Name: El Paso Back Clinic | Spine Specialists - El Paso, TX
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Wellness

Clinic Wellness Team. A key factor to spine or back pain conditions is staying healthy. Overall wellness involves a balanced diet, appropriate exercise, physical activity, restful sleep, and a healthy lifestyle. The term has been applied in many ways. But overall, the definition is as follows.

It is a conscious, self-directed, and evolving process of achieving full potential. It is multidimensional, bringing together lifestyles both mental/spiritual and the environment in which one lives. It is positive and affirms that what we do is, in fact, correct.

It is an active process where people become aware and make choices towards a more successful lifestyle. This includes how a person contributes to their environment/community. They aim to build healthier living spaces and social networks. It helps in creating a person’s belief systems, values, and a positive world perspective.

Along with this comes the benefits of regular exercise, a healthy diet, personal self-care, and knowing when to seek medical attention. Dr. Jimenez’s message is to work towards being fit, being healthy, and staying aware of our collection of articles, blogs, and videos.

Rectus Femoris Strain Management

by spinedoctors | Chiropractic, Chiropractic Examination, Chronic Pain, Health, Research Studies, Screening Tests, Spine Care, Sports Injuries, Treatments, Wellness

The rectus femoris muscle attaches to the pelvis and just below the knee as it is one of four muscles found at the front part of the thigh. It functions by extending the knee and flexing the hip. The rectus femoris muscle is made up of�fibers which adapt to quick action. Rectus femoris muscle strain is caused by forceful movements, such as kicking a ball or when beginning to sprint, and it is particularly vulnerable to stress and pressure.

Painful symptoms generally manifest at the top of the thigh after the rectus femoris muscle suffers a strain or tear. In severe cases, the health issue may even become noticeable if the tissue is completely ruptured. Fortunately, complete tears are rare. Healthcare professionals will commonly use an MRI scan to diagnose the extent of the sports injury. Proper diagnosis and treatment�are�essential. A rectus femoris muscle strain should not be rushed, as individuals who return-to-sport too soon may suffer re-injury.

Treatment for Rectus Femoris Strain

According to many healthcare professionals, when it comes to sports injuries to the rectus femoris muscle, it’s crucial to immediately apply the RICE principle (Rest, Ice, Compression, and Elevation) to the affected thigh. This treatment aims to decrease bleeding and inflammation to the muscle. Also, it will help reduce painful symptoms after the injury. Based on how much pain has been experienced, simple painkillers might be utilized, although it’s best to attempt to prevent the use of these.

Once movement is restored enough to allow the individual to walk using their regular range of motion, and once the swelling has gone down, then you will have recovered from the acute phase of the injury. It would then be an excellent time to engage in physical activity, without inflicting damage or stress to the quadriceps muscles. This can be performed on an exercise bicycle or through swimming, where the weight is kept�off the limb. Stretches and gentle resistance exercises are crucial, as this will help to align the scar tissue that has formed during the healing process.

Recovery must be monitored so that improvements can be noted and the treatment shifted to help the rehabilitation process. It is hard to measure the length of time to complete recovery. It can take from six to eight weeks or even longer, although some people will commonly recover within one to four weeks.�The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at�915-850-0900�.

Curated by Dr. Alex Jimenez

Additional Topics: Acute Back Pain

Back pain�is one of the most prevalent causes of disability and missed days at work worldwide. Back pain attributes to the second most common reason for doctor office visits, outnumbered only by upper-respiratory infections. Approximately 80 percent of the population will experience back pain at least once throughout their life. The spine is a complex structure made up of bones, joints, ligaments, and muscles, among other soft tissues. Because of this, injuries and/or aggravated conditions, such as�herniated discs, can eventually lead to symptoms of back pain. Sports injuries or automobile accident injuries are often the most frequent cause of back pain, however, sometimes the simplest of movements can have painful results. Fortunately, alternative treatment options, such as chiropractic care, can help ease back pain through the use of spinal adjustments and manual manipulations, ultimately improving pain relief.

EXTRA IMPORTANT TOPIC: Chiropractic Hip Pain Treatment

Developmental Dysplasia of the Hip

by spinedoctors | Chiropractic, Chiropractic Examination, Health, Research Studies, Screening Tests, Spine Care, Treatments, Wellness

The hip is commonly described as a “ball-and-socket” type joint. In a healthy hip, the ball at the top end of the thighbone, or femur, should fit firmly into the socket, which is part of the large pelvis bone. In babies and children with developmental dysplasia, or dislocation, of the hip, abbreviated as DDH, the hip joint may not have formed normally. As a result, the ball of the femur might easily dislocate and become loose from the socket.

Although DDH is often present from birth, it could also develop during a child’s first year of life. Recent research studies have demonstrated that infants whose thighs are swaddled closely with the hips and knees straight are at a higher risk for developing DDH. Because swaddling has become�increasingly popular, it is essential for parents to understand how to swaddle their babies safely, and they should realize that when done improperly, swaddling may cause health issues such as DDH.

Diagnosis for�Developmental Dysplasia of the Hip

In addition to visual cues, when�diagnosing for DDH, the healthcare professional will perform a careful evaluation, such as listening and feeling for “clunks” which indicates that the hip is placed in different positions. The doctor will also utilize other methods and techniques to determine if the hip is dislocated. Newborns recognized to be at higher risk for DDH are often tested using ultrasound. For babies and children, x-rays of the hip might be taken to provide further detailed images of the hip joint.

