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.
Dr. Alex Jimenez, D.C., presents how hypertension affects the human body and some causes that can increase hypertension in many individuals in this 2-part series. We refer our patients to certified medical providers who provide multiple available treatments for many individuals suffering from hypertension associated with the cardiovascular and immune systems affecting the body. We encourage each of our patients by mentioning them to associated medical providers based on their analysis appropriately. We understand that education is a delightful way when asking our providers questions at the patient’s request and understanding. Dr. Jimenez, D.C., only makes use of this information as an educational service. Disclaimer
How To Look For Hypertension
Dr. Alex Jimenez, D.C., presents: Let’s go back to the decision tree so you can begin to think about how you will apply the go-to-it model in functional medicine to hypertension and how you will start better assessing somebody with hypertension rather than telling them that their blood pressure is elevated. Is the body influenced by inflammation, oxidative stress, or immune response? Is it affecting endothelial function or vascular smooth muscle from those three categories of reactions, inflammation, oxidative stress, or immune response? Do we choose a diuretic calcium channel blocker or an ACE inhibitor? And so to do that, it’s really important in our gather section. Taking the medical history and the timeline of their hypertension, you get a clue about the organ damage to the questionnaires. You’re looking at their anthropometrics.
This includes the following questions:
What are the inflammatory markers?
What are the biomarkers and clinical indicators?
Those are outlined through the clinical decision tree. And already just doing that, you’re going to expand and fine-tune your lens on what you might see in your hypertensive patient. Let’s add to the timeline when does hypertension begin? The timeframe of hypertension begins actually in prenatally. It’s important to ask your patient if they were early or large educational age. Was their mother stressed? Were they born early or premature? Was there nutritional stress in their pregnancy? If they know that, you can have two people with the same kidney size, but the person who didn’t have enough protein during pregnancy can have up to 40% less glomeruli. Knowing that will change how you adjust the medication decades later if you know they possibly have 40% less glomeruli.
The Timeline For Blood Pressure
Dr. Alex Jimenez, D.C., presents: So it’s important to take the timeline of their blood pressure. Then it’s also important to recognize what is happening when we begin to organize and collect data through the biomarkers; the basic biomarkers will give you clues about whether they have issues with insulin lipids, whether they have problems with vascular reactivity, autonomic nervous system balance, imbalance, coagulation, or immune toxin effects. So this is a reasonable thing to print off because, in your hypertensive patient, this is through just the biomarkers you can begin to get a clue as to what areas of dysfunction affect inflammation, oxidative stress, and immune response and how these biomarkers reflect that information for you. This is very reasonable to have in front of you to help change your thoughts about hypertension and also enables you to refine some of the characteristics of the person on the other side of your stethoscope in a more personalized, precise way.
But let’s start at the very beginning. Does your patient have high blood pressure? We know that depending on the end organ effects of their comorbidities, you may run someone a slightly higher blood pressure if you have a profusion issue in the brain and the kidneys or the heart, but some guidelines are there. Our 2017 American Heart Association guidelines for blood pressure categories are listed here. They’ve waxed and waned back and forth over the last couple of decades, but this is very clear. Having elevated blood pressure, anything above 120, really shifted how many people we start seeing or considering addressing the root causes of their blood pressure. So we will come back to this, especially in the case to help us look at how we categorize people with blood pressure issues.
The Criteria To Mesure Blood Pressure
Dr. Alex Jimenez, D.C., presents: What is the first step? It’s how do you have the blood pressure taken in your patient? Do they monitor it at home? Do they bring those numbers to you? How do you monitor blood pressure in your clinic? How do you get accurate readings in your clinic? Here are the criteria to accurately measure blood pressure and the questions to consider whether you’re doing all these.
Do you ask your patient whether they’ve had caffeine in the last hour?
Whether they’ve smoked in the previous hour?
Were they exposed to smoke in the last hour?
Is the place where you’re taking blood pressure warm and quiet?
Are they sitting with their back supported in a chair with their feet on the ground?
Do you use the roll-around side table to rest your arm at the heart level?
Are they sitting at the exam table with their feet dangling, and a nurse aide elevates their arm and puts in their axillary fold to hold their arm there?
Are their feet on the ground?
Have they sat there for five minutes?
Have they exercised in the previous 30 minutes?
You may have systolic blood pressure if everything is in the criteria. Here’s the challenge. There are 10 to 15 millimeters of mercury higher when it comes to sitting and taking blood pressure. What about the cuff size? We know last century; most adults had an upper arm circumference of fewer than 33 centimeters. Over 61% of people now have an upper arm circumference greater than 33 centimeters. So the size of the cuff is different for around 60% of your adult patients, depending on your population. So you have to use a large cuff. So take a look at how blood pressure is collected in your office. Let’s say the blood pressure is elevated in your patients; then we have to ask, is it normal? Great.
