The Cobb angle is a mathematical measurement tool for assessing the curvature of the spine. Along with physical exams and other tests, how is it used to evaluate scoliosis and kyphosis of the spine?
Cobb Angle
The Cobb angle is used to quantify the curvature of the spine, particularly in conditions like scoliosis. It measures the degree of side-to-side spinal curvature, a deformity called scoliosis. The angle’s size helps determine what kind of treatment is needed. Monitoring may be all that’s necessary for mild curvature. With severe scoliosis, treatment may require spinal fusion surgery. Named for orthopedic surgery pioneer John Robert Cobb, it describes the distance a scoliotic curve may deviate from being straight. (Botterbush K. S. et al., 2023) Generally, it takes at least 10 degrees of deviation from straight before scoliosis is confirmed.
X-Ray and Interpretation
An X-ray is taken to measure the Cobb angle. Side and back views are taken. The healthcare provider or examiner then views the X-rays and locates the most affected vertebra in the curve, the apical vertebra. In a scoliotic curve, the apical vertebra is the spinal bone with the greatest degree of rotation that takes the biggest curve away from the center of a normal spine column.
Visualizing the Angle
The apical vertebra is where two lines drawn from the X-rays meet. Two lines are drawn along the edge of the top and bottom bones of the curve. The lines extend out as follows:
On the top bone, the line starts on the high side, continues along the top edge, and then slopes down according to the angle of the vertebra. (Jin, C. et al., 2022)
On the bottom vertebra, the line starts on the low side, continues along the bottom edge, and slopes upward.
The Cobb angle is found by measuring the angle of the two intersecting lines where they meet.
Then, the top and bottom vertebrae of the side-to-side curve are identified to create a number for the Cobb angle. These bones have the most tilt but the least rotation and displacement and are located above and below the apical vertebra. Computer software is commonly used to calculate the Cobb angle. (Jin, C. et al., 2022) Treatment is based on the:
Angle size
Gender: Scoliosis is more common and likely to progress in females
Scoliosis is diagnosed when the Cobb angle reaches 10 degrees or more. However, this is not generally considered a significant curvature (American Association of Neurological Surgeons, 2024). In around 80% of cases, the scoliosis is considered idiopathic or without congenital or other underlying causes.
Less Than 25 Degrees Cobb Angle
If a scoliotic curve is less than 25 degrees, individuals may only need to visit their healthcare provider periodically so long as the scoliosis is monitored. These are mild cases, often without symptoms, but there is a chance that the curvature can progress. This usually means reassessing the Cobb angle every four to six months in a growing child or adolescent. (National Scoliosis Foundation, 2015) A 5-degree or more progression can change the diagnosis and treatment. (Jin, C. et al., 2022)
Between 25 and 40 Degrees Cobb Angle
A Cobb angle of 25 to 40 degrees usually requires wearing a back brace and intensive physical therapy. The goal of these treatments is to help halt the curve’s progression. Braces are generally worn 16 to 23 hours every day. (National Scoliosis Foundation, 2015) The healthcare provider will provide a referral for physical therapy. Many report excellent results with the Schroth or other scoliosis-specific exercise methods. A study found that core stabilization exercise programs can decrease Cobb angles in adolescents with idiopathic scoliosis. (Ko K. J. & Kang S. J. 2017)
Scoliosis in Adults
Scoliosis is diagnosed in adults, usually in those who have had the condition, treated or not, that was identified in their youth. A study that followed various cases for 20 years found disease progression occurred in 40% of adults but was usually less than one degree per year. However, degenerative scoliosis can also occur in individuals aged 65 and older. (American Association of Neurological Surgeons, 2024)
40 Degrees or More Cobb Angle
Surgery may be recommended once the Cobb angle reaches 40 to 50 degrees. A spinal fusion is often used to force the curve to stop developing. In adults, surgery may be needed if the angle reaches 50 degrees and they experience complications, such as nerve damage or bowel/bladder dysfunction. Risk factors in adults include older age, a history of smoking, and a diagnosis of other conditions, including being overweight. (American Association of Neurological Surgeons, 2024)
Variations
Variations occur in measuring scoliosis, and it is important to understand the difference between a change in scoliosis and a change in the tools or measurement. Equipment errors, imaging errors, and the subjective reading of the healthcare provider can change the values. (Jin, C. et al., 2022) Scoliosis measurement software and intelligent medical devices continue to improve how scoliosis is evaluated and treated. Physical exams, symptoms, and careful monitoring of changes in posture or function are still critical to an accurate diagnosis. The healthcare provider will explain the Cobb angle and other test results.
