Back Clinic Holistic Medicine Team. A form of healing considers the whole person’s body, mind, spirit, and emotions in the quest for optimal health and wellness. With the holistic medicine philosophy, one can achieve optimal health, the primary goal of gaining proper balance in life. The art and science of healing that addresses the whole person through body, mind, and soul. The practice integrates conventional and alternative therapies to prevent and treat disease, and most importantly, to promote optimal health.
This condition of holistic health is defined as the unlimited and unblocked flow of an individual’s life force energy through body, mind, and spirit. It encompasses safe and appropriate modalities of diagnosis and treatment. It includes analysis of emotional, environmental, lifestyle, nutritional and physical elements. It focuses on patient education and participation through the healing process. Physicians that practice this form of medicine take on a safe, effective option in diagnosing and treatment. This includes education for lifestyle changes and caring for one’s self, much like chiropractic.
Dr. Alex Jimenez, D.C., presents how anti-inflammatory botanicals and phytochemicals can reduce inflammatory cytokines that can cause pain-like issues in the body. We dive into how different pharmaceuticals could influence NF-kappaB and how chronic conditions can affect inflammation. We refer our patients to certified providers that incorporate techniques and multiple therapies for many individuals suffering from inflammation, and its correlating symptoms can affect the musculoskeletal system. We encourage and appreciate each patient by referring them to associated medical providers based on their diagnosis when it is appropriate. We understand that education is a fantastic way when asking our providers intricated questions at the patient’s request and understanding. Dr. Jimenez, D.C., only utilizes this information as an educational service. Disclaimer
How Does The Body Deal With Inflammation
Dr. Alex Jimenez, D.C., presents: Our objectives are to look at the evidence for using selective phytochemicals and botanicals as anti-inflammatory and analgesic agents. Controlled studies have grown into mass numbers over the years, and we can feel more confident in some of their findings because a lot of these studies have been done with good-quality investigators and well-designed studies. And even though we get those studies published, the problem is that we rarely hear about them. The media needs to pick them up, and they usually don’t make it into the medical community despite their studies. If you compare that to when pharmaceutical research is done, you know it often makes the headlines and news. Let’s look at some of these botanicals and phytochemicals today.
In autoimmune conditions, pain is a huge issue in the body, and we also want to use its analgesic properties. And then, we have to identify the most appropriate phytochemicals and botanicals for specific inflammatory and pain conditions. So, before we jump into that, we want to review some of the mechanisms of the pharmaceuticals that are very commonly prescribed for inflammatory and autoimmune conditions. Even some of the newer biologics we’ve referred to a little bit, we want to look into them and, and look at how they work and some of their drawbacks, and then we’ll delve into these botanicals that are at our disposal. So it is important to remind anyone that all degenerative diseases have this pro-inflammatory state or inflammation as part of their underlying biochemical ideology. And that inflammation is a final common pathway for all these different dysfunctions. Diabetes, Alzheimer’s, atherosclerosis, cancer, and even some psychiatric disorders like schizophrenia and depression all have inflammation as one of their root causes. Now in this module, we’re focusing on the ones that are in the circles and these.
As you know, most chronic diseases are linked to excessive, persistent inflammation. We’ve pounded that point home well enough, as chronic inflammation occurs when the injury is ongoing or when a predisposed immune system just doesn’t shut off. It fails at counter-regulation and acute inflammation, which is beneficial; however, it can turn into a chronic inflammation if left untreated. Many chronic diseases have been associated with excessive or persistent inflammation. When it comes to chronic inflammation develops when an injury or traumatic event is ongoing, causing the muscles to tense up or when the immune system begins to attack the body when there are no pathogens that are affecting the body. And that the conventional pharmacological treatment focuses on specific pathways that are often really downstream in that inflammatory process, and from a functional medicine perspective, we want to look a bit more upstream to figure out what is the cause of chronic inflammation that is causing this many issues to this person and how anti-inflammatory botanicals and phytochemicals can dampen these inflammatory effects in the body.
How Do Pharmaceuticals Affect The Body?
Dr. Alex Jimenez, D.C., presents: One of the factors that can enhance inflammatory markers is pharmaceutical drugs. So, for example, pharmacologic controls like NSAIDs can inhibit the COX enzyme, while leukotriene inhibitors inhibit the LOX enzyme. DMARDs can affect various immune mechanisms that can influence the development of chronic inflammation. Biologics can inhibit multiple cytokines in the body, including the TNF-alpha and steroids, which can affect NF-kappaB and phospholipase-A2. So there are numerous ways to influence the inflammatory pathway and cause muscle and joint pain issues.
Pharmaceuticals are not the only factors that can cause inflammatory triggers to affect the body; it can be the food we eat or the environment that we live in that can trigger NF-kappaB, which disassociates from I-kappaB while going into the nucleus and binding to the DNA. That point leads to the transcription of many different genes. The body’s genes not only make DNA but can make RNA. When the body makes RNA, it is then biotransformed into DNA, leading to the turning of different inflammatory pathways. So when the pharmaceutical starts entering the body, it can inhibit the other cytokines and enzymes from turning on and cause chronic inflammation, thus causing the anti-inflammatory markers to dampen and causing the immune system to focus on the NF-kappaB.
NSAIDs
Dr. Alex Jimenez, D.C., presents: So let’s start looking at the non-steroidal anti-inflammatories or NSAIDs, which are ubiquitous as they are very common for many people to reach for when they are in pain. And the reason they use them is that they do work. NSAIDs inhibit cyclooxygenase enzymes and prevent those inflammatory prostaglandins, which cause inflammation and pain in the muscles or joints. Now paracetamol is on here, or acetaminophen is not technically an NSAID, but we will look at that separately.
But these NSAIDs, you know, aren’t without issues, as 70 million prescriptions for NSAIDs are written in the U.S. annually. And that over-the-counter uses included 30 billion doses of NSAIDs. That’s an enormous amount, and it’s no wonder most of us have taken them; we’re part of that 30 billion. However, that amount can lead to a leaky gut in our body system. We know their association with peptic ulcers and G.I. bleeding while inhibiting that resolving pathway, which is important to shut off the inflammatory response. So let’s look at DMARDs or disease-modifying anti-rheumatic agents. They’re the first-line therapy for rheumatoid arthritis. And one of the reasons they’re the first line of treatment is that they’re inexpensive but are slow acting and do decrease inflammation, but they don’t work very well to relieve pain directly.
So methotrexate is hydroxychloroquine, or Plaquenil is a very well-known one right now, especially with its use today. Still, methotrexate inhibits RNA and DNA synthesis, which has been used as a chemotherapy agent in cancer. And when it inhibits, it affects the dihydrofolate reductase, which is needed to make DNA and RNA; however, it also suppresses T and B-cell activation while inhibiting IL1 beta from binding to its receptors. So, unfortunately, even though they’re the first-line therapy, they come with several fairly severe side effects. But we keep talking about this idea of side effects; it’s no side effects. They’re the direct effects of the medication.
The Effects Of Pharmaceuticals
Dr. Alex Jimenez, D.C., presents: You know, they may be unwanted effects like rashes, stomach upset, liver, bone marrow, toxicity, congenital disabilities, and, of course, which we’ll see repeatedly. Any time that you shut down your immune system, you open yourself up for infections. So you become much more susceptible to infections. So, look at these biological DMARDs, which work as TNF-alpha blockers. These biological DMARDs work by curbing either T-cell activation or blocking TNF, which is the most common one, but they also can stop things like IL-six, deplete T-cells, and work in other ways. These biologics are called biologics because they’re actually monoclonal antibodies. And so these monoclonal antibodies, as antibodies do, they have very strong specific binding affinities.
And so, using antibodies as medications has been a great advance. Now, as we’re going to see, they may not be the ultimate solution for treating autoimmune disease, but they hold a lot of promise, especially when we need their specificity. So there are many chronic conditions that NSAIDs DMARDs or Biologic DMARDs that can mask inflammation and cause pain to the muscles and joints. Some of the chronic conditions include:
Ankylosing-spondylitis
Arthritis
Crohn’s disease
Endometriosis
Psoriasis
Rheumatoid Arthritis
Osteoarthritis
Fibromyalgia
Lupus
Conclusion
Dr. Alex Jimenez, D.C., presents: These pharmaceuticals can reduce the pain that the person is experiencing with these conditions, but they are short-termed and only mask the issue until a person goes into treatment. When a person has an autoimmune or chronic disorder associated with inflammation, the cost of any medication is high. Even though good pharmaceuticals are important, we need to look at treatments that can examine the lesser-known or rarer conditions that can reduce the inflammatory effects that cause joint and muscle pain. Incorporating anti-inflammatory botanicals and supplements like:
Fish oil
Curcumin
Ginger extract
Green Tea Extract
Resveratrol
All have anti-inflammatory properties that can reduce inflammatory cytokines from the muscle and joints and combine with physical therapy. Physical therapy can allow the body to heal itself and will enable the individual to be pain-free naturally.
Disc bulge and disc herniation are some of the most common conditions affecting the spine of both young and middle-aged patients. It is estimated that approximately 2.6% of the US population annually visits a clinician to treat spinal disorders. Roughly $ 7.1 billion alone is lost due to the time away from work.
Disc herniation is when the whole or part of the nucleus pulposus is protruded through the torn or weakened outer annulus fibrosus of the intervertebral disc. This is also known as the slipped disc and frequently occurs in the lower back, sometimes also affecting the cervical region. Herniation of the intervertebral disc is defined as a localized displacement of disc material with 25% or less of the disc circumference on an MRI scan, according to the North American Spine Society 2014. The herniation may consist of nucleus pulposus, annulus fibrosus, apophyseal bone or osteophytes, and the vertebral endplate cartilage in contrast to disc bulge.
There are also mainly two types of disc herniation. Disc protrusion is when a focal or symmetrical extension of the disc comes out of its confines in the intervertebral space. It is situated at the intervertebral disc level, and its outer annular fibers are intact. A disc extrusion is when the intervertebral disc extends above or below the adjacent vertebrae or endplates with a complete annular tear. In this type of disc extrusion, a neck or base is narrower than the dome or the herniation.
A disc bulge is when the outer fibers of the annulus fibrosus are displaced from the margins of the adjacent vertebral bodies. Here, the displacement is more than 25% of the circumference of the intervertebral disc. It also does not extend below or above the margins of the disc because the annulus fibrosus attachment limits it. It differs from disc herniation because it involves less than 25% of the disc’s circumference. Usually, the disc bulge is a gradual process and is broad. The disc bulge can be divided into two types. In a circumferential bulge, the whole disc circumference is involved. More than 90 degrees of the rim is involved asymmetrically in asymmetrical bulging.
Normal Intervertebral Disc Anatomy
Before going into detail about the definition of disc herniation and disc bulge, we need to look at the standard intervertebral disc. According to spine guidelines in 2014, a standard disc is something that has a classic shape without any evidence of degenerative disc changes. Intervertebral discs are responsible for one-third to one-fourth of the height of the spinal column.
One intervertebral disc is about 7 -10 mm thick and measures 4 cm in anterior-posterior diameter in the lumbar region of the spine. These spinal discs are located between two adjacent vertebral bodies. However, no discs can be found between the atlas and axis and the coccyx. About 23 discs are found in the spine, with six in the cervical spine, 12 in the thoracic spine, and only five in the lumbar spine.
Intervertebral discs are made of fibro cartilages, forming a fibrocartilaginous joint. The outer ring of the intervertebral disc is known as the annulus fibrosus, while the inner gel-like structure in the center is known as the nucleus pulposus. The cartilage endplates sandwich the nucleus pulposus superiorly and inferiorly. The annulus fibrosus comprises concentric collagen fiber sheets arranged in a radial tire-like structure into lamellae. The fibers are attached to the vertebral endplates and oriented at different angles. With their cartilaginous part, the endplates anchor the discs in their proper place.
The nucleus pulposus is composed of water, collagen, and proteoglycans. Proteoglycans attract and retain moisture, giving the nucleus pulposus a hydrated gel-like consistency. Interestingly, throughout the day, the amount of water found in the nucleus pulposus varies according to the person’s level of activity. This feature in the intervertebral disc serves as a cushion or a spinal shock-absorbing system to protect the adjacent vertebra, spinal nerves, spinal cord, brain, and other structures against various forces. Although the individual movement of the intervertebral discs is limited, some form of vertebral motion like flexion and extension is still possible due to the features of the intervertebral disc.
Effect of Intervertebral Disc Morphology on Structure and Function
The type of components present in the intervertebral disc and how it is arranged determine the morphology of the intervertebral disc. This is important in how effectively the disc does its function. As the disc is the most important element which bears the load and allows movement in the otherwise rigid spine, the constituents it is made up of have a significant bearing.
The complexity of the lamellae increases with advancing age as a result of the synthetic response of the intervertebral disc cells to the variations in the mechanical load. These changes in lamellae with more bifurcations, interdigitation and irregular size and number of lamellar bands will lead to the altered bearing of weight. This in turn establishes a self-perpetuated disruption cycle leading to the destruction of the intervertebral discs. Once this process is started it is irreversible. As there is an increased number of cells, the amount of nutrition the disc requires is also increasingly changing the normal concentration gradient of both metabolites and nutrients. Due to this increased demand, the cells may also die increasingly by necrosis or apoptosis.
Human intervertebral discs are avascular and hence the nutrients are diffused from the nearby blood vessels in the margin of the disc. The main nutrients; oxygen and glucose reach the cells in the disc through diffusion according to the gradient determined by the rate of transport to the cells through the tissues and the rate of demand. Cells also increasingly produce lactic acid as a metabolic end product. This is also removed via the capillaries and venules back to the circulation.
Since diffusion depends on the distance, the cells lying far from the blood capillaries can have a reduced concentration of nutrients because of the reduced supply. With disease processes, the normally avascular intervertebral disc can become vascular and innervated in degeneration and in disease processes. Although this may increase the oxygen and nutrient supply to the cells in the disc, this can also give rise to many other types of cells that are normally not found in the disc with the introduction of cytokines and growth factors.
The morphology of the intervertebral disc in different parts of the spine also varies although many clinicians base the clinical theories based on the assumption that both cervical and lumbar intervertebral discs have the same structure. The height of the disc was the minimum in the T4-5 level of the thoracic column probably due to the fact that thoracic intervertebral discs are less wedge-shaped than those of cervical and lumbar spinal regions.
From the cranial to caudal direction, the cross-sectional area of the spine increased. Therefore, by the L5-S1 level, the nucleus pulposus was occupying a higher proportion of the intervertebral disc area. The cervical discs have an elliptical shape on cross-section while the thoracic discs had a more circular shape. The lumbar discs also have an elliptical shape though it is more flattened or re-entrant posteriorly.
What is a Disc Bulge?
The bulging disc is when the disc simply bulges outside the intervertebral disc space it normally occupies without the rupture of the outer annulus fibrosus. The bulging area is quite large when compared to a herniated disc. Moreover, in a herniated disc, the annulus fibrosus ruptures or cracks. Although disc bulging is more common than disc herniation, it causes little or no pain to the patient. In contrast, the herniated disc causes a lot of pain.
Causes for Disc Bulging
A bulging disc can be due to several causes. It can occur due to normal age-related changes such as those seen in degenerative disc disease. The aging process can lead to structural and biochemical changes in the intervertebral discs and lead to reduced water content in the nucleus pulposus. These changes can make the patient vulnerable to disc bulges with only minor trauma. Some unhealthy lifestyle habits such as a sedentary lifestyle and smoking can potentiate this process and give rise to more severe changes with the weakening of the disc.
General wear and tear due to repeated microtrauma can also weaken the disc and give rise to disc bulging. This is because when the discs are strained, the normal distribution of weight loading changes. Accumulated micro-trauma over a long period of time can occur in bad posture. Bad posture when sitting, standing, sleeping, and working can increase the pressure in the intervertebral discs.
When a person maintains a forward bending posture, it can lead to overstretching and eventually weakness of the posterior part of the annulus fibrosus. Over time, the intervertebral disc can bulge posteriorly. In occupations that require frequent and repetitive lifting, standing, driving, or bending, the bulging disc may be an occupational hazard. Improper lifting up of items, and improper carrying of heavy objects can also increase the pressure on the spine and lead to disc bulges eventually.
The bulging intervertebral discs usually occur over a long period of time. However, the discs can bulge due to acute trauma too. The unexpected sudden mechanical load can damage the disc resulting in micro-tears. After an accident, the disc can become weakened causing long-term microdamage ultimately leading to bulging of the disc. There may also be a genetic component to the disc bulging. The individual may have a reduced density of elastin in the annulus fibrosus with increased susceptibility to disc diseases. Other environmental facts may also play a part in this disease process.
Symptoms of Disc Bulging
As mentioned previously, bulging discs do not cause pain and even if they do the severity is mild. In the cervical region, the disease will cause pain running down the neck, deep pain in the shoulder region, pain radiating along the upper arm, and forearm up to the fingers.
This may give rise to a diagnostic dilemma as to whether the patient is suffering from a myocardial infarction as the site of referred pain and the radiation is similar. Tingling feeling on the neck may also occur due to the bulging disc.
In the thoracic region, there may be pain in the upper back that radiates to the chest or the upper abdominal region. This may also suggest upper gastrointestinal, lung, or cardiac pathology and hence need to be careful when analyzing these symptoms.
The bulging discs of the lumbar region may present as lower back pain and tingling feeling in the lower back region of the spine. This is the most common site for disc bulges since this area holds the weight of the upper body. The pain or the discomfort can spread through the gluteal area, thighs, and to the feet. There may also be muscle weakness, numbness or tingling sensation. When the disc presses on the spinal cord, the reflexes of both legs can increase leading to spasticity.
Some patients may even have paralysis from the waist down. When the bulging disc compresses on the cauda equine, the bladder and bowel functions can also change. The bulging disc can press on the sciatic nerve leading to sciatica where the pain radiates in one leg from the back down to the feet.