The Different Types Of Hypertension
Dr. Alex Jimenez, D.C., presents: Is it elevated because of white-coat hypertension? Do they have normal blood pressure, elevated outside the clinic, or masked hypertension? Or do they just have sustained hypertension which is a challenge? We’ll talk about that. So when you interpret, it is also important to consider ambulatory blood pressure monitoring. So if you have somebody who’s hypertensive and don’t know whether the blood pressure goes down and you’re trying to figure out whether they have sustained hypertension, you can use 24-hour blood pressure monitoring. The mean daytime blood pressure above 130 over 80 is hypertensive the mean nighttime blood pressure above 110 over 65 is hypertensive. So why is this important? The average blood pressure dips to around 15% at night because of the issue with blood pressure dipping. Failure to have blood pressure drop while you sleep at night could develop problems that can affect a person throughout the day.
If your patient sleeps at night, it should drop about 15% when they sleep. If they have non-dipping blood pressure, it is associated with comorbidities. What are some of those comorbidities in non-dipping blood pressure? Some of the conditions correlated with non-dipping blood pressure include:
Congestive Heart Disease
Cardiovascular Disease
Cerebrovascular Disease
Congestive Heart Failure
Chronic Renal Failure
Silent Cerebral Infractions
Co-morbidities Associated With Non-Blood Pressure
Dr. Alex Jimenez, D.C., presents: These are the comorbidities associated with non-blood pressure. All of us agree that elevated blood pressure is not necessarily good in all those conditions. So when you look at different people groups or other comorbidities, non-dipping blood pressure is most commonly associated with sodium-sensitive folks, people who have renal insufficiency, people who have diabetes, people who have left ventricular hypertrophy, people who have refractory hypertension or autonomic nervous system dysfunction and finally, sleep apnea. So, non-dipping blood pressure increases your association with subclinical cardiac damage. Okay, Reverse dipping means you are more hypertensive at night and is more ascent associated than during the day is more related to hemorrhagic stroke. And if you have somebody with nocturnal hypertension, you have to start thinking about things like the carotid arteries and increased carotid, internal medial thickness. You start thinking about left ventricular hypertrophy and may see it on EKG. Here’s what we know about nocturnal hypertension. Nocturnal hypertension is a nighttime blood pressure greater than 120 over 70. It is associated with greater predictability of cardiovascular morbidity and mortality.
If you have nocturnal hypertension, it increases your risk of mortality from cardiovascular disease by 29 to 38%. We must know what’s happening at night when we sleep, right? Well, what’s another refinement? Another refinement is recognizing that resting blood pressure is controlled by your renin-angiotensin system. Waking blood pressure is controlled by your sympathetic nervous system. So let’s talk about how their renal angiotensin system drives their nighttime hypertension, and you think about what medication they’re taking. You might change the medication dosing to nighttime. Well, studies have shown that if you have nighttime hypertension and are a non-dipper, it’s best to take your ACE inhibitors, ARBs, calcium channel blockers, and certain beta blockers at night before bed. But it makes sense that you wouldn’t move your diuretics to nighttime, or you will have a disruptive sleep.
Addressing Daytime & Nighttime Blood Pressure
Dr. Alex Jimenez, D.C., presents: So if we don’t address daytime and nighttime blood pressure, we have to consider the effect of blood pressure load. What is your average daytime blood pressure and your moderate sleeping blood pressure is. We know that blood pressure load in young adults is hypertensive only about 9% of the time. So meaning the systolic load is about 9% versus in the elderly, about 80% of the blood pressure load is systolic. And so when you have a higher systolic load, you have more complications and end-organ damage. So what we’re talking about is helping identify your patient with hypertension; what is their timeline? What is their phenotype? Are they only hypertensive during the day, or they’re hypertensive at night also? We have to look at what helps balance that.
Here’s the other point, only about 3.5% of people with hypertension do it have a genetic cause. Only 3.5% of people their genes cause hypertension. The power is at the bottom of the matrix and recognizing these patterns, right? So you look at exercise, sleep, diet, stress, and relationships. So we know that these four autonomic balances help determine blood pressure. We will examine the renal angiotensin system, plasma volume where they hold onto too much fluid, secondary salt load, and endothelial dysfunction. Abnormalities in any of these can lead to hypertension. We’ve been talking about another one that can lead to hypertension: the link between insulin resistance and hypertension.
This diagrammatically gives you an idea of the physiologic interactions between insulin resistance and hypertension. It affects increasing sympathetic tone and increasing renal-angiotensin system balance. So let’s spend a few minutes on the renin-angiotensin system pathway angiotensinogen down to angiotensin two. We take advantage of these enzymes by giving inhibitors to angiotensin-converting enzymes in our hypertensives patients. Elevated angiotensin two leads to cardiovascular hypertrophy, leads to sympathetic phase constriction, increased blood volume, sodium fluid, retention, and aldosterone release. Can you inquire about your patient biomarkers? Can you ask whether they have elevated renin levels?
