For individuals going through post surgery, injury rehabilitation, illness and/or chronic condition management, can physical therapy isometric exercises help?
Isometric Exercise
Isometric exercises are used in physical therapy to help build muscle endurance, improve range of motion, relieve pain, and reduce blood pressure more effectively than other types of exercise. Because they don’t involve joint movement, they are a solid starting point for rehabilitation and are suitable for individuals with a limited range of motion. They can be performed by pushing against an immovable object, like a wall, or by having a therapist provide resistance. Examples of isometric exercises include:
A physical therapist/PT may have a patient perform isometric exercises after injury or illness. During an isometric contraction, the muscle does not change in length, and there is no motion around the joint surrounding the muscle/s. (Rhyu H. S. et al., 2015)
When To Use
Isometric muscular contractions can be used at any time during physical rehabilitation and strengthening or a home exercise program and are regularly used with the following (Rhyu H. S. et al., 2015)
Post-surgery
When muscles cannot contract forcefully enough to move the joint it surrounds.
To help increase neuromuscular input to a specific muscle/s.
When injury or condition frailty makes other forms of exercise dangerous and not beneficial.
A healthcare provider or physical therapist should be consulted first if isometrics are used in a rehabilitation program.
Benefits
The benefits of using isometric exercise after injury or surgery may include the following:
No special equipment is necessary to perform isometric exercises.
The ability to safely contract a muscle while protecting a surgical incision or scar tissue.
The muscles can be strengthened in a specific range of motion around a joint. (NikolaidouO. et al., 2017)
A physical therapist can help determine whether isometric exercise benefits the specific condition.
Effectiveness
Isometric exercise is very effective after injury or surgery. However, when a muscle is contracted isometrically, it gains strength in a very small area and with a short range of motion. For example, an isometric shoulder external rotation performed with the arm at the side will only strengthen the rotator cuff muscles in the specific position that the arm is in. (NikolaidouO. et al., 2017).
Strength gains are specific to the joint’s position during the exercise.
Individuals who want to strengthen their gluteal muscles in their hip using isometrics would have to contract their glute muscles in one specific position for several reps.
Once several reps of the exercise in one position have been performed, the individual moves their hip joint into a new position and repeats the gluteal contractions in the new position.
This makes the exercise time-consuming, but it is perfect for injury rehabilitation, preventing and avoiding worsening or further injuries.
How to Perform
To perform isometric exercises, all that is needed is something stable to push against. (Rhyu H. S. et al., 2015) For example, to strengthen the shoulder muscles:
Stand next to a wall and try to lift an arm out to the side.
Allow the hand to press against the wall so no motion occurs at the shoulder joint.
Once pressed against the wall, hold the contraction for 5 to 6 seconds and slowly release it.
Perform 6 to 10 repetitions of the exercise.
This could be one set of completed isometric exercises for the shoulder muscles.
Elastic resistance bands or tubing can also be used to perform isometric exercises. Hold the tubing in a specific position and then move the body away from the anchor point instead of moving the joint. The muscles will contract against the increased resistance of the elastic tubing, and no motion will occur at the joint. A physical therapist can show and train on how to perform isometric exercises with the bands.
Neuromuscular Stimulation
Isometric exercise can strengthen muscles and help improve the neuromuscular recruitment of the muscles being trained. This enhances muscle contraction and expedites gains in muscle recruitment while protecting the joint. Isometric exercise can also be used during physical therapy using neuromuscular electrical stimulation (NMES). (Fouré A. et al., 2014) For example, a PT may use NMES to improve muscular function for individuals who have difficulty contracting their quadriceps after knee surgery and may be instructed to perform isometric quad-setting exercises during the session.
Injury Medical Chiropractic and Functional Medicine Clinic
A physical therapist can use isometric exercises to help individuals injured or have had surgery and are experiencing difficulty with normal functional mobility by improving their strength during recovery. The exercises can safely enhance the function and stability of the muscles and return individuals to the previous level of activity and function. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.
Personal Injury Rehabilitation
References
Rhyu, H. S., Park, H. K., Park, J. S., & Park, H. S. (2015). The effects of isometric exercise types on pain and muscle activity in patients with low back pain. Journal of Exercise Rehabilitation, 11(4), 211–214. https://doi.org/10.12965/jer.150224
Nikolaidou, O., Migkou, S., & Karampalis, C. (2017). Rehabilitation after Rotator Cuff Repair. The Open Orthopaedics Journal, 11, 154–162. https://doi.org/10.2174/1874325001711010154
Fouré, A., Nosaka, K., Wegrzyk, J., Duhamel, G., Le Troter, A., Boudinet, H., Mattei, J. P., Vilmen, C., Jubeau, M., Bendahan, D., & Gondin, J. (2014). Time course of central and peripheral alterations after isometric neuromuscular electrical stimulation-induced muscle damage. PloS one, 9(9), e107298. https://doi.org/10.1371/journal.pone.0107298
What are the treatment options for individuals dealing with foot overpronation when the foot and ankle move too much downward and inward?