Treatment for�Developmental Dysplasia of the Hip

If DDH is discovered at birth, it can usually be treated with the use of a harness or brace. If the hip isn’t dislocated at birth, the condition might not be diagnosed until the child starts walking. At that point, treatment for DDH is much more complex, with less predictable results. If diagnosed and treated accordingly, children ought to have no restriction in function and develop the standard hip joint. DDH may result in atherosclerosis and other problems. It may produce a difference in agility or leg length.

In spite of proper treatment, hip deformity and osteoarthritis may develop later in life. This is particularly true when treatment starts after the age of 2 years. Therefore, diagnosis and treatment are essential in newborns and children with DDH. The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at�915-850-0900�.

Curated by Dr. Alex Jimenez

�

Additional Topics: Acute Back Pain

EXTRA IMPORTANT TOPIC: Chiropractic Hip Pain Treatment

Evaluation of the Patient with Hip Pain

by spinedoctors | Back Pain, Chiropractic Examination, Chronic Back Pain, Chronic Pain, Health, Lower Back Pain, Research Studies, Screening Tests, Severe Back Pain, Spine Care, Treatments, Wellness

Hip pain is a well-known health issue which can be caused by a wide array of problems, however, the site of the patient’s hip pain can provide valuable information regarding the underlying cause of this common health issue. Pain on the inside of the hip or groin can be due to problems within the hip joint itself while pain on the outside of the hip, upper thigh and outer buttocks may be due to problems with the ligaments, tendons and muscles, among other soft tissues, surrounding the hip joint. Furthermore, hip pain can be due to other injuries and conditions, including back pain.

Abstract

Hip pain is a common and disabling condition that affects patients of all ages. The differential diagnosis of hip pain is broad, presenting a diagnostic challenge. Patients often express that their hip pain is localized to one of three anatomic regions: the anterior hip and groin, the posterior hip and buttock, or the lateral hip. Anterior hip and groin pain is commonly associated with intra-articular pathology, such as osteoarthritis and hip labral tears. Posterior hip pain is associated with piriformis syndrome, sacroiliac joint dysfunction, lumbar radiculopathy, and less commonly ischiofemoral impingement and vascular claudication. Lateral hip pain occurs with greater trochanteric pain syndrome. Clinical examination tests, although helpful, are not highly sensitive or specific for most diagnoses; however, a rational approach to the hip examination can be used. Radiography should be performed if acute fracture, dislocations, or stress fractures are suspected. Initial plain radiography of the hip should include an anteroposterior view of the pelvis and frog-leg lateral view of the symptomatic hip. Magnetic resonance imaging should be performed if the history and plain radiograph results are not diagnostic. Magnetic resonance imaging is valuable for the detection of occult traumatic fractures, stress fractures, and osteonecrosis of the femoral head. Magnetic resonance arthrography is the diagnostic test of choice for labral tears.

Introduction

Hip pain is a common presentation in primary care and can affect patients of all ages. In one study, 14.3% of adults 60 years and older reported significant hip pain on most days over the previous six weeks.1 Hip pain often presents a diagnostic and therapeutic challenge. The differential diagnosis of hip pain (eTable A) is broad, including both intra-articular and extra-articular pathology, and varies by age. A history and physical examination are essential to accurately diagnose the cause of hip pain.

Anatomy

The hip joint is a ball-and-socket synovial joint designed to allow multiaxial motion while transferring loads between the upper and lower body. The acetabular rim is lined by fibrocartilage (labrum), which adds depth and stability to the femoroacetabular joint. The articular surfaces are covered by hyaline cartilage that dissipates shear and compressive forces during load bearing and hip motion. The hip’s major innervating nerves originate in the lumbosacral region, which can make it difficult to distinguish between primary hip pain and radicular lumbar pain.

The hip joint’s wide range of motion is second only to that of the glenohumeral joint and is enabled by the large number of muscle groups that surround the hip. The flexor muscles include the iliopsoas, rectus femoris, pectineus, and sartorius muscles. The gluteus maximus and hamstring muscle groups allow for hip extension. Smaller muscles, such as gluteus medius and minimus, piriformis, obturator externus and internus, and quadratus femoris muscles, insert around the greater trochanter, allowing for abduction, adduction, and internal and external rotation.

In persons who are skeletally immature, there are several growth centers of the pelvis and femur where injuries can occur. Potential sites of apophyseal injury in the hip region include the ischium, anterior superior iliac spine, anterior inferior iliac spine, iliac crest, lesser trochanter, and greater trochanter. The apophysis of the superior iliac spine matures last and is susceptible to injury up to 25 years of age.2

The hip joint is one of the larger joints found in the human body and it serves in locomotion as the thigh moves forward and backward. The hip joint also rotates when sitting and with changes of direction while walking. A variety of complex structures surround the hip joint. When an injury or condition affects these, it can ultimately lead to hip pain.

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

Evaluation of Hip Pain

History

Age alone can narrow the differential diagnosis of hip pain. In prepubescent and adolescent patients, congenital malformations of the femoroacetabular joint, avulsion fractures, and apophyseal or epiphyseal injuries should be considered. In those who are skeletally mature, hip pain is often a result of musculotendinous strain, ligamentous sprain, contusion, or bursitis. In older adults, degenerative osteoarthritis and fractures should be considered first.

Patients with hip pain should be asked about antecedent trauma or inciting activity, factors that increase or decrease the pain, mechanism of injury, and time of onset. Questions related to hip function, such as the ease of getting in and out of a car, putting on shoes, running, walking, and going up and down stairs, can be helpful.3 Location of the pain is informative because hip pain often localizes to one of three basic anatomic regions: the anterior hip and groin, posterior hip and buttock, and lateral hip (eFigure A).