Look For The Signs
Dr. Alex Jimenez, D.C., presents: Well, you can. You can check plasma renin activity and aldosterone levels. It’s important to do this if your patient is hypertensive and has never been on medication because this is where nitrous oxide is so important. This is where your endothelial nitric oxide synthase is present. This is where you have sheer and hemodynamic stress. This is where dietary intake of arginine or the environment that affects nitric oxide plays such a role in the health of this layer of endothelia. If you lay it all together somehow, miraculously, or at least in your mind’s eye, it’ll cover six tennis courts in the average adult. It’s a huge surface area. And the things that cause endothelial dysfunction are not new news to people in functional medicine. Increased oxidative stress and inflammation are two things we mentioned that play an effect.
And then, look at some of these other components, your ADMA being elevated and correlated with insulin resistance. It all begins to form together in a matrix that interacts. So you look at one comorbidity in cardiometabolic syndrome, and it affects another comorbidity. You suddenly see the interrelation between them or hyperhomocysteinemia, which is a one-carbon metabolism marker, meaning you’re looking at the adequacy of folate, b12, b6, riboflavin, and that activity of your one-carbon metabolism. So let’s look at some of these emerging risk markers to improve and track in patients with hypertension. Let’s reanalyze ADMA again. ADMA stands for asymmetric dimethyl arginine. Asymmetric, dimethyl arginine is a biomarker of endothelial dysfunction. That molecule inhibits nitric oxide synthase while impairing endothelial function, and in all of the comorbidities associated with cardiometabolic syndrome, ADMA can be elevated.
Conclusion
So, as a quick review, L-arginine is converted to nitric oxide via nitric oxide synthase, and nitric oxide adequacy leads to vasodilation. ADMA blocks this conversion. And if your ADMA levels are elevated and your nitric oxide levels are low, then you have decreased nitric oxide platelet aggregation increases in LDL oxidation. So many things reduce nitric oxide or are associated with lower nitric oxide levels, sleep apnea, low dietary arginine, protein, zinc insufficiency, and smoking.
Dr. Alex Jimenez, D.C., presents how anti-inflammatory phytochemicals can reduce inflammation and treat other chronic conditions that inflammation is correlated with. We dive into what medicines can trigger inflammatory cytokines and some treatments that work together to reduce chronic inflammation. We refer our patients to certified medical providers incorporating multiple therapies for many individuals suffering from chronic inflammation and its correlating symptoms affecting the body. We encourage each of our patients by mentioning them to associated medical providers based on their analysis appropriately. We understand that education is a delightful way when asking our providers questions at the patient’s request and understanding. Dr. Jimenez, D.C., only makes use of this information as an educational service. Disclaimer
How Medications Associate With Inflammation
Dr. Alex Jimenez, D.C., presents: When it comes to a person’s health and wellness, it is important to know that when you are introducing them to potential antigenic medication, that person’s immune system is already imbalanced and much more likely to make abnormal immune responses, which then can lead to inflammatory effects in the body’s system. You see them mostly with chimeric human marine antibodies, which are the ones that make antibodies for the immune system, to that point, will elicit a much higher immune response. When this happens, it becomes a challenge to long-term pharmacotherapy. So when people go to their doctors for a prescription, about 20-30% of medication prescriptions are never filled because, most of the time, the prescription will never fill them in the drugstore, which can cascade into various issues.
And when people follow their prescription, sometimes they’ll take it for a little while, and after six months, they stop taking it. So the drop in prescriptions taken for longer than six months is quite low. In the last article, we discussed NSAIDs, DMARDs, and biologics, and we will touch base with acetaminophen. Acetaminophen is another one that’s just really widely used, and it’s because it’s put into all of these different cold and flu, and pain products. They sneak it into many other medications; you must read the labels. This is because some people metabolize acetaminophen quickly, which can become toxic. This can lead to individuals getting random headaches throughout the day and causes their glutathiones to be used promptly. So when looking for cold and flu medicine, it is best to look at the labels for acetaminophen because it doesn’t have anti-inflammatory responses since it is used for pain control.
How Acetaminophen Affects the Immune System
Dr. Alex Jimenez, D.C., presents: So even though we do not know how exactly how the analgesic effects work when people take cold and flu medicines, however, we do know that when people take a ubiquitous amount of acetaminophen, it could increase the pain threshold by inhibiting nitric oxide pathways in the body through mediation through the receptors for NMDA and substance P. We still don’t have a great handle on that, but that’s how it works. So, these drugs can be quite useful in the short term, but long-term use has serious side effects.
When looking for medications, it is important to read the labels that have a black box warning, which is the highest warning that the FDA issues for any potential overlapping risk profiles that the FDA issues. This can include severe liver injuries or serious possible allergic reactions that can develop into chronic inflammation of the muscles and joints. Now there are ways to reduce inflammation and prevent the body from being in more pain by slowly introducing anti-inflammatory botanicals and phytochemicals to detoxify the medication causing these complications.
Some individuals may not realize that constant medication for various pains and issues affecting the body can mask other problems involving the body’s systems. This can include:
Endocrine system
Cardiovascular system
Gastrointestinal system
Reproductive system
When these systems have been affected by medications, they can develop inflammatory markers in the vital organs and cause lead to visceral-somatic dysfunction in the body. When pain medications target pain localized in one location, but the issue is in a different area, this is known as referred pain. Referred pain is where the pain is in one muscle group location but is felt in another area of the body. When the organs are involved, it can cause inflammatory symptoms in the system. To that point, this causes the immune system to be induced into autoimmunity.