Overpronation
Pronation is the normal foot and ankle movement when taking a step and is usually associated with flat feet. Overpronation is a movement pattern in which the ankle rolls inward and downward, causing the foot’s arch to collapse with each stride. Overpronation can strain the muscles and ligaments in the feet and legs, leading to heel pain, ankle pain, shin splints, and low-back pain. (Pedorthic Association of Canada, 2023) Orthotic inserts for shoes, prescribed stretches, ankle braces, physical therapy, and surgery can all help alleviate the impact of overpronation. (Sánchez-Rodríguez, R. et al., 2020)
Signs and Symptoms
Some individuals with overpronation can have no symptoms at all. (Pedorthic Association of Canada, 2023) while others experience pain or other symptoms in their legs and feet. Overpronation is not a medical condition but a movement pattern that, if left untreated, can increase the risk for certain medical conditions because it strains the feet and leg muscles, joints, and ligaments. (Sánchez-Rodríguez, R. et al., 2020) Certain medical conditions can be a sign of overpronation and include: (Pedorthic Association of Canada, 2023)
Bunions
Heel pain
Plantar fasciitis
Achilles tendon pain
Posterior tibial tendonitis
Shin splints
Knee pain, including patellofemoral pain syndrome
Pain in the iliotibial or IT band
Lower back pain
Arthritis in foot and ankle joints
Stress fractures
Individuals may also experience pain in the midfoot or hips, which can be a symptom of flat feet.
Underpronation
Pronation refers to the normal movement of the foot and ankle while walking. Overpronation and underpronation are both abnormal movement patterns.
Overpronation – when the ankle rolls too much inward and downward.
Underpronation – occurs when an individual’s foot lacks flexibility and moves too little. This condition is called supination and is often associated with a high-arch foot type.
Overpronation can be caused or worsened by flatfeet. However, some individuals have overpronation because their feet and ankles are very flexible, so they tend to move more. Risk factors for flatfeet can also increase the chances of developing overpronation and include:
Age, especially individuals over 40.
Wearing shoes like high heels and shoes with a narrow-toe box.
Women are more prone to overpronate because of the various shoes and high heels worn.
Being overweight
Doing repetitive, impactful movements like running.
Correction and Treatment
Treating overpronation focuses on alleviating strain on muscles in the foot, ankle, and leg to relieve symptoms in the heel, ankle, knees, hips, or back. Common treatments are wearing supportive shoes and/or using foot orthotics. Exercises and stretches are also recommended to maintain flexibility and strength. Surgery is rare, but correcting flat feet that can cause overpronation may be recommended. (Sánchez-Rodríguez, R. et al., 2020) Individuals with overpronation are advised to see a podiatrist who can explain the best treatment options.
Supportive Shoes
The first course of treatment is to wear added supportive footwear. This can include specialized shoes or inserts that support the foot and reduce ankle movement. Individuals are advised to use shoes with firm heel and midfoot support to help prevent disproportionate movement. (Pedorthic Association of Canada, 2023)
Orthotics
A healthcare provider can recommend orthotics for individuals with moderate overpronation. These are meant to support the foot, especially the arch, and reduce overpronation. (Naderi A. Degens H. and Sakinepoor A. 2019) Individuals can purchase orthotics from shoe stores and elsewhere, but those with severe overpronation may need custom orthotics molded to the foot to provide individualized support.
Exercises and Stretches
Exercises and stretches can also help. A study found that exercises targeting the feet, core, and hips helped correct pronation over nine weeks. The exercises included: (Sánchez-Rodríguez, R. et al., 2020)
Toe pickups in which the individuals grab small objects with their toes and move them from one position to another.
Flexing and pointing the toes using a resistance band placed around the toes.
Hip abduction exercises to target the hip and glutes.
Abdominal and oblique muscle exercises to stabilize the torso.
Short-foot exercise raises the foot arch off the ground, drawing the toes toward the heel. (Sulowska I. et al., 2016)
Surgery
Rarely will surgery be needed to treat flat feet and severe overpronation. But if necessary, reconstruction realigns the bones to support the arch better and reduce overpronation. A metal implant is used for flatfeet to stabilize the area. Surgery can also repair torn tendons or other damage contributing to overpronation. (Healthline, 2020)
Injury Medical Chiropractic and Functional Medicine Clinic
Individuals with overpronation but no symptoms don’t necessarily have to see a healthcare provider since this may be the body’s natural movement pattern. But if the feet, legs, hips, or back begin to present with pain and other symptoms, see a healthcare provider who can evaluate gait and recommend treatment options. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.