Injury Medical Chiropractic & 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.
Academic Low Back Pain: Impact and Chiropractic Solutions
References
Botterbush, K. S., Zhang, J. K., Chimakurty, P. S., Mercier, P., & Mattei, T. A. (2023). The life and legacy of John Robert Cobb: the man behind the angle. Journal of neurosurgery. Spine, 39(6), 839–846. https://doi.org/10.3171/2023.7.SPINE23146
Jin, C., Wang, S., Yang, G., Li, E., & Liang, Z. (2022). A Review of the Methods on Cobb Angle Measurements for Spinal Curvature. Sensors (Basel, Switzerland), 22(9), 3258. https://doi.org/10.3390/s22093258
National Scoliosis Foundation. (2015). Scoliosis Media & Community Guide. https://www.scoliosis.org/nsf2/wp-content/uploads/2015/06/ScoliMediaGuide_9June3.pdf
American Association of Neurological Surgeons. (2024). Scoliosis. https://www.aans.org/patients/conditions-treatments/scoliosis/
Ko, K. J., & Kang, S. J. (2017). Effects of 12-week core stabilization exercise on the Cobb angle and lumbar muscle strength of adolescents with idiopathic scoliosis. Journal of Exercise Rehabilitation, 13(2), 244–249. https://doi.org/10.12965/jer.1734952.476
Finger pulley injuries are unique digital injuries distinct from sprains or dislocations. They occur specifically in rock climbers and occasionally in baseball pitchers. What are the symptoms, diagnoses, and treatments available?
Finger Pulley Injury
A finger pulley injury, common in activities like climbing, involves damage to the fibrous bands (pulleys) that hold tendons against bones. This causes pain, swelling, and potentially bowstringing of the tendons.
Finger pulleys are structures that hold tendons against the bones of the fingers.
Injury symptoms include pain, swelling, and a popping sound heard at the time of the injury.
Finger pulley injuries, or ruptures of the digital pulley, are seen almost exclusively in rock climbers. (Miro P. H. et al., 2021)
This activity stresses the digits when maneuvering along uneven surfaces while supporting the entire body’s weight. The injuries result from the mechanics of the finger tendons and joints and the position the fingers hold while rock climbing. Rock climbing has grown in popularity. The only other sport in which this injury has been described is baseball, in pitchers. The forces acting on the finger are very different in these activities, but both place high stress on the finger pulleys.
Digital Pulleys
Everyone has structures in their fingers called digital pulleys. These pulleys hold the tendons against the bones of the fingers. Each finger has eight pulleys, but only two are considered critical to prevent the finger tendons’ bowstringing (when one pulley gives out or ruptures). This can result in various injury outcomes, from a simple strain of the pulley to ruptures of multiple pulleys in a single digit. Pain, stiffness, and an inability to fully flex the finger can occur. (Carruthers K. H., Skie M., & Jain M. 2016) In severe situations, when the tendons are bowstringing, the tendon may lift away from the finger when making a fist.
Symptoms
Pain and Tenderness
Localized pain and tenderness at the finger’s base, particularly when gripping or bending. Pain on the palm side of finger and tenderness with pressure
Swelling
Swelling and bruising around the affected finger joint, especially on the palm side.
Stiffness and pain when bending the fingers or difficulty gripping. Difficulty forming a fist
Bowstringing
Visible displacement of the tendon from its normal position, causing a bulge at the finger’s base.
Most commonly, the middle or index digit is the injured finger. The two critical pulleys in the finger are designated the A2 and A4. (Carruthers K. H., Skie M., & Jain M. 2016) Individuals may see swelling, redness, and inflammation at the base of the finger (A2) and/or in the space between the two finger joints closest to the tip of the finger (A4). In rock climbers, either or both of those pulleys may be injured. In baseball pitchers, the injury is typically isolated to the A4 pulley.
Causes
Overuse and Repetitive Strain: Frequent or intense gripping or crimping, common in rock climbing and other activities, can cause pulley injuries.
Dynamic or Sudden Movements: Desperate or dynamic moves or poor technique can lead to injury.
Excessive Force: Pulleys can rupture when the force exerted on them is too great.
Mechanism of injury: The A2 pulley is the most commonly injured, followed by the A4 pulley.