The pain from the bulging disc can get worse during some activities as the bulge can then compress on some of the nerves. Depending on what nerve is affected, the clinical features can also vary.
Diagnosis of Disc Bulging
The diagnosis may not be apparent from clinical history due to similar presentations in more serious problems. But the chronic nature of the disease may give some clues. Complete history and a physical examination need to be done to rule out myocardial infarction, gastritis, gastro-oesophageal reflux disease, and chronic lung pathology.
MRI of Disc Bulge
Investigations are necessary for the diagnosis. X-ray spine is performed to look for gross pathology although it may not show the bulging disc directly. There may be indirect findings of disk degeneration such as osteophytes in the endplates, gas in the disc due to the vacuum phenomenon, and the loss of height of the intervertebral disc. In the case of moderate bulges, it may sometimes appear as non-focal intervertebral disc material that is protruded beyond the borders of the vertebra which is broad-based, circumferential, and symmetrical.
Magnetic resonance imaging or MRI can exquisitely define the anatomy of the intervertebral discs especially the nucleus pulposus and its relationships. The early findings seen on MRI in disc bulging include the loss of normal concavity of the posterior disc. The bulges can be seen as broad-based, circumferential, and symmetrical areas. In moderate bulging, the disc material will protrude beyond the borders of the vertebrae in a non-focal manner. Ct myelogram may also give detailed disc anatomy and may be useful in the diagnosis.
Treatment of Disc Bulging
The treatment for the bulging disc can be conservative, but sometimes surgery is required.
Conservative Treatment
When the disc bulging is asymptomatic, the patient does not need any treatment since it does not pose an increased risk. However, if the patient is symptomatic, the management can be directed at relieving the symptoms. The pain is usually resolved with time. Till then, potent pain killers such as non-steroidal anti-inflammatory drugs like ibuprofen should be prescribed. In unresolved pain, steroid injections can also be given to the affected area and if it still does not work, the lumbar sympathetic block can be tried in most severe cases.
The patient can also be given the option of choosing alternative therapies such as professional massage, physical therapy, ice packs, and heating pads which may alleviate symptoms. Maintaining correct posture, tapes, or braces to support the spine are used with the aid of a physiotherapist. This may fasten the recovery process by avoiding further damage and keeping the damaged or torn fibers in the intervertebral disc without leakage of the fluid portion of the disc. This helps maintain the normal structure of the annulus and may increase the recovery rate. Usually, the painful symptoms which present initially get resolved over time and lead to no pain. However, if the symptoms get worse steadily, the patient may need surgery
If the symptoms are resolved, physiotherapy can be used to strengthen the muscles of the back with the use of exercises. Gradual exercises can be used for the return of function and for preventing recurrences.
Surgical Treatment
When conservative therapy does not work with a few months of treatment, surgical treatment can be considered. Most would prefer minimally invasive surgery which uses advanced technology to correct the intervertebral disc without having to grossly dissect the back. These procedures such as microdiscectomy have a lower recovery period and reduced risk of scar formation, major blood loss, and trauma to adjacent structures when compared to open surgery.
Previously, laminectomy and discectomy have been a mainstay of treatment. However, due to the invasiveness of the procedure and due to increased damage to the nerves these procedures are currently abandoned by many clinicians for disc bulging.
Disc bulging in the thoracic spine is being treated surgically with costotransversectomy where a section of the transverse process is resected to allow access to the intervertebral disc. The spinal cord and spinal nerves are decompressed by using thoracic decompression by removing a part of the vertebral body and making a small opening. The patient may also need a spinal fusion later on if the removed spinal body was significant.
Video-assisted thoracoscopic surgery can also be used where only a small incision is made and the surgeon can perform the surgery with the assistance of the camera. If the surgical procedure involved removing a large portion of the spinal bone and disc material, it may lead to spinal instability. This may need bone grafting to replace the lost portion with plates and screws to hold them in place.
What is a Disc Herniation?
As mentioned in the first section of this article, disc herniation occurs when there is disc material displaces beyond the limits of the intervertebral disc focally. The disc space consists of endplates of the vertebral bodies superiorly and inferiorly while the outer edges of the vertebral apophyses consist of the peripheral margin. The osteophytes are not considered a disc margin. There may be irritation or compression of the nerve roots and dural sac due to the volume of the herniated material leading to pain. When this occurs in the lumbar region, this is classically known as sciatica. This condition has been mentioned since ancient times although a connection between disc herniation and sciatica was made only in the 20th century. Disc herniation is one of the commonest diagnoses seen in the spine due to degenerative changes and is the commonest cause of spinal surgery.
Classifications of Disc Herniation
There are many classifications regarding intervertebral disc herniation. In focal disc herniation, there is a localized displacement of the disc material in the horizontal or axial plane. In this type, only less than 25% of the circumference of the disc is involved. In broad-based disc herniation, about 25 – 50 % of the disc circumference is herniated. The disc bulge is when 50 – 100 % of the disc material is extended beyond the normal confines of the intervertebral space. This is not considered a form of disc herniation. Furthermore, the intervertebral disc deformities associated with severe cases of scoliosis and spondylolisthesis are not classified as a herniation but rather adaptive changes of the contour of the disc due to the adjacent deformity.
Depending on the contour of the displaced material, the herniated discs can be further classified as protrusions and extrusions. In disc protrusion, the distance measured in any plane involving the edges of the disc material beyond intervertebral disc space (the highest measure is taken) is lower than the distance measured in the same plane between the edges of the base.
Imaging can show the disc displacement as a protrusion on the horizontal section and as an extrusion on the sagittal section due to the fact that the posterior longitudinal ligament contains the disc material that is displaced posteriorly. Then the herniation should be considered an extrusion. Sometimes the intervertebral disc herniation can occur in the craniocaudal or vertical direction through a defect in the vertebral body endplates. This type of herniation is known as intravertebral herniation.
The disc protrusion can also be divided into two focal protrusion and broad-based protrusion. In focal protrusion, the herniation is less than 25% of the circumference of the disc whereas, in broad-based protrusion, the herniated disc consists of 25 – 50 % of the circumference of the disc.
In disc extrusion, it is diagnosed if any of the two following criteria are satisfied. The first one is; that the distance measured between the edges of the disc material that is beyond the intervertebral disc space is greater than the distance measured in the same plane between the edges of the base. The second one is; that the material in the intervertebral disc space and material beyond the intervertebral disc space is having a lack continuity.
This can be further characterized as sequestrated which is a subtype of the extruded disc. It is called disc migration when disk material is pushed away from the site of extrusion without considering whether there is continuity of disc or not. This term is useful in interpreting imaging modalities as it is often difficult to show continuity in imaging.
The intervertebral disc herniation can be further classified as contained discs and discs that are unconfined. The term contained disc is used to refer to the integrity of the peripheral annulus fibrosus which is covering the intervertebral disc herniation. When fluid is injected into the intervertebral disc, the fluid does not leak into the vertebral canal in herniations that are contained.
Sometimes there are displaced disc fragments that are characterized as free. However, there should be no continuity between disc material and the fragment and the original intervertebral disc for it to be called a free fragment or a sequestered one. In a migrated disc and in a migrated fragment, there is an extrusion of disc material through the opening in the annulus fibrosus with a displacement of the disc material away from the annulus.
Even though some fragments that are migrated can be sequestered the term migrated means just to the position and it is not referred to the continuity of the disc. The displaced intervertebral disc material can be further described with regard to the posterior longitudinal ligament as submembranous, subcapsular, subligamentous, extra ligamentous, transligamentous, subcapsular, and perforated.
The spinal canal can also get affected by an intervertebral disc herniation. This compromise of the canal can also be classified as mild, moderate, and severe depending on the area that is compromised. If the canal at that section is compromised only less than one third, it is called mild whereas if it is only compromised less than two-thirds and more than one third it is considered moderate. In a severe compromise, more than two-thirds of the spinal canal is affected. For the foraminal involvement, this same grading system can be applied.
The displaced material can be named according to the position that they are in the axial plane from the center to the right lateral region. They are termed as central, right central, right subarticular, right foraminal, and right extraforaminal. The displaced intervertebral disc material’s composition can be further classified as gaseous, liquefied, desiccated, scarred, calcified, ossified, bony, nuclear, and cartilaginous.
Before going into detail on how to diagnose and treat intervertebral disc herniation, let us differentiate how cervical disc herniation differs from lumbar herniation since they are the most common regions to undergo herniation.
Cervical Disc Herniation vs. Thoracic Disc Herniation vs Lumbar Disc Herniation
Lumbar disc herniation is the most commonest type of herniation found in the spine which is approximately 90% of the total. However, cervical disc herniation can also occur in about one-tenth of patients. This difference is mainly due to the fact that the lumbar spine has more pressure due to the increased load. Moreover, it has comparatively large intervertebral disc material. The most common sites of intervertebral disc herniation in the lumbar region are L 5 – 6, in the Cervical region between C7, and in the thoracic region T12.
Cervical disc herniation can occur relatively commonly because the cervical spine acts as a pivoting point for the head and it is a vulnerable area for trauma and therefore prone to damage in the disc. Thoracic disc herniation occurs more infrequently than any of the two. This is due to the fact that thoracic vertebrae are attached to the ribs and the thoracic cage which limits the range of movement in the thoracic spine when compared to the cervical and lumbar spinal discs. However, thoracic intervertebral disc herniation can still occur.
Cervical disc herniation gives rise to neck pain, shoulder pain, pain radiating from the neck to the arm, tingling, etc. Lumbar disc herniation can similarly cause lower back pain as well as pain, tingling, numbness, and muscle weakness seen in the lower limbs. Thoracic disc herniation can give rise to pain in the upper back radiating to the torso.
Epidemiology
Although disc herniation can occur in all age groups, it predominantly occurs between the fourth and fifth decade of life with the mean age of 37 years. There have been reports that estimate the prevalence of intervertebral disc herniation to be 2 – 3 % of the general population. It is more commonly seen in men over 35 years with a prevalence of 4.8% and while in women this figure is around 2.5%. Due to its high prevalence, it is considered a worldwide problem as it is also associated with significant disability.
Risk Factors
In most instances, a herniated disc occurs due to the natural aging process in the intervertebral disc. Due to the disc degeneration, the amount of water that was previously seen in the intervertebral disc gets dried out leading to the shrinking of the disc with the narrowing of the intervertebral space. These changes are markedly seen in degenerative disc disease. In addition to these gradual changes due to normal wear and tear, other factors may also contribute to increasing the risk of intervertebral disc herniation.
Being overweight can increase the load on the spine and increase the risk of herniation. A sedentary life can also increase the risk and therefore an active lifestyle is recommended in preventing this condition. Improper posture with prolonged standing, sitting, and especially driving can put a strain on the intervertebral discs due to the additional vibration from the vehicle engine leading to microtrauma and cracks in the disc. The occupations which require constant bending, twisting, pulling and lifting can put a strain on the back. Improper weight lifting techniques are one of the major reasons.
When back muscles are used in lifting heavy objects instead of lifting with the legs and twisting while lifting can make the lumbar discs more vulnerable to herniation. Therefore patients should always be advised to lift weights with their legs and not the back. Smoking has been thought to increase disc herniation by reducing the blood supply to the intervertebral disc leading to degenerative changes of the disc.
Although the above factors are frequently assumed to be the causes for disc herniation, some studies have shown that the difference in risk is very small when this particular population was compared with the control groups of the normal population.
There have been several types of research done on genetic predisposition and intervertebral disc herniation. Some of the genes that are implicated in this disease include vitamin D receptor (VDR) which is a gene that codes for the polypeptides of important collagen called collagen IX (COL9A2).
Another gene called the human aggrecan gene (AGC) is also implicated as it codes for proteoglycans which is the most important structural protein found in the cartilage. It supports the biochemical and mechanical function of the cartilage tissue and hence when this gene is defective, it can predispose an individual to intervertebral disc herniation.
Apart from these, there are many other genes that are being researched due to the association between disc herniation such as matrix metalloproteinase (MMP) cartilage intermediate layer protein, thrombospondin (THBS2), collagen 11A1, carbohydrate sulfotransferase, and asporin (ASPN). They may also be regarded as potential gene markers for lumbar disc disease.
Pathogenesis of Sciatica and Disc Herniation
The sciatic pain originated from the extruded nucleus pulposus inducing various phenomena. It can directly compress the nerve roots leading to ischemia or without it, mechanically stimulate the nerve endings of the outer portion of the fibrous ring and release inflammatory substances suggesting its multifactorial origin. When the disc herniation causes mechanical compression of the nerve roots, the nerve membrane is sensitized to pain and other stimuli due to ischemia. It has been shown that in sensitized and compromised nerve roots, the threshold for neuronal sensitization is around half of that of a normal and non-compromised nerve root.
The inflammatory cell infiltration is different in extruded discs and non-extruded discs. Usually, in non-extruded discs, the inflammation is less. The extruded disc herniation causes the posterior longitudinal ligament to rupture which exposes the herniated part to the vascular bed of the epidural space. It is believed that inflammatory cells are originating from these blood vessels situated in the outermost part of the intervertebral disc.
These cells may help secrete substances that cause inflammation and irritation of the nerve roots causing sciatic pain. Therefore, extruded herniations are more likely to cause pain and clinical impairment than those that are contained. In contained herniations, the mechanical effect is predominant while in the unconfined or the extruded discs the inflammatory effect is predominant.
Clinical Disc Herniation and What to Look for in the History
The symptoms of the disc herniation can vary a great deal depending on the location of the pain, the type of herniation, and the individual. Therefore, history should focus on the analysis of the main complaint among the many other symptoms.
The chief complaint can be neck pain in cervical disc herniation and there can be referred pain in the arms, shoulders, neck, head, face, and even the lower back region. However, it is most commonly referred to as the interscapular region. The radiation of pain can occur according to the level at the herniation is taking place. When the nerve roots of the cervical region are affected and compressed, there can be sensory, and motor changes with changes in the reflexes.
The pain that occurs due to nerve root compression is called radicular pain and it can be described as deep, aching, burning, dull, achy, and electric depending on whether there is mainly motor dysfunction or sensory dysfunction. In the upper limb, the radicular pain can follow a dermatomal or myotomal pattern. Radiculopathy usually does not accompany neck pain. There can be unilateral as well as bilateral symptoms. These symptoms can be aggravated by activities that increase the pressure inside the intervertebral discs such as the Valsalva maneuver and lifting.
Driving can also exacerbate pain due to disc herniation due to stress because of vibration. Some studies have shown that shock loading and stress from vibration can cause a mechanical force to exacerbate small herniations but flexed posture had no influence. Similarly, activities that decrease intradiscal pressure can reduce the symptoms such as lying down.
The main complaint in lumbar disc herniation is lower back pain. Other associated symptoms can be a pain in the thigh, buttocks, and anogenital region which can radiate to the foot and toe. The main nerve affected in this region is the sciatic nerve causing sciatica and its associated symptoms such as intense pain in the buttocks, leg pain, muscle weakness, numbness, impairment of sensation, hot and burning or tingling sensation in the legs, dysfunction of gait, impairment of reflexes, edema, dysesthesia or paresthesia in the lower limbs. However, sciatica can be caused by causes other than herniation such as tumors, infection, or instability which need to be ruled out before arriving at a diagnosis.
The herniated disc can also compress on the femoral nerve and can give rise to symptoms such as numbness, tingling sensation in one or both legs, and a burning sensation in the legs and hips. Usually, the nerve roots that are affected in herniation in the lumbar region are the ones exiting below the intervertebral disc. It is thought that the level of the nerve root irritation determines the distribution of leg pain. In herniations at the third and fourth lumbar vertebral levels, the pain may radiate to the anterior thigh or the groin. In radiculopathy at the level of the fifth lumbar vertebra, the pain may occur in the lateral and anterior thigh region. In herniations at the level of the first sacrum, the pain may occur in the bottom of the foot and the calf. There can also be numbness and tingling sensation occurring in the same area of distribution. The weakness in the muscles may not be able to be recognized if the pain is very severe.
When changing positions the patient is often relieved from pain. Maintaining a supine position with the legs raised can improve the pain. Short pain relief can be brought by having short walks while long walks, standing for prolonged periods, and sitting for extended periods of time such as in driving can worsen the pain.
The lateral disc herniation is seen in foraminal and extraforaminal herniations and they have different clinical features to that of medial disc herniation seen in subarticular and central herniations. The lateral intervertebral disc herniations can when compared to medial herniations more directly irritate and mechanically compress the nerve roots that are exiting and the dorsal root ganglions situated inside the narrowed spinal canal.
Therefore, lateral herniation is seen more frequently in older age with more radicular pain and neurological deficits. There is also more radiating leg pain and intervertebral disc herniations in multiple levels in the lateral groups when compared to medial disc herniations.
The herniated disc in the thoracic region may not present with back pain at all. Instead, there are predominant symptoms due to referred pain in the thorax due to irritation of nerves. There can also be predominant pain in the body that travels to the legs, tingling sensation and numbness in one or both legs, muscle weakness, and spasticity of one or both legs due to exaggerated reflexes.
The clinician should look out for atypical presentations as there could be other differential diagnoses. The onset of symptoms should be inquired about to determine whether the disease is acute, sub-acute, or chronic in onset. Past medical history has to be inquired about in detail to exclude red flag symptoms such as pain that occurs at night without activity which can be seen in pelvic vein compression, and non-mechanical pain which may be seen in tumors or infections.
If there is a progressive neurological deficit, with bowel and bladder involvement is there, it is considered a neurological emergency and urgently investigated because cauda equine syndrome may occur which if untreated, can lead to permanent neurological deficit.
Getting a detailed history is important including the occupation of the patient as some activities in the job may be exacerbating the patient’s symptoms. The patient should be assessed regarding which activities he can and cannot do.
Differential Diagnosis
Degenerative disc disease
Mechanical pain
Myofascial pain leading to sensory disturbances and local or referred pain
Hematoma
Cyst leading to occasional motor deficits and sensory disturbances
Spondylosis or spondylolisthesis
Discitis or osteomyelitis
Malignancy, neurinoma or mass lesion causing atrophy of thigh muscles, glutei
Spinal stenosis is seen mainly in the lumbar region with mild low back pain, motor deficits, and pain in one or both legs.
