Disc bulge and disc herniation are some of the most common conditions affecting the spine of both young and middle-aged patients. It is estimated that approximately 2.6% of the US population annually visits a clinician to treat spinal disorders. Roughly $ 7.1 billion alone is lost due to the time away from work.
Disc herniation is when the whole or part of the nucleus pulposus is protruded through the torn or weakened outer annulus fibrosus of the intervertebral disc. This is also known as the slipped disc and frequently occurs in the lower back, sometimes also affecting the cervical region. Herniation of the intervertebral disc is defined as a localized displacement of disc material with 25% or less of the disc circumference on an MRI scan, according to the North American Spine Society 2014. The herniation may consist of nucleus pulposus, annulus fibrosus, apophyseal bone or osteophytes, and the vertebral endplate cartilage in contrast to disc bulge.
There are also mainly two types of disc herniation. Disc protrusion is when a focal or symmetrical extension of the disc comes out of its confines in the intervertebral space. It is situated at the intervertebral disc level, and its outer annular fibers are intact. A disc extrusion is when the intervertebral disc extends above or below the adjacent vertebrae or endplates with a complete annular tear. In this type of disc extrusion, a neck or base is narrower than the dome or the herniation.
A disc bulge is when the outer fibers of the annulus fibrosus are displaced from the margins of the adjacent vertebral bodies. Here, the displacement is more than 25% of the circumference of the intervertebral disc. It also does not extend below or above the margins of the disc because the annulus fibrosus attachment limits it. It differs from disc herniation because it involves less than 25% of the disc’s circumference. Usually, the disc bulge is a gradual process and is broad. The disc bulge can be divided into two types. In a circumferential bulge, the whole disc circumference is involved. More than 90 degrees of the rim is involved asymmetrically in asymmetrical bulging.
Normal Intervertebral Disc Anatomy
Before going into detail about the definition of disc herniation and disc bulge, we need to look at the standard intervertebral disc. According to spine guidelines in 2014, a standard disc is something that has a classic shape without any evidence of degenerative disc changes. Intervertebral discs are responsible for one-third to one-fourth of the height of the spinal column.
One intervertebral disc is about 7 -10 mm thick and measures 4 cm in anterior-posterior diameter in the lumbar region of the spine. These spinal discs are located between two adjacent vertebral bodies. However, no discs can be found between the atlas and axis and the coccyx. About 23 discs are found in the spine, with six in the cervical spine, 12 in the thoracic spine, and only five in the lumbar spine.
Intervertebral discs are made of fibro cartilages, forming a fibrocartilaginous joint. The outer ring of the intervertebral disc is known as the annulus fibrosus, while the inner gel-like structure in the center is known as the nucleus pulposus. The cartilage endplates sandwich the nucleus pulposus superiorly and inferiorly. The annulus fibrosus comprises concentric collagen fiber sheets arranged in a radial tire-like structure into lamellae. The fibers are attached to the vertebral endplates and oriented at different angles. With their cartilaginous part, the endplates anchor the discs in their proper place.
The nucleus pulposus is composed of water, collagen, and proteoglycans. Proteoglycans attract and retain moisture, giving the nucleus pulposus a hydrated gel-like consistency. Interestingly, throughout the day, the amount of water found in the nucleus pulposus varies according to the person’s level of activity. This feature in the intervertebral disc serves as a cushion or a spinal shock-absorbing system to protect the adjacent vertebra, spinal nerves, spinal cord, brain, and other structures against various forces. Although the individual movement of the intervertebral discs is limited, some form of vertebral motion like flexion and extension is still possible due to the features of the intervertebral disc.
Effect of Intervertebral Disc Morphology on Structure and Function
The type of components present in the intervertebral disc and how it is arranged determine the morphology of the intervertebral disc. This is important in how effectively the disc does its function. As the disc is the most important element which bears the load and allows movement in the otherwise rigid spine, the constituents it is made up of have a significant bearing.
The complexity of the lamellae increases with advancing age as a result of the synthetic response of the intervertebral disc cells to the variations in the mechanical load. These changes in lamellae with more bifurcations, interdigitation and irregular size and number of lamellar bands will lead to the altered bearing of weight. This in turn establishes a self-perpetuated disruption cycle leading to the destruction of the intervertebral discs. Once this process is started it is irreversible. As there is an increased number of cells, the amount of nutrition the disc requires is also increasingly changing the normal concentration gradient of both metabolites and nutrients. Due to this increased demand, the cells may also die increasingly by necrosis or apoptosis.
Human intervertebral discs are avascular and hence the nutrients are diffused from the nearby blood vessels in the margin of the disc. The main nutrients; oxygen and glucose reach the cells in the disc through diffusion according to the gradient determined by the rate of transport to the cells through the tissues and the rate of demand. Cells also increasingly produce lactic acid as a metabolic end product. This is also removed via the capillaries and venules back to the circulation.
Since diffusion depends on the distance, the cells lying far from the blood capillaries can have a reduced concentration of nutrients because of the reduced supply. With disease processes, the normally avascular intervertebral disc can become vascular and innervated in degeneration and in disease processes. Although this may increase the oxygen and nutrient supply to the cells in the disc, this can also give rise to many other types of cells that are normally not found in the disc with the introduction of cytokines and growth factors.
The morphology of the intervertebral disc in different parts of the spine also varies although many clinicians base the clinical theories based on the assumption that both cervical and lumbar intervertebral discs have the same structure. The height of the disc was the minimum in the T4-5 level of the thoracic column probably due to the fact that thoracic intervertebral discs are less wedge-shaped than those of cervical and lumbar spinal regions.
From the cranial to caudal direction, the cross-sectional area of the spine increased. Therefore, by the L5-S1 level, the nucleus pulposus was occupying a higher proportion of the intervertebral disc area. The cervical discs have an elliptical shape on cross-section while the thoracic discs had a more circular shape. The lumbar discs also have an elliptical shape though it is more flattened or re-entrant posteriorly.
What is a Disc Bulge?
The bulging disc is when the disc simply bulges outside the intervertebral disc space it normally occupies without the rupture of the outer annulus fibrosus. The bulging area is quite large when compared to a herniated disc. Moreover, in a herniated disc, the annulus fibrosus ruptures or cracks. Although disc bulging is more common than disc herniation, it causes little or no pain to the patient. In contrast, the herniated disc causes a lot of pain.
Causes for Disc Bulging
A bulging disc can be due to several causes. It can occur due to normal age-related changes such as those seen in degenerative disc disease. The aging process can lead to structural and biochemical changes in the intervertebral discs and lead to reduced water content in the nucleus pulposus. These changes can make the patient vulnerable to disc bulges with only minor trauma. Some unhealthy lifestyle habits such as a sedentary lifestyle and smoking can potentiate this process and give rise to more severe changes with the weakening of the disc.
General wear and tear due to repeated microtrauma can also weaken the disc and give rise to disc bulging. This is because when the discs are strained, the normal distribution of weight loading changes. Accumulated micro-trauma over a long period of time can occur in bad posture. Bad posture when sitting, standing, sleeping, and working can increase the pressure in the intervertebral discs.
When a person maintains a forward bending posture, it can lead to overstretching and eventually weakness of the posterior part of the annulus fibrosus. Over time, the intervertebral disc can bulge posteriorly. In occupations that require frequent and repetitive lifting, standing, driving, or bending, the bulging disc may be an occupational hazard. Improper lifting up of items, and improper carrying of heavy objects can also increase the pressure on the spine and lead to disc bulges eventually.
The bulging intervertebral discs usually occur over a long period of time. However, the discs can bulge due to acute trauma too. The unexpected sudden mechanical load can damage the disc resulting in micro-tears. After an accident, the disc can become weakened causing long-term microdamage ultimately leading to bulging of the disc. There may also be a genetic component to the disc bulging. The individual may have a reduced density of elastin in the annulus fibrosus with increased susceptibility to disc diseases. Other environmental facts may also play a part in this disease process.
Symptoms of Disc Bulging
As mentioned previously, bulging discs do not cause pain and even if they do the severity is mild. In the cervical region, the disease will cause pain running down the neck, deep pain in the shoulder region, pain radiating along the upper arm, and forearm up to the fingers.
This may give rise to a diagnostic dilemma as to whether the patient is suffering from a myocardial infarction as the site of referred pain and the radiation is similar. Tingling feeling on the neck may also occur due to the bulging disc.
In the thoracic region, there may be pain in the upper back that radiates to the chest or the upper abdominal region. This may also suggest upper gastrointestinal, lung, or cardiac pathology and hence need to be careful when analyzing these symptoms.
The bulging discs of the lumbar region may present as lower back pain and tingling feeling in the lower back region of the spine. This is the most common site for disc bulges since this area holds the weight of the upper body. The pain or the discomfort can spread through the gluteal area, thighs, and to the feet. There may also be muscle weakness, numbness or tingling sensation. When the disc presses on the spinal cord, the reflexes of both legs can increase leading to spasticity.
Some patients may even have paralysis from the waist down. When the bulging disc compresses on the cauda equine, the bladder and bowel functions can also change. The bulging disc can press on the sciatic nerve leading to sciatica where the pain radiates in one leg from the back down to the feet.
The pain from the bulging disc can get worse during some activities as the bulge can then compress on some of the nerves. Depending on what nerve is affected, the clinical features can also vary.
Diagnosis of Disc Bulging
The diagnosis may not be apparent from clinical history due to similar presentations in more serious problems. But the chronic nature of the disease may give some clues. Complete history and a physical examination need to be done to rule out myocardial infarction, gastritis, gastro-oesophageal reflux disease, and chronic lung pathology.
MRI of Disc Bulge
Investigations are necessary for the diagnosis. X-ray spine is performed to look for gross pathology although it may not show the bulging disc directly. There may be indirect findings of disk degeneration such as osteophytes in the endplates, gas in the disc due to the vacuum phenomenon, and the loss of height of the intervertebral disc. In the case of moderate bulges, it may sometimes appear as non-focal intervertebral disc material that is protruded beyond the borders of the vertebra which is broad-based, circumferential, and symmetrical.
Magnetic resonance imaging or MRI can exquisitely define the anatomy of the intervertebral discs especially the nucleus pulposus and its relationships. The early findings seen on MRI in disc bulging include the loss of normal concavity of the posterior disc. The bulges can be seen as broad-based, circumferential, and symmetrical areas. In moderate bulging, the disc material will protrude beyond the borders of the vertebrae in a non-focal manner. Ct myelogram may also give detailed disc anatomy and may be useful in the diagnosis.
Treatment of Disc Bulging
The treatment for the bulging disc can be conservative, but sometimes surgery is required.
Conservative Treatment
When the disc bulging is asymptomatic, the patient does not need any treatment since it does not pose an increased risk. However, if the patient is symptomatic, the management can be directed at relieving the symptoms. The pain is usually resolved with time. Till then, potent pain killers such as non-steroidal anti-inflammatory drugs like ibuprofen should be prescribed. In unresolved pain, steroid injections can also be given to the affected area and if it still does not work, the lumbar sympathetic block can be tried in most severe cases.
The patient can also be given the option of choosing alternative therapies such as professional massage, physical therapy, ice packs, and heating pads which may alleviate symptoms. Maintaining correct posture, tapes, or braces to support the spine are used with the aid of a physiotherapist. This may fasten the recovery process by avoiding further damage and keeping the damaged or torn fibers in the intervertebral disc without leakage of the fluid portion of the disc. This helps maintain the normal structure of the annulus and may increase the recovery rate. Usually, the painful symptoms which present initially get resolved over time and lead to no pain. However, if the symptoms get worse steadily, the patient may need surgery
If the symptoms are resolved, physiotherapy can be used to strengthen the muscles of the back with the use of exercises. Gradual exercises can be used for the return of function and for preventing recurrences.
