decreased intensity of T1 weighted images and increased intensity T2 weighted images. This is thought to occur because the end plates have undergone sclerosis and the adjacent bone marrow is showing inflammatory response as the diffusion coefficient increases. This increase of diffusion coefficient and the ultimate resistance to diffusion is brought about by the chemical substances released through an autoimmune mechanism. Modic type 2 changes include the destruction of the bone marrow of adjacent vertebral endplates due to an inflammatory response and the infiltration of fat in the marrow. These changes may lead to increased signal density on T1 weighted images. (Modic, M T et al.)

 

Computed Tomography (CT)

 

When MRI is not available, Computed tomography is considered a diagnostic test that can detect disc herniation because it has a better contrast between posterolateral margins of the adjacent bony vertebrae, perineal fat, and the herniated disc material. Even so, when diagnosing lateral herniations, MRI remains the imaging modality of choice.

 

CT scan has several advantages over MRI such as it has a less claustrophobic environment, low cost, and better detection of bonny changes that are subtle and may be missed on other modalities. CT can detect early degenerative changes of the facet joints and spondylosis with more accuracy. Bony integrity after fusion is also best assessed by CT.

 

Disc herniation and associated nerve impingement can be diagnosed by using the criteria developed by Gundry and Heithoff. It is important for the disc protrusion to lie directly over the nerve roots traversing the disc and to be focal and asymmetrical with a dorsolateral position. There should be demonstrable nerve root compression or displacement. Lastly, the nerve distal to the impingement (site of herniation) often enlarges and bulges with resulting edema, prominence of adjacent epidural veins, and inflammatory exudates resulting in blurring the margin.

 

Lumbar Discography

 

This procedure is controversial and, whether knowing the site of the pain has any value regarding surgery or not, has not been proven. False positives can occur due to central hyperalgesia in patients with chronic pain (neurophysiologic finding) and due to psychosocial factors. It is questionable to establish exactly when discogenic pain becomes clinically significant. Those who support this investigation advocates strict criteria for selection of the patients and when interpreting results and believe this is the only test that can diagnose discogenic pain. Lumbar discography can be used in several situations, although it is not scientifically established. These include; diagnosis of lateral herniation, diagnosing a symptomatic disc among multiple abnormalities, assessing similar abnormalities seen on CT or MRI, evaluation of the spine after surgery, selection of fusion level, and the suggestive features of discogenic pain existence.

 

The discography is more concerned about eliciting pathophysiology rather than determining the anatomy of the disc. Therefore, discogenic pain evaluation is the aim of discography. MRI may reveal an abnormally looking disc with no pain, while severe pain may be seen on discography where MRI findings are few. During the injection of normal saline or the contrast material, a spongy endpoint can occur with abnormal discs accepting more amounts of contrast. The contrast material can extend into the nucleus pulposus through tears and fissures in the annulus fibrosus in the abnormal discs. The pressure of this contrast material can provoke pain due to the innervations by recurrent meningeal nerve, mixed spinal nerve, anterior primary rami, and gray rami communicantes supplying the outer annulus fibrosus. Radicular pain can be provoked when the contrast material reaches the site of nerve root impingement by the abnormal disc. However, this discography test has several complications such as nerve root injury, chemical or bacterial diskitis, contrast allergy, and the exacerbation of pain. (Bartynski, Walter S., and A. Orlando Ortiz)

 

Imaging Modality Combination

 

In order to evaluate the nerve root compression and cervical stenosis adequately, a combination of imaging methods may be needed.

 

CT Discography

 

After performing initial discography, CT discography is performed within 4 hours. It can be used in determining the status of the disc such as herniated, protruded, extruded, contained or sequestered. It can also be used in the spine to differentiate the mass effects of scar tissue or disc material after spinal surgery.

 

CT Myelography

 

This test is considered the best method for evaluating nerve root compression. When CT is performed in combination or after myelography, details about bony anatomy different planes can be obtained with relative ease.