An epidural abscess can cause symptoms similar to radicular pain involving spinal disc herniation
Aortic aneurysm which can cause low back pain and leg pain due to compression can also rupture and lead to hemorrhagic shock.
Hodgkin’s lymphoma in advanced stages can lead to space-occupying lesions in the spinal column leading to symptoms like that of intervertebral disc herniation
Tumors
Pelvic endometriosis
Facet hypertrophy
Lumbar nerve root schwannoma
Herpes zoster infection results in inflammation along with the sciatic or lumbosacral nerve roots
Examination in Disc Herniation
Complete physical examination is necessary to diagnose intervertebral disc herniation and exclude other important differential diagnoses. The range of motion has to be tested but may have a poor correlation with disc herniation as it is mainly reduced in elderly patients with a degenerative disease and due to disease of the joints.
A complete neurological examination is often necessary. This should test muscle weakness and sensory weakness. In order to detect muscle weakness in small toe muscles, the patient can be asked to walk on tiptoe. The strength of muscle can also be tested by comparing the strength to that of the clinician. There may be dermatomal sensory loss suggesting the respective nerve root involvement. The reflexes may be exaggerated or sometimes maybe even absent.
There are many neurologic examination maneuvers described in relation to intervertebral disc herniation such as the Braggart sign, flip the sign, Lasegue rebound sign, Lasegue differential sign, Mendel Bechterew sign, Deyerle sign both legs or Milgram test, and well leg or Fajersztajin test. However, all these are based on testing the sciatic nerve root tension by using the same principles in the straight leg raising test. These tests are used for specific situations to detect subtle differences.
Nearly almost all of them depend on the pain radiating down the leg and if it occurs above the knee it is assumed to be due to a neuronal compressive lesion and if the pain goes below the knee, it is considered to be due to the compression of the sciatic nerve root. For lumbar disc herniation detection, the most sensitive test is considered to be radiating pain occurring down the leg due to provocation.
In the straight leg raising test also called the Lasegue’s sign, the patient stays on his or her back and keeps the legs straight. The clinician then lifts the legs by flexing the hip while keeping the knee straight. The angle at which the patient feels pain going down the leg below the knee is noted. In a normal healthy individual, the patient can flex the hip to 80- 90? without having any pain or difficulty.
However, if the angle is just 30 -70? degrees, it is suggestive of lumbar intervertebral disc herniation at the L4 to S1 nerve root levels. If the angle of hip flexion without pain is less than 30 degrees, it usually indicates some other causes such as tumor of the gluteal region, gluteal abscess, spondylolisthesis, disc extrusion, and protrusion, malingering patient, and acute inflammation of the dura mater. If pain with hip flexion occurs at more than 70 degrees, it may be due to tightness of the muscles such as gluteus maximus and hamstrings, tightness of the capsule of the hip joint, or pathology of sacroiliac or hip joints.
The reverse straight leg raising test or hip extension test can be used to test higher lumbar lesions by stretching the nerve roots of the femoral nerve which is similar to the straight leg raising test. In the cervical spine, in order to detect stenosis of the foramina, the Spurling test is done and is not specific to cervical intervertebral disc herniation or tension of the nerve roots. The Kemp test is the analogous test in the lumbar region to detect foraminal stenosis. Complications due to the disc herniation include careful examination of the hip region, digital rectal examination, and urogenital examination is needed.
Investigation of Disc Herniation
For the diagnosis of intervertebral disc herniation, diagnostic tests such as Magnetic resonance imaging (MRI), Computed tomography (CT), myelography, and plain radiography can be used either alone or in combination with other imaging modalities. Objective detection of disc herniation is important because only after such a finding the surgical intervention is even considered. Serum biochemical tests such as prostate-specific antigen (PSA) level, Alkaline phosphatize value, erythrocyte sedimentation rate (ESR), urine analysis for Bence Jones protein, serum glucose level, and serum protein electrophoresis may also be needed in specific circumstances guided by history.
Magnetic Resonance Imaging (MRI)
MRI is considered the best imaging modality in patients with history and physical examination findings suggestive of lumbar disc herniation associated with radiculopathy according to North American Spinal Society guidelines in 2014. The anatomy of the herniated nucleus pulposus and its associated relationships with soft tissue in the adjacent areas can be delineated exquisitely by MRI in cervical, thoracic, and lumbosacral areas. Beyond the confines of the annulus, the herniated nucleus can be seen as a focal, asymmetric disc material protrusion on MRI.
On sagittal T2 weighted images, the posterior annulus is usually seen as a high signal intensity area due to radial annular tear associated with the herniation of the disc although the herniated nucleus is itself hypointense. The relationship between the herniated nucleus and degenerated facets with the nerve roots which are exiting through the neural foramina are well-demarcated on sagittal images of MRI. Free fragments of the intervertebral disc can also be distinguished from MRI images.
There may be associated signs of intervertebral disc herniation on MRI such as radial tears on the annulus fibrosus which is also a sign of degenerative disc disease. There may be other telling signs such as loss of disc height, bulging annulus, and changes in the endplates. Atypical signs may also be seen with MRI such as abnormal disc locations, and lesions located completely outside the intervertebral disc space.
MRI can detect abnormalities in the intervertebral discs superiorly to other modalities although its bone imaging is a little less inferior. However, there are limitations with MRI in patients with metal implant devices such as pacemakers because the electromagnetic field can lead to abnormal functioning of the pacemakers. In patients with claustrophobia, it may become a problem to go to the narrow canal to be scanned by the MRI machine. Although some units contain open MRI, it has less magnetic power and hence delineates less superior quality imaging.
This is also a problem in children and anxious patients undergoing MRI because good image quality depends on the patient staying still. They may require sedation. The contrast used in MRI which is gadolinium can induce nephrogenic systemic fibrosis in patients who had pre-existing renal disease. MRI is also generally avoided in pregnancy especially during the first 12 weeks although it has not been clinically proven to be hazardous to the fetus. MRI is not very useful when a tumor contains calcium and in distinguishing edema fluid from tumor tissue.
Computed Tomography (CT)
CT scanning is also considered another good method to assess spinal disc herniation when MRI is not available. It is also recommended as a first-line investigation in unstable patients with severe bleeding. CT scanning is superior to myelography although when the two are combined, it is superior both of them. CT scans can show calcification more clearly and sometimes even gas in images. In order to achieve a superior imaging quality, the imaging should be focused on the site of pathology and thin sections taken to better determine the extent of the herniation.
However, a CT scan is difficult to be used in patients who have already undergone laminectomy surgical procedures because the presence of scar tissue and fibrosis causes the identification of the structures difficult although bony changes and deformity in nerve sheath are helpful in making a diagnosis.
The herniated intervertebral discs in the cervical disc can be identified by studying the uncinate process. It is usually projected posteriorly and laterally to the intervertebral discs and superiorly to the vertebral bodies. The uncinate process undergoes sclerosis, and hypertrophy when there is an abnormal relationship between the uncinate process and adjacent structures as seen in degenerative disc disease, intervertebral disc space narrowing, and general wear and tear.
Myelopathy can occur when the spinal canal is affected due to disc disease. Similarly, when neural foramina are involved, radiculopathy occurs. Even small herniated discs and protrusions can cause impingement of the dural sac because the cervical epidural space is narrowed naturally. The intervertebral discs have attenuation a little bit greater than the sac characterized in the CT scan.
In the thoracic region, a CT scan can diagnose an intervertebral disc herniation with ease due to the fact that there is an increased amount of calcium found in the thoracic discs. Lateral to the dural sac, the herniated disc material can be seen on CT as a clearly defined mass that is surrounded by epidural fat. When there is a lack of epidural fat, the disc appears as a higher attenuated mass compared to the surrounding.
Radiography
Plain radiography is not needed in diagnosing herniation of the intervertebral discs, because plain radiographs cannot detect the disc and therefore are used to exclude other conditions such as tumors, infections, and fractures.
In myelography, there may be deformity or displacement of the extradural contrast-filled thecal sac seen in herniation of the disc. There may also be features in the affected nerve such as edema, elevation, deviation, and amputation of the nerve root seen in the myelography image.
Diskography
In this imaging modality, the contrast medium is injected into the disc in order to assess the disc morphology. If pain occurs following injection that is similar to the discogenic pain, it suggests that that disc is the source of the pain. When a CT scan is also performed immediately after discography, it is helpful to differentiate the anatomy and pathological changes. However, since it is an invasive procedure, it is indicated only in special circumstances when MRI and CT have failed to reveal the etiology of back pain. It has several side effects such as headache, meningitis, damage to the disc, discitis, intrathecal hemorrhage, and increased pain.
Treatment of Herniated Disc
The treatment should be individualized according to the patient-guided through history, physical examination, and diagnostic investigation findings. In most cases, the patient gradually improves without needing further intervention in about 3 – 4 months. Therefore, the patient only needs conservative therapy during this time period. Because of this reason, there are many ineffective therapies that have emerged by attributing the natural resolution of symptoms to that therapy. Therefore, conservative therapy needs to be evidence-based.
Conservative Therapy
Since the herniation of the disc has a benign course, the aim of treatment is to stimulate the recovery of neurological function, reduce pain, and facilitate early return to work and activities of daily living. The most benefits of the conservative treatment are for younger patients with hernias that are sequestered and in patients with mild neurological deficits due to small disc hernias.
Bed rest has long been considered a treatment option in herniation of the disc. However, it has been shown that bed rest has no effect beyond the first 1 or 2 days. The bed rest is regarded as counterproductive after this period of time.
In order to reduce the pain, oral non-steroidal anti-inflammatory drugs such as ibuprofen and naproxen can be used. This can relieve the pain by reducing inflammation associated with the inflamed nerve. Analgesics such as acetaminophen can also be used although they lack the anti-inflammatory effect seen in NSAIDs. The doses and the drugs should be appropriate for the age and severity of the pain in the patient. If pain is not controlled by the current medication, the clinician has to go one step up on the WHO analgesics ladder. However, the long-term use of NSAIDs and analgesics can lead to gastric ulcers, liver, and kidney problems.
In order to reduce the inflammation, other alternative methods such as applying ice in the initial period and then switching to using heat, gels, and rubs may help with the pain as well as muscle spasms. Oral muscle relaxants can also be used in relieving muscle spasms. Some of the drugs include methocarbamol, carisoprodol, and cyclobenzaprine.
However, they act centrally and cause drowsiness and sedation in patients and it does not act directly to reduce muscle spasm. A short course of oral steroids such as prednisolone for a period of 5 days in a tapering regime can be given to reduce the swelling and inflammation in the nerves. It can provide immediate pain relief within a period of 24 hours.
When the pain is not resolved adequately with maximum effective doses, the patient can be considered for giving steroid injections into the epidural space. The major indication for the steroid injection into periradicular space is discal compression causing radicular pain that is resistant to conventional medical treatment. A careful evaluation with CT or MRI scanning is required to carefully exclude extra discal causes for pain. The contraindications for this therapy include patients with diabetes, pregnancy, and gastric ulcers. Epidural puncture is contraindicated in patients with coagulation disorders and therefore the foraminal approach is used carefully if needed.
This procedure is performed under the guidance of fluoroscopy and involves injecting steroids and an analgesic into the epidural space adjacent to the affected intervertebral disc to reduce the swelling and inflammation of the nerves directly in an outpatient setting. As much as 50% of the patients experience relief after the injection although it is temporary and they might need repeat injections at 2 weekly intervals to achieve the best results. If this treatment modality becomes successful, up to 3 epidural steroidal injections can be given per year.
Physical therapy can help the patient return to his previous life easily although it does not improve the herniated disc. The physical therapist can instruct the patient on how to maintain the correct posture, walking, and lifting techniques depending on the patient’s ability to work, mobility, and flexibility.
Stretching exercises can improve the flexibility of the spine while strengthening exercises can increase the strength of the back muscles. The activities which can aggravate the condition of the herniated disc are instructed to be avoided. Physical therapy makes the transition from intervertebral disc herniation to an active lifestyle smooth. The exercise regimes can be maintained for life to improve general well-being.
The most effective conservative treatment option that is evidence-based is observation and epidural steroid injection for the relief of pain in the short-term duration. However, if the patients so desire they can use holistic therapies of their choice with acupuncture, acupressure, nutritional supplements, and biofeedback although they are not evidence-based. There is also no evidence to justify the use of trans electrical nerve stimulation (TENS) as a pain relief method.
If there is no improvement in the pain after a few months, surgery can be contemplated and the patient must be selected carefully for the best possible outcome.
Surgical Therapy
The aim of surgical therapy is to decompress the nerve roots and relieve the tension. There are several indications for surgical treatment which are as follows.
Absolute indications include cauda equina syndrome or significant paresis. Other relative indications include motor deficits that are greater than grade 3, sciatica that is not responding to at least six months of conservative treatment, sciatica for more than six weeks, or nerve root pain due to foraminal bone stenosis.
There have been many discussions over the past few years regarding whether to treat herniation of intervertebral disc disease with prolonged conservative treatment or early surgical treatment. Much research has been conducted in this regard and most of them show that the final clinical outcome after 2 years is the same although the recovery is faster with early surgery. Therefore, it is suggested that early surgery may be appropriate as it enables the patient to return to work early and thereby is economically feasible.
Some surgeons may still use traditional discectomy although many are using minimally invasive surgical techniques over recent years. Microdiscectomy is considered to be the halfway between the two ends. There are two surgical approaches that are being used. Minimally invasive surgery and percutaneous procedures are the ones that are being used due to their relative advantage. There is no place for the traditional surgical procedure known as a laminectomy.
However, there are some studies suggesting microdiscectomy is more favorable because of its both short-term and long-term advantages. In the short term, there is a reduced length of operation, reduced bleeding, relief of symptoms, and reduced complication rate. This technique has been effective even after 10 years of follow-up and therefore is the most preferred technique even now. The studies that have been performed to compare the minimally invasive technique and microdiscectomy have resulted in different results. Some have failed to establish a significant difference while one randomized control study was able to determine that microdiscectomy was more favorable.
In microdiscectomy, only a small incision is made aided by an operating microscope and the part of the herniated intervertebral disc fragment which is impinging on the nerve is removed by hemilaminectomy. Some part of the bone is also removed to facilitate access to the nerve root and the intervertebral disc. The duration of the hospital stay is minimal with only an overnight stay and observation because the patient can be discharged with minimal soreness and complete relief of the symptoms.
However, some unstable patients may need more prolonged admission and sometimes they may need fusion and arthroplasty. It is estimated that about 80 – 85 % of the patients who undergo microdiscectomy recover successfully and many of them are able to return to their normal occupation in about 6 weeks.
There is a discussion on whether to remove a large portion of the disc fragment and curetting the disc space or to remove only the herniated fragment with minimal invasion of the intervertebral disc space. Many studies have suggested that the aggressive removal of large chunks of the disc could lead to more pain than when conservative therapy is used with 28% versus 11.5 %. It may lead to degenerative disc disease in the long term. However, with conservative therapy, there is a greater risk of recurrence of around 7 % in herniation of the disc. This may require additional surgery such as arthrodesis and arthroplasty to be performed in the future leading to significant distress and economic burden.
In the minimally invasive surgery, the surgeon usually makes a tiny incision in the back to put the dilators with increasing diameter to enlarge the tunnel until it reaches the vertebra. This technique causes lesser trauma to the muscles than when seen in traditional microdiscectomy. Only a small portion of the disc is removed in order to expose the nerve root and the intervertebral disc. Then the surgeon can remove the herniated disc by the use of an endoscope or a microscope.
These minimally invasive surgical techniques have a higher advantage of lower surgical site infections and shorter hospital stays. The disc is centrally decompressed either chemically or enzymatically with the use of chymopapain, laser, or plasma (ionized gas) ablation and vaporization. It can also be decompressed mechanically by using percutaneous lateral decompression or by aspirating and sucking with a shaver such as a nucleosome. Chemopapin was shown to have adverse effects and was eventually withdrawn. Most of the above techniques have shown to be less effective than a placebo. Directed segmentectomy is the one that has shown some promise in being effective similar to microdiscectomy.
In the cervical spine, the herniated intervertebral discs are treated anteriorly. This is because the herniation occurs anteriorly and the manipulation of the cervical cord is not tolerated by the patient. The disc herniation that is due to foraminal stenosis and that is confined to the foramen are the only instances where a posterior approach is contemplated.
The minimal disc excision is an alternative to the anterior cervical spine approach. However, the intervertebral disc stability after the procedure is dependent on the residual disc. The neck pain can be significantly reduced following the procedure due to the removal of neuronal compression although significant impairment can occur with residual axial neck pain. Another intervention for cervical disc herniation includes anterior cervical interbody fusion. It is more suitable for patients with severe myelopathy with degenerative disc disease.
Complications of the Surgery
Although the risk of surgery is very low, complications can still occur. Post-operative infection is one of the commonest complications and therefore needs more vigorous infection control procedures in the theatre and in the ward. During the surgery, due to poor surgical technique, nerve damage can occur. A dural leak may occur when an opening in the lining of the nerve root causes leakage of cerebrospinal fluid which is bathing the nerve roots. The lining can be repaired during the surgery. However, headache can occur due to loss of cerebrospinal fluid but it usually improves with time without any residual damage. If blood around the nerve roots clots after the surgery, that blood clot may lead to compression of the nerve root leading to radicular pain which was experienced by the patient previously. Recurrent herniation of the intervertebral disc due to herniation of disc material at the same site is a devastating complication that can occur long term. This can be managed conservatively but surgery may be necessary ultimately.