Surgical Treatment
When conservative therapy does not work with a few months of treatment, surgical treatment can be considered. Most would prefer minimally invasive surgery which uses advanced technology to correct the intervertebral disc without having to grossly dissect the back. These procedures such as microdiscectomy have a lower recovery period and reduced risk of scar formation, major blood loss, and trauma to adjacent structures when compared to open surgery.
Previously, laminectomy and discectomy have been a mainstay of treatment. However, due to the invasiveness of the procedure and due to increased damage to the nerves these procedures are currently abandoned by many clinicians for disc bulging.
Disc bulging in the thoracic spine is being treated surgically with costotransversectomy where a section of the transverse process is resected to allow access to the intervertebral disc. The spinal cord and spinal nerves are decompressed by using thoracic decompression by removing a part of the vertebral body and making a small opening. The patient may also need a spinal fusion later on if the removed spinal body was significant.
Video-assisted thoracoscopic surgery can also be used where only a small incision is made and the surgeon can perform the surgery with the assistance of the camera. If the surgical procedure involved removing a large portion of the spinal bone and disc material, it may lead to spinal instability. This may need bone grafting to replace the lost portion with plates and screws to hold them in place.
What is a Disc Herniation?
As mentioned in the first section of this article, disc herniation occurs when there is disc material displaces beyond the limits of the intervertebral disc focally. The disc space consists of endplates of the vertebral bodies superiorly and inferiorly while the outer edges of the vertebral apophyses consist of the peripheral margin. The osteophytes are not considered a disc margin. There may be irritation or compression of the nerve roots and dural sac due to the volume of the herniated material leading to pain. When this occurs in the lumbar region, this is classically known as sciatica. This condition has been mentioned since ancient times although a connection between disc herniation and sciatica was made only in the 20th century. Disc herniation is one of the commonest diagnoses seen in the spine due to degenerative changes and is the commonest cause of spinal surgery.
Classifications of Disc Herniation
There are many classifications regarding intervertebral disc herniation. In focal disc herniation, there is a localized displacement of the disc material in the horizontal or axial plane. In this type, only less than 25% of the circumference of the disc is involved. In broad-based disc herniation, about 25 – 50 % of the disc circumference is herniated. The disc bulge is when 50 – 100 % of the disc material is extended beyond the normal confines of the intervertebral space. This is not considered a form of disc herniation. Furthermore, the intervertebral disc deformities associated with severe cases of scoliosis and spondylolisthesis are not classified as a herniation but rather adaptive changes of the contour of the disc due to the adjacent deformity.
Depending on the contour of the displaced material, the herniated discs can be further classified as protrusions and extrusions. In disc protrusion, the distance measured in any plane involving the edges of the disc material beyond intervertebral disc space (the highest measure is taken) is lower than the distance measured in the same plane between the edges of the base.
Imaging can show the disc displacement as a protrusion on the horizontal section and as an extrusion on the sagittal section due to the fact that the posterior longitudinal ligament contains the disc material that is displaced posteriorly. Then the herniation should be considered an extrusion. Sometimes the intervertebral disc herniation can occur in the craniocaudal or vertical direction through a defect in the vertebral body endplates. This type of herniation is known as intravertebral herniation.
The disc protrusion can also be divided into two focal protrusion and broad-based protrusion. In focal protrusion, the herniation is less than 25% of the circumference of the disc whereas, in broad-based protrusion, the herniated disc consists of 25 – 50 % of the circumference of the disc.
In disc extrusion, it is diagnosed if any of the two following criteria are satisfied. The first one is; that the distance measured between the edges of the disc material that is beyond the intervertebral disc space is greater than the distance measured in the same plane between the edges of the base. The second one is; that the material in the intervertebral disc space and material beyond the intervertebral disc space is having a lack continuity.
This can be further characterized as sequestrated which is a subtype of the extruded disc. It is called disc migration when disk material is pushed away from the site of extrusion without considering whether there is continuity of disc or not. This term is useful in interpreting imaging modalities as it is often difficult to show continuity in imaging.
The intervertebral disc herniation can be further classified as contained discs and discs that are unconfined. The term contained disc is used to refer to the integrity of the peripheral annulus fibrosus which is covering the intervertebral disc herniation. When fluid is injected into the intervertebral disc, the fluid does not leak into the vertebral canal in herniations that are contained.
Sometimes there are displaced disc fragments that are characterized as free. However, there should be no continuity between disc material and the fragment and the original intervertebral disc for it to be called a free fragment or a sequestered one. In a migrated disc and in a migrated fragment, there is an extrusion of disc material through the opening in the annulus fibrosus with a displacement of the disc material away from the annulus.
Even though some fragments that are migrated can be sequestered the term migrated means just to the position and it is not referred to the continuity of the disc. The displaced intervertebral disc material can be further described with regard to the posterior longitudinal ligament as submembranous, subcapsular, subligamentous, extra ligamentous, transligamentous, subcapsular, and perforated.
The spinal canal can also get affected by an intervertebral disc herniation. This compromise of the canal can also be classified as mild, moderate, and severe depending on the area that is compromised. If the canal at that section is compromised only less than one third, it is called mild whereas if it is only compromised less than two-thirds and more than one third it is considered moderate. In a severe compromise, more than two-thirds of the spinal canal is affected. For the foraminal involvement, this same grading system can be applied.
The displaced material can be named according to the position that they are in the axial plane from the center to the right lateral region. They are termed as central, right central, right subarticular, right foraminal, and right extraforaminal. The displaced intervertebral disc material’s composition can be further classified as gaseous, liquefied, desiccated, scarred, calcified, ossified, bony, nuclear, and cartilaginous.
Before going into detail on how to diagnose and treat intervertebral disc herniation, let us differentiate how cervical disc herniation differs from lumbar herniation since they are the most common regions to undergo herniation.
Cervical Disc Herniation vs. Thoracic Disc Herniation vs Lumbar Disc Herniation
Lumbar disc herniation is the most commonest type of herniation found in the spine which is approximately 90% of the total. However, cervical disc herniation can also occur in about one-tenth of patients. This difference is mainly due to the fact that the lumbar spine has more pressure due to the increased load. Moreover, it has comparatively large intervertebral disc material. The most common sites of intervertebral disc herniation in the lumbar region are L 5 – 6, in the Cervical region between C7, and in the thoracic region T12.
Cervical disc herniation can occur relatively commonly because the cervical spine acts as a pivoting point for the head and it is a vulnerable area for trauma and therefore prone to damage in the disc. Thoracic disc herniation occurs more infrequently than any of the two. This is due to the fact that thoracic vertebrae are attached to the ribs and the thoracic cage which limits the range of movement in the thoracic spine when compared to the cervical and lumbar spinal discs. However, thoracic intervertebral disc herniation can still occur.
Cervical disc herniation gives rise to neck pain, shoulder pain, pain radiating from the neck to the arm, tingling, etc. Lumbar disc herniation can similarly cause lower back pain as well as pain, tingling, numbness, and muscle weakness seen in the lower limbs. Thoracic disc herniation can give rise to pain in the upper back radiating to the torso.
Epidemiology
Although disc herniation can occur in all age groups, it predominantly occurs between the fourth and fifth decade of life with the mean age of 37 years. There have been reports that estimate the prevalence of intervertebral disc herniation to be 2 – 3 % of the general population. It is more commonly seen in men over 35 years with a prevalence of 4.8% and while in women this figure is around 2.5%. Due to its high prevalence, it is considered a worldwide problem as it is also associated with significant disability.
Risk Factors
In most instances, a herniated disc occurs due to the natural aging process in the intervertebral disc. Due to the disc degeneration, the amount of water that was previously seen in the intervertebral disc gets dried out leading to the shrinking of the disc with the narrowing of the intervertebral space. These changes are markedly seen in degenerative disc disease. In addition to these gradual changes due to normal wear and tear, other factors may also contribute to increasing the risk of intervertebral disc herniation.
Being overweight can increase the load on the spine and increase the risk of herniation. A sedentary life can also increase the risk and therefore an active lifestyle is recommended in preventing this condition. Improper posture with prolonged standing, sitting, and especially driving can put a strain on the intervertebral discs due to the additional vibration from the vehicle engine leading to microtrauma and cracks in the disc. The occupations which require constant bending, twisting, pulling and lifting can put a strain on the back. Improper weight lifting techniques are one of the major reasons.
When back muscles are used in lifting heavy objects instead of lifting with the legs and twisting while lifting can make the lumbar discs more vulnerable to herniation. Therefore patients should always be advised to lift weights with their legs and not the back. Smoking has been thought to increase disc herniation by reducing the blood supply to the intervertebral disc leading to degenerative changes of the disc.
Although the above factors are frequently assumed to be the causes for disc herniation, some studies have shown that the difference in risk is very small when this particular population was compared with the control groups of the normal population.
There have been several types of research done on genetic predisposition and intervertebral disc herniation. Some of the genes that are implicated in this disease include vitamin D receptor (VDR) which is a gene that codes for the polypeptides of important collagen called collagen IX (COL9A2).
Another gene called the human aggrecan gene (AGC) is also implicated as it codes for proteoglycans which is the most important structural protein found in the cartilage. It supports the biochemical and mechanical function of the cartilage tissue and hence when this gene is defective, it can predispose an individual to intervertebral disc herniation.
Apart from these, there are many other genes that are being researched due to the association between disc herniation such as matrix metalloproteinase (MMP) cartilage intermediate layer protein, thrombospondin (THBS2), collagen 11A1, carbohydrate sulfotransferase, and asporin (ASPN). They may also be regarded as potential gene markers for lumbar disc disease.
Pathogenesis of Sciatica and Disc Herniation
The sciatic pain originated from the extruded nucleus pulposus inducing various phenomena. It can directly compress the nerve roots leading to ischemia or without it, mechanically stimulate the nerve endings of the outer portion of the fibrous ring and release inflammatory substances suggesting its multifactorial origin. When the disc herniation causes mechanical compression of the nerve roots, the nerve membrane is sensitized to pain and other stimuli due to ischemia. It has been shown that in sensitized and compromised nerve roots, the threshold for neuronal sensitization is around half of that of a normal and non-compromised nerve root.
The inflammatory cell infiltration is different in extruded discs and non-extruded discs. Usually, in non-extruded discs, the inflammation is less. The extruded disc herniation causes the posterior longitudinal ligament to rupture which exposes the herniated part to the vascular bed of the epidural space. It is believed that inflammatory cells are originating from these blood vessels situated in the outermost part of the intervertebral disc.
These cells may help secrete substances that cause inflammation and irritation of the nerve roots causing sciatic pain. Therefore, extruded herniations are more likely to cause pain and clinical impairment than those that are contained. In contained herniations, the mechanical effect is predominant while in the unconfined or the extruded discs the inflammatory effect is predominant.
Clinical Disc Herniation and What to Look for in the History
The symptoms of the disc herniation can vary a great deal depending on the location of the pain, the type of herniation, and the individual. Therefore, history should focus on the analysis of the main complaint among the many other symptoms.
The chief complaint can be neck pain in cervical disc herniation and there can be referred pain in the arms, shoulders, neck, head, face, and even the lower back region. However, it is most commonly referred to as the interscapular region. The radiation of pain can occur according to the level at the herniation is taking place. When the nerve roots of the cervical region are affected and compressed, there can be sensory, and motor changes with changes in the reflexes.
The pain that occurs due to nerve root compression is called radicular pain and it can be described as deep, aching, burning, dull, achy, and electric depending on whether there is mainly motor dysfunction or sensory dysfunction. In the upper limb, the radicular pain can follow a dermatomal or myotomal pattern. Radiculopathy usually does not accompany neck pain. There can be unilateral as well as bilateral symptoms. These symptoms can be aggravated by activities that increase the pressure inside the intervertebral discs such as the Valsalva maneuver and lifting.