 

Diagnostic Procedures

 

Transforaminal Selective Nerve Root Blocks (SNRBs)

 

When multilevel degenerative disc disease is suspected on an MRI scan, this test can be used to determine the specific nerve root that has been affected. SNRB is both a diagnostic and therapeutic test that can be used for lumbar spinal stenosis. The test creates a demotomal level area of hypoesthesia by injecting an anesthetic and a contrast material under fluoroscopic guidance to the interested nerve root level. There is a correlation between multilevel cervical degenerative disc disease clinical symptoms and findings on MRI and findings of SNRB according to Anderberg et al. There is a 28% correlation with SNRB results and with dermatomal radicular pain and areas of neurologic deficit. Most severe cases of degeneration on MRI are found to be correlated with 60%. Although not used routinely, SNRB is a useful test in evaluating patients before surgery in multilevel degenerative disc disease especially on the spine together with clinical features and findings on MRI. (Narouze, Samer, and Amaresh Vydyanathan)

 

Electro Myographic Studies

 

Distal motor and sensory nerve conduction tests, called electromyographic studies, that are normal with abnormal needle exam may reveal nerve compression symptoms that are elicited in the clinical history. Irritated nerve roots can be localized by using injections to anesthetize the affected nerves or pain receptors in the disc space, sacroiliac joint, or the facet joints by discography. (�Journal Of Electromyography & Kinesiology Calendar�)

 

Laboratory Studies

 

Laboratory tests are usually done to exclude other differential diagnoses.

 

As seronegative spondyloarthropathies, such as ankylosing spondylitis, are common causes of back pain, HLA B27 immuno-histocompatibility has to be tested. Estimated 350,000 persons in the US and 600,000 in Europe have been affected by this inflammatory disease of unknown etiology. But HLA B27 is extremely rarely found in African Americans. Other seronegative spondyloarthropathies that can be tested using this gene include psoriatic arthritis, inflammatory bowel disease, and reactive arthritis or Reiter syndrome. Serum immunoglobulin A (IgA) can be increased in some patients.

 

Tests like the erythrocyte sedimentation rate (ESR) and C- reactive protein (CRP) level test for the acute phase reactants seen in inflammatory causes of lower back pain such as osteoarthritis and malignancy. The full blood count is also required, including differential counts to ascertain the disease etiology. Autoimmune diseases are suspected when Rheumatoid factor (RF) and anti-nuclear antibody (ANA) tests become positive. Serum uric acid and synovial fluid analysis for crystals may be needed in rare cases to exclude gout and pyrophosphate dihydrate deposition.

 

Treatment

 

There is no definitive treatment method agreed by all physicians regarding the treatment of degenerative disc disease because the cause of the pain can differ in different individuals and so is the severity of pain and the wide variations in clinical presentation. The treatment options can be discussed broadly under; conservative treatment, medical treatment, and surgical treatment.

 

Conservative Treatment

 

This treatment method includes exercise therapy with behavioral interventions, physical modalities, injections, back education, and back school methods.

 

Exercise-Based Therapy with Behavioral Interventions

 

Depending on the diagnosis of the patient, different types of exercises can be prescribed. It is considered one of the main methods of conservative management to treat chronic low back pain. The exercises can be modified to include stretching exercises, aerobic exercises, and muscle strengthening exercises. One of the major challenges of this therapy includes its inability to assess the efficacy among patients due to wide variations in the exercise regimens, frequency, and intensity. According to studies, most effectiveness for sub-acute low back pain with varying duration of symptoms was obtained by performing graded exercise programs within the occupational setting of the patient. Significant improvements were observed among patients suffering from chronic symptoms with this therapy with regard to functional improvement and pain reduction. Individual therapies designed for each patient under close supervision and compliance of the patient also seems to be the most effective in chronic back pain sufferers. Other conservative approaches can be used in combination to improve this approach. (Hayden, Jill A., et al.)

 

Aerobic exercises, if performed regularly, can improve endurance. For relieving muscle tension, relaxation methods can be used. Swimming is also considered an exercise for back pain. Floor exercises can include extension exercises, hamstring stretches, low back stretches, double knee to chin stretches, seat lifts, modified sit-ups, abdominal bracing, and mountain and sag exercises.