How The Immune System Is Induced Into Autoimmunity
Dr. Alex Jimenez, D.C., presents: When the immune system has been induced with autoimmunity, the corticosteroids can develop side effects that can be long termed and delay the healing process. Some of the physical symptoms that are visible with autoimmunity include:
Muscle weakness
Diabetes
High blood pressure
Thin bones
Delay wound healing
Flare-ups
Rheumatoid arthritis
Mood changes
When dealing with these inflammatory symptoms associated with pain, there are fundamental functional treatment approaches that can reduce the inflammatory cytokines causing joint and muscle pain.
Treatments To Target Inflammation
Dr. Alex Jimenez, D.C., presents: Some of the treatments that target inflammation include the following:
Slowly incorporating healthy lifestyle choices into a person’s daily lifestyle can reduce the effects of inflammatory cytokines affecting the vital organs, muscles, and joints. It is important to know that incorporating antioxidants, phytonutrients, and anti-inflammatory supplements can reduce residual symptoms in the body. All these treatments are some of the foundations that can address these inflammatory triggers and help reduce muscle and joint pain associated with inflammation.
Anti-Inflammatory Vitamins & Supplements
Dr. Alex Jimenez, D.C., presents: Another important note about these treatments is that vitamins and supplements can combine to help treat inflammatory effects that are causing issues in the body. These anti-inflammatory botanicals and phytochemical agents can not only act on the different pathways in the body but also have different mechanisms similar to healthy nutritional foods. Incorporating anti-inflammatory botanicals and phytochemical agents into the body will help modulate the inflammatory cascades and provide multiple synergistic activities to the body.
These agents down-regulate the inflammatory pathways caused by NF-kappaB. They can act as modulators that dissociate the cytokines from causing more issues like oxidative stress or infections triggering inflammation. However, we need inflammation to heal the body from wounds and infections. We mustn’t want the cytokines too high to cause inflammatory effects. So incorporating anti-inflammatory botanicals and phytochemicals provides a much safer option to the body and can be used in many chronic inflammatory conditions.
Conclusion
Since many botanicals and phytochemicals have anti-inflammatory properties, it can be difficult to find a good amount that the body needs to reduce chronic inflammation. Since many cultures and places have used many nutritional plants and herbs for years worldwide, it can be exhausting. Some of the botanical supplements include:
Zinc
Green tea extract
Capsaicin
S-adenosylmethionine
Ginger
To summarize how it is important to know which supplements have anti-inflammatory properties, doing research and incorporating small changes into a daily lifestyle can provide amazing results and allow the individual to be pain-free and have good health when combining botanicals and phytonutrients.
Trail mix is a favorite snack for many individuals. A typical mix combines granola, dried fruits, nuts, seeds, cereals, and pretzels. The mix was originally developed as a portable snack/meal for hikers that was lightweight, could be stored in a backpack, and provided plenty of protein and energy. Prepackaged trail mix is available at many grocery stores and online retailers. It’s an excellent choice for traveling or going on a road trip because of its energy and nutritional content. However, not all types are considered equal in terms of nutrition. Some can consist of ingredients loaded with sugar and salt. Added consumption could cause weight gain and contribute to conditions like heart disease, type 2 diabetes, and liver problems. Here we look at choosing healthy mixes.
Trail Mix
The nutritional power comes from the high amounts of fiber and antioxidants.
Benefits
Protein and Healthy Fats
Protein is essential for tissue repair, immune health, and muscle development.
Nuts and seeds make up the largest portion.
A healthy source of protein, allowing individuals to snack on the go and not become hungry.
One of the greatest benefits of eating these is that they are full of heart-healthy fats.
These healthy fats help decrease unhealthy LDL cholesterol levels and reduce inflammation.
Fiber
The fiber in the seeds and granola helps keep the gut healthy and regular.
It also helps control appetite, aids in digestion, and keeps the body fuller longer.
Energy
Dried fruits and granola consist of healthy sugars.
Healthy sugars help stabilize blood sugar levels, providing the body with a consistent energy source.
Antioxidants, Vitamins, and Minerals
Dried fruit maintains a majority of its nutritional value.
The nuts and seeds are also packed with nutrients and antioxidants.
Choosing Healthy
Check the nutrition label and avoid varieties high in added sugar or sodium.
Look for products containing nutrient-dense ingredients like nuts, seeds, dried fruits, and limited amounts of candy or chocolate chips, if any.
Healthy ingredients include almonds, pumpkin seeds, cashews, sunflower seeds, dried fruit, popcorn, and dark chocolate.
Making trail mix at home allows control of its contents and maximizes its potential health benefits.
It is important to keep an eye on portion control.
A recommended serving is about a fourth of a cup.