Enhance Performance with Functional Foot Orthotics
References
Pedorthic Association of Canada. (2023). Overpronation and Underpronation Correction. https://pedorthic.ca/services/foot-health/pronation/
Sánchez-Rodríguez, R., Valle-Estévez, S., Fraile-García, P. A., Martínez-Nova, A., Gómez-Martín, B., & Escamilla-Martínez, E. (2020). Modification of Pronated Foot Posture after a Program of Therapeutic Exercises. International journal of environmental research and public health, 17(22), 8406. https://doi.org/10.3390/ijerph17228406
Naderi, A., Degens, H., & Sakinepoor, A. (2019). Arch-support foot orthoses normalize dynamic in-shoe foot pressure distribution in medial tibial stress syndrome. European journal of sport science, 19(2), 247–257. https://doi.org/10.1080/17461391.2018.1503337
Sulowska, I., Oleksy, Ł., Mika, A., Bylina, D., & Sołtan, J. (2016). The Influence of Plantar Short Foot Muscle Exercises on Foot Posture and Fundamental Movement Patterns in Long-Distance Runners, a Non-Randomized, Non-Blinded Clinical Trial. PloS one, 11(6), e0157917. https://doi.org/10.1371/journal.pone.0157917
Healthline. (2020). All About Surgery for Flat Feet: Pros and Cons. https://www.healthline.com/health/flat-feet-surgery
Can individuals with nerve injuries incorporate non-surgical treatments to reduce pain sensations and restore motor function to their bodies?
Introduction
The human body is a complex machine of nerves, bones, organs, tissues, and muscles that help the individual be mobile, flexible, and stable during various activities without pain and discomfort. However, when numerous factors start to hurt the body, it can lead to multiple overlapping risk profiles that can affect the body’s extremities and nerve injuries. Dealing with nerve injuries can lead to referred pain in the musculoskeletal system, and many people think it is muscle pain instead of nerve injury. When that happens, many individuals will begin to seek treatment to reduce not only the symptoms of nerve injuries but also reduce the pain associated with the nerves. In today’s article, we will look at what causes nerve injuries and how non-surgical treatments like chiropractic care and acupuncture can help with reducing the overlapping symptoms of nerve injuries and provide relief to the body. We discuss with certified medical providers who inform our patients about how nerve injuries can impact the musculoskeletal system. While asking informed questions to our associated medical providers, we advise patients to incorporate non-surgical treatments like chiropractic care and acupuncture to restore motor function to the body. Dr. Alex Jimenez, D.C., encompasses this information as an academic service. Disclaimer.
What Causes Nerve Injuries?
Do you constantly feel tingling or numbness in your legs, arms, feet, and hands? Do your muscles feel so weak that holding objects seems difficult? Or do you feel pain in your extremities, making it difficult to do everyday tasks? The body has trillions of nerves that branch out from the central nervous system and are intertwined with the muscles, tissues, and organs for motor-sensory function. Traumatic injuries, accidents, and normal environmental factors impact the nerves and cause overlapping risk profiles. More often than not, many individuals deal with non-mechanical and mechanical nerve injuries that can occur to the body. With nerve injuries, many individuals can feel various symptoms depending on the severity. Neuropraxia, a moderate form of nerve injury, causes nerve compression in the upper and lower extremities that causes motor dysfunction. (Carballo Cuello & De Jesus, 2024)
Additionally, neuropraxia can lead to functional impairment to the motor-sensory dysfunction that disrupts the peripheral nervous system, signaling this blocks nerve conduction and transient weakness or paresthesia. (Biso & Munakomi, 2024) When this happens, many individuals dealing with peripheral nerve injury that is associated with neuropraxia can experience structural and functional impairment to the sensory-motor skills in the extremities, which leads to physical disability and neuropathic pain, thus affecting a person’s quality of life. (Lopes et al., 2022) Many individuals dealing with nerve injuries can have various recovery periods depending on the severity. Many people often think they are dealing with musculoskeletal pain in their neck, shoulders, back, and extremities, but it is associated with nerve injury. When this happens, many individuals can seek out treatment to reduce the pain-like symptoms from nerve injuries.
Is Motion The Key To Healing?- Video
Non-Surgical Treatments For Nerve Injuries
When it comes to treating nerve injuries, it depends on the severity of the symptoms they cause. Surgical options are recommended to restore motor-sensory function if severe mechanical factors cause nerve injury. However, many individuals will opt out of surgical treatments due to their high cost and will often take over-the-counter medication to ease the pain. However, if the nerve injury is non-mechanical, many individuals can seek non-surgical treatments to reduce the nerve injury affecting the musculoskeletal system. Many non-surgical treatments are preferable to many people because they are cost-effective and can ultimately enhance a person’s care and improve their recovery outcome. (El Melhat et al., 2024) Non-surgical treatments can come in many forms, from chiropractic care to acupuncture, to help reduce the effects of non-mechanical nerve injuries and help restore the sensory-motor function of the musculoskeletal system.
Chiropractic Care
Chiropractic care is one of the many non-surgical therapies that use mechanical and manual manipulation of the spine to realign the body and help restore the sensory-motor function to the extremities. With nerve injuries, chiropractic care can help with neural mobilization to release trapped nerves in the affected muscle areas, thus reducing pain-like symptoms of tingling sensations. (Jefferson-Falardeau & Houle, 2019) Additionally, chiropractic care can help increase ROM (range of motion) in the extremities and reduce numbing and tingling sensations.