Outcomes of the Surgery
There has been extensive research done regarding the outcome of lumbar disc herniation surgery. Generally, the results from the microdiscectomy surgery are good. There is more improvement of leg pain than back pain and therefore this surgery is not recommended for those who have only back pain. Many patients improve clinically over the first week but they may improve over the following several months. Typically, the pain disappears in the initial recovery period and it is followed by an improvement in the strength of the leg. Finally, the improvement of the sensation occurs. However, patients may complain of feeling numbness although there is no pain. The normal activities and work can be resumed over a few weeks after the surgery.
Novel Therapies
Although conservative therapy is the most appropriate therapy in treating patients, the current standard of care does not address the underlying pathology of herniation of the intervertebral discs. There are various pathways that are involved in the pathogenesis such as inflammatory, immune-mediated, and proteolytic pathways.
The role of inflammatory mediators is currently under research and it has led to the development of new therapies that are directed at these inflammatory mediators causing damage to the nerve roots. The cytokines such as TNF ? are mainly involved in regulating these processes. The pain sensitivity is mediated by serotonin receptor antagonists and ?2 adrenergic receptor antagonists.
Therefore, pharmacological therapies that target these receptors and mediators may influence the disease process and lead to a reduction in symptoms. Currently, cytokine antagonists against TNF ? and IL 1? have been tested. Neuronal receptor blockers such as sarpogrelate hydrochloride etc have been tested in both animal models and in clinical studies for the treatment of sciatica. Cell cycle modifiers that target the microglia that are thought to initiate the inflammatory cascade have been tested with the neuroprotective antibiotic minocycline.
There is also research on inhibiting the NF- kB or protein kinase pathway recently. In the future, the treatment of herniation of the intervertebral disc will be much more improved thanks to the ongoing research. (Haro, Hirotaka)
Dr. Alex Jimenez DC, MSACP, RN, CCST
A disc bulge and/or a herniated disc is a health issue that affects the intervertebral discs found in between each vertebra of the spine. Although these can occur as a natural part of degeneration with age, trauma or injury as well as repetitive overuse can also cause a disc bulge or a herniated disc. According to healthcare professionals, a disc bulge and/or a herniated disc is one of the most common health issues affecting the spine. A disc bulge is when the outer fibers of the annulus fibrosus are displaced from the margins of the adjacent vertebral bodies. A herniated disc is when a part of or the whole nucleus pulposus is protruded through the torn or weakened outer annulus fibrosus of the intervertebral disc. Treatment of these health issues focuses on reducing symptoms. Alternative treatment options, such as chiropractic care and/or physical therapy, can help relieve symptoms. Surgery may be utilized in cases of severe symptoms. – Dr. Alex Jimenez D.C., C.C.S.T. Insight
Curated by Dr. Alex Jimenez D.C., C.C.S.T.
References
Anderson, Paul A. et al. Randomized Controlled Trials Of The Treatment Of Lumbar Disk Herniation: 1983-2007. Journal Of The American Academy Of Orthopaedic Surgeons, vol 16, no. 10, 2008, pp. 566-573. American Academy Of Orthopaedic Surgeons, doi:10.5435/00124635-200810000-00002.
Fraser I (2009) Statistics on hospital-based care in the United States. Agency for Healthcare Research and Quality, Rockville
Ricci, Judith A. et al. Back Pain Exacerbations And Lost Productive Time Costs In United States Workers. Spine, vol 31, no. 26, 2006, pp. 3052-3060. Ovid Technologies (Wolters Kluwer Health), doi:10.1097/01.brs.0000249521.61813.aa.
Fardon, D.F., et al., Lumbar disc nomenclature: version 2.0: Recommendations of the combined task forces of the North American Spine Society, the American Society of Spine Radiology, and the American Society of Neuroradiology. Spine J, 2014. 14(11): p. 2525-45.
Costello RF, Beall DP. Nomenclature and standard reporting terminology of intervertebral disk herniation. Magn Reson Imaging Clin N Am. 2007;15 (2): 167-74, v-vi.
Roberts, S. Disc Morphology In Health And Disease. Biochemical Society Transactions, vol 30, no. 5, 2002, pp. A112.4-A112. Portland Press Ltd., doi:10.1042/bst030a112c.
Johnson, W. E. B., and S. Roberts. Human Intervertebral Disc Cell Morphology And Cytoskeletal Composition: A Preliminary Study Of Regional Variations In Health And Disease. Journal Of Anatomy, vol 203, no. 6, 2003, pp. 605-612. Wiley-Blackwell, doi:10.1046/j.1469-7580.2003.00249.x.
Gruenhagen, Thijs. Nutrient Supply And Intervertebral Disc Metabolism. The Journal Of Bone And Joint Surgery (American), vol 88, no. suppl_2, 2006, p. 30. Ovid Technologies (Wolters Kluwer Health), doi:10.2106/jbjs.e.01290.
Mercer, S.R., and G.A. Jull. Morphology Of The Cervical Intervertebral Disc: Implications For Mckenzies Model Of The Disc Derangement Syndrome. Manual Therapy, vol 1, no. 2, 1996, pp. 76-81. Elsevier BV, doi:10.1054/math.1996.0253.
KOELLER, W et al. Biomechanical Properties Of Human Intervertebral Discs Subjected To Axial Dynamic Compression. Spine, vol 9, no. 7, 1984, pp. 725-733. Ovid Technologies (Wolters Kluwer Health), doi:10.1097/00007632-198410000-00013.
Lieberman, Isador H. Disc Bulge Bubble: Spine Economics 101. The Spine Journal, vol 4, no. 6, 2004, pp. 609-613. Elsevier BV, doi:10.1016/j.spinee.2004.09.001.
Lappalainen, Anu K et al. Intervertebral Disc Disease In Dachshunds Radiographically Screened For Intervertebral Disc Calcifications. Acta Veterinaria Scandinavica, vol 56, no. 1, 2014, Springer Nature, doi:10.1186/s13028-014-0089-4.
Moazzaz, Payam et al. 80. Positional MRI: A Valuable Tool In The Assessment Of Cervical Disc Bulge. The Spine Journal, vol 7, no. 5, 2007, p. 39S. Elsevier BV, doi:10.1016/j.spinee.2007.07.097.
Vialle, Luis Roberto et al. LUMBAR DISC HERNIATION. Revista Brasileira De Ortopedia (English Edition), vol 45, no. 1, 2010, pp. 17-22. Elsevier BV, doi:10.1016/s2255-4971(15)30211-1.
Mullen, Denis et al. Pathophysiology Of Disk-Related Sciatica. I. Evidence Supporting A Chemical Component. Joint Bone Spine, vol 73, no. 2, 2006, pp. 151-158. Elsevier BV, doi:10.1016/j.jbspin.2005.03.003.
Jacobs, Wilco C. H. et al. Surgical Techniques For Sciatica Due To Herniated Disc, A Systematic Review. European Spine Journal, vol 21, no. 11, 2012, pp. 2232-2251. Springer Nature, doi:10.1007/s00586-012-2422-9.
Rutkowski, B. Combined Practice Of Electrical Stimulation For Lumbar Intervertebral Disc Herniation.Pain, vol 11, 1981, p. S226. Ovid Technologies (Wolters Kluwer Health), doi:10.1016/0304-3959(81)90487-5.
Weber, Henrik. Spine Update The Natural History Of Disc Herniation And The Influence Of Intervention.Spine, vol 19, no. 19, 1994, pp. 2234-2238. Ovid Technologies (Wolters Kluwer Health), doi:10.1097/00007632-199410000-00022.
Disk Herniation Imaging: Overview, Radiography, Computed Tomography.Emedicine.Medscape.Com, 2017,
Carvalho, Lilian Braighi et al. Hrnia De Disco Lombar: Tratamento. Acta Fisitrica, vol 20, no. 2, 2013, pp. 75-82. GN1 Genesis Network, doi:10.5935/0104-7795.20130013.
Kerr, Dana et al. What Are Long-Term Predictors Of Outcomes For Lumbar Disc Herniation? A Randomized And Observational Study. Clinical Orthopaedics And Related Research, vol 473, no. 6, 2014, pp. 1920-1930. Springer Nature, doi:10.1007/s11999-014-3803-7.
Buy, Xavier, and Afshin Gangi. Percutaneous Treatment Of Intervertebral Disc Herniation. Seminars In Interventional Radiology, vol 27, no. 02, 2010, pp. 148-159. Thieme Publishing Group, doi:10.1055/s-0030-1253513.
Haro, Hirotaka. Translational Research Of Herniated Discs: Current Status Of Diagnosis And Treatment. Journal Of Orthopaedic Science, vol 19, no. 4, 2014, pp. 515-520. Elsevier BV, doi:10.1007/s00776-014-0571-x.
In today’s podcast, Dr. Alex Jimenez and Dr. Mario Ruja discuss the importance of the body’s genetic code and how micronutrients provide the necessary functional nutraceuticals that the body needs to promote overall health and wellness.
What Is Personalized Medicine?
[00:00:00] Dr. Alex Jimenez DC*: Welcome, guys. We’re Dr. Mario Ruja and me; we’re going to be discussing some essential topics for those athletes that want the advantage. We’re going to discuss fundamental necessary clinical technologies and information technologies that can make an athlete or even just the average person a little bit more aware of what’s happening in terms of their health. There’s a new word out there, and I have to give you a little heads up where we’re calling. We’re actually coming from the PUSH Fitness Center, and that people still work out late at night after going to church. So they’re working out, and they’re having a good time. So what we want to do is bring in these topics, and today we’re going to be talking about personalized medicine, Mario. Ever heard of that word?
[00:01:05] Dr. Mario Ruja DC*: Yeah, Alex, all the time. I dream about it. There you go, Mario.
[00:01:12] Dr. Alex Jimenez DC*: There you go, Mario. Always giving me a laugh. So we’re going to be talking about is the personalized arena of what we have now. We’ve come to a state where many people tell us, Hey, you know what? It would be best if you had some more proteins, fats, or they come up with some convoluted idea, and you’ll end up with your eyes crossed and, most of the time, more confused than anything else. And you’re pretty much a lab rat to all these different techniques, whether it’s the Mediterranean, low fat, high fat, all these kind of things. So the question is, what is it specific to you? And I think one of the frustrations that many of us have, Mario, is that we don’t know what to eat, what to take and what’s good exactly. What’s good for me doesn’t mean that it’s suitable for my friend. You know, Mario, I’d say it’s different. We come from a whole other type of genre. We live in a place, and we’ve gone through things that are different from two hundred years ago. What do people do? We’re going to be able to figure this out nowadays in today’s DNA dynamics; though we don’t treat with these, it gives us information and allows us to relate to the issues that are affecting us now. Today, we will be talking about personalized medicine, DNA testing, and micronutrient assessments. So we’re going to see what it is that how are our genes, the actual predisposing issues, or they’re the ones that give us the the the workings of our engine. And then also, if it’s good for that, we want to know what our level of nutrients is right now. I know Mario, and you had a very dear and near question the other day with one of your, I think, was your daughter. Yeah, so what was her question?
[00:02:52] Dr. Mario Ruja DC*: So Mia had had a well, excellent question. She was asking me about utilizing creatine, which is very predominant in athletes. You see, it’s the buzzword, you know? Use creatine to build more muscle and such. So the point that I talk to you about, Alex, is that this is something so important that we cannot let in terms of the sports environment and performance environment. It’s like taking a Bugatti, and you’re saying, “Well, you know what? Do you think about just putting synthetic oil in it?” And well, is it the synthetic oil necessary for that Bugatti? Well, it’s good because it’s synthetic. Well, no, there are lots of different synthetic forms, you know, it’s like five-thirty, five-fifteen, whatever it is, the viscosity level it has to match. So same thing for athletes and especially for Mia.
[00:04:06] Dr. Alex Jimenez DC*: Let the audience know who Mia is, what does she do? What kind of things does she do?
[00:04:08] Dr. Mario Ruja DC*: Oh, yeah. Mia plays tennis, so her passion is tennis.
[00:04:13] Dr. Alex Jimenez DC*: And she’s nationally ranked?
[00:04:15] Dr. Mario Ruja DC*: Nationally, and she plays internationally on the international circuit ITF. And she’s right now in Austin with Karen and the rest of the Brady Bunch, as I call them. You know, she’s working hard and through all this COVID kind of disconnect. Now she’s getting back into the fitness mode, so she wants to optimize. She wants to do her very best to catch up and move forward. And the question about nutrition, a question about what she needed. I needed a specific answer, not just general. Well, I think it’s good. You know good is good and better is best. And the way we look at it in that conversation of sports performance and genetic, nutritional, and functional medicine, it’s like, let’s get really functional, let’s be on point instead of buckshot. You know, it’s like you can go in and say, you know, generalities. But in terms of this, there is not a lot of information out there for athletes. And that’s where the conversation is linking the genetic and linking the micronutrients. That is phenomenal because, as you mentioned, Alex, when we look at the markers, genetic markers, we see the strengths, the weaknesses, and what’s at risk and what is not. Is the body adaptive, or is the body weak? So then we have to address the micronutrients to support. Remember, we talked about that to support that weakness in that DNA, that genetic pattern with something that we can strengthen. I mean, you can’t go and change your genetics, but you surely can increase and be specific with your micronutrients to change that platform and strengthen it and decrease the risk factors.
[00:06:24] Dr. Alex Jimenez DC*: It’s fair to say now that the technology is such that we can find the, I wouldn’t say weaknesses, but the variables that allow for us to improve an athlete at the genetic level. Now we can’t alter the genes. That’s not what we’re saying is that there’s a world of what they call SNPs or single nucleotide polymorphisms where we can figure out there’s a specific set of genes that can’t change. We can’t change like eye color. We can’t do those. Those are very coded in, right? But there are genes that we can influence through neutral genomics and neutral genetics. So what I mean by my neutral genomics is nutrition altering and affecting the genome to more adaptive or opportunistic dynamics? Now, wouldn’t you like to know what genes you have that are vulnerable? Wouldn’t she want to know where her vulnerability is as well?
Is My Body Receiving The Right Supplements?
[00:07:18] Dr. Mario Ruja DC*: What do we all want to know? I mean, whether you’re a high-level athlete or you’re a high-level CEO, or you’re just a high-level mom and dad, that’s running around from tournament to tournament. You cannot afford to have low energy that, when we talked about the markers, you know that methylation within the body we want to know, are we processing or how are we doing in terms of the oxidative pattern within ourselves? Do we need that extra boost? Do we need to increase your knowledge of that green intake detoxified pattern? Or are we doing well? And this is where when we look at the patterns of genetic markers, we can see that we are well-prepared or we are not well prepared. Therefore, we have to look at the micronutrients. Again, those markers to say, “Are we meeting our needs, yes or no? Or are we just generalizing?” And I would say 90 percent of athletes and people out there are generalizing. They’re saying, Well, you know, taking vitamin C is good and taking vitamin D is good and selenium, you know, that’s good. But again, are you on point, or are we just guessing right now?
[00:08:36] Dr. Alex Jimenez DC*: Exactly. That’s the thing when we’re in that store, and there’s a lot of great nutritional centers, Mario, that are out there, and we’re looking at a wall of a thousand products. Crazy. We don’t know where we have holes, and we don’t know where we need them. You know, there are certain deficiencies. You’ve got bleeding gums; most likely, you’ve got some scurvy or some kind of issue there. That unit may need a specialist, but let’s assume if we look at things like scurvy, right? Well, we know that gum starts bleeding. Well, it’s sometimes not that obvious, right, that we need certain things. There are hundreds and thousands of nutrients out there. One of the things that we call them, we call them, is cofactors. A cofactor is a thing that allows an enzyme to work right. So we are a machine of enzymes, and what codes those enzymes? Well, the DNA structure. Because it produces the proteins that code those enzymes, those enzymes have code factors like minerals like magnesium, iron, potassium, selenium, as you mentioned, and all different components. As we look at this, this hole that we’re we’re facing a wall. We would love to know exactly where our holes are because Bobby or my best friend says, you know, you should take protein, take whey protein, take iron, take what may be so, and we’re hit or miss. So today’s technology is allowing us to see precisely what it is, where we have the holes.
[00:10:00] Dr. Mario Ruja DC*: And this point that you mentioned about the holes, again, the majority of the factors are not that extreme like scurvy, you know, bleeding gums. We’re not, I mean, we live in a society where we’re gosh, I mean, Alex, we have all the foods that we need. We’ve got too much food. It’s crazy. Again, the issues that we talk about are overeating, not starving, OK? Or we’re overeating and still starving because the nutritional pattern is very low. So that’s a real factor there. But overall, we are looking and addressing the component of what subclinical issues, you know, we don’t have the symptoms. We don’t have those significant marker symptoms. But we do have low energy, but we do have a low recovery pattern. But we do have that problem with sleep, that quality of sleep. So those are not huge things, but those are subclinical that erode our health and performance. For example, little by little, athletes cannot be just good. They need to be the tip of the spear top. They need to recover quickly because they do not have time to guess their performance pattern. And I see that they don’t.
[00:11:21] Dr. Alex Jimenez DC*: You know, as you mentioned that, I mean, most of these athletes, when they want to, they want to assess their bodies. They want to know where every weakness is. They’re like scientists and laboratory rats for themselves. They’re pushing their bodies to the extreme, from mental to physical to psycho-social. Everything is being affected, and put it in at full throttle. But they want to know. They want to see where that extra edge is. You know what? If I could make you a little bit better? If there was a little hole, what would that amount to? Will that amount to a two more second drop over a while, a microsecond drop? The point is that technology is there, and we have the ability to do these things for people, and the information is coming faster than we can even imagine. We have doctors worldwide and scientists around the world looking at the human genome and seeing these issues, specifically at SNPs, which are single nucleotide polymorphisms that can be changed or altered or assisted in dietary ways. Go ahead.
Body Composition
[00:12:21] Dr. Mario Ruja DC*: I’ll give you one: the Inbody. How about that? Yeah, that’s a tool right there that is critical for a conversation with an athlete.
[00:12:31] Dr. Alex Jimenez DC*: The Inbody is the body composition.