Driving can also exacerbate pain due to disc herniation due to stress because of vibration. Some studies have shown that shock loading and stress from vibration can cause a mechanical force to exacerbate small herniations but flexed posture had no influence. Similarly, activities that decrease intradiscal pressure can reduce the symptoms such as lying down.
The main complaint in lumbar disc herniation is lower back pain. Other associated symptoms can be a pain in the thigh, buttocks, and anogenital region which can radiate to the foot and toe. The main nerve affected in this region is the sciatic nerve causing sciatica and its associated symptoms such as intense pain in the buttocks, leg pain, muscle weakness, numbness, impairment of sensation, hot and burning or tingling sensation in the legs, dysfunction of gait, impairment of reflexes, edema, dysesthesia or paresthesia in the lower limbs. However, sciatica can be caused by causes other than herniation such as tumors, infection, or instability which need to be ruled out before arriving at a diagnosis.
The herniated disc can also compress on the femoral nerve and can give rise to symptoms such as numbness, tingling sensation in one or both legs, and a burning sensation in the legs and hips. Usually, the nerve roots that are affected in herniation in the lumbar region are the ones exiting below the intervertebral disc. It is thought that the level of the nerve root irritation determines the distribution of leg pain. In herniations at the third and fourth lumbar vertebral levels, the pain may radiate to the anterior thigh or the groin. In radiculopathy at the level of the fifth lumbar vertebra, the pain may occur in the lateral and anterior thigh region. In herniations at the level of the first sacrum, the pain may occur in the bottom of the foot and the calf. There can also be numbness and tingling sensation occurring in the same area of distribution. The weakness in the muscles may not be able to be recognized if the pain is very severe.
When changing positions the patient is often relieved from pain. Maintaining a supine position with the legs raised can improve the pain. Short pain relief can be brought by having short walks while long walks, standing for prolonged periods, and sitting for extended periods of time such as in driving can worsen the pain.
The lateral disc herniation is seen in foraminal and extraforaminal herniations and they have different clinical features to that of medial disc herniation seen in subarticular and central herniations. The lateral intervertebral disc herniations can when compared to medial herniations more directly irritate and mechanically compress the nerve roots that are exiting and the dorsal root ganglions situated inside the narrowed spinal canal.
Therefore, lateral herniation is seen more frequently in older age with more radicular pain and neurological deficits. There is also more radiating leg pain and intervertebral disc herniations in multiple levels in the lateral groups when compared to medial disc herniations.
The herniated disc in the thoracic region may not present with back pain at all. Instead, there are predominant symptoms due to referred pain in the thorax due to irritation of nerves. There can also be predominant pain in the body that travels to the legs, tingling sensation and numbness in one or both legs, muscle weakness, and spasticity of one or both legs due to exaggerated reflexes.
The clinician should look out for atypical presentations as there could be other differential diagnoses. The onset of symptoms should be inquired about to determine whether the disease is acute, sub-acute, or chronic in onset. Past medical history has to be inquired about in detail to exclude red flag symptoms such as pain that occurs at night without activity which can be seen in pelvic vein compression, and non-mechanical pain which may be seen in tumors or infections.
If there is a progressive neurological deficit, with bowel and bladder involvement is there, it is considered a neurological emergency and urgently investigated because cauda equine syndrome may occur which if untreated, can lead to permanent neurological deficit.
Getting a detailed history is important including the occupation of the patient as some activities in the job may be exacerbating the patient’s symptoms. The patient should be assessed regarding which activities he can and cannot do.
Differential Diagnosis
Degenerative disc disease
Mechanical pain
Myofascial pain leading to sensory disturbances and local or referred pain
Hematoma
Cyst leading to occasional motor deficits and sensory disturbances
Spondylosis or spondylolisthesis
Discitis or osteomyelitis
Malignancy, neurinoma or mass lesion causing atrophy of thigh muscles, glutei
Spinal stenosis is seen mainly in the lumbar region with mild low back pain, motor deficits, and pain in one or both legs.
An epidural abscess can cause symptoms similar to radicular pain involving spinal disc herniation
Aortic aneurysm which can cause low back pain and leg pain due to compression can also rupture and lead to hemorrhagic shock.
Hodgkin’s lymphoma in advanced stages can lead to space-occupying lesions in the spinal column leading to symptoms like that of intervertebral disc herniation
Tumors
Pelvic endometriosis
Facet hypertrophy
Lumbar nerve root schwannoma
Herpes zoster infection results in inflammation along with the sciatic or lumbosacral nerve roots
Examination in Disc Herniation
Complete physical examination is necessary to diagnose intervertebral disc herniation and exclude other important differential diagnoses. The range of motion has to be tested but may have a poor correlation with disc herniation as it is mainly reduced in elderly patients with a degenerative disease and due to disease of the joints.
A complete neurological examination is often necessary. This should test muscle weakness and sensory weakness. In order to detect muscle weakness in small toe muscles, the patient can be asked to walk on tiptoe. The strength of muscle can also be tested by comparing the strength to that of the clinician. There may be dermatomal sensory loss suggesting the respective nerve root involvement. The reflexes may be exaggerated or sometimes maybe even absent.
There are many neurologic examination maneuvers described in relation to intervertebral disc herniation such as the Braggart sign, flip the sign, Lasegue rebound sign, Lasegue differential sign, Mendel Bechterew sign, Deyerle sign both legs or Milgram test, and well leg or Fajersztajin test. However, all these are based on testing the sciatic nerve root tension by using the same principles in the straight leg raising test. These tests are used for specific situations to detect subtle differences.
Nearly almost all of them depend on the pain radiating down the leg and if it occurs above the knee it is assumed to be due to a neuronal compressive lesion and if the pain goes below the knee, it is considered to be due to the compression of the sciatic nerve root. For lumbar disc herniation detection, the most sensitive test is considered to be radiating pain occurring down the leg due to provocation.
In the straight leg raising test also called the Lasegue’s sign, the patient stays on his or her back and keeps the legs straight. The clinician then lifts the legs by flexing the hip while keeping the knee straight. The angle at which the patient feels pain going down the leg below the knee is noted. In a normal healthy individual, the patient can flex the hip to 80- 90? without having any pain or difficulty.
However, if the angle is just 30 -70? degrees, it is suggestive of lumbar intervertebral disc herniation at the L4 to S1 nerve root levels. If the angle of hip flexion without pain is less than 30 degrees, it usually indicates some other causes such as tumor of the gluteal region, gluteal abscess, spondylolisthesis, disc extrusion, and protrusion, malingering patient, and acute inflammation of the dura mater. If pain with hip flexion occurs at more than 70 degrees, it may be due to tightness of the muscles such as gluteus maximus and hamstrings, tightness of the capsule of the hip joint, or pathology of sacroiliac or hip joints.
The reverse straight leg raising test or hip extension test can be used to test higher lumbar lesions by stretching the nerve roots of the femoral nerve which is similar to the straight leg raising test. In the cervical spine, in order to detect stenosis of the foramina, the Spurling test is done and is not specific to cervical intervertebral disc herniation or tension of the nerve roots. The Kemp test is the analogous test in the lumbar region to detect foraminal stenosis. Complications due to the disc herniation include careful examination of the hip region, digital rectal examination, and urogenital examination is needed.
Investigation of Disc Herniation
For the diagnosis of intervertebral disc herniation, diagnostic tests such as Magnetic resonance imaging (MRI), Computed tomography (CT), myelography, and plain radiography can be used either alone or in combination with other imaging modalities. Objective detection of disc herniation is important because only after such a finding the surgical intervention is even considered. Serum biochemical tests such as prostate-specific antigen (PSA) level, Alkaline phosphatize value, erythrocyte sedimentation rate (ESR), urine analysis for Bence Jones protein, serum glucose level, and serum protein electrophoresis may also be needed in specific circumstances guided by history.
Magnetic Resonance Imaging (MRI)
MRI is considered the best imaging modality in patients with history and physical examination findings suggestive of lumbar disc herniation associated with radiculopathy according to North American Spinal Society guidelines in 2014. The anatomy of the herniated nucleus pulposus and its associated relationships with soft tissue in the adjacent areas can be delineated exquisitely by MRI in cervical, thoracic, and lumbosacral areas. Beyond the confines of the annulus, the herniated nucleus can be seen as a focal, asymmetric disc material protrusion on MRI.
On sagittal T2 weighted images, the posterior annulus is usually seen as a high signal intensity area due to radial annular tear associated with the herniation of the disc although the herniated nucleus is itself hypointense. The relationship between the herniated nucleus and degenerated facets with the nerve roots which are exiting through the neural foramina are well-demarcated on sagittal images of MRI. Free fragments of the intervertebral disc can also be distinguished from MRI images.
There may be associated signs of intervertebral disc herniation on MRI such as radial tears on the annulus fibrosus which is also a sign of degenerative disc disease. There may be other telling signs such as loss of disc height, bulging annulus, and changes in the endplates. Atypical signs may also be seen with MRI such as abnormal disc locations, and lesions located completely outside the intervertebral disc space.
MRI can detect abnormalities in the intervertebral discs superiorly to other modalities although its bone imaging is a little less inferior. However, there are limitations with MRI in patients with metal implant devices such as pacemakers because the electromagnetic field can lead to abnormal functioning of the pacemakers. In patients with claustrophobia, it may become a problem to go to the narrow canal to be scanned by the MRI machine. Although some units contain open MRI, it has less magnetic power and hence delineates less superior quality imaging.
This is also a problem in children and anxious patients undergoing MRI because good image quality depends on the patient staying still. They may require sedation. The contrast used in MRI which is gadolinium can induce nephrogenic systemic fibrosis in patients who had pre-existing renal disease. MRI is also generally avoided in pregnancy especially during the first 12 weeks although it has not been clinically proven to be hazardous to the fetus. MRI is not very useful when a tumor contains calcium and in distinguishing edema fluid from tumor tissue.
Computed Tomography (CT)
CT scanning is also considered another good method to assess spinal disc herniation when MRI is not available. It is also recommended as a first-line investigation in unstable patients with severe bleeding. CT scanning is superior to myelography although when the two are combined, it is superior both of them. CT scans can show calcification more clearly and sometimes even gas in images. In order to achieve a superior imaging quality, the imaging should be focused on the site of pathology and thin sections taken to better determine the extent of the herniation.
However, a CT scan is difficult to be used in patients who have already undergone laminectomy surgical procedures because the presence of scar tissue and fibrosis causes the identification of the structures difficult although bony changes and deformity in nerve sheath are helpful in making a diagnosis.
The herniated intervertebral discs in the cervical disc can be identified by studying the uncinate process. It is usually projected posteriorly and laterally to the intervertebral discs and superiorly to the vertebral bodies. The uncinate process undergoes sclerosis, and hypertrophy when there is an abnormal relationship between the uncinate process and adjacent structures as seen in degenerative disc disease, intervertebral disc space narrowing, and general wear and tear.
Myelopathy can occur when the spinal canal is affected due to disc disease. Similarly, when neural foramina are involved, radiculopathy occurs. Even small herniated discs and protrusions can cause impingement of the dural sac because the cervical epidural space is narrowed naturally. The intervertebral discs have attenuation a little bit greater than the sac characterized in the CT scan.
In the thoracic region, a CT scan can diagnose an intervertebral disc herniation with ease due to the fact that there is an increased amount of calcium found in the thoracic discs. Lateral to the dural sac, the herniated disc material can be seen on CT as a clearly defined mass that is surrounded by epidural fat. When there is a lack of epidural fat, the disc appears as a higher attenuated mass compared to the surrounding.
Radiography
Plain radiography is not needed in diagnosing herniation of the intervertebral discs, because plain radiographs cannot detect the disc and therefore are used to exclude other conditions such as tumors, infections, and fractures.