Acupuncture
Acupuncture is another non-surgical treatment that can also help reduce non-mechanical nerve injuries to the body. When a professional acupuncturist uses small, thin needles at different pressure points to rewire the neuron signaling and restore the body’s energy flow, acupuncture can help improve the clinical efficacy of nerve pain intensity and help enhance the person’s quality of life. (Li et al., 2023) Additionally, acupuncture can help improve nerve injury’s emotional and cognitive function and can be combined with other non-surgical treatments. (Jang et al., 2021) When it comes to reducing pain-like symptoms correlated with nerve injury, non-surgical treatments can provide the relief many individuals seek and lead to a happier, healthier life.
El Melhat, A. M., Youssef, A. S. A., Zebdawi, M. R., Hafez, M. A., Khalil, L. H., & Harrison, D. E. (2024). Non-Surgical Approaches to the Management of Lumbar Disc Herniation Associated with Radiculopathy: A Narrative Review. J Clin Med, 13(4). https://doi.org/10.3390/jcm13040974
Jang, J. H., Song, E. M., Do, Y. H., Ahn, S., Oh, J. Y., Hwang, T. Y., Ryu, Y., Jeon, S., Song, M. Y., & Park, H. J. (2021). Acupuncture alleviates chronic pain and comorbid conditions in a mouse model of neuropathic pain: the involvement of DNA methylation in the prefrontal cortex. Pain, 162(2), 514-530. https://doi.org/10.1097/j.pain.0000000000002031
Jefferson-Falardeau, J., & Houle, S. (2019). Chiropractic Management of a Patient With Radial Nerve Entrapment Symptoms: A Case Study. J Chiropr Med, 18(4), 327-334. https://doi.org/10.1016/j.jcm.2019.07.003
Li, X., Liu, Y., Jing, Z., Fan, B., Pan, W., Mao, S., & Han, Y. (2023). Effects of acupuncture therapy in diabetic neuropathic pain: A systematic review and meta-analysis. Complement Ther Med, 78, 102992. https://doi.org/10.1016/j.ctim.2023.102992
Lopes, B., Sousa, P., Alvites, R., Branquinho, M., Sousa, A. C., Mendonca, C., Atayde, L. M., Luis, A. L., Varejao, A. S. P., & Mauricio, A. C. (2022). Peripheral Nerve Injury Treatments and Advances: One Health Perspective. Int J Mol Sci, 23(2). https://doi.org/10.3390/ijms23020918
For individuals trying to retrain their body movements for back health improvement, what is the spinal area that helps the body twist, bend, and stand upright?
Lumbosacral Joint L5-S1
The L5-S1, also called the lumbosacral joint, is a term used to describe a part of the spine. It is where the lumbar spine ends and the sacral spine begins, and it connects these bones. The lumbosacral joint is also susceptible to misalignment and injury, such as disc herniation or a spinal disorder called spondylolisthesis.
The spinal column is the structure that allows the body to stand upright and helps you twist, bend, and alter trunk and neck position. Typically, 24 movable bones in the spine connect to the sacrum and the coccyx, or the tailbone. The sacrum and the coccyx each have multiple bones that fuse over time. L5-S1 consists of the last bone in the lumbar spine, called L5, and the triangle-shaped bone under it, known as the sacrum. S1 is at the top of the sacrum and comprises five fused bones.
Risk of Injury
Each area of the spine has a curve that goes in opposite directions. The places where the spinal curve directions change are junctional levels. The risk of injuries may be higher at junctional levels because the body weight shifts direction as the curves shift. The L5-S1 junction is located between the lumbar curve and the sacral curve. The lumbar curve sweeps forward, and the sacral curve goes backward.
The lumbosacral joint L5-S1 junction is highly vulnerable to misalignment, wear and tear, and injury. This is because the top of the sacrum is positioned at an angle for most individuals. Aging and injury increase the vulnerability of the L5-S1 junction even more. Pain coming from L5-S1 is usually treated with:
Heat and/or ice
Over-the-counter anti-inflammatory medications
Prescription pain medications
Muscle relaxers
Physical therapy
Chiropractic adjustments
Epidural steroid injections
If these therapies do not help, surgery may be recommended. L5-S1 is one of the two most common sites for back surgery.
Conditions
Disc herniation at L5-S1 is a common injury and cause of sciatica, which can cause pain and other issues (MedlinePlus, 2024). The L5-S1 junction is often the site of a condition known as spondylolisthesis.
Disc Herniation
Discs separate the vertebrae, cushioning the spinal column and allowing movement between vertebrae. A disc herniation means the disc slips out of place. (MedlinePlus, 2022) A disc herniation at L5-S1 is a common cause of sciatica. Symptoms of sciatica include:
Burning
Numbness
Pain or tingling that radiates from the buttock down the leg to the knee or foot.