[00:12:32] Dr. Mario Ruja DC*: Yeah, the BMI. You’re looking at it in terms of your hydration pattern; you’re looking at in terms of like, yes, body fat, that that whole conversation everyone wants to know, you know, I’m overweight my belly fat again. We had discussions on metabolic syndrome. We talked about risk factors, high triglycerides, very low HDL, high LDL. I mean, those are risk factors that put you in a pattern in that line towards diabetes and that line towards cardiovascular disease in that line of dementia. But when you’re talking about an athlete, they’re not worried about diabetes; they’re concerned about, am I ready for the next tournament? And I’m going to make the cut going to the Olympics. That’s yes, I mean, they’re not what they want to do that Inbody. They’re the micronutrient, the combination of genome nutrition, that genomic nutrition conversation on point allows them to honor their work. Because I’m telling you, Alex, and you know, this here, I mean, everyone’s listening to us, again, the conversation I share with people is this, why are you training like a pro when you don’t want to be one? Why are you trained like a pro when you are not eating and have the data to support that pro-level workout? What you’re doing? If you don’t do that, you are destroying your body. So again, if you’re working as a pro, that means you’re grinding. I mean, you’re pushing your body to little miss neuromuscular. Furthermore, we’re chiropractors. We deal with inflammatory issues. If you’re doing that, you’re redlining that, but you are not turning around to recover through micronutrition-specific chiropractic work. Then you’re going to damn it; you’re not going to make it.
[00:14:26] Dr. Alex Jimenez DC*: We’re going to show that we’ve been able to see in a lot of times cities come together for specific sports, such as like wrestling. Wrestling is one of those notorious sports that puts the body through massive emotional and physical stresses. But a lot of times, what happens is individuals have to lose weight. You’ve got a guy who’s 160 pounds; he’s got a drop-down 130 pounds. So what the city has done to avoid these things is to use body-specific weight and determine the molecular weight of the urine, right? So they can tell, are you too concentrated, right? So what they do is that they have all these kids line up all the way to UTEP, and they do a specific gravity test to determine if they’re able to lose any more weight or what weight they are allowed to lose. So someone who’s about 220 says, You know what? You can drop up to about, you know, x y z pounds based on this test. And if you violate this, then you do that. But that’s not good enough. We want to know what’s going to happen because when the kids are in a load and are fighting another person that is just as good of an athlete, and he’s pushing his body, that’s when the body collapses. The body can handle the load, but the supplementation that the person has had, maybe their calcium, has been so depleted that suddenly you got this kid who was 100 injuries; the injuries, the elbow snapped dislocated. That’s what we see. And we wonder how did he snap his elbow because his body has been depleted from these supplements?
[00:15:59] Dr. Mario Ruja DC*: And Alex, on the same level, you’re talking about one on one like that pugilistic, that intense three minutes of your life on the other level, when it comes to tennis, that’s a three-hour conversation. Exactly. There are no subs there. There’s no coaching, no subs. You are in that gladiator arena. When I see Mia playing OK, I mean, it is intense. I mean, every ball that’s coming to you, it’s coming to you with power. It’s coming in like, can you take this? It’s like someone fighting across a net and looking at it. Are you going to quit? Are you going to chase this ball? Are you going to let it go? And that is where that definitive factor of optimal micronutrition connected with the conversation of what exactly you need in terms of genomic conversation will allow someone to scale up with a decreased risk factor of injuries where they know they can push themselves more and have the confidence. Alex, I’m telling you this is not just nutrition; this is about the confidence to know I got what I need, and I can redline this thing, and it’s going to hold. It’s not going to buckle.
[00:17:23] Dr. Alex Jimenez DC*: You know what? I’ve got little Bobby. He wants to wrestle, and he wants to be the biggest nightmare is the mom. Because you know what? They’re the ones that wish Bobby to thump the other Billy, right? And when their kids are getting thumped on, they want to provide for them. And moms are the best cooks. They’re the ones who take care of them, right? They’re the ones that make sure, and you could see it. The pressure on the child is immense when parents are watching, and sometimes it’s incredible to watch. But what can we give moms? What can we do for the parents to provide them with a better understanding of what’s going on? I got to tell you today with DNA tests. You know, all you have to do is get the kid in the morning, open his mouth, you know, do a swab, drag that stuff off the side of his cheek, put in a vial, and it is done within a couple of days. We can tell if Bobby’s got strong ligaments, if Bobby’s micronutrient levels are different to provide the parent with a better kind of a roadmap or a dashboard to understand the information that’s affecting Bobby, so to speak, correct?
[00:18:27] Dr. Mario Ruja DC*: Because and this is what we’ve come a long way. This is 2020, guys, and this is not 1975. That’s the year when Gatorade came over.
[00:18:42] Dr. Alex Jimenez DC*: Come on; I got my tub. It’s got a lot of things on the side of it. I will have everything you look like Buddha when you develop diabetes with so much sugar from those protein shakes.
The Right Supplements For Kids
[00:18:52] Dr. Mario Ruja DC*: We have come a long way, but we cannot just go in and go; oh, you need to hydrate here drink these electrolytes, Pedialyte and all that. That’s not good enough. I mean, that’s good, but it’s 2020, baby. You got to scale up and level up, and we can’t use old data and old instrumentation and diagnostics because the kids now start at three years old, Alex. Three years old. And I’m telling you right now at three, it is unbelievable. By the time they’re five and six, I mean, I’m telling you the kids that I see, they’re already in select teams.
[00:19:33] Dr. Alex Jimenez DC*: Mario…
[00:19:34] Dr. Mario Ruja DC*: Six years old, they’re in a select team.
[00:19:36] Dr. Alex Jimenez DC*: The thing that determines if a child is ready is their attention span. Yeah, I got to tell you, you can watch this. You got to see a kid who’s at three years and six months, and he isn’t paying attention. Three years and eight-month, all of a sudden, he can focus.
[00:19:50] Dr. Mario Ruja DC*: It’s on like a light switch.
[00:19:52] Dr. Alex Jimenez DC*: In front of the coach, right? And you can tell because they wander and they’re not ready. So we’re bringing the kids and exposing them to loads of experiences. Then what we need to do is give moms and dads the ability to understand and athletes of the NCAA and see how I can see what’s happening in my bloodstream? Not a CBC, because the CBC is for basic stuff, like a red blood cell, white blood cell. We can do things. Metabolic panel tells us a generic thing, but now we know more profound information about the susceptibility of the gene markers and see this on the test. And these reports tell us precisely what it is and how it pertains now and progression.
[00:20:37] Dr. Mario Ruja DC*: So this is where I love. This is where I love everything in the world of performance is pre and post. So when you’re a sprinter, they time you. It’s electronic time; when you’re a wrestler, they look at you. Do you know what your winning ratio is? What’s your percentage? Anything, it’s all data. It’s data-driven. As a tennis player, a soccer player, they will track you. Computers will track how strong? How fast is your serve? Is it 100 miles an hour? I mean, it is crazy. So now, if you have that data, Alex, why is it that we do not have the same information for the most critical component, which is that biochemistry, that micro nutritional, the foundation of performance is what happens inside of us, not what happens outside. And this is where people get confused. They think, “Well, my kid works four hours a day, and he has a private trainer. Everything.” My question is that is good, but you’re putting that kid at risk if you are not supplementing on point, say precisely when it comes to the special needs of that child or that athlete, because if we don’t do that, Alex, we are not honoring the journey and the battle, that warrior, we’re not. We’re putting them at risk. And then, all of a sudden, you know what, two-three months before a tournament, BAM! Pulled a hamstring. Oh, you know what? They got fatigued, or all of a sudden, they had to pull out of a tournament. You see, I see tennis players doing all of that. And why? Oh, they’re dehydrated. Well, you should never have that problem. Before you go in exactly where you are, you should already know what you’re doing. And I love the combination and a platform that we have for all of our patients because, within two or three months, we can show pre and post, can we?
[00:22:39] Dr. Alex Jimenez DC*: We can show body composition to the Inbody systems and the incredible systems we use. These DEXAS, we can do bodyweight fat analysis. We can do a lot of things. But when it comes down to predispositions and what’s unique to individuals, we go down to the molecular level, and we can go down to the level of the genes and understand what the susceptibilities are. We can go on once we have the genes. We can also understand the micronutrient level of each individual. So what’s pertaining to me? I may have more magnesium than you, and the other child may have depleted magnesium or calcium or selenium or his proteins or the amino acids or are shot. Maybe he’s got a digestive issue. Perhaps he’s got lactose intolerance. We need to be able to figure out these things that affect us.
[00:23:29] Dr. Mario Ruja DC*: We can’t guess. And the bottom line is there’s no need for that. Everyone has that beautiful conversation, Alex, about, “Oh, you know what? I feel OK.” When I hear that, I cringe, go, and feel OK. So you mean to tell me that you are putting your health the most precious thing you have and your performance based on a feeling like, wow, that means that your urine receptors and turns the pain tolerance are dictating your health. That’s dangerous. That is completely dangerous. And also, so clinically, you’re not able to feel your deficiency in terms of vitamin D, your deficiency in terms of selenium, your deficiency in vitamin A, E. I mean, all of these markers, you can’t feel it.
[00:24:21] Dr. Alex Jimenez DC*: We need to start presenting to the people out there, the information, it’s out there because what we want to let people know is that we’re going deep. We’re going down to these gene susceptibilities, the gene understanding as it is today; what we have learned is so powerful that it allows parents to understand a whole lot more of the issues pertaining to an athlete. Not only that, but the parents want to know what my susceptibility is? Do I have a risk of bone arthritis? Do we have issues with oxidative stress? Why am I always inflamed all the time, right? Well, believe it or not, if you got the genes for, let’s say you got the gene that makes you eat a lot, well, you’re likely going to gain weight. You can raise 10000 people’s hands who have that same gene marker, and you’re going to notice that their BIAs and BMI are way out of there because it’s the susceptibility to that now. Can they change it? Absolutely. That’s what we’re talking about. We’re talking about understanding the ability to adapt and change our lifestyle for the predispositions we may have.
[00:25:26] Dr. Mario Ruja DC*: Yeah, this is wonderful. And I see this quite frequently in terms of the conversation about losing weight, you know, and they go, “Oh, I did this program, and it works great.” And then you have 20 other people doing the same program, and it doesn’t even work, and it’s almost like hit and miss. So people are becoming disillusioned. They’re putting their bodies through this incredible roller coaster ride, which is like the worst thing you could do. You know, they’re doing these unnecessary things, but they cannot sustain it because why? At the end of the day, it’s not who you are. It wasn’t for you.
[00:26:05] Dr. Alex Jimenez DC*: You may need a different type of diet.
[00:26:06] Dr. Mario Ruja DC*: Yes. And so we, again, our conversation today is very general. We’re starting this platform together because we have to educate our community and share the latest in technology and science that addresses the needs.
[00:26:26] Dr. Alex Jimenez DC*: Personalized medicine, Mario. It’s not general; it’s a personalized health and personalized fitness. We understand that we don’t have to guess if a diet is better for us, such as a low calorie, high-fat diet or a Mediterranean style food or a high protein diet. We won’t be able to see that these scientists are putting information together from the information we are continuously gathering and compiling. It’s here, and it’s a swab away, or blood works away. It’s crazy. You know what? And this information, of course, let me be mindful of before this starts. My little disclaimer comes in. This is not for treatment. Please do not take anything; we’re taking this for treatment or diagnosis. You got to talk to your doctors, and your doctors have to tell you exactly what’s up there and what’s appropriate for every individual we integrate.
[00:27:18] Dr. Mario Ruja DC*: The point is that we integrate with all healthcare professionals and physicians. We are here to support and champion functional wellness. OK. And as you mentioned, we’re not here to treat these diseases. We’re here to optimize again when athletes come in and want to be better. They want to get healthier and help the recovery rate.
Can Stress Age You Faster?
[00:27:46] Dr. Alex Jimenez DC*: You know, that’s it. Do you know what the bottom line is? The testing is there. We can see Billy’s not been eating well. OK, Billy has not been eating well. I can tell you, well, he eats everything, but he hasn’t had this level of protein. Look at his protein depletion. So we’re going to present to you some of the studies out here because it’s information, though it’s a bit complex. But we want to make it simple. And one of the things that we were talking about here is the micronutrient test we were providing here. Now I’m going to present you guys to see a little bit here. And what we use in our office when a person comes in and says, I want to learn about my body. We present this micronutrient assessment to figure out what’s going on. Now, this one was, let’s say, just it was in a sample for me, but it tells you where the individual is. We want to be able to level the antioxidant level. Now everyone knows that, well, not everyone. But now we understand that if our genes are optimal and our food is optimal, but we live in an oxidative stress state…
[00:28:45] Dr. Mario Ruja DC*: Exactly
[00:28:46] Dr. Alex Jimenez DC*: Our genes will not function. So it’s important to understand what the problem is.
[00:28:51] Dr. Mario Ruja DC*: It’s rust. I mean, when you’re looking at this, and I see two markers, I see the one for oxidative, and then the other one is the immune system. Yes, right? So again, they correlate together, but they are different. So the oxidative I talk about is like your system is rusting out. Yeah, that’s oxidation. You see apples turning brown. You see metals rusting. So inside, you want to absolutely be at your best, which is in the green in that 75 to 100 percent functional rate. That means you can handle the craziness of the world tomorrow, you know?
[00:29:31] Dr. Alex Jimenez DC*: Yes, we can look at the stress of the human body, Mario. What we can see actually what’s going on, and as I continue with this kind of presentation here, we can see what this individual is and what is his actual immune function age. So a lot of people want to know this stuff. I mean, I want to know where I lie in terms of the dynamics of the body, right? So when I look at that, I can see precisely where I lie, and my age is 52. OK. In this situation, OK, now as we look down, we want to know.
[00:30:02] Dr. Mario Ruja DC*: Hold on. Let’s get real. So you mean to tell me that we can get younger through this incredible system? Is that what you’re telling me?
[00:30:14] Dr. Alex Jimenez DC*: It tells you if you’re aging quicker, OK, how does that sound, Mario? So if you can slow down, if you’re in that top 100, the green, you’re going to be looking like a 47-year-old man when you’re 55. Right? So from the structure, immune function, and oxidative stress in the body, what’s going to happen is that we’re going to be able to see exactly where we are in terms of our body.
[00:30:37] Dr. Mario Ruja DC*: So that is correct? Yes. So we could be our birth certificate could say 65, but our functional metabolic markers can say you’re 50.
[00:30:51] Dr. Alex Jimenez DC*: Yes. Let me make it real simple, OK? People often understand oxidative stress; yes, we hear about antioxidants and reactive oxygen species. Let me make it simple, OK, we’re a cell. You and I, we’re having a family meal right where we’re enjoying ourselves. We are normal cells. We’re happy, and we’re functioning where everything is appropriate. All of a sudden, there’s a wild-looking lady. She’s got blades and knives, and she’s greasy, and she’s slimy, and she comes on. She hits the table, boom, and she kind of walks away. You know, it’s going to unsettle us, right? It’s going to be, let’s call her an oxidant, OK? She’s called a reactive oxygen species. Now, if we got two of those walking around the restaurant, we kind of keep an eye on her, right? All of a sudden, a football player comes and takes her out. Boom knocks her out, right? In that situation, this greasy, slimy weapon-looking lady, correct, that’s scary. That was an antioxidant. That was vitamin C that wiped her out, right? There’s a balance between oxidants and antioxidants in the body. They have different purposes, right? We have to have antioxidants, and we have to have oxidants in order for our body to function. But if you got 800 of those ladies like zombies all of a sudden.
[00:32:02] Dr. Mario Ruja DC*:I could see them as zombies.
[00:32:07] Dr. Alex Jimenez DC*: It is. You know what you’re going to want. Where are the football players? Where are the antioxidants, right? Take them out. The football players come in, but there are just too many of them, right? Anything that you and I do in a conversation could be healthy cells, and we’re having this conversation at the dinner table. We’re disrupted totally. We cannot function in an oxidative stress environment. No. So basically, we may have all the supplements, and we may have all the nutrients, and we may have the proper genetics. But if we’re in an oxidative state, right, an elevated level, we’re not going to be aged. It will not be a comfortable night, and we will not recover.
[00:32:46] Dr. Mario Ruja DC*: We will be at a higher risk factor for injuries. Exactly. And the other thing is we also have the risk factor where we will age faster than we should.
[00:33:04] Dr. Alex Jimenez DC*: That night would be rough is there’s like a hundred of those people around. So we need to know the state of the balance in life, the antioxidants we see, and all the antioxidants foods like A, C, E. That is what this test does. It shows you the level of oxidants in the body.
[00:33:19] Dr. Mario Ruja DC*: Hey, Alex, let me ask you this. Everyone loves to work out. When you work out, does that increase or decrease your oxidative stress? Please tell me, because I want to know.
[00:33:30] Dr. Alex Jimenez DC*: It increases your oxidative state.
[00:33:31] Dr. Mario Ruja DC*: No, stop it.
[00:33:32] Dr. Alex Jimenez DC*: It does because you’re breaking the body down. However, the body responds. And if we are healthy, Mario, right? In that sense, our body first has to break down, and it has to repair. OK? We want to have antioxidants because it helps us go through the process. Part of healing and part of inflammation is oxidative balance. So, in essence, when you’re working out too hard or running hard, you can overburn the bar, and those are the things that you and I have to kind of look at, and this is the balance.
[00:34:08] Dr. Mario Ruja DC*: Now this is like the paradox, right? You know what, if you overwork, you’re going to look fabulous. But you know what? You’re actually breaking down. And if you don’t work out, there goes your cardio. There go other risk factors. So this is where it is so critical that we need to balance and know precisely what each person needs to be at their best. And we can’t guess; you can’t take the same supplements as me and vice versa.