Diagnosis
Emergency treatment is generally unnecessary. However, it is important to have suspected digital pulley injuries examined by a specialist within several days to a week after the injury. The most important aspect of an evaluation is determining whether the injury has caused the bowstringing of the tendons. Imaging tests may be performed to help with the diagnosis and plan treatment. An ultrasound is recommended as the initial imaging technique. (Miro P. H. et al., 2021)
If an ultrasound is inconclusive, an MRI may be advised. Sometimes, an MRI is performed with the finger held straight and then bent to see if the tendons are bowstringing. An X-ray can also help exclude other causes of finger pain, including sprains and fractures.
Treatment
Conservative Care
Immobilization, physical therapy, and pulley-protective measures, such as splints or taped fingers, are often used.
Surgery
Surgery may be necessary for severe grade IV injuries where conservative care fails.
Only in situations where there are multiple pulley ruptures or if there is delayed treatment should surgery be necessary.
Rehabilitation
Focuses on regaining flexibility, strength, and grip function through exercises and physical therapy.
If the tendons do not bowstring, treatment usually protects the injured finger until swelling and pain subside. If there is bowstringing of the tendons, more careful management of the injury is needed. Individuals who suspect a pulley injury rest or splint the finger and use nonsteroidal anti-inflammatory drugs as necessary for pain until they can get a medical evaluation. (Carruthers K. H., Skie M., & Jain M. 2016) Physical therapy, along with immobilization, the H-tape method, and a protective pulley splint, are recommended for most injuries. (Miro P. H. et al., 2021) Specialized splints and therapy techniques can allow the pulleys to heal properly.
Returning to activity varies significantly with the severity of the injury. With mild pulley strains, full activity can be resumed as soon as swelling and pain have subsided. Treatment for full ruptures being treated non-surgically is typically between one and three months. For individuals requiring surgical reconstruction of a pulley injury, restrictions may apply up to a year after the surgery.
Injury Medical Chiropractic & Functional Medicine Clinic
To prevent complications, a healthcare provider should evaluate pulley injuries as soon as possible. Treatment most often consists of physical therapy, but surgery may be necessary. 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.
Sports Injury Treatments
References
Miro, P. H., vanSonnenberg, E., Sabb, D. M., & Schöffl, V. (2021). Finger Flexor Pulley Injuries in Rock Climbers. Wilderness & environmental medicine, 32(2), 247–258. https://doi.org/10.1016/j.wem.2021.01.011
Carruthers, K. H., Skie, M., & Jain, M. (2016). Jam Injuries of the Finger: Diagnosis and Management of Injuries to the Interphalangeal Joints Across Multiple Sports and Levels of Experience. Sports Health, 8(5), 469–478. https://doi.org/10.1177/1941738116658643
For individuals struggling with constipation, a common digestive issue, could performing abdominal self-massage help bring relief?
Abdominal Self Massage
Constipation refers to having a bowel movement fewer than three times per week. In addition to stress, certain lifestyle issues can lead to constipation, including not getting enough fiber, exercise, and proper hydration. Many also experience constipation while traveling. Abdominal self-massage involves gently massaging the stomach with your hands, either in a circular motion or with strokes, to improve digestion, relieve constipation, and reduce bloating. Performing self-massage on and around the abdomen can help ease constipation in several ways, such as stimulating the muscles, producing bowel movements, and soothing chronic stress. (Sinclair M. 2011)
Massage and Constipation
Abdominal massage can provide several benefits, including:
Stimulates and Improves Digestion
Massage stimulates the muscles and nerves that control digestion, promoting bowel movements and reducing constipation.
Reduces Bloating
Massaging the abdomen may help to reduce bloating and gas by gently moving fluids and gases through the digestive system.
In addition, it can help soften stool, speed up the movement of stool through the gut, and reduce the need to use laxatives. (University of Michigan Medicine, 2021)
Relieves Constipation
Abdominal massage can help with constipation by encouraging bowel movements.
Reduces Pain and Discomfort
Some find that abdominal massage helps to reduce pain and discomfort related to digestive issues.
Massage can help relax tense abdominal muscles and reduce pain associated with conditions like irritable bowel syndrome (IBS).
Improved lymphatic drainage
Massage helps move lymphatic fluid, which carries waste products and toxins away from the abdominal area.