In myelography, there may be deformity or displacement of the extradural contrast-filled thecal sac seen in herniation of the disc. There may also be features in the affected nerve such as edema, elevation, deviation, and amputation of the nerve root seen in the myelography image.
Diskography
In this imaging modality, the contrast medium is injected into the disc in order to assess the disc morphology. If pain occurs following injection that is similar to the discogenic pain, it suggests that that disc is the source of the pain. When a CT scan is also performed immediately after discography, it is helpful to differentiate the anatomy and pathological changes. However, since it is an invasive procedure, it is indicated only in special circumstances when MRI and CT have failed to reveal the etiology of back pain. It has several side effects such as headache, meningitis, damage to the disc, discitis, intrathecal hemorrhage, and increased pain.
Treatment of Herniated Disc
The treatment should be individualized according to the patient-guided through history, physical examination, and diagnostic investigation findings. In most cases, the patient gradually improves without needing further intervention in about 3 – 4 months. Therefore, the patient only needs conservative therapy during this time period. Because of this reason, there are many ineffective therapies that have emerged by attributing the natural resolution of symptoms to that therapy. Therefore, conservative therapy needs to be evidence-based.
Conservative Therapy
Since the herniation of the disc has a benign course, the aim of treatment is to stimulate the recovery of neurological function, reduce pain, and facilitate early return to work and activities of daily living. The most benefits of the conservative treatment are for younger patients with hernias that are sequestered and in patients with mild neurological deficits due to small disc hernias.
Bed rest has long been considered a treatment option in herniation of the disc. However, it has been shown that bed rest has no effect beyond the first 1 or 2 days. The bed rest is regarded as counterproductive after this period of time.
In order to reduce the pain, oral non-steroidal anti-inflammatory drugs such as ibuprofen and naproxen can be used. This can relieve the pain by reducing inflammation associated with the inflamed nerve. Analgesics such as acetaminophen can also be used although they lack the anti-inflammatory effect seen in NSAIDs. The doses and the drugs should be appropriate for the age and severity of the pain in the patient. If pain is not controlled by the current medication, the clinician has to go one step up on the WHO analgesics ladder. However, the long-term use of NSAIDs and analgesics can lead to gastric ulcers, liver, and kidney problems.
In order to reduce the inflammation, other alternative methods such as applying ice in the initial period and then switching to using heat, gels, and rubs may help with the pain as well as muscle spasms. Oral muscle relaxants can also be used in relieving muscle spasms. Some of the drugs include methocarbamol, carisoprodol, and cyclobenzaprine.
However, they act centrally and cause drowsiness and sedation in patients and it does not act directly to reduce muscle spasm. A short course of oral steroids such as prednisolone for a period of 5 days in a tapering regime can be given to reduce the swelling and inflammation in the nerves. It can provide immediate pain relief within a period of 24 hours.
When the pain is not resolved adequately with maximum effective doses, the patient can be considered for giving steroid injections into the epidural space. The major indication for the steroid injection into periradicular space is discal compression causing radicular pain that is resistant to conventional medical treatment. A careful evaluation with CT or MRI scanning is required to carefully exclude extra discal causes for pain. The contraindications for this therapy include patients with diabetes, pregnancy, and gastric ulcers. Epidural puncture is contraindicated in patients with coagulation disorders and therefore the foraminal approach is used carefully if needed.
This procedure is performed under the guidance of fluoroscopy and involves injecting steroids and an analgesic into the epidural space adjacent to the affected intervertebral disc to reduce the swelling and inflammation of the nerves directly in an outpatient setting. As much as 50% of the patients experience relief after the injection although it is temporary and they might need repeat injections at 2 weekly intervals to achieve the best results. If this treatment modality becomes successful, up to 3 epidural steroidal injections can be given per year.
Physical therapy can help the patient return to his previous life easily although it does not improve the herniated disc. The physical therapist can instruct the patient on how to maintain the correct posture, walking, and lifting techniques depending on the patient’s ability to work, mobility, and flexibility.
Stretching exercises can improve the flexibility of the spine while strengthening exercises can increase the strength of the back muscles. The activities which can aggravate the condition of the herniated disc are instructed to be avoided. Physical therapy makes the transition from intervertebral disc herniation to an active lifestyle smooth. The exercise regimes can be maintained for life to improve general well-being.
The most effective conservative treatment option that is evidence-based is observation and epidural steroid injection for the relief of pain in the short-term duration. However, if the patients so desire they can use holistic therapies of their choice with acupuncture, acupressure, nutritional supplements, and biofeedback although they are not evidence-based. There is also no evidence to justify the use of trans electrical nerve stimulation (TENS) as a pain relief method.
If there is no improvement in the pain after a few months, surgery can be contemplated and the patient must be selected carefully for the best possible outcome.
Surgical Therapy
The aim of surgical therapy is to decompress the nerve roots and relieve the tension. There are several indications for surgical treatment which are as follows.
Absolute indications include cauda equina syndrome or significant paresis. Other relative indications include motor deficits that are greater than grade 3, sciatica that is not responding to at least six months of conservative treatment, sciatica for more than six weeks, or nerve root pain due to foraminal bone stenosis.
There have been many discussions over the past few years regarding whether to treat herniation of intervertebral disc disease with prolonged conservative treatment or early surgical treatment. Much research has been conducted in this regard and most of them show that the final clinical outcome after 2 years is the same although the recovery is faster with early surgery. Therefore, it is suggested that early surgery may be appropriate as it enables the patient to return to work early and thereby is economically feasible.
Some surgeons may still use traditional discectomy although many are using minimally invasive surgical techniques over recent years. Microdiscectomy is considered to be the halfway between the two ends. There are two surgical approaches that are being used. Minimally invasive surgery and percutaneous procedures are the ones that are being used due to their relative advantage. There is no place for the traditional surgical procedure known as a laminectomy.
However, there are some studies suggesting microdiscectomy is more favorable because of its both short-term and long-term advantages. In the short term, there is a reduced length of operation, reduced bleeding, relief of symptoms, and reduced complication rate. This technique has been effective even after 10 years of follow-up and therefore is the most preferred technique even now. The studies that have been performed to compare the minimally invasive technique and microdiscectomy have resulted in different results. Some have failed to establish a significant difference while one randomized control study was able to determine that microdiscectomy was more favorable.
In microdiscectomy, only a small incision is made aided by an operating microscope and the part of the herniated intervertebral disc fragment which is impinging on the nerve is removed by hemilaminectomy. Some part of the bone is also removed to facilitate access to the nerve root and the intervertebral disc. The duration of the hospital stay is minimal with only an overnight stay and observation because the patient can be discharged with minimal soreness and complete relief of the symptoms.
However, some unstable patients may need more prolonged admission and sometimes they may need fusion and arthroplasty. It is estimated that about 80 – 85 % of the patients who undergo microdiscectomy recover successfully and many of them are able to return to their normal occupation in about 6 weeks.
There is a discussion on whether to remove a large portion of the disc fragment and curetting the disc space or to remove only the herniated fragment with minimal invasion of the intervertebral disc space. Many studies have suggested that the aggressive removal of large chunks of the disc could lead to more pain than when conservative therapy is used with 28% versus 11.5 %. It may lead to degenerative disc disease in the long term. However, with conservative therapy, there is a greater risk of recurrence of around 7 % in herniation of the disc. This may require additional surgery such as arthrodesis and arthroplasty to be performed in the future leading to significant distress and economic burden.
In the minimally invasive surgery, the surgeon usually makes a tiny incision in the back to put the dilators with increasing diameter to enlarge the tunnel until it reaches the vertebra. This technique causes lesser trauma to the muscles than when seen in traditional microdiscectomy. Only a small portion of the disc is removed in order to expose the nerve root and the intervertebral disc. Then the surgeon can remove the herniated disc by the use of an endoscope or a microscope.
These minimally invasive surgical techniques have a higher advantage of lower surgical site infections and shorter hospital stays. The disc is centrally decompressed either chemically or enzymatically with the use of chymopapain, laser, or plasma (ionized gas) ablation and vaporization. It can also be decompressed mechanically by using percutaneous lateral decompression or by aspirating and sucking with a shaver such as a nucleosome. Chemopapin was shown to have adverse effects and was eventually withdrawn. Most of the above techniques have shown to be less effective than a placebo. Directed segmentectomy is the one that has shown some promise in being effective similar to microdiscectomy.
In the cervical spine, the herniated intervertebral discs are treated anteriorly. This is because the herniation occurs anteriorly and the manipulation of the cervical cord is not tolerated by the patient. The disc herniation that is due to foraminal stenosis and that is confined to the foramen are the only instances where a posterior approach is contemplated.
The minimal disc excision is an alternative to the anterior cervical spine approach. However, the intervertebral disc stability after the procedure is dependent on the residual disc. The neck pain can be significantly reduced following the procedure due to the removal of neuronal compression although significant impairment can occur with residual axial neck pain. Another intervention for cervical disc herniation includes anterior cervical interbody fusion. It is more suitable for patients with severe myelopathy with degenerative disc disease.
Complications of the Surgery
Although the risk of surgery is very low, complications can still occur. Post-operative infection is one of the commonest complications and therefore needs more vigorous infection control procedures in the theatre and in the ward. During the surgery, due to poor surgical technique, nerve damage can occur. A dural leak may occur when an opening in the lining of the nerve root causes leakage of cerebrospinal fluid which is bathing the nerve roots. The lining can be repaired during the surgery. However, headache can occur due to loss of cerebrospinal fluid but it usually improves with time without any residual damage. If blood around the nerve roots clots after the surgery, that blood clot may lead to compression of the nerve root leading to radicular pain which was experienced by the patient previously. Recurrent herniation of the intervertebral disc due to herniation of disc material at the same site is a devastating complication that can occur long term. This can be managed conservatively but surgery may be necessary ultimately.
Outcomes of the Surgery
There has been extensive research done regarding the outcome of lumbar disc herniation surgery. Generally, the results from the microdiscectomy surgery are good. There is more improvement of leg pain than back pain and therefore this surgery is not recommended for those who have only back pain. Many patients improve clinically over the first week but they may improve over the following several months. Typically, the pain disappears in the initial recovery period and it is followed by an improvement in the strength of the leg. Finally, the improvement of the sensation occurs. However, patients may complain of feeling numbness although there is no pain. The normal activities and work can be resumed over a few weeks after the surgery.
Novel Therapies
Although conservative therapy is the most appropriate therapy in treating patients, the current standard of care does not address the underlying pathology of herniation of the intervertebral discs. There are various pathways that are involved in the pathogenesis such as inflammatory, immune-mediated, and proteolytic pathways.
The role of inflammatory mediators is currently under research and it has led to the development of new therapies that are directed at these inflammatory mediators causing damage to the nerve roots. The cytokines such as TNF ? are mainly involved in regulating these processes. The pain sensitivity is mediated by serotonin receptor antagonists and ?2 adrenergic receptor antagonists.
Therefore, pharmacological therapies that target these receptors and mediators may influence the disease process and lead to a reduction in symptoms. Currently, cytokine antagonists against TNF ? and IL 1? have been tested. Neuronal receptor blockers such as sarpogrelate hydrochloride etc have been tested in both animal models and in clinical studies for the treatment of sciatica. Cell cycle modifiers that target the microglia that are thought to initiate the inflammatory cascade have been tested with the neuroprotective antibiotic minocycline.