The Right Cofactors For Your Body
[00:34:41] Dr. Alex Jimenez DC*: I can, we can. But it’s to me, I may not be a lot of waste of money, or maybe we’re just missing the whole process. So in this entire dynamics here, just looking at this test, Mario, just using it at this particular assessment, we want to see also what our cofactors are on. We talked about proteins; we talked about genetics. We talked about things that make these enzymes work, our body functions, and pure enzymes in this particular model that you’re seeing what the cofactors are and the metabolites are. Well, you see amino acids levels and where they are in your body. If you’re an extreme athlete, you want to know what those things are.
[00:35:14] Dr. Mario Ruja DC*: Oh yeah, I mean, look at that. Those aminos. Those are critical.
[00:35:20] Dr. Alex Jimenez DC*: You think Mario?
[00:35:21] Dr. Mario Ruja DC*: Yeah, I mean it’s like every athlete I know, they’re like, Hey, I got to take my aminos. My question is, are you taking the right ones at the right level? Or do you even know, and they’re guessing. Ninety percent of the people are assuming you’re looking at antioxidants. Look at that. That’s the beast right there, glutathione. That’s like the granddaddy of antioxidants right there. And you want to know is, is that football players, that linebackers are going to crush those zombies, you know? And again, vitamin E, CoQ10. Everyone talks about CoQ10 and heart health.
[00:36:00] Dr. Alex Jimenez DC*: Coenzyme Q, exactly. A lot of people take cardiac medications specifically to lower their cholesterol.
[00:36:10] Dr. Mario Ruja DC*: What does CoQ10 do, Alex? I want to get you started.
[00:36:15] Dr. Alex Jimenez DC*: Because you know what? Many documentation came out early on when they did many of these medications. Yeah, they knew they had to end it and put coenzyme Q in it. They knew, and they patented it because they knew that they had it. Because if you don’t give coenzyme Q right, you have inflammatory states and neuropathies. But these people have issues, and now they’re starting to understand. That’s why you see all the commercials with the coenzymes. But the point is that we need to know where our present state is right. So when we understand those things, we can look at the tests. And we can look at the dynamics of it. Wouldn’t you like to know which antioxidants? It’s so clear.
[00:36:52] Dr. Mario Ruja DC*: I love this. I mean, look at that. You know what? It’s red, green, black and that’s it. I mean, you can see it right away. This is your board. This is your command center. You know, I love the command center. It’s like, everything’s there.
[00:37:10] Dr. Alex Jimenez DC*: I know Mario, you know, with those athletes, they want to be at the top level. Yes, it looks like this person’s floating somewhere in the middle, but they want to top it at 100 percent, right?
[00:37:19] Dr. Mario Ruja DC*: Alex, they’re on the bench.
[00:37:23] Dr. Alex Jimenez DC*: Yeah. And when they’re under a lot of stress, who knows what? Now, these tests are straightforward to do. They’re not complex to go in. Take a lab test sometimes are these are urine tests, something we can do.
[00:37:33] Dr. Mario Ruja DC*: And we can do those in our offices in a matter of minutes, precisely in a matter of minutes. Crazy.
[00:37:38] Dr. Alex Jimenez DC*: It’s crazy.
[00:37:40] Dr. Mario Ruja DC*: This is why it’s so simple. It’s like my question is, what color is the red bus? I don’t know. It’s a trick question.
What Supplements Are Right For You?
[00:37:50] Dr. Alex Jimenez DC*: Well, going back into our topic today was personalized medicine and personalized wellness and personalized fitness. Doctors around the country are starting to understand that they cannot just say, OK, you’re pregnant. Here’s a folic acid pill. OK, here are some nutrients, though every doctor has to be taking care of their own clients. They’re the ones that are doing this. But people have the ability to understand; where are the other holes? Wouldn’t you want to make sure you have suitable selenium?
[00:38:17] Dr. Mario Ruja DC*: Before you have symptoms. That’s the thing, and this is why we are not treating. We’re not saying that issues, diagnosis issues, what are you doing to optimize and decrease your risk factors?
[00:38:35] Dr. Alex Jimenez DC*: There’s the issue of longevity, too, because I mean, the issue of longevity is if you’re providing your body with the right substrates, the right cofactors, the right nutrition. Your body has a chance to make it to 100 years plus and actually function. And if you have a depleted life, well, you’re burning the engine, so the body starts having issues, you know, so as we look at those kinds of things…
[00:39:00] Dr. Mario Ruja DC*: Can you return to our two markers? Look at that immune system.
[00:39:12] Dr. Alex Jimenez DC*: Yeah, there’s a reason they stop here at 100 because that’s the whole idea. The entire idea is to get you to live 100 Centennial. So if we can do this, if you’re a person who’s, let’s say, 38 years old, and you’re in the midst of your life, and let’s say you’re a business person and you’re a junkie for business. You’re a junkie for entrepreneurship. You want to throttle you against the world. You do not want a kind of Nicholas the worm weakness, so to speak, taking you out of your football run in life. Because otherwise, you can trip up on things. And what we want to be able to provide people through nutritionists who registered dietitians to doctors through the information out there to supplement your lives better. And it’s not just about little Bobby; it’s about me, it’s about you. It’s about our patients. It’s about every single one of them who wants to live a better quality of life. Because if there’s a depletion in certain things, it’s not now. But in the future, you may have a susceptibility that will bring out diseases. And that’s where those susceptibilities are. We can take it to the next level because we can see what’s going on. In terms of this, I’m going to go ahead and bring this back up here so you can just see what we’re looking at. You can see the B-complex is now we have a lot of B-complexes, and we got people texting all over the place here, and I’m getting zapped with messages.
[00:40:42] Dr. Mario Ruja DC*: Your oxidative stress is going up, Alex.
[00:40:45] Dr. Alex Jimenez DC*: Well, it’s crazy that we’ve been here an hour, so we want to be able to bring information out for you guys as time goes on. I want to go through this and talk about the individual antioxidants now; those are your football players, man, those are the ones taking those people out. Making your whole life a lot better, right, Mario. This is the kind of stuff that we look at. You know your glutathione on your knees. Your coenzyme Q selenium is your vitamin E’s carbohydrate metabolism.
[00:41:10] Dr. Mario Ruja DC*: Look at that, I mean, glucose and insulin interaction called energy. The last time I checked, it was called turbo.
[00:41:21] Dr. Alex Jimenez DC*: We got to listen; we got a lot of good doctors. We got like Dr. Castro out there. We got all the great doctors out there that are running over.
[00:41:30] Dr. Mario Ruja DC*: I mean, we’re going to get in trouble.
[00:41:32] Dr. Alex Jimenez DC*: All right. Facebook is going to knock us out.
[00:41:41] Dr. Mario Ruja DC*: It will put a time limit on this.
[00:41:43] Dr. Alex Jimenez DC*: I think it’s our views. But the bottom line is to stay tuned. We’re coming. This can’t cover everything. Hey, Mario, when I went to school, we were terrorized by this machine called the psycho cycle.
[00:41:58] Dr. Mario Ruja DC*:How many ATP’s, Alex?
[00:42:00] Dr. Alex Jimenez DC*: I mean, how many miles? Is it glycolysis or aerobic or anaerobic, right? So when we start looking at that, we start seeing how those coenzymes and those vitamins play a role in our energy metabolism, right? So in this individual, there were certain depletions. You can see where the yellow comes in. It affects the whole metabolic process, energy production. So the person is always tired. Well, we kind of understand the dynamics of what’s going on. So this is critical information as you and I kind of look at this, right? We can see what is it that we can offer? Can we provide information to change how the body works better dynamically? So this is crazy. So, in terms of it, we can go on and on, guys. So what we’re going to be doing is we’re probably going to be coming back because this is just fun. Do you think so? Yeah, I think we’re going to come back to what we’ve got to change the way that all El Paso is and not only for our community but also for those moms who want to know what is the best for their family members. What can we offer? The technology is not. We’re not going to allow ourselves in El Paso to be ever called the fattest sweaty town in the United States. We do have unbelievable talent out here that really can teach us about what’s going on. So I know that you’ve seen that, correct? Yeah.
[00:43:18] Dr. Mario Ruja DC*: Absolutely. And what I can say is this Alex? It’s about peak performance and peak ability. And also, getting the correct specific customized genomic nutrition pattern for each individual is the game-changer. That’s the game-changer from longevity to performance and just being happy and living the life that you were meant to live.
Conclusion
[00:43:51] Dr. Alex Jimenez DC*: Mario, I can say that when we look at this stuff, we get excited about it, as you can tell, but it affects all our patients. People come in all depleted, tired, in pain, inflamed, and sometimes we need to find out what it is. And in our scope, we are mandated to be responsible and figure out where this relies upon and where this lies in our patients’ problems. Because what we’re doing, if we help their structure, the musculoskeletal, neurological system, their mind system through a proper diet and understanding through exercise, we can change people’s lives, and they want to be able to fulfill their lives and enjoy their lives the way it should be. So there’s a lot to be said. So we will come back sometime next week or this week. We’re going to continue this topic on personalized medicine, personalized wellness, and personalized fitness because working with many doctors through integrative health and integrative medicine allows us to be a part of a team. We have GI doctors, you know, cardiologists. There’s a reason we work as a team together because we all bring a different science level. No team is complete without a nephrologist, and that person will figure out precisely the implications of all the things we do. So that person is very important in the dynamics of integrative wellness. So for us to be able to be the best kind of providers, we have to expose and tell people about what’s out there because a lot of people don’t know. And what we need to do is bring it to them and let the cards lie and teach them that they had to tell their doctors, “Hey, Doc, I need you to talk to me about my health and sit down. Explain to me my labs.” And if they don’t, well, you know what? Say you need to do that. And if you don’t, well, time to find a new doctor. OK, it’s that simple because today’s information technology is such that our doctors cannot neglect nutrition. They cannot neglect wellness. They cannot overlook the integration of all the sciences put together to make people healthy. This is one of the most important things that we got to do. It’s a mandate. It’s our responsibility, and we’re going to do it, and we’re going to knock it out of the ballpark. So, Mario, it’s been a blessing today, and we’ll continue to do this in the next couple of days, and we’ll keep on hammering and giving people the insights as to what they can do in terms of their science. This is a Health Voice 360 channel, so we’re going to talk about many different things and bring a lot of other talents. Thanks, guys. And you got anything else, Mario?
[00:46:11] Dr. Mario Ruja DC*: I’m all in.
[00:46:12] Dr. Alex Jimenez DC*:All right, brother, talk to you soon. Love you, man. Bye.
In today’s podcast, Dr. Alex Jimenez and Dr. Ruja discuss why chiropractic care is important to the body’s overall wellbeing.
Why Chiropractic Care Is Important?
[00:00:01] Dr. Alex Jimenez DC*: Mario, hi. We’re talking here to Dr. Mario Ruja. We are the power chiropractors; what are we calling ourselves, Mario? What are we going to say?
[00:00:12] Dr. Mario Ruja DC*: You know, I’m going to tell you right now it’s called the Bad Boys of Chiropractic.
[00:00:16] Dr. Alex Jimenez DC*: The Bad Boys of Chiropractic. Yes. All right.
[00:00:19] Dr. Mario Ruja DC*: So we’re going to get nasty up in here. We’re going to talk about stuff that people don’t want to bring up, Alex.
[00:00:26] Dr. Alex Jimenez DC*: Yeah, we are live.
[00:00:27] Dr. Mario Ruja DC*: Well, we’re live. Good. I love it live. I hate dead.
[00:00:32] Dr. Alex Jimenez DC*: Well, we’re going to discuss the power of chiropractic and why people have chosen around the world to choose chiropractic as a great option for treatment protocols and things beyond most people’s experiences. But in our new modern world, we understand what chiropractic is. Mario, I know this is an excellent topic for you, and then you and I have discussed this on many occasions. And tell me a bit of why chiropractic has been impactful in your life?
[00:01:07] Dr. Mario Ruja DC*: I’ve gone through many experiences, especially in the area of sports. Again, I played high school, college soccer. I have always enjoyed being active, from CrossFit to marathons, biathlon, and other things. That chiropractic synergize is synergistic with the movement of life, and life, in general, is straightforward. Number one, it is simple. We don’t need technology. No batteries are required, no facilities are required. You can receive chiropractic anywhere at any time with our hands. These are the instruments. These are the power tools from ancient China to the Mayans to the Egyptians. They had chiropractic but by different names and different presentations. But in those ancient worlds, chiropractic was only for the upper class. The kings and queens and their families only because they knew that chiropractic opened up and optimized the body’s energy, the energy of life and movement. So it wasn’t for the everyday folks; it was for the elite only. And so that’s the beauty of it. So when we look at chiropractic, we look at the cycle that went through, and in the beginning, it was for the elite, and then it was lost. And then with Didi Palmer and BJ Palmer and the whole lineage of chiropractors, the founders, the pioneers, the warriors, you know, that went to jail. Yeah, they went to prison to stand for the art and science of the healing art of chiropractic. And that’s amazing. I mean, it is incredible how people don’t realize that. And then coming full swing 360 to now out of that, it is accepted by all insurances, all providers. The VA is covering chiropractic. 101 percent. All I would say is every pro team in the world. OK, maybe that’s taking a little far, but I know for sure the pro teams in the U.S., all of hockey, baseball, basketball, soccer, and such volleyball, every one of the high elite athletes, they all have chiropractic in their corner. They all have chiropractic in their toolkit. Armstrong had it all of the tops. I mean, Phelps had it. I can go on. Bolt had it. You name atop gold medalist, and I’m going to tell you that they had some hands put on them to calibrate their spine, their energy. And most of all, Alex, I’m going to tell you this is what I want to share with our viewers and listeners. Chiropractic is one of the most potent tools and instruments, not just for healing when you’re hurt, but it is for optimizing energy, function, and recovery. I can tell you, and I’ve worked with powerlifters with Olympic lifters, and after the adjustment, they could squat more and bench press more immediately. I have people coming off the table. Olympic athletes come off the table, and they jump up and down. They say I feel lighter, jump faster, and run faster. So that is unbelievable. We are here to empower everyone, and it is cost-effective. Like, let me tell you, we don’t need to high instrumentation. We don’t need $2 million worth of equipment and all of that. This is the power to the people, Alex. And you are an incredible athlete and both of our families. We have astonishing athletes for children. I want to ask you this because you dealt with bodybuilding, and we have so many chiropractors that are bodybuilders, former athletes. How has chiropractic impacted your performance and recovery in terms of sports?
How Chiropractic Influenced Dr. Jimenez?
[00:06:13] Dr. Alex Jimenez DC*: Stepping back a little bit, Mario, one of the things when I first decided to become a chiropractor, when I first had to assess what type of profession was in line with what I believed, I was an athlete. I was a bodybuilder, was a powerlifter, and we’re talking about in the 80s. And yeah, I got to say that I had my buddy Jeff Goods, and we were like the strongest guys at 16. I played in South Florida, so it’s very competitive in football in South Florida, and I was a big boy. Now, I played against Bennie Blades, Brian Blades. I played with Michael Irving. I played at Piper High School, and we dealt with high-performance athletes. Every day. I got to see up close the Miami Dolphins. I got to see Andre Franklin, Lorenzo White, who worked out in my gym. This was an amazing kind of world I lived in. When I decided to look into a profession, I was looking for a profession focused on health, mobility, agility, and things to touch people. And that’s what I was. I was a health care provider. I had no idea that the day I decided to be a chiropractor and met a chiropractor, he told me what he did, and I had no idea what one was, what I did was I asked them, Hey, can I do this? Can I do nutrition? Can I do weightlifting? Can I do plyometrics? Which was the new thing back in the day. They didn’t call it CrossFit. It was a dynamic movement. It was agility training. In that process, what I did was I asked them a couple of questions, and he checked mark every one of my boxes. I go, I can I touch people? Can I work on people? Can I do things? Can I help people become better? I was passionate about the elderly. I loved that I came from a health care background, so I enjoyed that kind of stuff. But when I went into chiropractic college, believe it or not, I had not seen an inside of a chiropractic office other than the philosophies that I had read on what there was in books. I could say LAPD of Britannica career books on what chiropractic is, but there was no such thing as the internet in 1985 to find and reference stuff and search it as we can today. I think Prodigy began around the nineteen nineties. So this is where I got the idea. When I walked into the school, I was hit with a required class, the course on the history of chiropractic. I had no idea that I would go into a profession where the leader had been thrown in jail about 60 times. You know what we learned, and we can try to figure out why only 60 where did it stopped? Why not at the sixty-one time, 60 first time that he stopped getting arrested. The world changed when they figured out what we were doing, and the arts of mobility impacted the world. We understood the dynamics of the movements. We had not understood embryology to that level. Today, we’ve learned that the first notal cord of the neural groove becomes the spine. It is the central circuit. You drop the wires, cables, and infrastructure when you look at a formed city. That’s what we were designed, and our creator designed a system that starts at the spine. And from there, it builds in the dynamic movement of the cells as they develop and grow, creating a structure that is designed for motion. It is designed to move. It is not a surprise that many of the diseases and pathologies that you and I treat are in some way linked in co-mingled together with motion itself. Now the world’s waking up to this, and as they wake up, we’re going to be the bad boys of chiropractic, and we’re going to teach people about what we do and what it is that we articulate. Because every day I get the the the the privilege to touch people in an area where they’re not supposed to be touched, their neck, their spine, their joints. You and I do that every single day. We have the pleasure of assessing and treating the dynamics of human existence and understanding that the creator loves motion. He’s got a; I’d even say a fetish. Everything moves from planet spin; light moves, joint moves, roots grow, birds sing, and the wind blows. Motion is part of all existence. So the closer we get to motion, it becomes the most important thing that we associate with God’s intention. And that’s the huge thing. So when you asked me that question, where did I begin? We have to go back and step back and kind of begin at the beginning and ask ourselves, where did this freak come out from? Which is BJ Palmer, Didi Palmer comes up with the philosophies these crazy guys that came up with that, and we’re here to kind of tell the story, at least from about 50, some almost 60 years of chiropractic treatment between you and I. We can tell the story about that, but I hope that gives you an idea of what started my belief in motion in chiropractic because it’s a passion for who we are and what we do. Our children are athletes. We have given our children to the arts of motion. No child in our families is yours, and my family has not lived with motion as part of the thing that they wake up, and they got to do something. Whether it’s volleyball, tennis, baseball, whatever they do, soccer and judo.