Research
Although massage isn’t a standard treatment for constipation, some research shows it may help restore regularity. A report reviewed several clinical trials focusing on abdominal massage and its use as a treatment for chronic constipation. The results showed that abdominal massage may provide relief by promoting peristalsis, a series of muscle contractions that help move food through the digestive tract. The report also found that massage may help lessen colonic transit time, which is when digested food passes through the colon or last segment of the digestive tract. The report determined that abdominal massage can help alleviate constipation-related pain and discomfort. (Sinclair M. 2011)
In clinical trials, individuals with constipation reported improved quality of life after abdominal self-massage. However, some research suggests that using abdominal massage for constipation relief will not decrease the use of laxatives, the most commonly used treatment. (Lämås K. et al., 2009)
How to Massage
Various massage techniques may help relieve constipation and promote bowel movements. These are typically performed while lying down.
One technique involves placing the palm on the abdomen and making small, circular, clockwise motions around your belly button.
Individuals can also widen these circles so that the massage covers their entire abdomen.
Another technique begins by placing your hand below your breastbone, then gliding that hand down the length of your abdomen in one smooth stroke.
Repeat the movement with the other hand and continue this cycle for a few minutes.
When practicing self-massage, use light and gentle pressure, then gradually increase the pressure.
If you experience pain or tenderness, lighten up and return to a comfortable pressure level.
Try performing massage twice daily, aiming for a 20-minute session. Incorporating deep breathing into each session may also help. Before trying a massage or any home remedy, it is recommended to discuss it with a healthcare provider to see if it’s appropriate and safe. Pregnant women, for example, should avoid any massage on their abdomen. Constipation can sometimes signal an underlying condition that requires medical treatment, such as an underactive thyroid. Other symptoms like abdominal pain may be present, but sometimes constipation may be the only symptom.
Other Remedies
Self-massage alone is unlikely to treat chronic constipation; the goal should be to improve overall digestion to keep the organs functioning properly. To maintain regularity, it’s essential to drink plenty of water daily, eat enough fiber-rich foods, and engage in physical activity. Other alternative treatments include therapies like:
Acupressure
Biofeedback
Probiotics
Before trying self-massage, consult a medical caregiver to ensure it is safe and correct for the individual. Abdominal massage may not help with painful bloating caused by disease, infection, or other reasons.
Injury Medical Chiropractic & 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.
Massage Therapy Rehabilitation
References
Sinclair M. (2011). The use of abdominal massage to treat chronic constipation. Journal of bodywork and movement therapies, 15(4), 436–445. https://doi.org/10.1016/j.jbmt.2010.07.007
University of Michigan Medicine. (2021). Self-abdominal massage. https://www.med.umich.edu/1libr/MBCP/AbdominalSelfmassage.pdf
Lämås, K., Lindholm, L., Stenlund, H., Engström, B., & Jacobsson, C. (2009). Effects of abdominal massage in management of constipation–a randomized controlled trial. International journal of nursing studies, 46(6), 759–767. https://doi.org/10.1016/j.ijnurstu.2009.01.007
Individuals dealing with chronic pain following a minor injury, surgery, or trauma could be experiencing complex regional pain syndrome. What are the symptoms, diagnosis, and treatments available?
Complex Regional Pain Syndrome
Reflex sympathetic dystrophy syndrome (RSDS), more commonly known as complex regional pain syndrome (CRPS), is a chronic pain condition where a person experiences severe, persistent pain in a limb, usually following an injury, that is significantly more profound than from the initial trauma. It is considered a neuroinflammatory disorder in which the body’s response to injury is dysregulated. The condition is characterized by severe burning pain, often in an arm or leg, that can occur following a minor injury, surgery, or trauma. It is associated with abnormal changes in skin temperature, swelling, and sensitivity to touch, usually affecting the affected area’s nerves, skin, muscles, blood vessels, and bones. Other names it is known by include:
Causalgia
Shoulder-Hand Syndrome
Sudeck’s Atrophy
Causes
CRPS is a chronic pain condition believed to result from dysfunction in the central or peripheral nervous systems (National Institute of Neurological Disorders and Stroke, 2017). It involves irritation and abnormal excitation of nervous tissue, leading to abnormal impulses along nerves that affect blood vessels and skin. Animal studies indicate that norepinephrine, a catecholamine released from sympathetic nerves, acquires the ability to activate pain pathways after tissue or nerve injury, resulting in CRPS. Another theory is that CRPS, which follows an injury, is caused by triggering an immune response and continuous inflammation symptoms (swelling, redness, warmth). (Goh E. L., Chidambaram S., & Ma, D. 2017) It is believed to have multiple causes producing similar symptoms.
Extreme sensitivity to touch, often causing significant disability in the affected limb.
Stiffness and swelling in affected joints
Skin color changes – blotchy, purple, pale, red.
Skin temperature changes – warmer or cooler than the opposing extremity.