Nutritionist
Nutritional consultation can improve an individual’s quality of life, health, and well-being. A nutritionist can help individuals with precision or personalized nutrition that focuses on the individual. Nutritionists can create meal plans for their clients and provide education and knowledge on appropriate food choices.
Potassium
References
Devitt, A A et al. “Appetitive and Dietary Effects of Consuming an Energy-Dense Food (Peanuts) with or between Meals by Snackers and Nonsnackers.” Journal of nutrition and metabolism vol. 2011 (2011): 928352. doi:10.1155/2011/928352
Grillo, Andrea et al. “Sodium Intake and Hypertension.” Nutrients vol. 11,9 1970. 21 Aug. 2019, doi:10.3390/nu11091970
Mehlhose, Clara, et al. “PACE Labels on Healthy and Unhealthy Snack Products in a Laboratory Shopping Setting: Perception, Visual Attention, and Product Choice.” Foods (Basel, Switzerland) vol. 10,4 904. 20 Apr. 2021, doi:10.3390/foods10040904
Vreman, Rick A et al. “Health and economic benefits of reducing sugar intake in the USA, including effects via non-alcoholic fatty liver disease: a microsimulation model.” BMJ open vol. 7,8 e013543. 3 Aug. 2017, doi:10.1136/bmjopen-2016-013543
Chiropractic care has a powerful therapeutic effect on the body’s systems. This includes the nervous, muscular, skeletal, and lymphatic. The lymphatic system is a part of the immune system. It circulates lymph, a fluid comprised of white blood cells that support the immune system, proteins, and fats. The lymphatic system collects toxins, moves waste, and protects the body from foreign invaders. Together with the immune system, the lymphatic system keeps the body balanced. However, imbalances occur due to misalignments, subluxations, compressed nerves, chronic conditions, and injuries. Chiropractic care, massage, and decompression therapy can help mobilize stuck or misaligned joints, reduce muscular tension, alleviate nerve inflammation and discomfort, and restore optimal function.
Spinal Lymphatic Detox
Lymphatic System
The lymphatic system is a network throughout the body. The system drains lymph fluid from the blood vessels into the tissues and empties it back into the bloodstream through the lymph nodes. The main functions of the system include the following:
Regulates fluid levels in the body.
Activates when bacteria or viruses enter.
Manages and removes cancer cells or cell byproducts that could result in disease or disorders.
Absorbs some of the fats from the intestine.
The lymph nodes and other structures like the spleenand thymushouse specialized white blood cells called lymphocytes. These are ready to go and can rapidly multiply and release antibodies when bacteria, viruses, and other stimuli, enter the body.
Fluid Balance
The blood in the vessels is under constant pressure. Nutrients, fluids, and certain cells need to circulate throughout the body to supply the tissues and maintain the system’s defense. The lymphatic system:
Removes all fluids and contents that leak into the tissues.
Eliminates waste products formed in the tissues.
Eliminates bacteria that enter through the skin.
The digestive and respiratory systems are lined with lymphatic tissue because the systems are exposed. The most important sites are the tonsils, the intestinal region, and the appendix. Lymph nodes are the filters. Viruses and cancer cells get trapped and destroyed in the lymph nodes. More lymphocytes are produced when an infection is present, which is why the nodes experience swelling. When the lymphatic system does not drain fluids from the tissues properly, the tissues swell and can cause symptoms of discomfort. If the swelling is only for a short period, it is called edema. If it lasts more than three months, it is called lymphoedema.
Symptoms of Unhealthy Circulation
Unhealthy circulation can include the following symptoms:
Fatigue
Concentration problems
Cold hands or feet
Swelling
Muscle cramps
Numbness
Tingling
Stinging
Throbbing
Development of ulcers on the feet, ankles, and legs.
Chiropractic Care
A chiropractic spinal lymphatic detoxtreatment releases stagnant fluid collected in the joints, muscles, and tissues. A personalized treatment plan will consist of massage therapy to increase circulation, release and relax the muscles and nerves, chiropractic to realign the body, decompression to open the spine, stretching techniques to improve flexibility, and nutritional guidance to support optimal circulation. The benefits include:
Discomfort and pain relief.
Stress and anxiety relief.
Balanced and realigned body.
Relaxed muscles.
Helps with allergy symptoms.
Detoxes bacteria along the spine.
Lymphatic Anatomy
References
Dmochowski, Jacek P et al. “Computational Modeling of Deep Tissue Heating by an Automatic Thermal Massage Bed: Predicting the Effects on Circulation.” Frontiers in medical technology vol. 4 925554. 14 Jun. 2022, doi:10.3389/fmedt.2022.925554
Majewski-Schrage, Tricia, and Kelli Snyder. “The Effectiveness of Manual Lymphatic Drainage in Patients With Orthopedic Injuries.” Journal of sport rehabilitation vol. 25,1 (2016): 91-7. doi:10.1123/jsr.2014-0222
Mihara, Makoto et al. “Combined conservative treatment and lymphatic venous anastomosis for severe lower limb lymphedema with recurrent cellulitis.” Annals of vascular surgery vol. 29,6 (2015): 1318.e11-5. doi:10.1016/j.avsg.2015.01.037
Mortimer, Peter S, and Stanley G Rockson. “New developments in clinical aspects of lymphatic disease.” The Journal of clinical investigation vol. 124,3 (2014): 915-21. doi:10.1172/JCI71608
Weerapong, Pornratshanee et al. “The mechanisms of massage and effects on performance, muscle recovery and injury prevention.” Sports medicine (Auckland, N.Z.) vol. 35,3 (2005): 235-56. doi:10.2165/00007256-200535030-00004
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.