Physical Examination

The hip examination should evaluate the hip, back, abdomen, and vascular and neurologic systems. It should start with a gait analysis and stance assessment (Figure 1), followed by evaluation of the patient in seated, supine, lateral, and prone positions (Figures 2 through 6, and eFigure B). Physical examination tests for the evaluation of hip pain are summarized in Table 1.

Imaging

Radiography. Radiography of the hip should be performed if there is any suspicion of acute fracture, dislocation, or stress fracture. Initial plain radiography of the hip should include an anteroposterior view of the pelvis and a frog-leg lateral view of the symptomatic hip.4

Magnetic Resonance Imaging and Arthrography. Conventional magnetic resonance imaging (MRI) of the hip can detect many soft tissue abnormalities, and is the preferred imaging modality if plain radiography does not identify specific pathology in a patient with persistent pain.5 Conventional MRI has a sensitivity of 30% and an accuracy of 36% for diagnosing hip labral tears, whereas magnetic resonance arthrography provides added sensitivity of 90% and accuracy of 91% for the detection of labral tears.6,7

Ultrasonography. Ultrasonography is a useful technique for evaluating individual tendons, confirming suspected bursitis, and identifying joint effusions and functional causes of hip pain.8 Ultrasonography is especially useful for safely and accurately performing imaging-guided injections and aspirations around the hip.9 It is ideal for an experienced ultrasonographer to perform the diagnostic study; however, emerging evidence suggests that less experienced clinicians with appropriate training can make diagnoses with reliability similar to that of an experienced musculoskeletal ultrasonographer.10,11

These are numerous causes for hip pain. Although some hip pain may only be temporary, other forms of hip pain can become chronic if left untreated for an extended period of time. Several common causes of hip pain include, arthritis, fracture, sprain, avascular necrosis, Gaucher’s disease, sciatica, muscle strain, iliotibial band syndrome or IT band syndrome and hematoma, among others described below.

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

Differential Diagnosis of Anterior Hip Pain

Anterior hip or groin pain suggests involvement of the hip joint itself. Patients often localize pain by cupping the anterolateral hip with the thumb and forefinger in the shape of a �C.� This is known as the C sign (Figure 1A).

Osteoarthritis

Osteoarthritis is the most likely diagnosis in older adults with limited motion and gradual onset of symptoms. Patients have a constant, deep, aching pain and stiffness that are worse with prolonged standing and weight bearing. Examination reveals decreased range of motion, and extremes of hip motion often cause pain. Plain radiographs demonstrate the presence of asymmetrical joint-space narrowing, osteophytosis, and subchondral sclerosis and cyst formation.12

Femoroacetabular Impingement

Patients with femoroacetabular impingement are often young and physically active. They describe insidious onset of pain that is worse with sitting, rising from a seat, getting in or out of a car, or leaning forward.13 The pain is located primarily in the groin with occasional radiation to the lateral hip and anterior thigh.14 The FABER test (flexion, abduction, external rotation; Figure 3) has a sensitivity of 96% to 99%. The FADIR test (flexion, adduction, internal rotation; Figure 4), log roll test (Figure 5), and straight leg raise against resistance test (Figure 6) are also effective, with sensitivities of 88%, 56%, and 30%, respectively.14,15 In addition to the anteroposterior and lateral radiograph views, a Dunn view should be obtained to help detect subtle lesions.16

Hip Labral Tear

Hip labral tears cause dull or sharp groin pain, and one-half of patients with a labral tear have pain that radiates to the lateral hip, anterior thigh, and buttock. The pain usually has an insidious onset, but occasionally begins acutely after a traumatic event. About one-half of patients with this injury also have mechanical symptoms, such as catching or painful clicking with activity.17 The FADIR and FABER tests are effective for detecting intra-articular pathology (the sensitivity is 96% to 75% for the FADIR test and is 88% for the FABER test), although neither test has high specificity.14,15,18 Magnetic resonance arthrography is considered the diagnostic test of choice for labral tears.6,19 However, if a labral tear is not suspected, other less invasive imaging modalities, such as plain radiography and conventional MRI, should be used first to rule out other causes of hip and groin pain.

Iliopsoas Bursitis (Internal Snapping Hip)

Patients with this condition have anterior hip pain when extending the hip from a flexed position, often associated with intermittent catching, snapping, or popping of the hip.20 Dynamic real-time ultrasonography is particularly useful in evaluating the various forms of snapping hip.8

Occult or Stress Fracture

Occult or stress fracture of the hip should be considered if trauma or repetitive weight-bearing exercise is involved, even if plain radiograph results are negative.21 Clinically, these injuries cause anterior hip or groin pain that is worse with activity.21 Pain may be present with extremes of motion, active straight leg raise, the log roll test, or hopping.22 MRI is useful for the detection of occult traumatic fractures and stress fractures not seen on plain radiographs.23

Transient Synovitis and Septic Arthritis

Acute onset of atraumatic anterior hip pain that results in impaired weight bearing should raise suspicion for transient synovitis and septic arthritis. Risk factors for septic arthritis in adults include age older than 80 years, diabetes mellitus, rheumatoid arthritis, recent joint surgery, and hip or knee prostheses.24 Fever, complete blood count, erythrocyte sedimentation rate, and C-reactive protein level should be used to evaluate the risk of septic arthritis.25,26 MRI is useful for differentiating septic arthritis from transient synovitis.27,28 However, hip aspiration using guided imaging such as fluoroscopy, computed tomography, or ultrasonography is recommended if a septic joint is suspected.29