Skin texture changes – shiny, thin, sweaty.
Changes in nail and hair growth patterns.
Pain can spread, for example, from the finger to the entire arm and the opposite extremity or from the left to the right arm.
Emotional stress can cause symptoms to worsen.
Some experts suggest three stages during which progressive changes occur in the affected area’s skin, muscles, joints, ligaments, and bones (Harvard Health Publishing, 2023). However, further research is needed.
Injury Medical Chiropractic & 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.
The Root Causes of Pain
References
National Institute of Neurological Disorders and Stroke. (2017). Complex regional pain syndrome fact sheet. Retrieved from https://www.ninds.nih.gov/sites/default/files/migrate-documents/CRPS_FactSheet-E_508C.pdf
Goh, E. L., Chidambaram, S., & Ma, D. (2017). Complex regional pain syndrome: a recent update. Burns & Trauma, 5, 2. https://doi.org/10.1186/s41038-016-0066-4
Bruehl S. (2015). Complex regional pain syndrome. BMJ (Clinical research ed.), 351, h2730. https://doi.org/10.1136/bmj.h2730
Harvard Health Publishing. (2023). Complex Regional Pain Syndrome (CRPS). https://www.health.harvard.edu/a_to_z/complex-regional-pain-syndrome-crps-a-to-z
Tajerian, M., & Clark, J. D. (2016). New Concepts in Complex Regional Pain Syndrome. Hand Clinics, 32(1), 41–49. https://doi.org/10.1016/j.hcl.2015.08.003
Can incorporating nutritional yeast be an option for individuals seeking a healthy vegan and vegetarian cheese substitute?
Nutritional Yeast
Nutritional yeast is a deactivated form of Saccharomyces cerevisiae yeast, commonly known as baker’s or brewer’s yeast. It’s popular in vegan and vegetarian cooking for its savory, cheesy flavor and nutritional benefits. Nutritional yeast is harvested, rinsed, and heat-dried to deactivate it, removing its leavening properties. This means it doesn’t cause food to rise but adds flavor and vital nutrients.
Around 1.5 tablespoons contains 5 grams of carbohydrates, including 3 grams of fiber.
Yeast provides an especially beneficial form of soluble fiber known as beta-glucan, with unique health benefits. (Bashir K. M. I., & Choi J. S. 2017)
Fats
Most brands are naturally fat-free.
Protein
It provides all essential amino acids with 8 grams per 1.5 tablespoons.
Vitamins and Minerals
Most nutritional yeast products are fortified with added B vitamins. Most provide 600% or more B vitamins per 16 grams and 1,000% of the daily value for vitamin B12, depending on the brand. It also has:
Calcium
Thiamin
Iron
Potassium
Nutritional Yeast Health Benefits
Health benefits include:
Reduces Risk of Anemia
Iron is typically the first nutrient to come to mind. However, inadequate folate or vitamin B12 also causes anemia. A common treatment for a vitamin B12 deficiency is injections, but large doses consumed can also be effective. (National Institutes of Health, Office of Dietary Supplements, 2024) Individuals who follow a plant-based or vegan diet often have limited sources of vitamin B12. Most brands of nutritional yeast are fortified with B12, providing more than 500% of the daily value per serving. Because B12 is water-soluble, it won’t cause toxicity when consumed in high doses and can serve as a key source of this essential nutrient.
Supports Heart Health
Nutritional yeast contains beta-glucan, a carbohydrate found in the cell walls of plants, bacteria, and fungi. Higher intakes lead to favorable cardiovascular outcomes, including lowering bad cholesterol and increasing good cholesterol. (Bashir K. M. I., & Choi J. S. 2017) In addition, most brands contain potassium, which reduces blood pressure.
Promote Healthy Immune System Function
More research is needed, but several studies have shown how yeast-derived beta-glucan can strengthen the immune system. (Stier H., Ebbeskotte V., & Gruenwald J. 2014) These benefits are attributed to beta glucan’s bacterial fermentation in the intestines. Beta-glucan may also stimulate the activity of crucial immune system cells, like macrophages.
Prevents Constipation
Fiber is essential. The recommended fiber intake is at least 25 to 35 grams daily. Unfortunately, many do not get enough. Nutritional yeast contributes 3 grams of fiber per 16 grams. Fiber regulates bowel movements by pulling water into the colon and adding bulk and softness to stool. (University of Michigan, 2008)
Using nutritional yeast can help reach an adequate fiber intake.