 

Physical Modalities

 

This method includes the use of electrical nerve stimulation, relaxation, ice packs, biofeedback, heating pads, phonophoresis, and iontophoresis.

 

Transcutaneous Electrical Nerve Stimulation (TENS)

 

In this non-invasive method, electrical stimulation is delivered to the skin in order to stimulate the peripheral nerves in the area to relieve the pain to some extent. This method relieves pain immediately following application but its long term effectiveness is doubtful. With some studies, it has been found that there is no significant improvement in pain and functional status when compared with placebo. The devices performing these TENS can be easily accessible from the outpatient department. The only side effect seems to be a mild skin irritation experienced in a third of patients. (Johnson, Mark I)

 

Back School

 

This method was introduced with the aim of reducing the pain symptoms and their recurrences. It was first introduced in Sweden and takes into account the posture, ergonomics, appropriate back exercises, and the anatomy of the lumbar region. Patients are taught the correct posture to sit, stand, lift weights, sleep, wash face, and brush teeth avoiding pain. When compared with other treatment modalities, back school therapy has been proven to be effective in both immediate and intermediate periods for improving back pain and functional status.

 

Patient Education

 

In this method, the provider instructs the patient on how to manage their back pain symptoms. Normal spinal anatomy and biomechanics involving mechanisms of injury is taught at first. Next, using the spinal models, the degenerative disc disease diagnosis is explained to the patient. For the individual patient, the balanced position is determined and then asked to maintain that position to avoid getting symptoms.

 

Bio-Psychosocial Approach to Multidisciplinary Back Therapy

 

Chronic back pain can cause a lot of distress to the patient, leading to psychological disturbances and low mood. This can adversely affect the therapeutic outcomes rendering most treatment strategies futile. Therefore, patients must be educated on learned cognitive strategies called �behavioral� and �bio-psychosocial� strategies to get relief from pain. In addition to treating the biological causes of pain, psychological, and social causes should also be addressed in this method. In order to reduce the patient�s perception of pain and disability, methods like modified expectations, relaxation techniques, control of physiological responses by learned behavior, and reinforcement are used.

 

Massage Therapy

 

For chronic low back pain, this therapy seems to be beneficial. Over a 1 year period, massage therapy has been found to be moderately effective for some patients when compared to acupuncture and other relaxation methods. However, it is less efficacious than TENS and exercise therapy although individual patients may prefer one over the other. (Furlan, Andrea D., et al.)

 

Spinal Manipulation

 

This therapy involves the manipulation of a joint beyond its normal range of movement, but not exceeding that of the normal anatomical range. This is a manual therapy that involves long lever manipulation with a low velocity. It is thought to improve low back pain through several mechanisms like the release of entrapped nerves, destruction of articular and peri-articular adhesions, and through manipulating segments of the spine that had undergone displacement. It can also reduce the bulging of the disc, relax the hypertonic muscles, stimulate the nociceptive fibers via changing the neurophysiological function and reposition the menisci on the articular surface.

 

Spinal manipulation is thought to be superior in efficacy when compared to most methods such as TENS, exercise therapy, NSAID drugs, and back school therapy. The currently available research is positive regarding its effectiveness in both the long and short term. It is also very safe to administer under-trained therapists with cases of disc herniation and cauda equina being reported only in lower than 1 in 3.7 million people. (Bronfort, Gert, et al.)

 

Lumbar Supports

 

Patients suffering from chronic low back pain due to degenerative processes at multiple levels with several causes may benefit from lumbar support. There is conflicting evidence with regards to its effectiveness with some studies claiming moderate improvement in immediate and long term relief while others suggesting no such improvement when compared to other treatment methods. Lumbar supports can stabilize, correct deformity, reduce mechanical forces, and limit the movements of the spine. It may also act as a placebo and reduce the pain by massaging the affected areas and applying heat.