There is also research on inhibiting the NF- kB or protein kinase pathway recently. In the future, the treatment of herniation of the intervertebral disc will be much more improved thanks to the ongoing research. (Haro, Hirotaka)
Dr. Alex Jimenez DC, MSACP, RN, CCST
A disc bulge and/or a herniated disc is a health issue that affects the intervertebral discs found in between each vertebra of the spine. Although these can occur as a natural part of degeneration with age, trauma or injury as well as repetitive overuse can also cause a disc bulge or a herniated disc. According to healthcare professionals, a disc bulge and/or a herniated disc is one of the most common health issues affecting the spine. A disc bulge is when the outer fibers of the annulus fibrosus are displaced from the margins of the adjacent vertebral bodies. A herniated disc is when a part of or the whole nucleus pulposus is protruded through the torn or weakened outer annulus fibrosus of the intervertebral disc. Treatment of these health issues focuses on reducing symptoms. Alternative treatment options, such as chiropractic care and/or physical therapy, can help relieve symptoms. Surgery may be utilized in cases of severe symptoms. – Dr. Alex Jimenez D.C., C.C.S.T. Insight
Curated by Dr. Alex Jimenez D.C., C.C.S.T.
References
Anderson, Paul A. et al. Randomized Controlled Trials Of The Treatment Of Lumbar Disk Herniation: 1983-2007. Journal Of The American Academy Of Orthopaedic Surgeons, vol 16, no. 10, 2008, pp. 566-573. American Academy Of Orthopaedic Surgeons, doi:10.5435/00124635-200810000-00002.
Fraser I (2009) Statistics on hospital-based care in the United States. Agency for Healthcare Research and Quality, Rockville
Ricci, Judith A. et al. Back Pain Exacerbations And Lost Productive Time Costs In United States Workers. Spine, vol 31, no. 26, 2006, pp. 3052-3060. Ovid Technologies (Wolters Kluwer Health), doi:10.1097/01.brs.0000249521.61813.aa.
Fardon, D.F., et al., Lumbar disc nomenclature: version 2.0: Recommendations of the combined task forces of the North American Spine Society, the American Society of Spine Radiology, and the American Society of Neuroradiology. Spine J, 2014. 14(11): p. 2525-45.
Costello RF, Beall DP. Nomenclature and standard reporting terminology of intervertebral disk herniation. Magn Reson Imaging Clin N Am. 2007;15 (2): 167-74, v-vi.
Roberts, S. Disc Morphology In Health And Disease. Biochemical Society Transactions, vol 30, no. 5, 2002, pp. A112.4-A112. Portland Press Ltd., doi:10.1042/bst030a112c.
Johnson, W. E. B., and S. Roberts. Human Intervertebral Disc Cell Morphology And Cytoskeletal Composition: A Preliminary Study Of Regional Variations In Health And Disease. Journal Of Anatomy, vol 203, no. 6, 2003, pp. 605-612. Wiley-Blackwell, doi:10.1046/j.1469-7580.2003.00249.x.
Gruenhagen, Thijs. Nutrient Supply And Intervertebral Disc Metabolism. The Journal Of Bone And Joint Surgery (American), vol 88, no. suppl_2, 2006, p. 30. Ovid Technologies (Wolters Kluwer Health), doi:10.2106/jbjs.e.01290.
Mercer, S.R., and G.A. Jull. Morphology Of The Cervical Intervertebral Disc: Implications For Mckenzies Model Of The Disc Derangement Syndrome. Manual Therapy, vol 1, no. 2, 1996, pp. 76-81. Elsevier BV, doi:10.1054/math.1996.0253.
KOELLER, W et al. Biomechanical Properties Of Human Intervertebral Discs Subjected To Axial Dynamic Compression. Spine, vol 9, no. 7, 1984, pp. 725-733. Ovid Technologies (Wolters Kluwer Health), doi:10.1097/00007632-198410000-00013.
Lieberman, Isador H. Disc Bulge Bubble: Spine Economics 101. The Spine Journal, vol 4, no. 6, 2004, pp. 609-613. Elsevier BV, doi:10.1016/j.spinee.2004.09.001.
Lappalainen, Anu K et al. Intervertebral Disc Disease In Dachshunds Radiographically Screened For Intervertebral Disc Calcifications. Acta Veterinaria Scandinavica, vol 56, no. 1, 2014, Springer Nature, doi:10.1186/s13028-014-0089-4.
Moazzaz, Payam et al. 80. Positional MRI: A Valuable Tool In The Assessment Of Cervical Disc Bulge. The Spine Journal, vol 7, no. 5, 2007, p. 39S. Elsevier BV, doi:10.1016/j.spinee.2007.07.097.
Lumbar Disc Disease: Background, History Of The Procedure, Problem. Emedicine.Medscape.Com, 2017, http://emedicine.medscape.com/article/249113-overview.
Vialle, Luis Roberto et al. LUMBAR DISC HERNIATION. Revista Brasileira de Ortopedia 45.1 (2010): 1722. PMC. Web. 1 Oct. 2017.
Vialle, Luis Roberto et al. LUMBAR DISC HERNIATION. Revista Brasileira De Ortopedia (English Edition), vol 45, no. 1, 2010, pp. 17-22. Elsevier BV, doi:10.1016/s2255-4971(15)30211-1.
Mullen, Denis et al. Pathophysiology Of Disk-Related Sciatica. I. Evidence Supporting A Chemical Component. Joint Bone Spine, vol 73, no. 2, 2006, pp. 151-158. Elsevier BV, doi:10.1016/j.jbspin.2005.03.003.
Jacobs, Wilco C. H. et al. Surgical Techniques For Sciatica Due To Herniated Disc, A Systematic Review. European Spine Journal, vol 21, no. 11, 2012, pp. 2232-2251. Springer Nature, doi:10.1007/s00586-012-2422-9.
Rutkowski, B. Combined Practice Of Electrical Stimulation For Lumbar Intervertebral Disc Herniation.Pain, vol 11, 1981, p. S226. Ovid Technologies (Wolters Kluwer Health), doi:10.1016/0304-3959(81)90487-5.
Weber, Henrik. Spine Update The Natural History Of Disc Herniation And The Influence Of Intervention.Spine, vol 19, no. 19, 1994, pp. 2234-2238. Ovid Technologies (Wolters Kluwer Health), doi:10.1097/00007632-199410000-00022.
Disk Herniation Imaging: Overview, Radiography, Computed Tomography.Emedicine.Medscape.Com, 2017,
Carvalho, Lilian Braighi et al. Hrnia De Disco Lombar: Tratamento. Acta Fisitrica, vol 20, no. 2, 2013, pp. 75-82. GN1 Genesis Network, doi:10.5935/0104-7795.20130013.
Kerr, Dana et al. What Are Long-Term Predictors Of Outcomes For Lumbar Disc Herniation? A Randomized And Observational Study. Clinical Orthopaedics And Related Research, vol 473, no. 6, 2014, pp. 1920-1930. Springer Nature, doi:10.1007/s11999-014-3803-7.
Buy, Xavier, and Afshin Gangi. Percutaneous Treatment Of Intervertebral Disc Herniation. Seminars In Interventional Radiology, vol 27, no. 02, 2010, pp. 148-159. Thieme Publishing Group, doi:10.1055/s-0030-1253513.
Haro, Hirotaka. Translational Research Of Herniated Discs: Current Status Of Diagnosis And Treatment. Journal Of Orthopaedic Science, vol 19, no. 4, 2014, pp. 515-520. Elsevier BV, doi:10.1007/s00776-014-0571-x.
In today’s podcast, Dr. Alex Jimenez DC, Health Coaches Adriana Caceres and Faith Arciniega, Massage Therapist Amparo Armendáriz-Pérez, and Clinical Nutritionist Ana Paola Rodriguez Arciniega discuss today what they do and offer with Functional Medicine.
Discussion
Dr. Alex Jimenez introduces his guests.
[01:00:11] Dr. Alex Jimenez DC*: Welcome, guys. We’re here talking today about what we do. Today is a special day. It’s my father’s birthday, Alberto Jimenez. Alberto Augusto Jimenez. He is an immigrant from Colombia who gave me my knowledge. My amazing father. So happy birthday, dad. We’re going to be talking today is we’re going to be talking about what we do. We have a group of wonderful individuals here. We have five individuals. We have a whole lot more people in the background. So what we’re doing today is we’re beginning a process of notifying ourselves of a change that is going on. We’re going to be talking about nutrition, wellness, exercise, what we do in the office, how we do a little bit different techniques within the office, and how we compare and contrast to other services and let people understand what we do as we do change. So today, we’re in a new podcast room where we left the Push Fitness Center, which is now going to be another big, fantastic thing. So as they do the construction, we moved our podcast here. So you’re going to notice that we’re going to be communicating from this particular podcast. Still, we’re so connected to our Push counterparts and our Push Fitness centers and Daniel Alvarado, and we’ll be making that happen as it starts coming up. So today, we’re going to be talking about nutrition. I have Ana Paola Rodriguiez Arciniega here, so say hello there. We have Faith Arciniega. We have Adriana Caceres, and we have Amparo Armendáriz-Pérez as a massage therapist there. So we are going to be talking about different things. So each one of us has different specialties. So I’m going to start with some of the unique things we’re doing in our office, such as the types of treatments we do. We deal with a lot of inflammation, many injuries, a lot of trauma, and many soft tissue injuries. But you can’t get away from soft tissue injuries without discussing inflammation. So at the basis of inflammation, what we do is we associate, collaborate, find out the coincidence of inflammation to injuries, and we deal with the true causation of inflammation and come up with treating protocols and health care plans that affect people and their disorders. So many people come to us with a back injury or a neck injury after, let’s say, a motor vehicle accident, a car accident, or a work-related accident. But they may also have, you know, subclinical issues of inflammation that are just looming and then aggravate the direct trauma that’s going on. So what we’re going to do is introduce our team here one at a time so we can see what’s going on. And we’re going to start with Ana Paola Rodriguez Arciniega. Ana, how are you doing?
[01:02:57] Ana Paola: I am doing fine, and how are you doing?
[01:03:00] Dr. Alex Jimenez DC*: Good, can you hear us OK over there?
[01:03:02] Ana Paola: Yes, I can hear you, OK.
[01:03:04] Dr. Alex Jimenez DC*: Excellent. Tell us a bit of what you do, and we actually because you work hand-in-hand with us all here, and you are our virtual eye in the sky for nutrition at this point. But the nutrition that you deal with works a little bit with functional medicine. Tell us what you do and how we integrate that particular type of practice in our office.
Ana Paola Rodriguez Arciniega
Clinical Nutritionist Ana Paola Rodriguez Arciniega introduces herself and talks about what she does.
[01:03:23] Ana Paola: OK, so I am the head nutritionist, and basically, what I do is I take care of their nutritional assessment. But as you said before, we try to look for the root causes, and this allows us to create a more integral treatment plan for our patients, so that is focusing a little bit more on finding what is the root cause of the inflammation because it is related to injuries, accident, and stress, and to maybe delay the recovery part of our patients. So this is what we are trying to do to get like a fast track recovery for our patients for nutrition because it has to do with that.
[01:04:09] Dr. Alex Jimenez DC*: Yes. And then? Don’t worry.
[01:04:17] Ana Paola: OK, I’m here.
[01:04:18] Dr. Alex Jimenez DC*: It’s all technology. Just keep on going and telling me. We’ll figure it out as we go.
[01:04:22] Ana Paola: So what we always start doing is very simple. I try to focus on what is going on with my patient physically, which has a lot to do with the body composition of my patient. So I find that that is the principle, not the principle, but the first step could do it that way. So we try to integrate this body composition analysis with the Inbody 770 machine that we use. And that way, we can correlate all the body composition, either a fat mass percentage or BMI or muscle mass or lean body mass, that our patient has and try to associate with injuries or correlated with inflammation. And it is often, very often, or all of the time, that we find a direct correlation with inflammation or this type of injury. Specifically, talking about intracellular and extracellular water is one of the most exciting starting with my patients. But the thing about nutritional assessment is that even if it’s like separated into different parts, it kind of overlaps within each other, and that is like the thing that has in common with functional medicine, functional nutrition, then trying to treat your patient as a holistic, like a whole person and try to integrate the nutritional part of it, the fast recovery of an injury, the massage therapist and of course, all the wellness part of their recovery that has to do with our health coaches. So mostly, what I think that I do right here is that I perform for that. I am part of a team that integrates like a holistic care plan for patients.