Osteonecrosis

Legg-Calv�-Perthes disease is an idiopathic osteonecrosis of the femoral head in children two to 12 years of age, with a male-to-female ratio of 4:1.4 In adults, risk factors for osteonecrosis include systemic lupus erythematosus, sickle cell disease, human immunodeficiency virus infection, smoking, alcoholism, and corticosteroid use.30,31 Pain is the presenting symptom and is usually insidious. Range of motion is initially preserved but can become limited and painful as the disease progresses.32 MRI is valuable in the diagnosis and prognostication of osteonecrosis of the femoral head.30,33

Differential Diagnosis of Posterior Hip and Buttock Pain

Piriformis Syndrome and Ischiofemoral Impingement

Piriformis syndrome causes buttock pain that is aggravated by sitting or walking, with or without ipsilateral radiation down the posterior thigh from sciatic nerve compression.34,35 Pain with the log roll test is the most sensitive test, but tenderness with palpation of the sciatic notch can help with the diagnosis.35

Ischiofemoral impingement is a less well-understood condition that can lead to nonspecific buttock pain with radiation to the posterior thigh.36,37 This condition is thought to be a result of impingement of the quadratus femoris muscle between the lesser trochanter and the ischium.

Unlike sciatica from disc herniation, piriformis syndrome and ischiofemoral impingement are exacerbated by active external hip rotation. MRI is useful for diagnosing these conditions.38

Other

Other causes of posterior hip pain include sacroiliac joint dysfunction,39 lumbar radiculopathy,40 and vascular claudication.41 The presence of a limp, groin pain, and limited internal rotation of the hip is more predictive of hip disorders than disorders originating from the low back.42

Differential Diagnosis of Lateral Hip Pain

Greater Trochanteric Pain Syndrome

Lateral hip pain affects 10% to 25% of the general population.43 Greater trochanteric pain syndrome refers to pain over the greater trochanter. Several disorders of the lateral hip can lead to this type of pain, including iliotibial band thickening, bursitis, and tears of the gluteus medius and minimus muscle attachment.43�45 Patients may have mild morning stiffness and may be unable to sleep on the affected side. Gluteus minimus and medius injuries present with pain in the posterior lateral aspect of the hip as a result of partial or full-thickness tearing at the gluteal insertion. Most patients have an atraumatic, insidious onset of symptoms from repetitive use.43,45,46

In conclusion, hip pain is a common complaint which may occur due to a wide variety of health issues. Moreover, the precise location of the patient’s hip pain can provide valuable information to healthcare professionals regarding the underlying cause of the problem. The purpose of the article above was to demonstrate and discuss the evaluation of the patient with hip pain. The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at�915-850-0900�.

Curated by Dr. Alex Jimenez

Data Sources: We searched articles on hip pathology in American Family Physician, along with their references. We also searched the Agency for Healthcare Research and Quality Evidence Reports, Clinical Evidence, Institute for Clinical Systems Improvement, the U.S. Preventive Services Task Force guidelines, the National Guideline Clearinghouse, and UpToDate. We performed a PubMed search using the keywords greater trochanteric pain syndrome, hip pain physical examination, imaging femoral hip stress fractures, imaging hip labral tear, imaging osteomyelitis, ischiofemoral impingement syndrome, meralgia paresthetica review, MRI arthrogram hip labrum, septic arthritis systematic review, and ultrasound hip pain. Search dates: March and April 2011, and August 15, 2013.

Author Information:�Aafp.org

Additional Topics: Acute Back Pain

EXTRA IMPORTANT TOPIC: Hip Pain Chiropractic Treatment

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References

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Achondroplasia Clinical Presentation

by spinedoctors | Back Pain, Chiropractic, Chiropractic Examination, Health, Research Studies, Screening Tests, Spine Care

Achondroplasia is a genetic disorder that leads to dwarfism. In those with the condition, the legs and arms are short, while the chest is generally of regular length. Those affected have an average adult height of 131 centimetres (4 ft 4 in) for males and 123 centimetres (4 feet ) for females. Other features include a prominent forehead and an enlarged head. Intelligence is typically considered normal in people with achondroplasia. The condition affects approximately 1 in 27,500 individuals.

Diagnosis for Achondroplasia

Achondroplasia is the result of a mutation in the fibroblast growth factor receptor 3 (FGFR3) gene. This occurs during early development as a new mutation. It is also inherited from the parents in an autosomal dominant way. Those with two affected genes do not survive. Testing if uncertain of diagnosis based on symptoms is often strongly encouraged.

Achondroplasia can be detected before birth�through the use of prenatal ultrasound. Moreover, a DNA test can also be performed to identify homozygosity, where two copies of the gene are inherited causing the deadly condition resulting in stillbirths. Clinical features include megalocephaly, short limbs, prominent forehead, thoracolumbar kyphosis and mid-face hypoplasia. Complications such as dental malocclusion, hydrocephalus and replicated otitis media may also develop. The risk of death in infancy may be increased as a result of the probability of compression of the spinal cord with or without upper airway obstruction.