[00:11:39] Dr. Mario Ruja DC*: Yes. And you know, Alex, that is the reason why we are the bad boys of chiropractic because you know what, B.J. Palmer, Didi Palmer, and the whole crew. I mean the founders of National College in Chicago, St. Louis, Logan Chiropractic, all of those. They were the bad boys. They were considered outlaws. These are not real doctors. What are they doing? You know, they’re messing up the stuff, you know? And let me tell you, just like we talked about in the last conversation, you know, in the beginning, the people will look at innovative technologies and innovative thought and healing as being terrible and abusive. So if that’s bad, they try to put it out and criticize it. Then after a while, they see that it works in the results. Chiropractic is about results. The bottom line? It cannot lie. It can’t, Alex. This is the beauty of chiropractic. It either works, or it doesn’t. There’s nothing to cover it up. We cannot cover it up. We can’t give you a magic pill to make you feel better.
[00:13:02] Dr. Alex Jimenez DC*: You know, you and I got to get out of its way. You got to get out of its way because it’s steam. It’s past me. I jumped on it as a young chiropractic student, and when it took me on for a ride that I didn’t know, we got to get out of this way because it’s an intense motion is what life’s about. And this is what you and I know, and I believe that you and I have experienced a love for this science, and we probably developed it more passionately. The more the years we had, huh?
[00:13:30] Dr. Mario Ruja DC*: Oh, absolutely. And we’ve gone through a lot of what I call the roller coaster of life, the ups and downs and sideways the rocket launches and the slamming on brakes and your story. I love your story, Alex. And mine is much different, and I think every chiropractor has their own story because this is not something you just pick up. After all, someone said, Oh, you know what? I think you should be a chiropractor. Like what? We hold on. We need to pray for you. Don’t do that.
[00:14:01] Dr. Alex Jimenez DC*: No, chiropractic chooses you.
How Chiropractic Chose Dr. Ruja?
[00:14:02] Dr. Mario Ruja DC*: This is it. I got smacked head-on in a car collision. Yes, I was hit in a car, spun around, and went through six months of rehab and orthopedic and all of that. And at the end, I had residual pain. I had residual issues, and I did not want to accept those limitations. I was a college athlete, and there is no way that I’m going to go, “OK, well, let’s take a pill for the rest of my life.” It wasn’t going to happen, Alex. And somehow, my buddy said, “Hey, my grandmother will see this doctor, and she feels fantastic, and she’s moving. She’s walking every day.” I said, “OK, who is this guy?” Dr. Farense in Savannah, Georgia. If he’s around, give me a call now because I love you.
[00:14:53] Dr. Alex Jimenez DC*: How do you spell Dr. Farense?
[00:14:54] Dr. Mario Ruja DC*: I don’t know how you spell it because I can’t remember, but I’ll look it up. But let me tell you that guy. I walked to his office and said, “Look, I’m banged up. I’m jacked up. I need some help because I’m not happy. I am just not happy. I want to get back to my performance, my biking.” I cycled, I ran. I did marathons, half marathons. I couldn’t sit still. I can’t sit still even today. I’m 54, and I’m just getting warmed up.
[00:15:22] Dr. Alex Jimenez DC*: You know what? I don’t know him, and I probably have never heard of his name. But you know what you did say that you referenced a chiropractor who influenced your life. This is correct. This is a profession that we were about the fifth generation, and we honor our leaders, our teachers. And it’s nice. I mean, Dr. Farense may not have ever realized that one day, 30 years later, a chiropractor was going to mention his name because we have to honor B.J. Palmer, Didi Palmer, the teachers, and the professors that made it an influence on your life. Amazingly, we were following through with this. We have a purpose that is beyond even time itself. It’s incredible what you’re doing.
[00:16:06] Dr. Mario Ruja DC*: It’s growing, Alex. It’s building momentum. This is about momentum, and what is momentum? Movement. You can’t build momentum sitting down. You cannot build momentum, just accepting average, accepting mediocrity, and accepting, well, that’s just how it is now. So this is where the power of breaking barriers of crushing limits is all about chiropractic. I just want to bring in that thought is that movement, that calibration. And this is where I get passionate. You know, I’ve been doing this for 25 years plus, and everywhere I go, I just got back from Chihuahua. Yeah, I just got back from Chihuahua, and I was there for four days.
[00:16:55] Dr. Alex Jimenez DC*: Oh, the commercial, says “Donde Jale?” “It’s a machine.” Chihuahua commercials are pretty badass.
[00:17:03] Dr. Mario Ruja DC*: Yes, I love it. So let me tell you, wherever I go, I open my mouth, and they said, “Dr. Ruja, my neck hurts. Me duele me culo, ay si.” You know what? What can you do? And that’s it. That’s my intro, Alex. That is my intro, and I start to dance. I see myself as salsa. Merengue. Yeah, I see myself doing that, and they look at me like, “What is this guy doing?” And I’m going to tell you right now, I put my hands on them, and they’re never the same again. They will never forget that. And each one of them, they get up. I don’t care if it’s on the bed. I don’t care for it; it’s on a bench. Yeah, I said it.
[00:17:44] Dr. Alex Jimenez DC*: Mario has an international license.
[00:17:48] Dr. Mario Ruja DC*: That’s right.
[00:17:49] Dr. Alex Jimenez DC*: He is internationally known.
[00:17:51] Dr. Mario Ruja DC*: Absolutely. And let me tell you, the impact is clear. It’s about chiropractic. I don’t need it, and we do not need special equipment. The special equipment is care. It’s care. It’s called love. It’s honoring our brothers and sisters and wishing them the best. And it’s healing hands. And even in the Bible, it says, “Lay hands, lay hands to heal.” That’s what it’s about. We got to lay hands and don’t be afraid. And I’m not talking about laying some hands. You know, momma used to lay some hands on my butt when I misbehaved. I mean, even my dad, he used to lay some hands. He wasn’t a chiropractor, but he adjusted me. He adjusted my attitude. Do you know what I’m saying, right, Alex? Do you remember those hands?
[00:18:38] Dr. Alex Jimenez DC*: Oh, I remember. I remember running, and it was whatever my mom had something near her, she would throw it.
[00:18:45]Dr. Mario Ruja DC*: Oh, it was the chancla.
[00:18:46] Dr. Alex Jimenez DC*: I was talking my mouth enough, and she had a fork in her. She stuck me with a fork on my butt when I misbehaved. Corporal punishment was the way.
[00:18:56] Dr. Mario Ruja DC*: Yeah. It wasn’t abused, was it, Alex. Yeah. But we learned to move away from her quickly. That’s why you did so well in football, Alex. It’s called plyometrics, and that’s how you jump.
[00:19:06] Dr. Alex Jimenez DC*: Oh, yeah, and it’s good as some of my counterparts, but they were very good. But I have to tell you, that’s it. You know what? When we look at it, I wonder about the science of chiropractic and how it’s evolved over and continues to evolve. It links so many other sciences, and there is no other word that describes what chiropractic is other than holistic. It is a holistic approach. It is a natural way of healing the body through motion. And like I indicated before, I think God’s got a fetish for it because he gives us so many damn joints, and this whole thing was our design. And in that process, we heal.
[00:19:51] Dr. Mario Ruja DC*: Now, Alex, I’m going to stop you right there, and I want you to grab this thought. Chiropractic has often been limited to back, you know, like the neck and mid-back and lower back, and that’s it. But let me tell you, I got news for you. Chiropractic for the whole body. Hands, wrists, elbow, shoulders, knees, ankles, feet. OK, chiropractic is about calibrating, balancing, aligning, and optimizing the whole body. Again, this is not something that I specialize in cranial adjustments, cranial for concussions. There are chiropractors, and we will have to talk more about this in the future. But the specialty of chiropractic goes all the way from pediatrics to geriatrics to sports chiropractic, cranial-sacral chiropractic, biomechanics. I mean, orthopedic, neurological.
[00:21:01] Dr. Alex Jimenez DC*: Yes, there are so many branches that it does that today wasn’t present 20 years ago. No, it was present, but it was in its beginning. Today, the world wants it, demands it, demands specialization, even chiropractic for just a thing, a sport, a movement, a low back, a sacral technique, its cervical technique.
[00:21:25] Dr. Mario Ruja DC*: And this is what we want to empower as the bad boys of chiropractic. It’s about getting in your face and getting real.
[00:21:35] Dr. Alex Jimenez DC*: In your face.
Holistic Approaches to Chiropractic Care
[00:21:38] Dr. Mario Ruja DC*:Yes, that’s right. We will grab your attention. OK? You’re not falling asleep tonight. So in chiropractic, we have specialists. Atlas Orthogonal. They only adjust to vertebrates, atlas, and axes. Very specific. And I love this. We will honor chiropractic, all the specialties and nuances, and all those excellent flows to segments, the atlas, and axes. These are right under your cranium with the Farina Magnum. This is where the whole area of the flow of energy from your brain is. It goes from the brain, brain stem into the spinal cord; that area is so empowering that chiropractic has gotten so specialized that they only adjust special X-rays. Very unique. It’s like high level. I don’t do that, but I tell you what, I love those chiropractors to do that, and I want them to do more of it, and we want to enlighten them. And we want to support every chiropractic in the world, not just the nation. The word chiropractic is all over the world, Alex, all over.
[00:23:09] Dr. Alex Jimenez DC*: Everywhere you went, I went to school like yours. It was Palmer, and yours was Palmer. I was national, not too far from each other within a few three or four hundred miles apart from each other. We would do that there was a thirst for chiropractic from different countries and these countries, from Japan, from France. They would send their students to learn in our environments because the laws differed in those days. These were my Chinese, my Japanese cohorts that spent in the dorms just to learn what we were doing out in the world of the states. Our school was welcome. Our schools were very and always have been an international attraction to teach the students. And today, now those countries have their colleges. You know, France has its own college. England has its college. This didn’t exist. You cannot stop it. No, it is coming, and it is motion. And as you said, you know, chiropractic has always been about all joints. You cannot talk about an ankle, and then you cannot talk about the neck. You cannot deal with it. And if you want to see how well connected, well, I’d like you to walk in the middle of the night and step on a tack and see how it’s all connected, and you’ll see the body dance in its dynamics, the cerebellum, the way you mentioned it sits on the foramen magnum. That is a huge, important part. The sciences developed due to understanding the connectivity between the foramen magnum, midbrain, and medulla have been unbelievable over the last two or three decades. So we are in a world of awakening, OK? An awakening of what chiropractic is. So as we go out, as the bad boys, we’re going to go deep. We’re going to get intense. We’re going to go deep into the world of science because, in today’s world, we have nothing but confusion. Misunderstanding. Yes, today, one thing some vitamin talks about this, then in the next day, it causes this. So one supplement does this. One drug starts with a better outcome. But I’ve got to tell you the story of Bextra, Celebrex within months of each other, of all of us taking it, they were pulled. You know what? We come and go. So the bottom line is natural. Approaches of holistic dynamics are the things that heal people and prevent them before they become clinical, and that’s what we do.
[00:25:35] Dr. Mario Ruja DC*: That’s the area that chiropractic is so powerful. I would say, in my opinion, I’m a little biased because, you know what? I’m going to get real with you. Yes. How is chiropractic the number one motion optimization, recovery, and maintenance system globally?
[00:25:59] Dr. Alex Jimenez DC*: Repeat it. Chiropractic is the what? Yes, it is number one in line.
[00:26:06] Dr. Mario Ruja DC*: That’s right. Listen carefully and replay this one. That’s right. You play it and put on your favorites. And you know, what do all this stuff? Whatever you’re going to do with this video, just put on rerun, baby. We are the number one optimization system for biomechanics from the world’s movement for maintenance and recovery. In the world, we do not wait for the pain to occur. We crush pain before it happens. This is like having your Bugatti. OK, you are the Bugatti, and there are no other parts; there’s nothing to do. There are no parts to buy and to take over. Again, there are no parts of you; whatever you’re born with is what you got. The most critical, most powerful thing you can do for yourself is to utilize chiropractic art. That means finding chiropractic in your area. And I mean find the real one and sit down and say, You know what? I want to talk to you. What are you up to?
[00:27:24] Dr. Alex Jimenez DC*: When you said real, Mario. Because there are some people out there that come on, come on, you know what, I’ve got to tell you…
[00:27:30] Dr. Mario Ruja DC*: We are the bad boys of chiropractic.
[00:27:31] Dr. Alex Jimenez DC*: You know what? Come on; we’re going to go there. We’re going to go there, Mario, because you have got to find the right one.
[00:27:37] Dr. Mario Ruja DC*: You got to find a real one, and you know what? This is what I’m saying. There’s deadwood in every forest. Yeah, that’s what Mama told me. Yeah, in every forest, I’m talking about chiropractic. There’s deadwood, orthopedic, everyone, teachers, and there’s deadwood. Some folks want to get some benefits, and let me tell you, get the real one. Sit down face to face, get real with them, ask them some fundamental questions, and look them up. And this is what we’re about. We’re about results.
[00:28:10] Dr. Alex Jimenez DC*: Yeah, Mario, here’s the thing when you get it when you go to a chiropractor, and this is now I can say this because I am one. I would never disparage any other profession because there are significant physical medicine sciences. Physical therapists, you know, these people know what they’re doing. These people have unbelievable science. But again, physical therapists, massage therapists, orthopedics. We all wrap around the science of motion into it and embrace it. So when we look for somebody, it’s a most offensive thing for me to hear when you go to a chiropractor. Someone went to a chiropractor, and the guy pulled out a piece of paper and said, OK, do some exercises, and that guy didn’t touch. You see, we are chiropractors who touch people; we wrap around them like pythons. Suppose your chiropractor isn’t wrapping around you and working around and trying to recalibrate you, time for a new chiropractor structurally. It’s not the practice of chiropractic.
[00:29:07] Dr. Mario Ruja DC*: Why don’t we get real since we’re the bad boys of chiropractic and we’re going to get down and dirty, OK? Number one, Chiro means hand. Practic means this is practical. That’s right. Please don’t ask me to spell it.
[00:29:22] Dr. Alex Jimenez DC*: Well, chiro means in atomic the carbon atoms, they’re equal mirror images.
How Does Chiropractic Compliments Other Professions?
[00:29:28] Dr. Mario Ruja DC*: Yes. So, the point is this. Again, you go to a chiropractor; they better lay some hands on you. You know what? It is highly recommended to remove some bones. They do all of that unless it is a specialty. Now here it is, like atlas orthogonal. And some other specialties like these are like high-end stuff. They need to do that, and it’s not about rubbing your back. That’s a different conversation for a different day. It is about creating movement calibration within the whole body. And also, I would like to add this complementing all of the healing arts around us. We complement orthopedics. We complement physical therapies, surgeons, neurosurgeons, allottees, occupational therapy. We complement psychologists, psychiatrists. We compliment teachers. We compliment coaches
[00:30:30] Dr. Alex Jimenez DC*: We compliment endocrinologists.
[00:30:32] Dr. Mario Ruja DC*: Yes, we compliment the world. We don’t interfere. We are the ones who break down the interference and create clarity in the energy flow of the body. That is that parasympathetic, sympathetic nervous system, autonomic nervous system that controls and creates harmonics, and 50 trillion-plus cells create who you are. Trillions with a T.
[00:31:09] Dr. Alex Jimenez DC*: Yeah. No, it’s amazing. You and I have been a part of a movement era. You know what I share with you that we’ve seen the attempts to limit the professions, whether it be physical therapists who have been determined by different forces out there. Each century had its limitations on other practices: the chiropractors, the optometrists, and the psychologists. But what we’ve learned is that you can’t hold it down. As you said initial results, you cannot stop the movement. But these chiropractors are working in Indonesia, Africa, Ethiopia, and special areas of all over Europe. They’re treating their patients in different ways. And one of the great things is the the the bringing in of other professions. The integration where the word integrative medicine has come in, integrative medicine is the form of sciences that brings all whatever it takes. All the dynamics and all the arts together to make it work. From there, we treat it in what’s the newest world of chiropractic is functional medicine. Our functional medicine is now the connector of many other holistic approaches, and it holistically looks at the body. How can we not take joints? How can we not have psychiatric issues, psychological issues, and traumas? Well, emotion is an important part of the therapy. If it’s endocrine, a metabolic disease, or metabolic syndrome, motion is in the treatment protocol. Neurological Parkinson’s neurodegenerative issues…
[00:32:48] Dr. Mario Ruja DC*: Fibromyalgia, chronic fatigue…
[00:32:51] Dr. Alex Jimenez DC*: Intestinal issues.
[00:32:52] Dr. Mario Ruja DC*: Depression. Yes, anxiety, I can tell you right now. And this is science talking to you. This is science. Number one, you don’t move. You will get depressed. You don’t move. Let me have someone let. Let’s do an excellent little test. Let me have you stay in bed for a month. Let me see what happens to you. Yeah. Let me know what happens to you. Let me have you sit down in that chair for a month, and then you tell me you’re not depressed. You tell me you don’t sleep and tell me you don’t have metabolic syndrome. If you don’t have one, you will. And this is where chiropractic compliments the power of life and movement, creating beautiful harmonies. So we can continue. The word continues to go and workout every athlete. I will say this. We don’t have enough chiropractors in the world. We don’t have enough chiropractors, period. Every human being should have a chiropractic visit at least four or five times a year, at least. Why? Because this is the problem. You know, we get into this chronic pain management. We get into all this disease care. This is the problem, Alex. We are reactive. Our society is focused on disease and managing the disease. I would like to share, empower, motivate, and challenge the world as the bad boys of chiropractic. It’s about challenging, folks. And the challenge is this. Why don’t we decrease the number of people with diabetes? Why don’t we reduce the number of people with depression anxiety? Why don’t we decrease that by movement? Movement cost? Yes. The cost is less.