Disc herniation can also cause chronic back pain and stiffness and trigger painful muscle spasms. Bowel problems are also possible with disc issues at L5-S1. Research links irritable bowel syndrome to herniated discs in the lower back. (Bertilson BC, Heidermakr A, Stockhaus M. 2015) Additional studies found disc problems at L5-S1 can lead to difficulty with sphincter control. (Akca N. et al., 2014) Initial treatments for disc herniation include rest and pain relievers to reduce inflammation and swelling, then physical therapy. Most recover with conservative interventions, and those who don’t may require a steroid injection or surgery. (MedlinePlus, 2022)
Spondylolisthesis
Spondylolisthesis occurs when a vertebra slips forward relative to the bone below it. The most common form of this condition is degenerative spondylolisthesis, which generally begins when the spine wears down with age. Isthmic spondylolisthesis is another common variation and starts as a tiny fracture in the pars interarticularis, a bone that connects the adjoining parts of the facet joint. (American Academy of Orthopaedic Surgeons, 2020) These fractures often occur before age 15, but symptoms do not develop until adulthood. Degeneration of the spine in later adulthood can further worsen the condition.
The angle of the sacrum can also contribute to spondylolisthesis. This is because the S1 tips down in the front and up in the back rather than being horizontal. Individuals with a greater tilt are usually at a higher risk of spondylolisthesis. (Gong S. et al., 2019) However, individuals with spondylolisthesis may not have any symptoms. Those who do may experience: (American Academy of Orthopaedic Surgeons, 2020)
Back stiffness
Standing difficulties
Walking difficulties
Lower back pain
Hamstring tightness
Spondylolisthesis is typically treated with non-surgical interventions that can include:
Pain medications
Heat and/or ice application
Physical therapy
Epidural steroid injections
Usually, non-surgical care is tried for at least six months. If pain and symptoms persist, surgery may be an option. Spinal fusion surgery can be effective but requires a long recovery time and can have additional risks.
Injury Medical Chiropractic and Functional Medicine Clinic
Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.
Chiropractic Healing After Trauma
References
MedlinePlus. (2024). Sciatica. Retrieved from https://medlineplus.gov/sciatica.html
MedlinePlus. (2022). Herniated disk. Retrieved from https://medlineplus.gov/ency/article/000442.htm
American Association of Neurological Surgeons. (2024). Herniate disc. https://www.aans.org/patients/conditions-treatments/herniated-disc/
Bertilson, B. C., Heidermark, A., & Stockhaus, M. (2015). Irritable Bowel Syndrome–a Neurological Spine Problem. Journal of Advances in Medicine and Medical Research, 4(24), 4154–4168. https://doi.org/10.9734/BJMMR/2014/9746
Akca, N., Ozdemir, B., Kanat, A., Batcik, O. E., Yazar, U., & Zorba, O. U. (2014). Describing a new syndrome in L5-S1 disc herniation: Sexual and sphincter dysfunction without pain and muscle weakness. Journal of craniovertebral junction & spine, 5(4), 146–150. https://doi.org/10.4103/0974-8237.147076
American Academy of Orthopaedic Surgeons. (2020). Spondylolysis and spondylolisthesis. https://orthoinfo.aaos.org/en/diseases–conditions/spondylolysis-and-spondylolisthesis/
Gong, S., Hou, Q., Chu, Y., Huang, X., Yang, W., & Wang, Z. (2019). Anatomical factors and pathological parts of isthmic fissure and degenerative lumbar spondylolisthesis.
Sleep is vital at all ages, but what is the amount of sleep for older individuals?
Amount of Sleep For Older Individuals
Individuals 65 and older are still recommended to get the same amount of sleep as younger adults. (National Council on Aging, 2023) As the body ages, it still needs around 7–9 hours of sleep, but how an individual sleeps is what changes. Older individuals begin to sleep lighter, and their sleep is broken up, causing them to wake up more at night. This can be due to natural changes in the internal body clock, medications, health conditions like arthritis or sleep apnea, or a combination. Older adults often face sleep barriers that are less common in younger individuals, like disabilities and chronic illnesses, and nearly half of adults aged 75 and above have a disability. Aging also shifts the circadian rhythm, causing older individuals to fall asleep and wake up earlier. Melatonin begins to decline with age, starting in the 30s, which can affect body temperature regulation and disrupt the sleep-wake cycle. (Hood S. & Amir S. 2017)
Healthy Sleep and Healthy Aging
Research found that older individuals who sleep poorly have an increased risk of:
As the body ages, a consistent, healthy amount of sleep prepares you for all the ups and downs. Healthy sleep maintains:
Overall health
Mental health
Mood
Memory
Improves cognitive function
Enhances emotional resilience
Supports heart health
Increases immune system function
Keeps energy levels steady.
Well-rested individuals are less likely to have falls or accidents because their focus and coordination are optimal.
Sleeping Healthier as You Age
Maintaining healthy sleep hygiene and being more mindful of routines will improve sleep patterns. This includes:
Going to bed and waking up at the same time every day.
Avoiding long naps during the day.
Monitoring nutrition and physical activity levels.
Creating a calming bedtime routine like meditation and reading.
Keeping the bedroom dark, cool, and quiet.
Reducing caffeine or alcohol, especially in the evening, can affect sleep patterns.
Sleep aids can help for short periods and should be combined with cognitive behavioral therapy and used with caution in the long term to prevent possible dependency. Medications can help by addressing health issues that impact sleep, like pain, depression, or anxiety. However, some medicines can have side effects that alter or worsen sleep patterns.