 

Lumbar Traction

 

This method uses a harness attached to the iliac crest and lower rib cage and applies a longitudinal force along the axial spine to relieve chronic low back pain. The level and duration of the force are adjusted according to the patient and it can be measured by using devices both while walking and lying down. Lumbar traction acts by opening the intervertebral disc spaces and by reducing the lumbar lordosis. The symptoms of degenerative disc disease are reduced through this method due to temporary spine realignment and its associated benefits. It relieves nerve compression and mechanical stress, disrupts the adhesions in the facet and annulus, and also nociceptive pain signals. However, there is not much evidence with regard to its effectiveness in reducing back pain or improving daily function. Furthermore, the risks associated with lumbar traction are still under research and some case reports are available where it has caused a nerve impingement, respiratory difficulties, and blood pressure changes due to heavy force and incorrect placement of the harness. (Harte, A et al.)

 

Medical Treatment

 

Medical therapy involves drug treatment with muscle relaxants, steroid injections, NSAIDs, opioids, and other analgesics. This is needed, in addition to conservative treatment, in most patients with degenerative disc disease. Pharmacotherapy is aimed to control disability, reduce pain and swelling while improving the quality of life. It is catered according to the individual patient as there is no consensus regarding the treatment.

 

Muscle Relaxants

 

Degenerative disc disease may benefit from muscle relaxants by reducing the spasm of muscles and thereby relieving pain. The efficacy of muscle relaxants in improving pain and functional status has been established through several types of research. Benzodiazepine is the most common muscle relaxant currently in use.

 

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

 

These drugs are commonly used as the first step in disc degenerative disease providing analgesia, as well as anti-inflammatory effects. There is strong evidence that it reduces chronic low back pain. However, its use is limited by gastrointestinal disturbances, like acute gastritis. Selective COX2 inhibitors, like celecoxib, can overcome this problem by only targeting COX2 receptors. Their use is not widely accepted due to its potential side effects in increasing cardiovascular disease with prolonged use.

 

Opioid Medications

 

This is a step higher up in the WHO pain ladder. It is reserved for patients suffering from severe pain not responding to NSAIDs and those with unbearable GI disturbances with NSAID therapy. However, the prescription of narcotics for treating back pain varies considerably between clinicians. According to literature, 3 to 66% of patients may be taking some form of the opioid to relieve their back pain. Even though the short term reduction in symptoms is marked, there is a risk of long term narcotic abuse, a high rate of tolerance, and respiratory distress in the older population. Nausea and vomiting are some of the short term side effects encountered. (�Systematic Review: Opioid Treatment For Chronic Back Pain: Prevalence, Efficacy, And Association With Addiction�)

 

Anti-Depressants

 

Anti-depressants, in low doses, have analgesic value and may be beneficial in chronic low back pain patients who may present with associated depression symptoms. The pain and suffering may be disrupting the sleep of the patient and reducing the pain threshold. These can be addressed by using anti-depressants in low doses even though there is no evidence that it improves the function.

 

Injection Therapy

 

Epidural Steroid Injections

 

Epidural steroid injections are the most widely used injection type for the treatment of chronic degenerative disc disease and associated radiculopathy. There is a variation between the type of steroid used and its dose. 8- 10 mL of a mixture of methylprednisolone and normal saline is considered an effective and safe dose. The injections can be given through interlaminar, caudal, or trans foramina routes. A needle can be inserted under the guidance of fluoroscopy. First contrast, then local anesthesia and lastly, the steroid is injected into the epidural space at the affected level via this method. The pain relief is achieved due to the combination of effects from both local anesthesia and the steroid. Immediate pain relief can be achieved through the local anesthetic by blocking the pain signal transmission and while also confirming the diagnosis. Inflammation is also reduced due to the action of steroids in blocking pro-inflammatory cascade.