Achondroplasia and Sciatica

Individuals with achondroplasia commonly experience back pain, which may often progress to sciatica symptoms, such as pain and discomfort, tingling and burning sensations in the lower extremities, and numbness, among other consequences. Both children and adults with achondroplasia have hip flexion contractures which have been found to be a contributing factor for sciatica and muscle fatigue reported by individuals with achondroplasia. Individuals with achondroplasia also typically demonstrate a mixed pattern of joint mobility, including joint contracture and joint hypermobility at characteristic joints.�

Achondroplasia Management

There is no known cure for achondroplasia even though the cause of the mutation has been found. Management for the condition might include support groups and growth hormone treatment. Efforts to treat or prevent complications like obesity, hydrocephalus, obstructive sleep apnea, middle ear infections, or spinal stenosis may be required for the management�of achondroplasia. Life expectancy of those affected is approximately 10 years less than ordinary.�The scope of our information is limited to chiropractic, spinal injuries, and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at�915-850-0900�.

Curated by Dr. Alex Jimenez

Additional Topics: Acute Back Pain

Back pain�is one of the most prevalent causes of disability and missed days at work worldwide. Back pain attributes to the second most common reason for doctor office visits, outnumbered only by upper-respiratory infections. Approximately 80 percent of the population will experience back pain at least once throughout their life. The spine is a complex structure made up of bones, joints, ligaments, and muscles, among other soft tissues. Because of this, injuries and/or aggravated conditions, such as�herniated discs, can eventually lead to symptoms of back pain. Sports injuries or automobile accident injuries are often the most frequent cause of back pain, however, sometimes the simplest of movements can have painful results. Alternative treatment options, such as chiropractic care, can help ease back pain through spinal adjustments and manual manipulations, ultimately improving pain relief.

EXTRA IMPORTANT TOPIC: Lower Back Bain Pain Chiropractic Relief

How Combining Chiropractic & Yoga Can Be Beneficial To Your Spine

by Dr. Alex Jimenez DC, APRN, FNP-C | Chiropractic, Mind Body and Spirit, Mobility & Flexibility

Yoga has long been touted as a healing activity that extends beyond its known fitness benefits. It can help alleviate depression, relieve stress, and decrease anxiety as well as tighten and tone the body.

A 2016 study by Yoga Alliance and Yoga Journal shows that the more than 20 million people who practice yoga spend more than $10 billion on related classes and products. Chiropractors have picked up on the benefits of yoga and are recommending it to their patients. Why, because it helps to improve flexibility as well as spinal health.

Chiropractic and the spine�s role in the body.

Chiropractic is primarily intended to align the spine and balance the body. The spine is the primary support for the body. It houses most of the central nervous system and provides pathways for neural impulses to move throughout the body.

When the spine is out of alignment, it can affect how the central nervous system functions. It can also affect flexibility and even overall mobility as well as cause pain and stiffness.

Chiropractic treatment brings the spine back into alignment. It helps to balance the body and treat injuries as well as help with the changes the aging body experiences.

One of the best-known uses for chiropractic is to treat pain. It is a medication free, non-invasive treatment for chronic pain, sports-related injuries, and even automobile accidents. Many patients had reported finding relief with chiropractic when nothing else worked.

Combining yoga with chiropractic increases the effectiveness of the treatment while strengthening the body and making it better able to respond to it. It is the perfect complement to chiropractic care, and many patients are discovering tremendous health benefits from this winning, healthy combination.

What is Yoga?

In its purest form, it is an ascetic and spiritual discipline that comes from Hindu culture. It involves simple meditation, conscious breathing or breath control, and performing certain body postures.

While an ancient practice long used for spiritual and emotional healing as well as physical wellness, yoga has been adopted in western culture and widely accepted as a form of fitness as well as a therapeutic practice used for relaxation and overall good health. It focuses on inward healing for outward results.

People who regularly practice find they are more centered, handle stress better, and aren�t as likely to experience depression and anxiety. They also are more flexible, have better mobility, and have stronger leaner bodies.

What happens when you combine yoga and chiropractic care?

Because yoga helps to lower blood pressure, decrease stress, and strengthen the body�s core, it is perfect therapy for the chiropractic patient. While chiropractic care is working to align the spine and balance the body, yoga is helping to strengthen the muscles surrounding the spine, providing better support. The numerous health benefits, particularly regarding blood flow and relaxation help to increase chiropractic�s effectiveness as a pain management tool.

Patients who combine yoga and chiropractic will also often find that they see the effects of both treatments much faster than they would if they were only doing one or the other. Both chiropractic and yoga help with balance, flexibility, and mobility, but they come at it from somewhat different approaches. The benefit of this is that it provides a more balanced, well-rounded treatment in these areas as one supports the other.

Yoga also tones and tightens the body, preparing it for much more profound levels of healing, cleansing and releasing the body of tensions that may have been held�in for years. It also works to stretch muscles that have been restricted for years, or even for the patient�s entire life. It prepares the body to accept the full benefits of chiropractic and respond faster and more thoroughly.

Chiropractic Care & Sports Injuries

How to Set Realistic Goals that’ll Change Your Overall Health

by Dr. Alex Jimenez DC, APRN, FNP-C | Fitness, Health, Wellness

New Year�s Resolutions made by well-meaning but, unfortunately, less than 10 percent of people who make resolutions feel that they successfully achieve them and only 45 percent last past six months. Self-improvement goals like lose weight, eat healthier, quit smoking, and life improvement rank in the top five more popular resolutions. So, what is that 10 percent doing that makes them successful at achieving their goals? What sets them apart?

SMART Approach to Successful Goals

The SMART approach is a guide for setting realistic goals and attaining them. It is an acronym that outlines a success-focused strategy for goal setting:

Specific
Measurable
Accountable
Realistic
Timeframe

Each step will bring you closer to achieving your goals and improve your health.