Injury Medical Chiropractic and Functional Medicine Clinic
Therefore, older individuals still need 7–9 hours of sleep every night to maintain and enhance mental, physical, and emotional well-being, reducing risks associated with aging. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.
Enhancing Health
References
National Council on Aging. (2023). How Sleep Impacts the Top Age-Related Health Concerns. https://www.ncoa.org/adviser/sleep/chronic-conditions-and-sleep/
Hood, S., & Amir, S. (2017). The aging clock: circadian rhythms and later life. The Journal of clinical investigation, 127(2), 437–446. https://doi.org/10.1172/JCI90328
Stone, K. L., & Xiao, Q. (2018). Impact of Poor Sleep on Physical and Mental Health in Older Women. Sleep medicine clinics, 13(3), 457–465. https://doi.org/10.1016/j.jsmc.2018.04.012
Individuals who have been injured or ill or have a chronic disability may be having difficulty performing everyday activities. Can recreation therapy help rehabilitate injuries and manage chronic conditions?
Recreation Therapy
Living with a chronic disability or functional limitation due to an illness or injury can significantly impact an individual’s quality of life. Working with a team of rehabilitation professionals can help improve mobility and the ability to complete everyday tasks comfortably. A recreational therapist is one professional who helps regain emotional and functional well-being. A recreational therapist is a healthcare professional who helps individuals maximize physical and emotional health through recreational activities. Also known as therapeutic recreation, the therapist will use activities to help move and feel better. A physical or occupational therapist uses exercises to improve functional mobility, and a recreational therapist uses recreational activities to help regain mobility and improve well-being. Activities can include:
Playing games
Outdoor activities
Hiking
Puzzles
Horseback riding
Cooking
Therapy
A healthcare specialist uses activity-based interventions to help individuals move and feel better after injury or illness or if they have a chronic disability. The interventions and therapies are based on recreational activities the individual likes and are designed to help recover physical, functional, and emotional health. Recreational therapists are trained to evaluate an individual’s condition and intervene in ways that help maximize social, mental, and physical health. The main goal is to reduce depression and anxiety and to help individuals socialize comfortably. (American Therapeutic Recreation Association, 2024)
Activities
Therapeutic recreation involves engaging in specific activities to help individuals regain their confidence and independence. Examples of activities can include: (American Therapeutic Recreation Association, 2024)
Painting or drawing
Dancing
Sports programs
Cooking
Community outings
Group exercise classes
The key to a positive experience is that the activity should be specific to the individual’s emotional and physical needs and capabilities and something the individual would want to do as an activity.
Other Types of Therapy
Individuals may be familiar with other types of therapists, like physical and occupational therapists. These professionals help individuals regain pain-free functional mobility after injury or illness. For individuals who cannot move their upper extremities after falling, the physical therapist can measure their shoulder range of motion and strength and develop a personalized treatment program. Recreation therapists are similar; they meet with patients regularly to help them recover from injuries or positively socialize with their community. During the initial meeting, they will evaluate the individual’s condition and learn how their emotional and physical needs prevent them from achieving maximal potential. (American Therapeutic Recreation Association, 2024) The patient and therapist will engage in activities to help move and feel better during therapy. During the activity, the therapist may suggest adjustments or ideas that improve movement and ability to interact with the environment.
Who Can Benefit?
Individuals of all ages and abilities with physical and psychological conditions can benefit from working with a recreational therapist. Children, teenagers, adults, and older individuals who have a disability, either temporary or permanent, can engage in recreation therapy as part of a rehabilitation and recovery program. (American Therapeutic Recreation Association, 2024)
Benefits
Whenever engaging in any healthcare activity or treatment, ask if that treatment can help your specific condition. A review of the use of recreational dance in children and young people ages 5 to 21 found evidence of the benefits of the therapy, which included: (Burkhardt J, Brennan C. 2012)
Decreased anxiety
Improve self-image
Improved cardiovascular fitness
Decreased obesity
Improved bone health
Another study examined health improvements in individuals injured in military service after a week-long recreational therapy wellness retreat. The participating service members’ results showed significant improvement in outcome measures for post-traumatic stress disorder, stress, anxiety, and depression. The health improvements remained three and six months after completing the recreation therapy. This shows that therapeutic recreation may offer significant emotional and psychological benefits to injured military service members’ long-term health and an effective treatment to improve the well-being of injured or disabled individuals with limited negative side effects. (Townsend J, Hawkins BL, Bennett JL, et al., 2018)
Professional Background
Most therapists have a bachelor’s degree in recreational or leisure studies, focusing on art, psychology, and music classes. Upon graduation, students can take a national exam and become Certified Therapeutic Recreation Specialists/CTRS. (Hoss M.A.K, 2019) Once certified, therapists must regularly take continuing education classes and undergo a recertification process every five years.
Receiving Therapy Services
To start working with a recreational therapist, visit your healthcare provider and request a referral. They can ensure the treatment is appropriate for the specific injury and/or condition and should be able to help find a therapist. (American Therapeutic Recreation Association, 2024) Individuals in an inpatient hospital will likely spend time with a recreational therapist at some point. Just like working with a physical or occupational therapist to help individuals move better, working with a recreation therapist while in rehabilitation may be an everyday occurrence to help reintegrate into the community after discharge.