 

During the recent decade, the use of epidural steroid injection has increased by 121%. However, there is controversy regarding its use due to the variation in response levels and potentially serious adverse effects. Usually, these injections are believed to cause only short term relief of symptoms. Some clinicians may inject 2 to 3 injections within a one-week duration, although the long term results are the same for that of a patient given only a single injection. For a one year period, more than 4 injections shouldn�t be given. For more immediate and effective pain relief, preservative-free morphine can also be added to the injection. Even local anesthetics, like lidocaine and bupivacaine, are added for this purpose. Evidence for long term pain relief is limited. (�A Placebo-Controlled Trial To Evaluate Effectivity Of Pain Relief Using Ketamine With Epidural Steroids For Chronic Low Back Pain�)

 

There are potential side effects due to this therapy, in addition to its high cost and efficacy concerns. Needles can get misplaced if fluoroscopy is not used in as much as 25% of cases, even with the presence of experienced staff. The epidural placement can be identified by pruritus reliably. Respiratory depression or urinary retention can occur following injection with morphine and so the patient needs to be monitored for 24 hours following the injection.

 

Facet Injections

 

These injections are given to facet joints, also called zygapophysial joints, which are situated between two adjacent vertebrae. Anesthesia can be directly injected to the joint space or to the associated medial branch of the dorsal rami, which innervates it. There is evidence that this method improves the functional ability, quality of life, and relieves pain. They are thought to provide both short and long term benefits, although studies have shown both facet injections and epidural steroid injections are similar in efficacy. (Wynne, Kelly A)

 

SI Joint Injections

 

This is a diarthrodial synovial joint with nerve supply from both myelinated and non-myelin nerve axons. The injection can effectively treat degenerative disc disease involving sacroiliac joint leading to both long and short term relief from symptoms such as low back pain and referred pain at legs, thigh, and buttocks. The injections can be repeated every 2 to 3 months but should be performed only if clinically necessary. (MAUGARS, Y. et al.)

 

Intradiscal Non-Operative Therapies for Discogenic Pain

 

As described under the investigations, discography can be used both as a diagnostic and therapeutic method. After the diseased disc is identified, several minimally invasive methods can be tried before embarking on surgery. Electrical current and its heat can be used to coagulate the posterior annulus thereby strengthening the collagen fibers, denaturing and destroying inflammatory mediators and nociceptors, and sealing figures. The methods used in this are called intradiscal electrothermal therapy (IDET) or radiofrequency posterior annuloplasty (RPA), in which an electrode is passed to the disc. IDET has moderate evidence in relief of symptoms for disc degenerative disease patients, while RPA has limited support regarding its short term and long term efficacy. Both these procedures can lead to complications such as nerve root injury, catheter malfunction, infection, and post-procedure disc herniation.

 

Surgical Treatment

 

Surgical treatment is reserved for patients with failed conservative therapy taking into account the disease severity, age, other comorbidities, socio-economic condition, and the level of outcome expected. It is estimated that around 5% of patients with degenerative disc disease undergo surgery, either for their lumbar disease or cervical disease. (Rydevik, Bj�rn L.)

 

Lumbar Spine Procedures

 

Lumbar surgery is indicated in patients with severe pain, with a duration of 6 to 12 months of ineffective drug therapy, who have critical spinal stenosis. The surgery is usually an elective procedure except in the case of cauda equina syndrome. There are two procedure types that aim to involve spinal fusion or decompression or both. (�Degenerative Disk Disease: Background, Anatomy, Pathophysiology.�)

 

Spinal fusion involves stopping movements at a painful vertebral segment in order to reduce the pain by fusing several vertebrae together by using a bone graft. It is considered effective in the long term for patients with degenerative disc disease having spinal malalignment or excessive movement. There are several approaches to fusion surgery. (Gupta, Vijay Kumar, et al)

 

  • Lumbar spinal posterolateral guttur fusion

 

This method involves placing a bone graft in the posterolateral part of the spine. A bone graft can be harvested from the posterior iliac crest. The bones are stripped off from its periosteum for successful grafting. A back brace is needed in the post-operative period and patients may need to stay in the hospital for about 5 to 10 days. Limited motion and cessation of smoking are needed for successful fusion. However, several risks such as non-union, infection, bleeding, and solid union with back pain may occur.