Conclusion
[00:34:48] Dr. Alex Jimenez DC*: Yeah, you know what? Welcome to our show. This is Dr. Alex Jimenez and Dr. Mario Ruja. We are the bad boys of chiropractic, absolutely going to expose the realities of what we have learned and what we have understood in the physical sciences and how they correlate with different issues, diseases, and disorders. We’re going to develop protocols and advanced treatment dynamics that are esoteric, and we’re going to bring it in. And you know what? We’re going to use science. We’re going to use real science, and we as the bad boys because there will be a lot of thumbs down in terms of what we say. But there’s going to be a whole lot of thumbs up in terms of our dynamics. Because Mario, we have it. It is our legacy is; what do we have to do? You mentioned the other day that you know what this is, what you wanted to do. We need to teach people what we have learned. We not only need to teach people what we have to wake up those people that are willing to and want to teach and give of their lives for the future of chiropractic and physical medicine, physical therapies, orthopedic surgeons. We need a neurologist, anyone in the physical world. It seemed that even if we talk about the physical medicine doctors, we’re going to associate with all other professions. It doesn’t take you far drop in to throw here to realize that endocrinologists are linked to a rheumatologist. Rheumatologists are linked to chiropractic. Chiropractic is correlated to the orthopedist. Whether it’s neurology or the practicing of different dynamics, this whole thing of science will affect the future of what we have in health care. It will be a change, a movement, and we will be known as the bad boys of chiropractic, which we’re going to expose. We will do an exposé of many different topics, and I welcome you, Mario. We are brothers, and we have to teach the future people. So check-in; make sure you guys keep your ideas because we could talk forever, by the way. Yeah, Mario, I get to speak with them like we can sit here till four o’clock in the morning. Our families will not like that. We will come to you and teach you what we know and share with you. And I hope it matters. I know, Mario, you got a couple of thoughts.
[00:37:03] Dr. Mario Ruja DC*: Yeah, and this is the thought. Chiropractic is about optimizing movement. Optimize and move in a body, creating recovery, optimal recovery, maintenance, and complementing all of the healing arts. We are here to compliment all of the healing arts. Orthopedic, physical therapy, occupational therapy, speech therapy, and psychiatric psychological counseling are all here to complement educators. We’re here to complement and optimize students in their performance in school. We’re here to complement and optimize coaches and athletes to their highest level of life. And most of all, I would like to say this to create closure for our next show. There’s plenty of room at the top, the bottoms crowded, so come on with us, you got bad boys at the top.
[00:38:10] Dr. Alex Jimenez DC*: With that said, we’re all closing up here, and we look forward to making sure this works well for all of us and ensures the knowledge for all the people we’re here to come and in the future.
People are exposed to toxins, such as pesticides and air pollutants in food and the environment, on a regular basis. Meanwhile, other toxins are produced in the body through normal functions and microbes. That’s why it’s fundamental to support the liver, one of the major detoxification systems in the body. If the liver isn’t working properly, harmful compounds can start to pile up in the cells and tissues, leading to a variety of health issues. Liver detoxification is a two-step process that converts fat-soluble toxins into water-soluble toxins that the body can eliminate accordingly.
In the following article, we will discuss the importance of liver detox, what happens in the two phases of liver detoxification, and how you can support liver detox to promote overall health.
The Importance of Liver Detox
The liver is responsible for the detoxification of all of the harmful compounds and toxins that the body is exposed to on a regular basis. Moreover, it’s fundamental to eliminate these from the liver and the rest of the body regularly to tremendously reduce their negative effects. If toxins start to pile up in the cells and tissues of the liver, it can potentially lead to liver damage as well as a variety of other health issues. By way of instance, toxins are associated with obesity, dementia, and even cancer. And they are also believed to be a factor in chronic health issues, such as fibromyalgia.
There are two main ways that the body eliminates toxins. First, fat-soluble toxins are metabolized in the liver to make them water-soluble. Then, water-soluble toxins are sent directly to the kidneys where these are eliminated in the urine. Another of the body�s safeguards against harmful compounds is that the blood collected from the gut goes to the liver first. The blood from the gut may be especially high in toxins if a person has a leaky gut. Through the detoxification of toxins first, the liver can considerably reduce the number of toxins that reach other organs, such as the brain and heart.
Phases of Liver Detoxification
The liver is one of the main detoxification systems in the body. Detoxification or detox in the liver is separated into two categories. They are known as Phase I and Phase II liver detoxification pathways.
Phase I Liver Detoxification Pathway
The Phase I liver detoxification pathway is the first line of defense against harmful components and toxins. It’s made up of a collection of enzymes known as the cytochrome P450 family. The enzymes help neutralize substances, such as caffeine and alcohol. They offer protection by converting these toxins into less harmful components. However, if the byproducts of the Phase I liver detoxification pathway are allowed to pile up in the liver, they can damage DNA and proteins. It is ultimately the role of the Phase II liver detoxification pathway to make sure that those toxins do not pile up in the liver.
Phase II Liver Detoxification Pathway
The Phase II liver detoxification pathway neutralizes the byproducts of the Phase I liver detoxification pathway as well as that of other remaining toxins. This is done by metabolizing fat-soluble toxins in the liver to make them water-soluble so that they can be eliminated from the body. This process is known as conjugation. Glutathione, sulfate, and glycine are the primary molecules responsible for this process. Under normal conditions, Phase II liver detoxification pathway enzymes produce low levels of glutathione. Under times of high toxic stress, the body increases glutathione production.
We are exposed to toxins like pesticides and air pollutants in the food we eat as well as in the environment every day while other harmful compounds are produced by microbes through normal functions in the body. It’s essential to support liver function because it is our main detoxification system. If the liver isn’t working properly, toxins and harmful compounds can start to pile up in the liver which can eventually cause a variety of health issues. The phases of liver detoxification are a two-step pathway that converts fat-soluble toxins into water-soluble toxins that the body can eliminate accordingly. In the article above, we discussed the importance of liver detox, the phases of liver detoxification, and how you can support liver detox to promote overall health.�- Dr. Alex Jimenez D.C., C.C.S.T. Insight
Zesty Beet Juice
Servings: 1 Cook time: 5-10 minutes
� 1 grapefruit, peeled and sliced
� 1 apple, washed and sliced
� 1 whole beet, and leaves if you have them, washed and sliced
� 1-inch knob of ginger, rinsed, peeled and chopped
Juice all ingredients in a high-quality juicer. Best served immediately.
Just one carrot gives you all of your daily vitamin A intake
Yes, eating just one boiled 80g (2�oz) carrot gives you enough beta carotene for your body to produce 1,480 micrograms (mcg) of vitamin A (necessary for skin cell renewal). That’s more than the recommended daily intake of vitamin A in the United States, which is about 900mcg. It’s best to eat carrots cooked, as this softens the cell walls allowing more beta carotene to be absorbed. Adding healthier foods into your diet is a great way to improve your overall health.
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.
References:
Ask The Scientists Staff. �Liver Detoxification Pathways.� Ask The Scientists, 30 Jan. 2019, askthescientists.com/qa/liver-detoxification-pathways/#:~:text=liver%20detoxification%20pathways.-,Phase%20I%20Liver%20Detoxification%20Pathway,toxins%20into%20less%20harmful%20ones.
Watts, Todd, and Jay Davidson. �Phases of Liver Detox: What They Do & How to Support Them.� Phases of Liver Detox: What They Do & How to Support Them – Microbe Formulas�, 24 Jan. 2020, microbeformulas.com/blogs/microbe-formulas/phases-of-liver-detox-what-they-do-how-to-support-them.
DM; Grant. �Detoxification Pathways in the Liver.� Journal of Inherited Metabolic Disease, U.S. National Library of Medicine, 1 July 1991, pubmed.ncbi.nlm.nih.gov/1749210/.
Dowden, Angela. �Coffee Is a Fruit and Other Unbelievably True Food Facts.� MSN Lifestyle, 4 June 2020, www.msn.com/en-us/foodanddrink/did-you-know/coffee-is-a-fruit-and-other-unbelievably-true-food-facts/ss-BB152Q5q?li=BBnb7Kz&ocid=mailsignout#image=24.
The body is capable of eliminating harmful components generated by the production of toxic metabolites and the ingestion of toxic substances. When these overwhelm the organs of detoxification and excretion, the body can store these chemicals in the connective tissues. Detoxification is essential for the restoration of the body�s regulatory mechanisms in order to improve function. In the following article, we will discuss what is detox and how each of the organs of detoxification is responsible for the proper functioning of the organism in general, among other fundamental tasks.
Liver
The liver performs a variety of fundamental tasks, including digestion and hormonal balance. It’s considered to be the body’s main detoxification system. Several functions of the liver include:
removing harmful compounds like food additives, toxic medications, and excess hormones, etc.
extracting waste material from the bloodstream and transforming them so that they can be excreted by the kidneys or intestines
eliminating toxic metabolites and other waste products from intestinal fermentation and putrefaction
a source of Kupffer�s cells which filter and eliminate foreign invaders, such as bacteria, fungi, viruses and cancerous cells
Kidneys
The kidneys help to purify the blood from harmful compounds, including food additives, toxic medications, excess hormones, and other chemicals, by extracting them from the bloodstream and eliminating them through the urine. For proper filtration of the blood, an individual’s blood pressure and volume should be stable. Furthermore, proper hydration is essential for proper kidney function.
Intestines
The gastrointestinal tract is also responsible for the detoxification and excretion of harmful compounds.�Throughout the different phases of digestion, harmful compounds are extracted and excreted by the liver into the bile and finally into the small intestine in order to continue through the intestinal tract to be eliminated in the stool. In the final phase of digestion, anything that can still be utilized in the colon, such as fiber, is ultimately broken down further with the help of the gut microbiome and it is transported to the liver for detoxification. The intestines are another essential detoxification system.
Respiratory Tract
The respiratory tract, including the lungs and the bronchi, eliminates harmful compounds in the form of carbonic gas. It may also excrete phlegm. Constant irritation by foreign invaders, such as bacteria, fungi, viruses, and cancerous cells, can cause the alveoli to act as an emergency exit for toxins that the liver, kidneys, and the gastrointestinal tract did not succeed in eliminating. These harmful compounds are transported by the bloodstream towards the lungs and bronchi where they are coughed up as phlegm. This phlegm consists of waste resulting from insufficient digestion and excretion.
Skin
The skin is the largest organ of protection and defense. It plays a fundamental role in the elimination of harmful compounds and it can help with kidney function. It evacuates waste products in the form of “crystals” that are soluble in liquids and are then eliminated in the form of sweat through the sweat glands. Crystals are the residues of the metabolism of foods that are high in protein, such as legumes, eggs, dairy products, fish, meats, and cereals. These may also result from an excess of refined sugar. Other types of waste products and harmful compounds are excreted in the form of rashes.
Lymph System
Finally, the lymph system is another main detoxification system. Lymph fluid allows waste products to leave the cells and be carried away to the bloodstream. Lymphatic capillaries are responsible for the defense of the body and purification of the body fluids to maintain its proper functioning.�Other sites of lymphocyte production are the spleen, the thymus, etc. If foreign invaders enter into the body, the production of white blood cells increases rapidly and proportionally to the intensity of the aggression. The lymph nodes that are closest to the site react first to defend and protect the body.
The body is capable of eliminating harmful components generated by the production of toxic metabolites and the ingestion of toxic substances. When these overwhelm the organs of detoxification and excretion, the body can store these chemicals in the connective tissues. Detoxification is essential for the restoration of the body�s regulatory mechanisms in order to improve function. In the following article, we will discuss what is detox and how each of the organs of detoxification, including the liver, kidneys, intestines, respiratory tract, skin, and lymph system, is responsible for the proper functioning of the organism in general, among other fundamental tasks. – Dr. Alex Jimenez D.C., C.C.S.T. Insight
Zesty Beet Juice
Servings: 1 Cook time: 5-10 minutes
� 1 grapefruit, peeled and sliced
� 1 apple, washed and sliced
� 1 whole beet, and leaves if you have them, washed and sliced
� 1-inch knob of ginger, rinsed, peeled and chopped
Juice all ingredients in a high-quality juicer. Best served immediately.
Just one carrot gives you all of your daily vitamin A intake
Yes, eating just one boiled 80g (2�oz) carrot gives you enough beta carotene for your body to produce 1,480 micrograms (mcg) of vitamin A (necessary for skin cell renewal). That’s more than the recommended daily intake of vitamin A in the United States, which is about 900mcg. It’s best to eat carrots cooked, as this softens the cell walls allowing more beta carotene to be absorbed. Adding healthier foods into your diet is a great way to improve your overall health.
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.
References:
Issels, Ilse Marie. �Information on Detoxification and the Organs That Remove Toxins.� Issels Integrative Immuno-Oncology, 22 May 2015, issels.com/publication-library/information-on-detoxification/.
Dowden, Angela. �Coffee Is a Fruit and Other Unbelievably True Food Facts.� MSN Lifestyle, 4 June 2020, www.msn.com/en-us/foodanddrink/did-you-know/coffee-is-a-fruit-and-other-unbelievably-true-food-facts/ss-BB152Q5q?li=BBnb7Kz&ocid=mailsignout#image=24.
Most detox diets are normally short-term diet and lifestyle modifications made to help eliminate toxins from your body. A common detox diet may include a period of fasting and a diet of fruits, vegetables, juices, and water. A detox diet may also include teas, supplements, and enemas or colon cleanses. According to healthcare professionals, the role of a detox diet is to rest your organs, stimulate your liver function, promote toxin elimination, improve circulation, and provide healthy nutrients. Detox diets are recommended due to possible exposure to harmful compounds like heavy metals and pollutants.
Detox diets are also believed to help improve a variety of health issues, including digestive problems, bloating, inflammation, allergies, autoimmune diseases, obesity, and chronic fatigue.�However, there currently aren’t enough research studies on detox diets in humans and those that exist are considered flawed. In the following article, we will discuss the role of a detox diet on health and wellness.
Potential Benefits of a Detox Diet
Healthcare professionals have attempted to demonstrate the exact mechanisms in which detox diets can help eliminate toxins from your body. As a matter of fact, because of the current lack of research studies on detox diets in humans, there is currently little to no evidence which even demonstrates if detox diets can remove any toxins from your body as most of these rarely specify the type of harmful components they aim to remove. Moreover, your body is capable of cleansing itself through sweat, urine, and feces. Your liver also makes toxins harmless and then releases them from your body.
However, there are several harmful components that aren’t easily removed by these processes, including persistent heavy metals, phthalates, bisphenol A (BPA), and organic pollutants (POPs). These generally accumulate in fat tissue or blood and can take an extended period for your body to flush them. These harmful compounds are generally limited or removed in commercial products today.
Detox diets may also have other possible health benefits and these can also help encourage the following, including:
Avoiding processed foods
Eating nutritious, healthy whole foods
Exercising regularly and sweating accordingly
Drinking juices, teas, and water
Losing excessive fat; weight loss
Limiting stress, relaxing, and getting good sleep
Avoiding dietary sources of heavy metals and POPs
Following these guidelines is generally associated with improved health and wellness, regardless of whether you�re following a detox diet.
Bottom Line
Many detox diets are typically short-term diet and lifestyle changes made to help eliminate toxins from your body. A well-known detox diet may include a period of fasting and a diet of fruits, vegetables, juices, and water. A detox diet may also include teas, supplements, and enemas or colon cleanses. According to healthcare professionals, the role of a detox diet is to rest your organs, stimulate your liver function, promote toxin elimination, improve circulation, and provide healthy nutrients. Detox diets are recommended due to possible exposure to harmful compounds like heavy metals and pollutants.
Detox diets are also believed to help improve a variety of health issues, including digestive problems, bloating, inflammation, allergies, autoimmune diseases, obesity, and chronic fatigue. However, there currently aren’t enough research studies on detox diets in humans and those that exist are considered flawed. In the article above, we discussed the role of a detox diet on health and wellness.
Detox diets are made to help eliminate toxins from your body. A detox diet may include fasting, followed by a diet made up of fruits, vegetables, juices, and water. A detox diet may also include teas, supplements, and enemas. The role of a detox diet is to help your organs rest, promote liver function, support toxin elimination, improve circulation, and to offer various healthy nutrients. Detox diets are recommended when a person has been exposed to harmful compounds like heavy metals and pollutants. Detox diets are also believed to help improve digestive problems, bloating, inflammation, allergies, autoimmune diseases, obesity, and chronic fatigue, among a variety of other health issues. However, further research studies are still required. – Dr. Alex Jimenez D.C., C.C.S.T. Insight
Zesty Beet Juice
Servings: 1 Cook time: 5-10 minutes
� 1 grapefruit, peeled and sliced
� 1 apple, washed and sliced
� 1 whole beet, and leaves if you have them, washed and sliced
� 1-inch knob of ginger, rinsed, peeled and chopped
Juice all ingredients in a high-quality juicer. Best served immediately.
Just one carrot gives you all of your daily vitamin A intake
Yes, eating just one boiled 80g (2�oz) carrot gives you enough beta carotene for your body to produce 1,480 micrograms (mcg) of vitamin A (necessary for skin cell renewal). That’s more than the recommended daily intake of vitamin A in the United States, which is about 900mcg. It’s best to eat carrots cooked, as this softens the cell walls allowing more beta carotene to be absorbed. Adding healthier foods into your diet is a great way to improve your overall health.
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*�
Dowden, Angela. �Coffee Is a Fruit and Other Unbelievably True Food Facts.� MSN Lifestyle, 4 June 2020, www.msn.com/en-us/foodanddrink/did-you-know/coffee-is-a-fruit-and-other-unbelievably-true-food-facts/ss-BB152Q5q?li=BBnb7Kz&ocid=mailsignout#image=24.
IFM's Find A Practitioner tool is the largest referral network in Functional Medicine, created to help patients locate Functional Medicine practitioners anywhere in the world. IFM Certified Practitioners are listed first in the search results, given their extensive education in Functional Medicine