Be SPECIFIC about your goals

Vague, ambiguous goals can�t stand up to time and temptation. Get specific.

Say you want to lose weight. How much do you want to lose? How do you plan to accomplish it? What are your reasons for setting this goal? Whatever goal you are setting, ask why and get specific about the details.

Set Goals that are MEASURABLE

If you set a goal that you can�t measure, how will you know when you reach it?

Any goal that you have can be measured in some way. Weight loss is measured in pounds, how your clothes fit, or how many inches you�ve lost. Eating healthy can be measured by what foods you incorporate into your diet, getting the junk food out of your pantry, and finding healthy recipes.

It helps to break your main goal into several smaller, attainable ones. It lets you see success very early, and you keep seeing success which spurs your motivation, making you less likely to abandon your efforts.

Hold Yourself ACCOUNTABLE

Accountability is a great motivator for helping you stick to your goals. Keeping a journal has long been a great way to keep yourself accountable, but there are many website and software programs that you can use to track your efforts that may prove to be even more effective.

Partnering up with a buddy is also a great strategy. Choosing someone who has a goal similar to yours allows you to hold each other accountable. Plus, success is always better when you can share it with a friend.

Keep Your Goals REALISTIC

Unrealistic or unattainable goals are motivation killers. Even goals that are too difficult or require high-pressure effort over a long period can be challenging to�see all the way through.

As you sit down, think about not only what you want to achieve, but what that looks like in your life. In other words, consider your personality and lifestyle, structuring your goals to accommodate those factors.

If your goal is to lose weight, setting a goal of 30 pounds in 30 days is not only unrealistic but unhealthy. On the other hand, setting a 2 pound per week loss is a goal that you will likely find to be much easier.

Set a TIME-FRAME, but Keep it Flexible

Creating a timeframe for meeting your goals gives your efforts structure which helps to keep you motivated. Make sure your timelines are realistic; give yourself enough time.

If the constraints are too tight, you could find that you veer off the path and even lose sight. Stay flexible, though. If you don�t reach a target within a given timeframe, don�t be afraid to move it a little.

As long as you are moving forward, toward your goal you don�t need to limit yourself just because you didn�t complete it within the time you allotted initially. It�s about meeting your goals�and making lasting changes that will affect your overall health for the better. Cut yourself some slack.

Chiropractic Care & Cross Fit Rehabilitation

How Long are Patients with Chronic Kidney Disease Expected to Live?

by spinedoctors | Health, Research Studies, Treatments, Wellness

Approximately 30 million adults in the United States have been diagnosed with chronic kidney disease, or CKD. The conditions categorized under CKD can damage the kidneys, decreasing their ability to function accordingly. Patients with this health issue can develop high blood pressure, anemia, weak bones, nerve damage and overall poor health. Chronic kidney disease may also increase a patient’s risk of developing heart and blood vessel disease, although these complications may occur slowly over time.

Chronic kidney disease may be caused by diabetes, high blood pressure and a variety of other disorders. Early detection and treatment is important to prevent CKD from getting worse. Chronic kidney disease may lead to kidney failure which may require additional care to maintain the patient’s quality of life. The purpose of the article below is to demonstrate the accurate prognosis and life expectancy of patients with chronic kidney disease. The evidence on the prediction of how long patients with CKD are expected to live provides important new data which may be useful for treatment.

Abstract

Can renal prognosis and life expectancy be accurately predicted? Increasingly, the answer is yes. The natural history of different forms of renal disease is becoming clearer; the degree of reduction in glomerular filtration rate (GFR) and the magnitude of proteinuria are strong predictors of renal outcome. Actuarial data on life expectancy from the start of renal replacement therapy are available from renal registries such as the U.S. Renal Data System (USRDS), and the UK Renal Registry. Recently, similar data have become available for patients with chronic kidney disease. Data collected from a large population-based registry in Alberta, Canada and stratified for different levels of estimated GFR (eGFR) have shown that the reduction in life expectancy with kidney failure is not a uremic event associated with starting dialysis but a continuous process that is evident from an eGFR of ?60 ml/min. Nevertheless, despite the poor prognosis of the last stages of renal failure, progress in the treatment and management of these patients and, in particular, of their cardiovascular risk factors continues to improve long-term outcome.

Keywords: Adolescent, Chronic kidney disease, Progressive renal failure, Life expectancy, CAKUT, End-stage kidney disease

Introduction

How much do we know about renal prognosis and life expectancy in adolescents with chronic kidney disease (CKD)? If one sees a new patient, a 19-year-old youth with a serum creatinine level of 200 ?mol/l, can one predict his likely renal prognosis and his life expectancy? The answer is yes, and this is frequently done when the question is posed in a medico-legal context; however, is the answer accurate?

We know that life expectancy is much reduced with end-stage renal failure�but what about the different degrees or stages of renal failure? For this review I have searched the adult and paediatric literature for papers cited in PubMed and Google Scholar that might contain data on life expectancy with CKD, or for series that have followed patients with CKD from childhood to end-stage kidney disease (ESKD) and through to renal replacement therapy (RRT). I summarise the evidence on the prediction of renal prognosis, describe important new data from Canada that for the first time looks at life expectancy with different stages of CKD and cite the U.S. Renal Data System (USRDS) and UK renal registries that report annual data regarding life expectancy with RRT.