Adriana Caceres
Health Coach Adriana Caceres introduces herself and explains what she does.
[01:06:28] Dr. Alex Jimenez DC*: Well said. That is very, very good. I have to tell you there is no separating inflammation, nutrition, and injuries that there’s no way. So as we deal with it, we can learn about it. It’s almost like saying exercising and not talking nutrition. We have to deal with nutritional components. Now, specifically that we are talking about exercise. Adrianna, here, she’s our specialist and our expert on exercise physiology. She works with nutrition. She has extensive experience of working with clients online and in video as well as in your home. So she gets in there and exercises with you as she does her thing. Adriana, tell us a bit of your experience and what you do and what you offer these particular dynamics with our team here.
[01:07:14] Adriana Caceres: Sure. Well, my name is Adriana Caceres, and I’m your health coach, fitness trainer, and of course, exercise specialist. And as Ana was saying, nutrition and exercise go hand in hand. Nutrition is the base, but exercise gives you the mobility and gives you that range of mobility that you need to live a proper and, well, life until you know when you age. So definitely, it’s the base for a lot of recovery for injuries. The stretching is super important, and we use that a lot here to stretch our patients and make them do their small stretching so they can grow their range of mobility and have a better life in their daily life, their daily style. Right now, I work online a lot. So since COVID started, we started working out online with our patients and clients, and it’s different. But at the same time is super fun. The difference between going to an in-person exercise session and doing an online session is that you don’t have the time. We always hear excuses like; I can’t make it. I don’t have the time. I’m too busy. I know that I’m in pain, but I just think it’s too far. So the online cuts all those excuses. I mean, you’re doing that from the comfort of your home. You are just opening your TV or your computer, laptop, or tablet and connecting to a session. It’s on your time. So that helps a lot. The second excuse we always hear is if we are parents who watch our kids, what will I do? There’s no daycare, and this is just the same thing. It’s at your home, so you can even involve your family in this new and different lifestyle. Usually, when we have somebody who is overweight, it is a family. It’s the household. Because of course, it’s the same poor nutrition that they have or bad nutrition that they have and the same habits. So starting with the workouts online helps you realize, or your household realize that it’s a group thing, it’s a whole lifestyle, and you want to be the role model for your kids. You always want the best for your kids, so you want to be the role model for them. Normally they will. If you’re overweight or have a little extra pounds on, your kids usually will have the same habits. And of course, we’ll tend to be with the same kind of overweight that you have. So this helps them see a life change experience and get involved in this new experience.
[01:10:12] Dr. Alex Jimenez DC*: You know, now that you mention that, you know, it’s essential to be the change that you expect in the world. I think Gandhi or something that says, might that be the change you want to see? Right. So the thing is, when you go purchase foods or exercise in front of your kids and see what you do, this is who they will become and what do we want for our children? We want the best. Our legacy is our family sometimes or our friends. And when you have family, they’re watching you. They learn they observe and appreciate mom, you know, wiggling around the living room and dealing with it. Everyone’s got memories of their parents exercising or doing something. And then, you know what happens, later on, we end up becoming our parents? Right. So if we have good habits, we eventually will become habits. I have become my father, and it’s the truth. The reality is in my son, and I listen to him. He doesn’t realize it, but he says everything I used to say. So it’s a continuous change. So if you’ve got nutrition and exercise, which seems to be one of the most extraordinary kinds of collaborative associative and treatment protocols, you can’t separate exercise from recovery. So Parkinson’s… exercise, Alzheimer’s… exercise, diabetes… exercise, brain disorder… exercise, health issues… exercise is such an essential component of fitness that by not doing it and not being part of it, you’re going to minimize the ability to return to an optimal configuration. Now, whether you like it or not, exercising mobility is one of the most important key factors. I realize that when you start working on so many patients over the years, you kind of start kind of seeing the intent of God. Right. So the intent of God is mobility, and he gives you tons of joints. I mean, why does he give you so many joints so we can wiggle, OK? To move, right? So using that and integrating the brain and the function of the brain with your body moving and pumping, and blood does heal a lot of issues and should be part of most treatment protocols. Even if exercise doesn’t look like, let’s say, a Zumba class, maybe it’s just wiggling around in a chair or doing certain things. We can do it for a lot of people. People think that I’ve seen from, you know, a nine-month literally about to have a baby, women doing CrossFit, and the baby is born fine. The body is designed to handle certain things too. Older adults about 100 years old, exercising. And children, they love to exercise. So it’s an essential component. So yes, that is what you do, Adriana, and we integrate that in the office, and we look or minimize the excuses to do that, so that’s very important. So do you also do nutrition a little bit?
[01:13:06] Adriana Caceres: Yes, I do. I’m a nutrition consultant, so I do help a lot with that part. As I said, it goes hand in hand, definitely to have a higher health span. You want to have a healthy habit, so one thing is lifespan, and one thing is healthspan, and lifespan comes out of years we’re going to live. Yes, eventually, we’ll die, and then our health span is how we want to live them. Are we going to leave them healthy our last ten years? Are we going to be able to walk? Are we going to able to say, are we going to be able to get out of a bathtub? So that’s what you want to have, and that’s what we don’t think about when we say, Oh, you know what? I know what I’m doing, and I don’t think exercising is for me. Everybody has a fitness level, and everybody has a way. And the trick for this is to find what you want to do. And what we do here is a lot of that we build up people and save injury, save from injuries and, you know, prolong their life and prolong how they live, their life, their daily activities.
Amparo Armendáriz-Pérez
Massage Therapist Amparo Armendáriz-Pérez introduces herself and talks about what she does.
[01:14:15] Dr. Alex Jimenez DC*: You know, it’s excellent that approach. Now we also have a young lady named Amparo Armendáriz-Pérez. So for Amparo, she does our massage. And what she does is she works on individuals with a deep level of knowledge of fitness. Now, she comes to us with a vast amount of personal experience working with people and her desire for health care. So I would like her to tell us. Welcome. And tell us about what you do in terms of massage as a component within this group.
[01:14:55] Amparo Armendáriz-Pérez: Thank you. Being here as a part of this family, this community of servers, because that’s what we do. We serve those that come to us. We’re all about education. So we’re listening to, you know, nutritional education, physical education on how to help them to make better choices for themselves. What I do is I discuss with our patients what I’m going to do for them, what’s happening as I put my hands on their muscles. What I feel, and they even ask me questions, Well, what is that? Why do I feel so restricted? What’s happening? So I enjoy helping them understand their own body with all my heart because they’re in their own body. We exist in our body, and we know we have hands and feet and all these components. But sometimes, when they’re not operating correctly, we don’t know why, and that’s very frustrating. And so, I enjoy discussing with the patients. OK, well, this is what I’m feeling, and how do you feel as I’m, you know, applying pressure here as we’re moving and grooving here? And the feedback is what helps them to accelerate. They want to learn more. They want to know; well, what else can I do? You know, when I go home, how do I prolong this feeling of feeling like I’m standing up straight now? Like I feel more empowered? You know, I didn’t realize my feet felt that way. I didn’t know my arm felt that way. And I understand where they’re coming from because massage therapy was one of my avenues of healing when I went through a healing process. So it’s just a fantastic tool to reach out to the patients and allow them to know that this is another way that we support them is not just OK; we’re going to do this one two three. No, it goes further than that. These are your muscles, and this is how you can assist yourself, and this is what we’re going to do for you. And you can take it a step further and understand that you have the power to help these muscles become more pliable through nutrition, exercise, movement, and anyway, shape or form. And you can put your hand on yourself and feel like, you know, that’s tight today. I think I can kind of touch that a little and massage that, and you don’t need a license to touch your arm. And I think that that’s what’s beautiful about what we do. We empower our patients, and that’s important.
[01:17:16] Dr. Alex Jimenez DC*: You know, when you were saying that in your approach, because I see that when you work on the patients, sometimes there are areas in the body that hurt. However, the human dynamics is that the body was designed with duality, such as one muscle affects another. The tricep, you know, pushes the bicep disengages. There’s a constant synergy with the muscular structure. Sometimes the pain or discomfort in those areas is remote or not, even in the area where you had, you know, you were initially told where the person’s issues were. Tell us a bit of that, Amparo. How you kind of tracked down the discomfort in, let’s say, an area over a problem that you’ve treated in the past.
[01:18:07] Amparo Armendáriz-Pérez: One of the most common areas I’ve experienced with many patients is when they discuss low back pain or sometimes even sciatic pain. And they tell me, you know, this is restricting me from sitting up straight. It’s restricting me from just going in the grocery store and walking to and from and not having to feel like I need to sit. And so, OK, I understand. And then they get on the table, and as I’m working on their back, I’m listening to what they’re saying. I also married together, what my hands are saying, and basically, my hands are just interpreting what their muscles are saying because sometimes, we can say something. I know in and out ourselves, OK, I feel this pain right here. However, the muscle is saying, well, something else is happening, and it’s extending, so they’ll tell me my pain is in the lower back while I follow the connection from that low back. And as I’m feeling alongside the side of their leg, I feel how tight it is, and it’s like, that’s got to be very restrictive down to the knee. And I’m like, OK, so let’s release that. And then as I’m working on that, it’s very powerful to hear the patient say, Wow, I can feel that, but you’re on my knee, and I’m like, It all goes together because the knee attachments go straight into the low back or into the hip area. And it was beautiful. Is that when they love to, everybody loves to learn about themselves? Why wouldn’t you want to know about yourself? It helps you become a better you. And so when I love to explain that to them, they’re like, Wow, so if I do this, I can feel better doing this. Absolutely. You know, ma’am or sir, right in here is where I’m touching. I’m massaging, and I’m applying compressions. It’s straightforward. It’s even over your clothes. I’m just playing some pressure right there, gently releasing, and they’re like, Wow, the movement is a lot better. And it’s interesting that just to the right around the knee, in the back and the front even, and it helps to release that low back pain.
[01:20:05] Dr. Alex Jimenez DC*: You know, you mentioned just like the referral pain patterns, it’s incredible. How the body adapts is like that gecko, you know, when it’s hot and lifts its left leg and throws up on a different leg; that’s what the human body works. So if you have a lower back problem, it will affect the mid-back. It will affect your knees. The knees and lower back are directly and indirectly related. So as we look at those dynamic changes. One of the things we look at as we track down the problem. OK, it’s not just so easy to treat a low back problem for what it is. We have to find out the problem for every person and every person’s design, and we can track it down quickly after a couple of minutes of working in your body. We got the suspect in, and it’s not so apparent many times that it’s just a low back problem. You mentioned sciatica. Sciatica is one of these things where it isn’t a disorder. It’s a group of syndrome disorders that creates a lot of drama, and it almost has its mind. It’s like, it’s like you’ve got stress or sciatica flares up. You got, you know, you get upset about financial worries, sciatica flares up. It’s like it sits there looming, and it bites you, and it causes a whole array of problems and hinders a lot of people, which we don’t want to do surgically. And sometimes, there are issues where it does require surgical intervention. We have diagnostic procedures to determine the differences over a thousand reasons, and I would venture to say there are even more than a thousand reasons for causing sciatica. So we got to get to the root cause of it. And does nutrition play? Yes. Will exercise play? Yes, we have to look at all these components. Now we have another individual here, that is Faith Arciniega. So Faith comes to us with a lot of great experiences. She’s going to be an incredible doctor, nurse practitioner. That’s the goal right now. She’s in the process of going through that, but she also does our health coach integration. So she does many different things from, you know, body compositions, as Ana mentioned, all the way to in laboratory tests and X-rays are integrated with Ana. So we facilitate the ability to communicate the issues, treat the problems, and develop an appropriate care plan. So Faith, tell us a bit of what you do here in this particular group of people?