Insurance Coverage
One question regarding recreational therapy is, will my insurance cover the services of a recreational therapist?
For individuals with Medicare insurance, recreational therapy is a covered service for individuals with certain diagnoses and settings.
Therapeutic recreation is a covered rehabilitation service for individuals in an inpatient rehabilitation facility.
Individuals who receive outpatient recreational therapy should ensure they have a prescription and letter of medical necessity from a physician to qualify for Medicare reimbursement. (American Therapeutic Recreation Association, 2024)
Individuals with private insurance should call their insurance provider and inquire about coverage for recreation therapy.
Individuals who do not have insurance can expect to pay $100-$150 per session.
Injury Medical Chiropractic and Functional Medicine Clinic
Working in therapeutic recreation may help decrease anxiety and depression, improve the sense of well-being, and improve function in daily tasks. (Townsend J, Hawkins BL, Bennett JL, et al., 2018) Always consult your healthcare provider before beginning new treatment methods. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.
Integrative Healthcare
References
American Therapeutic Recreation Association. Association, A. T. R. (2024). What is Recreational Therapy? https://www.atra-online.com/about-rt
American Therapeutic Recreation Association. Association, A. T. R. (2024). Who We Are. https://www.atra-online.com/who-we-are
Burkhardt, J., & Brennan, C. (2012). The effects of recreational dance interventions on the health and well-being of children and young people: A systematic review. Arts & Health, 4(2), 148–161. https://doi.org/10.1080/17533015.2012.665810
Townsend, J., Hawkins, B. L., Bennett, J. L., Hoffman, J., Martin, T., Sotherden, E., … Duregger, C. (2018). Preliminary long-term health outcomes associated with recreation-based health and wellness programs for injured service members. Cogent Psychology, 5(1). https://doi.org/10.1080/23311908.2018.1444330
Hoss, PhD, CTRS, FACHE, FDRT, M. A. K. (2019). Recreational therapy workforce: An update. American Journal of Recreation Therapy, 18(3), 9–15. https://doi.org/10.5055/ajrt.2019.0191
De Vries, DHA, MPA, CTRS, D. (2014). Regulatory requirements for recreational therapy in nursing homes. American Journal of Recreation Therapy, 13(1), 25–30. https://doi.org/10.5055/ajrt.2014.0063
How are MRIs used to help diagnose bulging and herniated discs and help healthcare providers develop effective treatment programs for individuals experiencing back pain symptoms?
Herniated Bulging Disc MRI
A herniated bulging disc is often identified during magnetic resonance imaging (MRI); however, it’s usually an incidental finding that was done for other reasons where spinal problems and/or injuries are found. A bulging disc is relatively common, even in individuals who experience no symptoms. A herniated or bulging disc in the back can be identified with an MRI test, typically recommended when someone experiences back pain symptoms for at least six weeks. (American Academy of Neurological Surgeons, 2024) Normal wear and tear and age cause changes in the spinal disc/s cushion to bulge and become misaligned with the spine. (Brinjikji W. et al., 2015) And with a herniated disc, it can press against the spinal cord and nerves. Repeated heavy lifting, practicing unhealthy postures, a history of back injuries, or underlying health conditions are common causes.
Bulging Disc
Bulging discs are common even in healthy individuals but can be difficult to interpret independently on an MRI, so other symptoms and findings are as important in diagnosis.
Causes
A bulging disc is usually considered age-related degenerative changes that cause the disc to bulge downward with gravity. (Penn Medicine, 2018)
A significant bulge is expected to cause leg pain due to irritation to the nerves going down the legs. (Amin R. M., Andrade N. S., & Neuman B. J. 2017) As the condition progresses, more than one disc can be affected, leading to other spinal conditions, including spinal stenosis.
A Bulging Disc On MRI
A disc bulge will measure over 25% of the total disc circumference. Its displacement is usually 3 millimeters or less from the normal shape and position of the disc. (Radiopaedia, 2024)
Herniated Disc
A herniated disc shifts out of its correct position and compresses nearby spinal nerves, causing pain and mobility issues.
Herniated discs will measure less than 25% of the total disc circumference. However, herniation is based on the type and can include: (Wei B., & Wu H. 2023)
Disc Protrusion – the displacement is limited, and the ligaments are intact.
Disc Extrusion – part of the disc remains connected but has slipped through the annulus or outer covering of the disc.
Disc Sequestration – a free fragment has separated and broken off from the main disc.
Candidates For Spinal MRI
The MRI is generally safe for most, including those with implanted cardiac devices like newer-model pacemakers. (Bhuva A. N. et al., 2020) However, it’s important to ensure that the healthcare team is aware of cochlear implants or other devices so that necessary precautions can be taken. It is recommended for all individuals that symptoms be present for six weeks before an MRI. A specialist may want to see MRI results sooner, especially if symptoms include: (American Academy of Neurological Surgeons, 2024)
A specific injury, like a fall that caused the pain
Recent or current infection or fever with spinal symptoms
Significant weakness in arms or legs
Loss of pelvic sensation.