Predicting Renal Outcome

To predict renal outcome I first make a number of assumptions. On the balance of probabilities (medico-legal language for a >50 % chance), at this age (19 years) the patient will have some form of renal dysplasia that would fall under the general heading of congenital anomalies of the kidney and urinary tract (CAKUT)�or some other congenital disease that might be tubular. If my history and examination make both of these possibilities unlikely, then further investigation is required which might include a biopsy.

If the patient has no proteinuria (protein creatinine ratio <50 mg/mmol), then the renal function should be currently stable. Renal deterioration will not occur until there is increasing proteinuria [1�5]. The exception to this would be a pure tubular disease, and I am assuming that this disease will have been picked up during the history, examination and other basic investigations.

Patients with inexorably progressive renal failure tend to deteriorate at a rate proportional to their proteinuria [6], but generally speaking the more proteinuria, the more the rate of progression can be slowed by angiotensin converting enzyme inhibitors (ACEIs) and good control of blood pressure [2, 7�9].

Patients with small asymmetric kidneys (renal hypodysplasia�often described in the UK as reflux nephropathy) tend to deteriorate at the slowest rates, and this is rarely greater than an estimated glomerular filtration ration (eGFR) of 3�4 ml/min/1.73 m2/year [3, 7]. Studies by of our own group have shown that controlling blood pressure and reducing proteinuria with an ACEI should reduce the rate of loss down to around 1.5 ml/min/1.73 m2/year [2, 7].

Assuming that the 19-year-old patient with a serum creatinine level of 200 ?mol/l has an eGFR of 35 ml/min/1.73 m2 and that he will need dialysis when his eGFR is around 10 ml/min/1.73 m2, then he should reach ESRD in approximately 17 years [(35 ? 10) divided by 1.5 years]. If he were to lose function at the faster rate of 3 ml/min/year, this would be 8.3 years.

Chronic kidney disease (CKD) is characterized by the gradual loss of kidney function over time. If kidney disease becomes worse, it may lead to kidney failure, requiring dialysis or a kidney transplant to maintain life. The following article demonstrates that life expectancy in patients with chronic kidney disease can be predicted. While it’s known that life expectancy in patients with end-stage renal failure is reduced, life expectancy in patients with different degrees or stages of renal failure shouldn’t necessarily be affected. Kidney function outcome predictions are not a patient’s destiny but an option for how long they are expected to live.

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

Life Expectancy with CKD

Life expectancy tables for people with CKD have been created from a large population-based registry in Alberta, Canada and stratified for different levels of eGFR [10]. Data are calculated for men and women from 30 years of age to age 85 years by their levels of kidney function as defined by eGFRs of ?60, 45�59, 30�44 and 15�29 ml/min/1.73 m2 (see Table 1) [10]. These data show that life expectancy is progressively reduced with each age band of worse renal function.

Assuming our 19-year-old patient will be alive in 11 years, when he reaches 30 (the starting age of the Canadian data), what can be expected? Looking at men age 30�34 years (see Table 1), the life expectancy for those with an eGFR of ?60 ml/min/1.73 m2 is 39.1 years. This is lower than expected and certainly much less than in the UK database. For instance, data from the UK predict that a normal, healthy white male aged 30 years in 2015 has a remaining expected lifetime of 50.7 years [11]. The equivalent figure for the USA suggests that for a 30- to 34-year-old male the expected life expectancy is 45.7 years [12] (see Table 2). The authors of this latter study explain that this difference is attributed to the selective nature of their study cohort, which was limited to individuals who had outpatient serum creatinine measurements as part of routine care. They write that those with an eGFR of >60 ml/min/1.73 m2 cannot be considered as a �normal population� as patients having their creatinine measured are likely to be less well than the general population (who would not have a creatinine measure) and therefore have a lower life expectancy.

From Table 1 it can be seen that for the first three age groups (30�34, 35�39, 40�44 years), life expectancy falls by approximately 20 % with an eGFR of 45�59 ml/min/1.73 m2, by approximately 50 % with an eGFR of 30�44 ml/min/1.73 m2 and by approximately 65 % with an eGFR of 15�29 ml/min/1.73 m2, when compared with those with an eGFR of ?60 ml/min/1.73 m2 (note: these figures are calculated from the first three age groups, i.e. 30, 35 and 40 years, respectively). Thus, the GFR of our patient now age 30 would be approximately 19 ml/min/1.73 m2 (eGFR decline of 1.5 ml/min/1.73 m2) and that at this level of function his life expectancy is reduced by 70 % from 50.6 to 15 years.

The excess mortality associated with renal failure is due principally to the increased risk of cardiovascular disease. An investigation of the causes of death associated with CKD in Alberta revealed that the major cause of death was cardiovascular (including an increase in heart failure and valvular disease). The unadjusted proportion of patients who died from cardiovascular disease increased with decreasing eGFR [21, 37, 41, and 44 % of patients with an eGFR of ?60 (with proteinuria), 45�59.9, 30�44.9, and 15�29.9 ml/min/1.73 m2, respectively]. The proportion of deaths from infection also increased but not those from cancer [13].