Diabetes Management
Getting enough fiber helps prevent blood sugar fluctuations. Low-fiber diets have been shown to increase the risk of diabetes in various populations. (Harvard T.H. Chan, School of Public Health, 2022) Fiber slows digestion and increases satiety, controlling hunger and the glycemic response. Fiber is beneficial for preventing diabetes and helping those with diabetes maintain good numbers.
Allergies
Individuals who suspect a yeast or mold allergy see an allergist for a full evaluation.
Yeast overgrowth is another possible condition that is unrelated to yeast allergies.
Yeast overgrowth can occur in compromised immune systems or following antibiotic treatment.
Because yeast is present in many foods, anyone with a true yeast allergy may have to avoid several food items, including baked goods, fermented alcoholic beverages, marmite/vegemite, sourdough bread, and certain multivitamins. (Cunningham E. 2013)
Adverse Effects
Nutritional yeast is inactive and unlikely to cause negative effects. However, for individuals who suffer from irritable bowel syndrome (IBS) or migraines, yeast may be a trigger. (UMass Medical School Center for Applied Nutrition, 2020)
Check the label to see if the product is fortified with added vitamins and minerals or has added sodium.
Nutritional yeast is a dry food product available year-round in supermarkets or sold in a bulk food bin.
Storage, Safety, and Use
Although nutritional yeast is a dry product, it will stay in the refrigerator longer after it has been opened. Store it in an airtight container, and be mindful of the expiration date on the label.
It can be added to savory dishes such as pasta, roasted meats, vegetables, and salads. Ways to use include:
On scrambled eggs.
On top of garlic bread.
Popcorn seasoning.
Add to soups.
In pasta dishes, as a substitute for parmesan cheese.
An alternative to cheese sauce.
Injury Medical Chiropractic and Functional Medicine Clinic
Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop highly effective treatment plans through an integrated approach for each patient and restore health and function to the body through nutrition and wellness, functional medicine, acupuncture, Electroacupuncture, and integrated medicine protocols. We focus on what works for you to relieve pain, restore function, prevent injury, and mitigate issues through adjustments that help the body realign itself. The clinic can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.
Learning About Food Substitutions
References
U.S. Department of Agriculture. FoodData Central. (2019). Nutritional yeast. Retrieved from https://fdc.nal.usda.gov/food-details/1744022/nutrients
Bashir, K. M. I., & Choi, J. S. (2017). Clinical and Physiological Perspectives of β-Glucans: The Past, Present, and Future. International journal of molecular sciences, 18(9), 1906. https://doi.org/10.3390/ijms18091906
National Institutes of Health, Office of Dietary Supplements. (2024). Vitamin B12: Fact sheet for health professionals. Retrieved from https://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional/
Stier, H., Ebbeskotte, V., & Gruenwald, J. (2014). Immune-modulatory effects of dietary Yeast Beta-1,3/1,6-D-glucan. Nutrition journal, 13, 38. https://doi.org/10.1186/1475-2891-13-38
University of Michigan. (2008). Bowel function anatomy. https://medicine.umich.edu/sites/default/files/content/downloads/bowel-function.pdf
Harvard T.H. Chan, School of Public Health. (2022). Fiber. https://nutritionsource.hsph.harvard.edu/carbohydrates/fiber/
Cunningham E. (2013). Is there a diet for “yeast allergy”? Journal of the Academy of Nutrition and Dietetics, 113(3), 484. https://doi.org/10.1016/j.jand.2013.01.013
UMass Medical School Center for Applied Nutrition. Chan, U., School, M., & Nutrition, C. F. A. (2020). Nutritional yeast: Nourishing or no-go? UM. https://www.umassmed.edu/nutrition/blog/blog-posts/2020/2/nutritional-yeast–nourishing-or-no-go/
Broken bones are common injuries. Because children’s bones grow rapidly, they have increased flexibility. When injuries, specifically fractures, occur, they do not always break cleanly across the bone or into pieces. What type of fracture is this, and how are they treated?
Greenstick Fracture
A greenstick fracture is a partial break in a bone that occurs when a bone bends and cracks instead of breaking into separate pieces. (Wolfe J. A. et al., 2019) The term is based on a young green branch that bends and splinters but does not break into pieces when bent. Only one side of the bone is broken, while the other side gets bent. Many children experience at least one fracture during their growing years. This is one of multiple fracture types seen in children. They can happen in adults but are uncommon.