A history of metastatic cancer.
Loss of bladder or bowel control
An MRI may be needed if symptoms are rapidly worsening. However, many with a disc bulge don’t have symptoms at all. In most cases, an MRI is an outpatient procedure that can be completed in an hour or less but can take longer if contrast dye is used. The healthcare provider will provide specific instructions about MRI preparation.
Treatment
Treatment for a herniated or bulging disc depends on the cause and severity of symptoms.
Over-the-counter pain relief, including nonsteroidal anti-inflammatory drugs (NSAIDs).
Physical therapy
In rare cases that have not resolved with conservative treatment, surgery may be recommended.
Remember that the MRI findings may not identify or rule out all conditions, including muscle strains or ligament injuries, which may require different treatments, such as targeted stretches and exercises. (Brinjikji W. et al., 2015) (Fujii K. et al., 2019)
Herniated Disc
Treatment depends on the cause and severity of symptoms, if any. It can include stand-alone or a combination of physical therapy, medication, and steroid injections. Cases usually resolve in six to 12 weeks (Penn Medicine, 2018). Electrical nerve stimulation may be performed through specialized devices and/or acupuncture to help with nerve compression. (National Institute of Neurological Disorders and Stroke, 2020) Surgery may be recommended if conservative treatments fail to achieve significant pain relief and healing. (Wang S. et al., 2023)
Injury Medical Chiropractic and Functional Medicine Clinic
A healthcare provider can discuss treatment options such as pain medication, physical therapy, and surgery. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.
Root Causes of Spinal Stenosis
References
American Academy of Neurological Surgeons. (2024). Herniated disc. https://www.aans.org/patients/conditions-treatments/herniated-disc/
Brinjikji, W., Diehn, F. E., Jarvik, J. G., Carr, C. M., Kallmes, D. F., Murad, M. H., & Luetmer, P. H. (2015). MRI Findings of Disc Degeneration are More Prevalent in Adults with Low Back Pain than in Asymptomatic Controls: A Systematic Review and Meta-Analysis. AJNR. American journal of neuroradiology, 36(12), 2394–2399. https://doi.org/10.3174/ajnr.A4498
Penn Medicine. (2018). Bulging Disc vs. Herniated Disc: What’s The Difference? Penn Musculoskeletal and Rheumatology Blog. https://www.pennmedicine.org/updates/blogs/musculoskeletal-and-rheumatology/2018/november/bulging-disc-vs-herniated-disc
Wu, P. H., Kim, H. S., & Jang, I. T. (2020). Intervertebral Disc Diseases PART 2: A Review of the Current Diagnostic and Treatment Strategies for Intervertebral Disc Disease. International journal of molecular sciences, 21(6), 2135. https://doi.org/10.3390/ijms21062135
Amin, R. M., Andrade, N. S., & Neuman, B. J. (2017). Lumbar Disc Herniation. Current reviews in musculoskeletal medicine, 10(4), 507–516. https://doi.org/10.1007/s12178-017-9441-4
American Academy of Orthopaedic Surgeons. (2022). Herniated disk in the lower back. https://orthoinfo.aaos.org/en/diseases–conditions/herniated-disk-in-the-lower-back/
Wei, B., & Wu, H. (2023). Study of the Distribution of Lumbar Modic Changes in Patients with Low Back Pain and Correlation with Lumbar Degeneration Diseases. Journal of pain research, 16, 3725–3733. https://doi.org/10.2147/JPR.S430792
Bhuva, A. N., Moralee, R., Moon, J. C., & Manisty, C. H. (2020). Making MRI available for patients with cardiac implantable electronic devices: growing need and barriers to change. European radiology, 30(3), 1378–1384. https://doi.org/10.1007/s00330-019-06449-5
Brinjikji, W., Luetmer, P. H., Comstock, B., Bresnahan, B. W., Chen, L. E., Deyo, R. A., Halabi, S., Turner, J. A., Avins, A. L., James, K., Wald, J. T., Kallmes, D. F., & Jarvik, J. G. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR. American journal of neuroradiology, 36(4), 811–816. https://doi.org/10.3174/ajnr.A4173
Fujii, K., Yamazaki, M., Kang, J. D., Risbud, M. V., Cho, S. K., Qureshi, S. A., Hecht, A. C., & Iatridis, J. C. (2019). Discogenic Back Pain: Literature Review of Definition, Diagnosis, and Treatment. JBMR plus, 3(5), e10180. https://doi.org/10.1002/jbm4.10180
Wang, S., Zhao, T., Han, D., Zhou, X., Wang, Y., Zhao, F., Shi, J., & Shi, G. (2023). Classification of cervical disc herniation myelopathy or radiculopathy: a magnetic resonance imaging-based analysis. Quantitative imaging in medicine and surgery, 13(8), 4984–4994. https://doi.org/10.21037/qims-22-1387
National Institute of Neurological Disorders and Stroke. (2020). Low back pain fact sheet. Retrieved from https://www.ninds.nih.gov/sites/default/files/migrate-documents/low_back_pain_20-ns-5161_march_2020_508c.pdf
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