Faith Arciniega
Health Coach Faith Arciniega introduces herself and explains what she does.
[01:22:27] Faith Arciniega: Absolutely. So as Dr. Jimenez mentioned, my name is Faith Arciniega. I bridged the gap between Ana and Adriana, and Amparo. We all work very closely together to ensure the patients leave here to understand better how their bodies should operate and function. So if the doctor goes in and finds out they’re having issues with their sciatica, I will go in before that gather together their medical history, see what’s going on, and see if they have problems with the gut. Depression, anxiety. And then, I would then communicate with Ana about those issues, and we can work together to find supplements or with the correct diet for them. So I work together with Ana and Adriana to ensure that the patient leads healthier and better understands their body because a car wouldn’t operate correctly. If we fill it with water, the human body will not function if we don’t fuel it correctly, so we teach them. How they should eat, what supplements they should take, and how they should exercise so that they’re moving and operating as they should be like the body was created to.
[01:23:26] Dr. Alex Jimenez DC*: You know, as like you, as you kind of work with patients, we mean right before we have this little unified meeting together. We noticed that we had a patient that had, you know, chronic inflammation and pain everywhere. And it’s crazy. But you know, the problem comes as a low back problem and leads to ankle issues. But we could see that there was a dietary issue, and it was almost like inflammation. No injury; keeps on inflaming. Then we find out that there’s a lot of sugar, many processed foods, a lot of meat. Well, to say that those are bad, it’s not just that easy, but we have to figure out the cause for that particular individual. We assess food sensitivities, and we do laboratory diagnostics. We figure out what it is the root cause. Not everything is a surgical procedure; as a matter of fact, most things are non-surgical. So what we try to do is is allow the intelligence of the body wants to figure it out, using the knowledge that we have and the expertise that we have in functional wellness and functional nutrition to be able to come up with a treatment plan that’s appropriate with exercise and the protocols that we use. So we have a lot going on here. So we wanted to do this as a beginning because we will be doing quite a few different presentations. But as we do changes, we haven’t been communicating well. So now what we’re going to be doing is we’re going to be coming back at different presentations, discussing particular topics. If you have a specific topic that you want us to discuss, particularly about an injury, inflammation, and a disorder that falls into the world of functional wellness and even functional medicine, we commonly associate and look for corporations related to the musculoskeletal system. So what we want to do is to be able to assess and determine the true causes because once we fix you, we want to improve you, right? We want to give you the tools to go on and live an extraordinary life because everyone here knows that I touted as much as possible. And man, if we’re designed to live 100 years and probably more, according to even the statisticians out there, if you take care of everything, the heart will continue to pump years after it’s removed from the body. So our body doesn’t get clogged with some atherosclerotic plaques or inflammatory disorders or some diseases or cancers; if we can keep it healthy, we will live a good life. God willing, God wants you to take you now. OK, so we all know that. So the focus of today was to present a little bit of a review. So Ana, thank you very much for helping us out. You know, a little bit of information there. You know, Faith, you’re out there. You’ve got the calm, soothing voice, and she’s cool with her voice there; you’ve got Amparo, which is our therapist that finds and tracks down. We got everyone here. We have many massage therapists that track down the issues. She’s just the one that has been able to formulate the ability to communicate the intention of the human body, which is and also the results, and that takes years to do. You can’t just go ahead and present yourself. Doctors worldwide will tell you a doctor that graduates, whether it’s in any clinical practice on his first day, is not the same doctor ten years later. And they’re like wine. They get better each time, and most of the time, you’ll find that doctors, the wiser they become, the more they rely on the wisdom of the body to manipulate and facilitate the healing process. So for Adriana, she’s our exercise, and she’ll have you dancing and doing the Zumba and seeing, you know, what’s best for you. And by the way, if you feel ugly that day, you can put the screen off, so you don’t have to be showing your body. You just know that she’s there, and you just tell her you’re doing the exercise. It’s pretty funny. Someone probably has the video off and is sitting there, you know, eating something. Yeah, I’m exercising, but we do have tools for that, like a cardio thing. They’ll tell us what your heart rate’s at; we will know if you are fibbing, but it doesn’t happen anyway. But anyway, it was a tremendous little connection today. It was the first, and we looked forward to more. Thank you, guys. Thank you very much, and does anyone have anything else to say. Faith, anything good, anything you want to add.
Conclusion
Dr. Alex Jimenez and crew recap on Functional Medicine.
[01:27:40] Faith Arciniega: No, just super excited for you all to come in here so that we can work together to find the best treatment plan for you. We’re all very passionate about patient care, and we’re excited to work with you.
[01:27:49] Dr. Alex Jimenez DC*: All right, Amparo?
[01:27:50] Amparo Armendáriz-Pérez: Just like, she said. We’re ready to help you be empowered. Understand that you are the boss of you.
[01:27:58] Dr. Alex Jimenez DC*: I’m the boss of me. I tell my wife that you know what she says all the time; you think you’re the boss of you, right?
[01:28:02] Dr. Alex Jimenez DC*: And like I’m saying, OK. Anyways.
[01:28:05] Dr. Alex Jimenez DC*: Ana, anything you have to say.
[01:28:10] Ana Paola: We’re so excited to work with all our patients, and we try to follow through and listen to all of the symptoms you’re having. So I guess that from our part, you will always have ears to follow through.
[01:28:32] Dr. Alex Jimenez DC*: Thank you so much. Adriana, anything?
[01:28:34] Adriana Caceres: Well, we are here waiting for all of you, and we have a great team, all very passionate, as you see. And we are just here waiting for you to come in, and we will help you resolve.
[01:28:47] Dr. Alex Jimenez DC*: We’re going to tear it up, guys. We’re going to tear it up. We’re going to make it. We’re going to happen. OK, so this is called Cobra Kai Chiropractic Center. OK, so if you think you’re going to come in here and just have a little talk? We’re going to get it on. We’re going to get it on with your body, and we’re going to take it to the next level. And yeah, we got to go, OK, we’re going to make the body what it should be, OK. And we’re going to release it without in pain, and it’s going to be a very comfortable dynamic. So thank you, guys, and we look forward to being connected the next one. So God bless you guys. Have a good one.
Antioxidants like resveratrol, lycopene, vitamin C, and vitamin E can be found in many foods. However, one of the most powerful antioxidants is naturally produced by the body.�Glutathione is known as the �master antioxidant�. Many foods have some glutathione but it is ultimately broken down by digestion before it can be properly used. Research studies have found that dietary glutathione isn�t associated with glutathione in the blood. As previously mentioned, glutathione is naturally produced by the body. But, if your capacity to do so is affected, it can cause a variety of health issues.
Glutathione is essential for liver detox or detoxification. Unlike other ways in which we can detox the body, scientists have demonstrated the benefits of glutathione for detoxification. It�s also necessary for healthy immune function and antioxidant defenses against free radicals. Glutathione deficiency is associated with health problems from overtraining to HIV/AIDS. In the following article, we will look at the role of this well-known amino acid in detox or detoxification. Glutathione is made up of three essential amino acids, including L-cysteine, L-glutamic acid, and glycine. It is responsible for:
Promoting liver detox or detoxification before bile is released
Reducing harmful components and toxins, such as peroxides
Neutralizing free radicals and other chemicals or substances
Cleaning out the body and supporting the immune and nervous system
What is Glutathione Responsible for in Detox?
Glutathione is essential for liver detox or detoxification. Glutathione binds to harmful components and toxins before they�re eliminated which is an important step in getting them out of your body.�Glutathione may also be very essential for helping your body eliminate harmful components and toxins found in the food you eat and the environment. By way of instance, one research study found that in people who eat a lot of fish, the total amount of mercury in their bodies was associated with genes that regulate glutathione levels in the blood. The more glutathione people made, the less amount of mercury they had.
Glutathione is found in every cell and tissue of the body. However, concentrations are seven to 10 times higher in the liver than anywhere else in the body. That�s because the well-known tripeptide plays a fundamental role in the Phase II liver detoxification pathway. The Phase II liver detoxification pathway is the process of metabolizing molecules that need to be eliminated from the body. Glutathione commonly binds to these molecules to eliminate them from the body. Glutathione ultimately has the capacity to bind to harmful compounds and toxins, flagging them as hazardous.
This helps eliminate chemicals and substances, scientifically known as xenobiotics, which weren�t produced in the body. And it can identify drugs, environmental pollutants, or any number of chemicals and substances. It�s important that glutathione binds to these harmful compounds and toxins before they can bind to important cells and tissues.�But the detox process isn�t complete. The next step is to turn the harmful compounds and toxins into a form that can be further metabolized and/or eliminated. Glutathione plays a role in turning fat-soluble toxins into water-soluble toxins so you can eliminate them from your body. The Phase II liver detoxification pathway involving glutathione plays physiologically essential roles in detox or detoxification. Without it, you�d probably be filled with hazardous material.
In conclusion, glutathione is essential for liver detox or detoxification. Glutathione is made up of three essential amino acids, including L-cysteine, L-glutamic acid, and glycine. Unlike other ways in which we can detox the body, scientists have demonstrated the benefits of glutathione for detoxification. As previously mentioned, it�s also necessary for healthy immune function and antioxidant defenses against free radicals. Glutathione deficiency is associated with a variety of health problems. In the article above, we looked at the role of this well-known amino acid in detox or detoxification.
Glutathione is an essential antioxidant for liver detox or detoxification, regulating inflammation, and supporting healthy immune function. But it�s not like other nutrients where you can eat more of it to take advantage of its health benefits. Instead, the important part about glutathione is supporting your body�s natural ability to produce it on its own. Think less �glutathione supplement� and more �eating your broccoli and moderate exercise� to help your body cleanse and protect itself against harmful components and toxins as well as bacteria and viruses. – Dr. Alex Jimenez D.C., C.C.S.T. Insight
Protein Power Smoothie
Serving: 1 Cook time: 5 minutes
� 1 scoop protein powder
� 1 tablespoon ground flaxseed
� 1/2 banana
� 1 kiwi, peeled
� 1/2 teaspoon cinnamon
� Pinch of cardamom
� Non-dairy milk or water, enough to achieve desired consistency
Blend all ingredients in a high-powered blender until completely smooth. Best served immediately.
Cucumber is 96.5% Water
Because they’re so naturally high in water, cucumber is also very low in calories. It only has 14 calories per 100g (3.5oz). That means you can nibble on it all day without worrying about your waistline.
The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas*& New Mexico*�
Ask The Scientists Staff. �Glutathione – The Amazing Detoxification Molecule You Might Not Know.� Ask The Scientists, 19 Dec. 2019, askthescientists.com/qa/glutathione/.
Dr. Judy. �Glutathione: The Detox Boss.� Vitality Natural Health Care, 14 Apr. 2018, vitalitywellnessclinic.com/detox-immune-system/glutathione-the-detox-boss/.
Dowden, Angela. �Coffee Is a Fruit and Other Unbelievably True Food Facts.� MSN Lifestyle, 4 June 2020, www.msn.com/en-us/foodanddrink/did-you-know/coffee-is-a-fruit-and-other-unbelievably-true-food-facts/ss-BB152Q5q?li=BBnb7Kz&ocid=mailsignout#image=24.
People are exposed to toxins, such as pesticides and air pollutants in food and the environment, on a regular basis. Meanwhile, other toxins are produced in the body through normal functions and microbes. That’s why it’s fundamental to support the liver, one of the major detoxification systems in the body. If the liver isn’t working properly, harmful compounds can start to pile up in the cells and tissues, leading to a variety of health issues. Liver detoxification is a two-step process that converts fat-soluble toxins into water-soluble toxins that the body can eliminate accordingly.
In the following article, we will discuss the importance of liver detox, what happens in the two phases of liver detoxification, and how you can support liver detox to promote overall health.