Causes
Greenstick fractures mostly occur in infants or toddlers, sometimes in children during their early adolescent and pre-adolescent years. They are partial-thickness fractures (a break in a bone that doesn’t completely break it) characterized by a break on one side and a bend on the other. Buckle fractures and bow fractures are different types of partial-thickness fractures. Greenstick fractures commonly occur:
In children under 10 years old
Occurs when a child reaches out to break a fall
During motor vehicle collisions
Sports
Direct impacts
Non-accidental trauma
It is more common in long bones, including:
Radius
Ulna
Humerus
Fibula
Tibia
Clavicle
The fracture pattern often indicates a limb’s bending or contortion.
Deformity, such as the affected body part looking crooked or out of alignment.
Treatment
If the bone is not significantly bent out of alignment, a splint or cast may be all that is necessary to treat the break. If the bone is visibly out of alignment, it must be manually straightened before the limb is put into a cast. If the break is severe, surgery may be required. Fortunately, a growing skeleton can remodel bone, so fractured bones can often realign themselves over time with minimal intervention. Healing depends on various factors, including:
Sometimes, the fracture must be bent back and repositioned in a fracture reduction procedure. An anesthetic may be used as the doctor manually realigns the bone into the correct position. After the reduction, a cast or splint will stabilize the bone and maintain proper alignment. Depending on how quickly the bone heals, a cast may be necessary for a few weeks, months, or longer, depending on the patient and/or underlying conditions.
Healing
Healing involves specialized cells that gradually rebuild and fine-tune the new bone.
The average time for a greenstick fracture to heal completely may take four weeks.
Injury Medical Chiropractic & 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.
Building a Stronger Body
References
Wolfe, J. A., Wolfe, H., Banaag, A., Tintle, S., & Perez Koehlmoos, T. (2019). Early Pediatric Fractures in a Universally Insured Population within the United States. BMC pediatrics, 19(1), 343. https://doi.org/10.1186/s12887-019-1725-y
Atanelov, Z., & Bentley, T. P. (2025). Greenstick Fracture. In StatPearls. https://www.ncbi.nlm.nih.gov/pubmed/30020651
Pountos, I., Clegg, J., & Siddiqui, A. (2010). Diagnosis and treatment of greenstick and torus fractures of the distal radius in children: a prospective randomised single-blind study. Journal of children’s orthopaedics, 4(4), 321–326. https://doi.org/10.1007/s11832-010-0269-3
For individuals dealing with posture problems causing neck, back, and shoulder pain, can pectoralis minor stretches designed to work these areas be a part of physical therapy or as regular exercises at home?
Pectoralis Minor Muscle Stretches
The pectoralis minor is a small, triangular muscle situated deep to the pectoralis major in the anterior chest wall. It originates from the margins of the third to fifth ribs adjacent to the costochondral junction and connects to the coracoid process of the scapula. The pectoralis minor helps with posture, mobility, and shoulder stability and aids breathing. Muscle tightness can cause pain in the chest, shoulder, and neck and a restricted range of motion. Strain and injuries can occur during activities involving overhead movements or forceful pushing. Pectoralis minor stretches are designed to work these muscles that span the ribs and connect to the shoulder to help improve posture and relieve pain and chest weakness. They can help reduce muscle tightness and other conditions like thoracic outlet syndrome. (Kaur U. et al., 2023) (Wagner E. R. et al., 2023) Talk with a healthcare provider Before starting any exercise or stretching program.
Corner Pectoralis Stretch
A corner pec stretch is similar to a wall push-up, except the emphasis is on staying in a position that lengthens the chest muscles. It’s important to move the whole body as a unit and not bend.
Stand facing a corner with a relaxed, upright posture.
Place your feet so they are parallel, and bend your knees slightly.
Stay as relaxed as possible during the movement to protect your joints.
Keep your gaze forward.
Place your forearms and palms over the walls where two walls connect at a right angle.
With your elbows bent to 90 degrees, move forward into the corner of the wall until you feel a comfortable stretch in the pectorals.
The doorway stretch is similar to the corner stretch. It works the pectoralis major and the minor muscles and helps with mobility. To perform: (Maryland Pain & Wellness Center, 2025)
Stand in a doorway with your feet placed together.
Place the palms and forearms on either side of the doorway.
Your elbows should be even with your shoulders and bend at a 90-degree angle.
Keep your back straight.
Take a step forward, leaning into the doorway.
You should feel the stretch in the muscle.
Repeat the stretch with the other foot.
Exercise and ergonomic changes to your chair or desk height can help improve posture and relieve muscle tightness. (Kaur U. et al., 2023)
T Stretch
The T stretch stretches the front of the chest and is done on the floor, typically with a foam roller placed directly under the spine. To perform: (OrthoCarolina, N.D.)