The hips in the lower portions of the body allow the legs to move the host from one location to another and provide stability to support the upper body’s weight. The hips will enable the torso to twist and turn without feeling pain. This is due to the various muscles and ligaments surrounding the pelvic bone and hip joint socket that allow the motion to be possible. However, when various injuries or factors start to affect the multiple muscles surrounding the pelvis or there is a chronic condition like osteoarthritis that causes wear and tear on the hip joints can cause underlying symptoms associated with the hips and cause many individuals to have difficulty when moving around. Luckily there are ways to improve hip mobility and the surrounding muscles in the hip and pelvic region of the body. Today’s article looks at the causes of the development of tight hips in the body and how different stretches can release tight hip flexor muscles. We refer our patients to certified providers that incorporate techniques and multiple therapies for many individuals suffering from hip pain and its correlating symptoms that can affect the musculoskeletal system in the hips, legs, and lumbar region of the spine. 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
What Causes The Body To Develop Tight Hips?
Have you been dealing with hip mobility issues? When you sit, do you feel uncomfortable, and your hip muscles become tight? Or do you have a decreased range of motion when moving your hips? It could correlate with your hips if you have been experiencing muscle pain issues in the lower extremities. The hips help stabilize the upper and lower portions of the body while providing the full leg’s range of motion. When a person begins to sit for long periods or twist their body in a weird position, it can cause the muscles that surround the hips to become shortened. Other issues, like chronic conditions, can play a role in developing tight hip flexors. Studies reveal that various pathologies affecting the hips, lumbar spine, and lower extremities could strongly correlate with restricted hip mobility that can cause harmful effects that can affect the hips. To that point, some of the symptoms associated with tight hip flexors include:
Instability
Hypermobility
Limited range of motion
Reduce muscle strength in the groin
Muscle cramps
Sharp, sudden pain in the hips, pelvis, or groin
Low back pain
Piriformis syndrome
Other research studies mentioned that hypermobility disorders could affect the hip joints. Hypermobility disorders like EDS (Ehlers-Danlos syndrome) could cause micro or macro-trauma on the hip joint and affect the ligaments surrounding the hip joint. To that point, it can cause the hip flexor muscles to become tense and potentially affect how a person moves, which then causes soft tissue injuries and chronic pain.
Hip Flexor Stretches-Video
Do you feel tight along your hips? Do you see yourself hobbling around when walking? Or do you feel aches or strains when stretching? Many of these issues correlate with tight hip flexors that could result from hip pain in the lower extremities. When a person has tight hip flexors, it could be due to them constantly sitting down, causing the hip muscles to be shortened, or chronic conditions that can affect the hip joint and muscles. However, there are various ways to prevent tight hip flexors and regain mobility back to the hips. Studies reveal that stretching combined with core stabilization can help improve the hip’s range of motion while ensuring core endurance exercises can help strengthen the surrounding muscles in the hip area. The video above shows stretches targeting the hip flexor muscles and helps improve hip mobility.
Different Stretches To Release Tight Hip Flexors
Studies have shown that the hip flexor muscles are the main contributors to lumbar spine stability when releasing tight hip flexor muscles. So when there are tight hip flexors, it can cause overlapping risk profiles to the lumbar spine, which leads to pain and impairment in performance. The best way to reduce the pain-like symptoms associated with tight hip flexors is by stretching the lower half of the body to reduce muscle strain and tightness in the hip flexors. Additional studies have found that stretching combined with exercises targeting the low back can reduce the pain caused in the low back and help improve stability and strengthen the surrounding muscles located in the hips. Now it is important to remember that stretching for at least 5-10 minutes before and after working out allows the muscles to warm up and improve flexibility. Below are some different stretches that can release tight hip flexors.
High Crescent Lunge
While standing on the mat, take a step forward to allow your right foot to be in a staggard stance *Think in a lunge position.
Bend the front knee gently while keeping the back leg straight, as this allows the heel in the back leg to be lifted off the mat; the bent front knee enables the thigh to be parallel to the floor, and the right foot is pressed flat on the mat.
Square up the hips, so they face toward the mat’s front.
Extend the arm up towards the ceiling to stretch upwards while pressing into the mat to feel the hips stretch
Hold for five breaths before slowly rising out of the lunge position and repeating on the other side.
This stretch helps release tension in the hip flexors and quads while warming up the muscles and increasing blood flow to the legs.