In a separate review using meta-analysis to examine the influence of both reduced eGFR and albuminuria on cardiovascular mortality the authors found that both lower eGFR (<60 ml/min/1.73 m2) and higher albumin/creatinine ratio (ACR ?10 mg/g) were independent predictors of mortality risk in the general population [14]. Adjusted hazard ratios (HRs) for all-cause mortality at eGFRs of 60, 45 and 15 ml/min/1.73 m2 (vs. 95 ml/min/1.73 m2) were 1.18 [95 % confidence interval (CI) 1.05�1.32], 1.57 (95 % CI 1.39�1.78) and 3.14 (95 % CI 2.39�4.13), respectively. The ACR was associated with mortality risk linearly on the log-log scale without threshold effects. Adjusted HRs for all-cause mortality at ACRs of 10, 30, and 300 mg/g (vs. 5 mg/g) were 1.20 (1.15�1.26), 1.63 (1.50�1.77) and 2.22 (1.97�2.51), respectively. These data are derived from populations a higher mean age, but age was not an independent variable.

Thus, our patient, aged 19�36, even with an eGFR of approximately 45 ml/min/1.73 m2, has an increased risk of dying of around 57 % [risk ratio (RR) 1.57] compared with an eGFR of 95 ml/min/1.73 m2; similarly, with a ACR of 30 mg/g, our patient has an increased risk of dying of around 63 % (RR 1.63) compared with ACR of 5 mg/g [14]. These figures correlate with life expectancy tables [10] in which a 30-year male with an eGFR of 30�44 ml/min/1.73 m2 has a life expectancy reduced by approximately 50 % compared with a similar patient with an eGFR of ?60 ml/min/1.73 m2.

To this equation we should also consider modification of life expectancy by such factors as race, gender and socio-economic status [15, 16], as well as control of blood pressure and hyperlipidemia [17]. All of these factors are being studied in the ongoing Chronic Kidney Disease in Children (CKiD) Study.

Predicting Life Expectancy at End-Stage

If our patient is well looked after for the next 17 years, I will assume that he will not die before he reaches ESRD at the age of 36 (age 19 + 17 years at a GFR decline rate of 1.5 ml/min/1.73 m2/year). However, we now know that this assumption cannot be made. As we have seen from the Canadian data, even at age 19 years with a GFR of 35 ml/min/1.73 m2, we can extrapolate that his life expectancy is reduced by around 50 %. For a UK male aged 19 years, a life expectancy of 61.4 years [11] is reduced to 30 years (age 49 years) [10].

Assuming that our patient would be around 36 years of age when end-stage renal failure is reached, then one can use two sources of actuarial information regarding future life expectancy:-

The USRDS Annual Report�s chapter on mortality and survival has actuarial tables which show data in 5-year age bands [12] (Table 2). Thus, at 36 years of age, our patient falls into the age band 35�39 years. This shows us that a normal U.S. male of this age group can expect to live a further 41 years. The same age group will live a further 12.5 years on dialysis and 30.8 years after a successful transplant. Of course, in reality, RRT life will tend to be a mixture of the two modes.
The UK Renal Registry annual report chapter on survival also has actuarial data in 5-year age bands [18]. However, these show that the median life expectancy for patients starting RRT at the 90-day time point and for this age group (35�39 years) is a further 13.5 years (dialysis and transplant combined).
In comparison, the Canadian data show that at age 35 years with an eGFR of 15�29 ml/min/1.73 m2, the remaining life expectancy is +13.8 years [10].

Trends in Life Expectancy

A review of annual reports from the USRDS in the period 1996�2013 reveals that the life expectancy for a 36-year-old man on haemodialysis has improved steadily and linearly from 7.2 years in 1996 to 11.5 years in 2013 (see Fig. 1). Thus, one can anticipate that our current projections of life expectancy probably err on the pessimistic side of reality. This is supported by a detailed analysis of paediatric outcome over the period 1990�2010 [19].

Summary and Conclusions

We can now predict renal outcome and life expectancy with some accuracy, but data sources on life expectancy are few. The new information from Canada on life expectancy with CKD is very important but will need verifying from other parts of the world. We must not forget that collected data are often a decade old before they are analysed and published. While several long-term studies like CKiD [15�17] are running, it is still too early for them to have generated new information on life expectancy. However, trends in outcome continue to improve, suggesting that we can be more optimistic than current data suggest.

Summary Points

Life expectancy is reduced for all levels of renal function below an eGFR of 60 ml/min/1.73 m2.
Actuarial data are now available on life expectancy both for patients with chronic kidney disease and end-stage kidney disease.
The increased risk of premature death is principally related to the increase in cardiovascular morbidity.

Questions (Answers Provided Below)

Proteinuria predicts progressive renal failure if greater than:
a. 50 mg/mmol creatinine (0.5 g/d)
b. 100 mg/mmol creatinine (1.0 g/d)
c. 150 mg/mmol creatinine
d. 200 mg/mmol creatinine
Life expectancy is reduced when eGFR falls below:
a. 60 ml/min
b. 50 ml/min
c. 50 ml/min
d. 30 ml/min
Life expectancy on dialysis in USA has stopped increasing
a. Since 2000
b. Since 2005
c. Since 2010
d. Is still increasing
The increased relative risk of dying in young patients with CKD is:
a. Cardiovascular
b. Cancer
c. Infection
d. None of these

Acknowledgements

Particular thanks to Retha Steenkamp and UK Renal Registry for their generous help and advice.

Compliance with ethical standards

Conflict of Interest

The author declares no conflict of interest

Footnotes

Answers:

In conclusion, the prognosis and life expectancy predictions for patients with CKD don’t guarantee how long a patient with CKD is expected to live. Instead, these statistics may be useful towards determining an alternative treatment option which may help change these outcomes in patients with CKD. Information referenced from the National Center for Biotechnology Information (NCBI). The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at�915-850-0900�.

Curated by Dr. Alex Jimenez

Additional Topics: Acute Back Pain