Lie down on your back with the foam roller aligned to the spine.
Make sure your head and tailbone are supported.
Open your arms straight out like a T.
Hold the position while stretching.
Y Stretch
The Y stretch is similar to the T stretch; both reduce chest muscle tightness and discomfort. To perform: (OrthoCarolina, N.D.)
Use the same foam roll position, lying on your back with the head and tailbone supported and aligned.
Stretch the arms out above your head, placing them into the shape of a Y.
Allow the chest muscles that connect to the arms to relax.
Studies have examined how quickly a prone scapular retraction can help stretch the back and shoulders. Results suggest the exercises must be performed longer before the pectoralis minor is lengthened to improve symptoms. (Dye J., Allyn M., & Frank C. 2024) However, further research is needed.
Health Conditions
Pectoralis minor stretches may be part of a personalized therapy program to improve mobility, posture, and/or breathing and sleep quality with health conditions that include:
Stretching and strengthening exercises can help improve their flexibility and function. Exercises can improve strength and function by standing or lying down, depending on the stretch.
Injury Medical Chiropractic and Functional Medicine Clinic
The pectoralis minor muscles are often overlooked in clinical examinations but can contribute to musculoskeletal pain and dysfunction. A healthcare provider can teach about stretches, how they can help, and whether they are safe for the individual’s injury and/or condition. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to build optimal health and wellness solutions. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. The clinic can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.
Doorway Stretching Routine
References
Kaur, U., Shrestha, D., Hussain, M. A., Dalal, P., Kalita, M., Sharma, V., & Sharma, S. (2023). Prompt Impact of Muscle Energy Technique on Pectoralis Muscle Tightness in Computer Users: A Quasi-Experimental Study. Journal of Lifestyle Medicine, 13(2), 123–128. https://doi.org/10.15280/jlm.2023.13.2.123
Wagner, E. R., Gottschalk, M. B., Ahmed, A. S., Graf, A. R., & Karzon, A. L. (2023). Novel Diagnostic and Treatment Techniques for Neurogenic Thoracic Outlet Syndrome. Techniques in hand & upper extremity surgery, 27(2), 100–114. https://doi.org/10.1097/BTH.0000000000000419
University of North Carolina School of Medicine. (2020). Upper Body Stretching. https://www.med.unc.edu/htcenter/wp-content/uploads/sites/711/2020/04/Upper-Body-Stretching.pdf
Maryland Pain & Wellness Center. (2025). Stretches to Help with Strained Chest Muscles. Maryland Pain & Wellness Center Restoring Hope, Rebuilding Lives. https://www.marylandpainandwellnesscenter.com/blog/stretches-to-help-with-strained-chest muscles#:~:text=With%20your%20knees%20bent%20and,assist%20in%20deepening%20the%20stretch.
OrthoCarolina. (N.D.). Stretching Guide to Ease Tight Muscles. https://www.orthocarolina.com/storage/wysiwyg/stretching_guide_1.pdf
Dye, J., Allyn, M., & Frank, C. (2024). Is there an immediate effect on pectoralis minor length after performing a prone scapular retraction exercise using typical sets and repetitions in pain-free participants? Journal of bodywork and movement therapies, 40, 1014–1019. https://doi.org/10.1016/j.jbmt.2024.07.026
Chankavee, N., Amatachaya, S., Hunsawong, T., Thaweewannakij, T., & Mato, L. (2023). Effects of modified long stick exercise on hyperkyphosis, muscle imbalance, and balance control in elderly community-dwelling women with hyperkyphosis. Journal of back and musculoskeletal rehabilitation, 36(5), 1151–1162. https://doi.org/10.3233/BMR-220350
Liao, Y. X., Saiken, A., Chang, X., Guo, Y. F., Tan, Z., Deng, F., Meng, Q. L., Zhen, H., Li, Y. M., & Fang, B. M. (2025). Associations of fat, bone, and muscle indices with disease severity in patients with obstructive sleep apnea-hypopnea syndrome. Sleep & breathing = Schlaf & Atmung, 29(1), 82. https://doi.org/10.1007/s11325-024-03241-8
Thongchote, K., Chinwaro, U., & Lapmanee, S. (2024). Effects of scapulothoracic exercises on chest mobility, respiratory muscle strength, and pulmonary function in male COPD patients with forward shoulder posture: A randomized controlled trial. F1000Research, 11, 1284. https://doi.org/10.12688/f1000research.126832.2
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