Knee-To Chest Stretch
Lie on the mat with both legs extended out and feet flexed.
Pull on the left knee to the chest while keeping the right leg straight, and the lumbar portion of the back is pressed into the mat.
Hold the position while taking deep breaths for 30 seconds to 2 minutes.
Release slowly and repeat on the right leg *You can lift both knees to your chest and rock slowly from side to side to relieve low back tension as an alternative.
This stretch is extremely helpful for tight hamstrings and allows the tense muscles on the hips and lower back to relax while increasing blood flow back to the muscles.
Piriformis Stretch
On the mat, sit with both legs extended out.
Cross the right leg over the left and place the other flat on the floor while the left foot is flexed
Place the right hand behind the body while the left elbow is on the right knee.
On inhale, press the right leg to the left while allowing the torso to twist on the right.
Take five breaths for a deeper stretch and switch sides to repeat the action with the left hand *If you have low back pain issues, the modified version allows you to use your left hand to pull the right quad in and out to the left and vice versa.
This stretch helps loosen tight muscles in the lower back, hips, and glutes. If you have sciatic nerve pain associated with piriformis syndrome, this stretch helps release muscle tension from the piriformis muscle aggravating the sciatic nerve.
Happy Baby Pose
Lie on the mat with both knees bent and feet on the ground.
On inhale, lift the feet off the ground and grab the outer sections of the feet with your hands.
Then gently pull the feet towards the chest and allow the knees to lower to the ground, on either side of the body, while keeping the back flat on exhale.
Hold the position for at least five breaths.
This stretch helps with the inner thigh muscles or hip adductors and helps them become loose and mobile without feeling any strain or tension.
Bridge Pose
On the mat, lie on your back and sides, and extend your arms while your feet are flat on the floor with your knees bent.
Press with your heels to lift the hips and allow the feet to walk a few steps toward the body. *Keep the feet and knees hip-width apart.
Clasp hands together underneath the body and press them into the mat
Hold the position for five breaths.
This stretch helps take the pressure off the hip muscles while strengthening the glutes and abdominal muscles.
Conclusion
When it comes to releasing tight hip flexors after sitting for a long time or having hip issues affecting your low back or pelvis, Doing different stretches that target the hips can reduce the pain and release tight muscles associated with other conditions that can affect the body. The hips are important to take care of since they provide mobility and stability to the upper and lower portions of the body. They support the upper body’s weight while providing a huge range of motion to the legs. Incorporating these different stretches can reduce the pain that they have been under and help warm up the other muscles that surround the lower extremities.
References
Lee, Sang Wk, and Suhn Yeop Kim. “Effects of Hip Exercises for Chronic Low-Back Pain Patients with Lumbar Instability.” Journal of Physical Therapy Science, U.S. National Library of Medicine, Feb. 2015, www.ncbi.nlm.nih.gov/pmc/articles/PMC4339134/.
Moreside, Janice M, and Stuart M McGill. “Hip Joint Range of Motion Improvements Using Three Different Interventions.” Journal of Strength and Conditioning Research, U.S. National Library of Medicine, May 2012, pubmed.ncbi.nlm.nih.gov/22344062/.
Reiman, Michael P, and J W Matheson. “Restricted Hip Mobility: Clinical Suggestions for Self-Mobilization and Muscle Re-Education.” International Journal of Sports Physical Therapy, U.S. National Library of Medicine, Oct. 2013, www.ncbi.nlm.nih.gov/pmc/articles/PMC3811738/.
The various muscles and ligaments that encompass the back help protect the spine’s thoracic region. The spine has three sections: cervical, thoracic, and lumbar, which assist the body with bending, turning, and twisting. For the thoracic spine, various muscles like the rhomboid, trapezoid, and other superficial muscles provide functionality to the scapula or shoulder blades to stabilize the ribcage. When the body succumbs to injuries or traumatic forces, it can develop myofascial pain syndrome associated with upper back pain. Upper back pain can lead to unwanted symptoms affecting their quality of life. Fortunately, various exercises target the upper portion of the back and can strengthen multiple muscles from injuries. Today’s article looks at the effects of upper back pain in the body and shows a few stretches and exercises that can support the various muscle groups in the upper back region. We refer our patients to certified providers that incorporate techniques and multiple therapies for many individuals suffering from upper back pain and its correlating symptoms that can affect the musculoskeletal system in the neck, shoulders, and thoracic region of the spine. 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
The Effects Of Upper Back Pain In The Body
Have you been experiencing stiffness around or near your shoulder blades? Do you feel muscle strain when you are rotating your shoulders? Or does it hurt when you stretch your upper back in the morning? Many of these issues are signs and symptoms of upper back pain. Studies reveal that back pain is one of the most common complaints many individuals would go for emergency care. Back pain can affect the different regions in the back and cause unwanted symptoms in various areas in the upper back. Additional studies mentioned that persistent pain in the thoracic region could cause hyper-sensitization of the intercoastal nerves that mimic other conditions affecting the back. Some of the causes and effects that can lead to the development of upper back pain include:
When this happens, it can lead to overlapping conditions that mimic other issues and, if not treated right away, leave individuals with chronic disabling symptoms that correlate with upper back pain.