 

  • Posterior lumbar interbody fusion

 

In this method, decompression or diskectomy methods can also be performed via the same approach. The bone grafts are directly applied to the disc space and ligamentum flavum is excised completely. For the degenerative disc disease, interlaminar space is widened additionally by performing a partial medial facetectomy. Back braces are optional with this method. It has several disadvantages when compared to anterior approach such as only small grafts can be inserted, the reduced surface area available for fusion, and difficulty when performing surgery on spinal deformity patients. The major risk involved is non-union.

 

  • Anterior lumbar interbody fusion

 

This procedure is similar to the posterior one except that it is approached through the abdomen instead of the back. It has the advantage of not disrupting the back muscles and the nerve supply. It is contraindicated in patients with osteoporosis and has the risk of bleeding, retrograde ejaculation in men, non-union, and infection.

 

  • Transforaminal lumbar interbody fusion

 

This is a modified version of the posterior approach which is becoming popular. It offers low risk with good exposure and it is shown to have an excellent outcome with a few complications such as CSF leak, transient neurological impairment, and wound infection.

 

Total Disc Arthroplasty

 

This is an alternative to disc fusion and it has been used to treat lumbar degenerative disc disease using an artificial disc to replace the affected disc. Total prosthesis or nuclear prosthesis can be used depending on the clinical situation.

 

Decompression involves removing part of the disc of the vertebral body, which is impinging on a nerve to release that and provide room for its recovery via procedures called diskectomy and laminectomy. The efficacy of the procedure is questionable although it is a commonly performed surgery. Complications are very few with a low chance of recurrence of symptoms with higher patient satisfaction. (Gupta, Vijay Kumar, et al)

 

  • Lumbar discectomy

 

The surgery is performed through a posterior midline approach by dividing the ligamentum flavum. The nerve root that is affected is identified and bulging annulus is cut to release it. Full neurological examination should be performed afterward and patients are usually fit to go home 1 � 5 days later. Low back exercises should be started soon followed by light work and then heavy work at 2 and 12 weeks respectively.

 

  • Lumbar laminectomy

 

This procedure can be performed thorough one level, as well as through multiple levels. Laminectomy should be as short as possible to avoid spinal instability. Patients have marked relief of symptoms and reduction in radiculopathy following the procedure. The risks may include bowel and bladder incontinence, CSF leakage, nerve root damage, and infection.

 

Cervical Spine Procedures

 

Cervical degenerative disc disease is indicated for surgery when there is unbearable pain associated with progressive motor and sensory deficits. Surgery has a more than 90% favorable outcome when there is radiographic evidence of nerve root compression. There are several options including anterior cervical diskectomy (ACD), ACD, and fusion (ACDF), ACDF with internal fixation, and posterior foraminotomy. (�Degenerative Disk Disease: Background, Anatomy, Pathophysiology.�)

 

Cell-Based Therapy

 

Stem cell transplantation has emerged as a novel therapy for degenerative disc disease with promising results. The introduction of autologous chondrocytes has been found to reduce discogenic pain over a 2 year period. These therapies are currently undergoing human trials. (Jeong, Je Hoon, et al.)

 

Gene Therapy

 

Gene transduction in order to halt the disc degenerative process and even inducing disc regeneration is currently under research. For this, beneficial genes have to be identified while demoting the activity of degeneration promoting genes. These novel treatment options give hope for future treatment to be directed at regenerating intervertebral discs. (Nishida, Kotaro, et al.)

 

 

Degenerative disc disease is a health issue characterized by chronic back pain due to a damaged intervertebral disc, such as low back pain in the lumbar spine or neck pain in the cervical spine. It is a breakdown of an intervertebral disc of the spine. Several pathological changes can occur in disc degeneration. Various anatomical defects can also occur in the intervertebral disc. Low back pain and neck pain are major epidemiological problems, which are thought to be related to degenerative disc disease. Back pain is the second leading cause of doctor office visits in the United States. It is estimated that about 80% of US adults suffer from low back pain at least once during their lifetime. Therefore, a thorough understanding of degenerative disc disease is needed for managing this common condition. – Dr. Alex Jimenez D.C., C.C.S.T. Insight

 

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas*& New Mexico*�

 

Curated by Dr. Alex Jimenez D.C., C.C.S.T.

 

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