Upper Back Pain Relief-Video
Have you been experiencing stiffness in your shoulders or neck? Do you feel aches and pains when stretching your arms? Or what about feeling muscle strain when lifting a heavy object? Many of these factors correlate with upper back pain affecting the thoracic spine region. When this happens, it can lead to overlapping risk profiles that can develop into different issues that can cause even more pain to the body. There are various ways to prevent upper back pain from causing further issues to the individual and can relieve the pain associated with it. Many people would go to chiropractic therapy to have their spine re-aligned to bring adequate relief or incorporate upper back exercises and stretches to relieve tension accumulated in the neck and shoulder regions. The video above explains how stretches work for different muscle regions in the upper back and provide relief to the thoracic spine.
Exercises For Upper Back Pain
Regarding the upper back, it is important to understand that incorporating various exercises that target the thoracic region can cause prolonged injuries. Studies reveal that different back exercises focus not only on the back but the shoulders, arms, chest, core, and hips providing stability, balance, and coordination to the individual. This allows the muscles in the back region to improve strength and endurance over time when a person continues to work out. More studies reveal that protocols like the McKenzie back exercise are effective programs to treat various musculoskeletal conditions that can cause pain in the back. Many physical therapists use this protocol on their patients to relieve back pain and help improve their muscular structure to have better posture.
Warm Up
Just like any individual that is starting to get back to their health and wellness through exercise, the most important step that anyone has to do is warming up their muscles before getting into a workout. Warming up each muscle group can prevent future injuries and increase blood flow before starting the exercise. Many individuals would incorporate stretches and foam rolling for 5-10 minutes to ensure that each muscle is ready to perform with maximum effort.
Exercises
After the body is warmed up, it is time to begin the exercise regime. Many different exercise movements target each muscle group and help build muscle mass and improve functionality. It is important to build up momentum when it comes to working out. Starting slowly with minimum reps and sets is important to ensure the exercise is done correctly. Afterward, the individual can increase the workout reps and go with a heavier weight. Below are some of the exercise routines that are suited for the upper back.
Superman
Lie on your stomach and extend your arms above the head
Keep neck in a neutral position and lift legs and arms off the floor at the same time
Make sure to use the back and glutes to lift
Briefly pause at the top, then return to starting position
Complete three sets of 10 reps
This exercise helps strengthen the spine and surrounding muscles to support the spine and reduce any future injuries from upper back pain.
Reverse Dumbbell Flies
Grab light weighted dumbbells
Hinge at the waist at 45 degrees while standing
Make sure the arms are hanging down with the weights
Keep the neck in a neutral position while gazing down
Lift the arms (with the dumbbells) out to the side and upwards
Squeeze the shoulders together at the top during this movement
Complete three sets of 8-12 reps
This exercise is excellent for strengthening the muscles that surround the shoulder and upper back.
Rows
Use a resistance band or a light weighted dumbbell.
For the resistance band, affix the band to a stable surface above eye level. For the light weighted dumbbells, extend the arms in front of the body above eye level.
Use an overhead grip when holding the resistance band handles and the light weighted dumbbells.
Pull resistance bands or dumbbells toward the face.
Flare out the upper arms to the sides
Squeeze the shoulders together
Pause for a bit and then return to starting position
Complete three sets of 12 reps
This exercise helps strengthen the shoulder muscles and prevent future injuries from occurring in the upper back.
Conclusion
Some various muscles and ligaments encompass the back and help protect the spine’s thoracic region. These muscles help with the stabilization of the ribcage and help provide the functionality to the upper back. When multiple factors cause traumatic injuries to the upper back, it can lead to pain-like symptoms that can cause overlapping features and affect a person’s quality of life. Luckily, various exercises target the upper back and surrounding muscle groups. Each activity targets all the muscles in the upper back and allows a person to regain health and wellness without constant pain.
References
Atalay, Erdem, et al. “Effect of Upper-Extremity Strengthening Exercises on the Lumbar Strength, Disability and Pain of Patients with Chronic Low Back Pain: A Randomized Controlled Study.” Journal of Sports Science & Medicine, U.S. National Library of Medicine, 1 Dec. 2017, www.ncbi.nlm.nih.gov/pmc/articles/PMC5721192/.
Casiano, Vincent E, et al. “Back Pain – Statpearls – NCBI Bookshelf.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 4 Sept. 2022, www.ncbi.nlm.nih.gov/books/NBK538173/.
Louw, Adriaan, and Stephen G Schmidt. “Chronic Pain and the Thoracic Spine.” The Journal of Manual & Manipulative Therapy, U.S. National Library of Medicine, July 2015, www.ncbi.nlm.nih.gov/pmc/articles/PMC4534852/.
Mann, Steven J, et al. “McKenzie Back Exercises – Statpearls – NCBI Bookshelf.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 4 July 2022, www.ncbi.nlm.nih.gov/books/NBK539720/.
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