The Importance of Liver Detox
The liver is responsible for the detoxification of all of the harmful compounds and toxins that the body is exposed to on a regular basis. Moreover, it’s fundamental to eliminate these from the liver and the rest of the body regularly to tremendously reduce their negative effects. If toxins start to pile up in the cells and tissues of the liver, it can potentially lead to liver damage as well as a variety of other health issues. By way of instance, toxins are associated with obesity, dementia, and even cancer. And they are also believed to be a factor in chronic health issues, such as fibromyalgia.
There are two main ways that the body eliminates toxins. First, fat-soluble toxins are metabolized in the liver to make them water-soluble. Then, water-soluble toxins are sent directly to the kidneys where these are eliminated in the urine. Another of the body�s safeguards against harmful compounds is that the blood collected from the gut goes to the liver first. The blood from the gut may be especially high in toxins if a person has a leaky gut. Through the detoxification of toxins first, the liver can considerably reduce the number of toxins that reach other organs, such as the brain and heart.
Phases of Liver Detoxification
The liver is one of the main detoxification systems in the body. Detoxification or detox in the liver is separated into two categories. They are known as Phase I and Phase II liver detoxification pathways.
Phase I Liver Detoxification Pathway
The Phase I liver detoxification pathway is the first line of defense against harmful components and toxins. It’s made up of a collection of enzymes known as the cytochrome P450 family. The enzymes help neutralize substances, such as caffeine and alcohol. They offer protection by converting these toxins into less harmful components. However, if the byproducts of the Phase I liver detoxification pathway are allowed to pile up in the liver, they can damage DNA and proteins. It is ultimately the role of the Phase II liver detoxification pathway to make sure that those toxins do not pile up in the liver.
Phase II Liver Detoxification Pathway
The Phase II liver detoxification pathway neutralizes the byproducts of the Phase I liver detoxification pathway as well as that of other remaining toxins. This is done by metabolizing fat-soluble toxins in the liver to make them water-soluble so that they can be eliminated from the body. This process is known as conjugation. Glutathione, sulfate, and glycine are the primary molecules responsible for this process. Under normal conditions, Phase II liver detoxification pathway enzymes produce low levels of glutathione. Under times of high toxic stress, the body increases glutathione production.
We are exposed to toxins like pesticides and air pollutants in the food we eat as well as in the environment every day while other harmful compounds are produced by microbes through normal functions in the body. It’s essential to support liver function because it is our main detoxification system. If the liver isn’t working properly, toxins and harmful compounds can start to pile up in the liver which can eventually cause a variety of health issues. The phases of liver detoxification are a two-step pathway that converts fat-soluble toxins into water-soluble toxins that the body can eliminate accordingly. In the article above, we discussed the importance of liver detox, the phases of liver detoxification, and how you can support liver detox to promote overall health.�- Dr. Alex Jimenez D.C., C.C.S.T. Insight
Zesty Beet Juice
Servings: 1 Cook time: 5-10 minutes
� 1 grapefruit, peeled and sliced
� 1 apple, washed and sliced
� 1 whole beet, and leaves if you have them, washed and sliced
� 1-inch knob of ginger, rinsed, peeled and chopped
Juice all ingredients in a high-quality juicer. Best served immediately.
Just one carrot gives you all of your daily vitamin A intake
Yes, eating just one boiled 80g (2�oz) carrot gives you enough beta carotene for your body to produce 1,480 micrograms (mcg) of vitamin A (necessary for skin cell renewal). That’s more than the recommended daily intake of vitamin A in the United States, which is about 900mcg. It’s best to eat carrots cooked, as this softens the cell walls allowing more beta carotene to be absorbed. Adding healthier foods into your diet is a great way to improve your overall health.
The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas*& New Mexico*�
Curated by Dr. Alex Jimenez D.C., C.C.S.T.
References:
Ask The Scientists Staff. �Liver Detoxification Pathways.� Ask The Scientists, 30 Jan. 2019, askthescientists.com/qa/liver-detoxification-pathways/#:~:text=liver%20detoxification%20pathways.-,Phase%20I%20Liver%20Detoxification%20Pathway,toxins%20into%20less%20harmful%20ones.
Watts, Todd, and Jay Davidson. �Phases of Liver Detox: What They Do & How to Support Them.� Phases of Liver Detox: What They Do & How to Support Them – Microbe Formulas�, 24 Jan. 2020, microbeformulas.com/blogs/microbe-formulas/phases-of-liver-detox-what-they-do-how-to-support-them.
DM; Grant. �Detoxification Pathways in the Liver.� Journal of Inherited Metabolic Disease, U.S. National Library of Medicine, 1 July 1991, pubmed.ncbi.nlm.nih.gov/1749210/.
Dowden, Angela. �Coffee Is a Fruit and Other Unbelievably True Food Facts.� MSN Lifestyle, 4 June 2020, www.msn.com/en-us/foodanddrink/did-you-know/coffee-is-a-fruit-and-other-unbelievably-true-food-facts/ss-BB152Q5q?li=BBnb7Kz&ocid=mailsignout#image=24.
The body is capable of eliminating harmful components generated by the production of toxic metabolites and the ingestion of toxic substances. When these overwhelm the organs of detoxification and excretion, the body can store these chemicals in the connective tissues. Detoxification is essential for the restoration of the body�s regulatory mechanisms in order to improve function. In the following article, we will discuss what is detox and how each of the organs of detoxification is responsible for the proper functioning of the organism in general, among other fundamental tasks.
Liver
The liver performs a variety of fundamental tasks, including digestion and hormonal balance. It’s considered to be the body’s main detoxification system. Several functions of the liver include:
removing harmful compounds like food additives, toxic medications, and excess hormones, etc.
extracting waste material from the bloodstream and transforming them so that they can be excreted by the kidneys or intestines
eliminating toxic metabolites and other waste products from intestinal fermentation and putrefaction
a source of Kupffer�s cells which filter and eliminate foreign invaders, such as bacteria, fungi, viruses and cancerous cells
Kidneys
The kidneys help to purify the blood from harmful compounds, including food additives, toxic medications, excess hormones, and other chemicals, by extracting them from the bloodstream and eliminating them through the urine. For proper filtration of the blood, an individual’s blood pressure and volume should be stable. Furthermore, proper hydration is essential for proper kidney function.
Intestines
The gastrointestinal tract is also responsible for the detoxification and excretion of harmful compounds.�Throughout the different phases of digestion, harmful compounds are extracted and excreted by the liver into the bile and finally into the small intestine in order to continue through the intestinal tract to be eliminated in the stool. In the final phase of digestion, anything that can still be utilized in the colon, such as fiber, is ultimately broken down further with the help of the gut microbiome and it is transported to the liver for detoxification. The intestines are another essential detoxification system.
Respiratory Tract
The respiratory tract, including the lungs and the bronchi, eliminates harmful compounds in the form of carbonic gas. It may also excrete phlegm. Constant irritation by foreign invaders, such as bacteria, fungi, viruses, and cancerous cells, can cause the alveoli to act as an emergency exit for toxins that the liver, kidneys, and the gastrointestinal tract did not succeed in eliminating. These harmful compounds are transported by the bloodstream towards the lungs and bronchi where they are coughed up as phlegm. This phlegm consists of waste resulting from insufficient digestion and excretion.
Skin
The skin is the largest organ of protection and defense. It plays a fundamental role in the elimination of harmful compounds and it can help with kidney function. It evacuates waste products in the form of “crystals” that are soluble in liquids and are then eliminated in the form of sweat through the sweat glands. Crystals are the residues of the metabolism of foods that are high in protein, such as legumes, eggs, dairy products, fish, meats, and cereals. These may also result from an excess of refined sugar. Other types of waste products and harmful compounds are excreted in the form of rashes.
Lymph System
Finally, the lymph system is another main detoxification system. Lymph fluid allows waste products to leave the cells and be carried away to the bloodstream. Lymphatic capillaries are responsible for the defense of the body and purification of the body fluids to maintain its proper functioning.�Other sites of lymphocyte production are the spleen, the thymus, etc. If foreign invaders enter into the body, the production of white blood cells increases rapidly and proportionally to the intensity of the aggression. The lymph nodes that are closest to the site react first to defend and protect the body.
The body is capable of eliminating harmful components generated by the production of toxic metabolites and the ingestion of toxic substances. When these overwhelm the organs of detoxification and excretion, the body can store these chemicals in the connective tissues. Detoxification is essential for the restoration of the body�s regulatory mechanisms in order to improve function. In the following article, we will discuss what is detox and how each of the organs of detoxification, including the liver, kidneys, intestines, respiratory tract, skin, and lymph system, is responsible for the proper functioning of the organism in general, among other fundamental tasks. – Dr. Alex Jimenez D.C., C.C.S.T. Insight
Zesty Beet Juice
Servings: 1 Cook time: 5-10 minutes
� 1 grapefruit, peeled and sliced
� 1 apple, washed and sliced
� 1 whole beet, and leaves if you have them, washed and sliced
� 1-inch knob of ginger, rinsed, peeled and chopped
Juice all ingredients in a high-quality juicer. Best served immediately.
Just one carrot gives you all of your daily vitamin A intake
Yes, eating just one boiled 80g (2�oz) carrot gives you enough beta carotene for your body to produce 1,480 micrograms (mcg) of vitamin A (necessary for skin cell renewal). That’s more than the recommended daily intake of vitamin A in the United States, which is about 900mcg. It’s best to eat carrots cooked, as this softens the cell walls allowing more beta carotene to be absorbed. Adding healthier foods into your diet is a great way to improve your overall health.
The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas*& New Mexico*�
Curated by Dr. Alex Jimenez D.C., C.C.S.T.
References:
Issels, Ilse Marie. �Information on Detoxification and the Organs That Remove Toxins.� Issels Integrative Immuno-Oncology, 22 May 2015, issels.com/publication-library/information-on-detoxification/.
Dowden, Angela. �Coffee Is a Fruit and Other Unbelievably True Food Facts.� MSN Lifestyle, 4 June 2020, www.msn.com/en-us/foodanddrink/did-you-know/coffee-is-a-fruit-and-other-unbelievably-true-food-facts/ss-BB152Q5q?li=BBnb7Kz&ocid=mailsignout#image=24.
Most detox diets are normally short-term diet and lifestyle modifications made to help eliminate toxins from your body. A common detox diet may include a period of fasting and a diet of fruits, vegetables, juices, and water. A detox diet may also include teas, supplements, and enemas or colon cleanses. According to healthcare professionals, the role of a detox diet is to rest your organs, stimulate your liver function, promote toxin elimination, improve circulation, and provide healthy nutrients. Detox diets are recommended due to possible exposure to harmful compounds like heavy metals and pollutants.
Detox diets are also believed to help improve a variety of health issues, including digestive problems, bloating, inflammation, allergies, autoimmune diseases, obesity, and chronic fatigue.�However, there currently aren’t enough research studies on detox diets in humans and those that exist are considered flawed. In the following article, we will discuss the role of a detox diet on health and wellness.
Potential Benefits of a Detox Diet
Healthcare professionals have attempted to demonstrate the exact mechanisms in which detox diets can help eliminate toxins from your body. As a matter of fact, because of the current lack of research studies on detox diets in humans, there is currently little to no evidence which even demonstrates if detox diets can remove any toxins from your body as most of these rarely specify the type of harmful components they aim to remove. Moreover, your body is capable of cleansing itself through sweat, urine, and feces. Your liver also makes toxins harmless and then releases them from your body.
However, there are several harmful components that aren’t easily removed by these processes, including persistent heavy metals, phthalates, bisphenol A (BPA), and organic pollutants (POPs). These generally accumulate in fat tissue or blood and can take an extended period for your body to flush them. These harmful compounds are generally limited or removed in commercial products today.
Detox diets may also have other possible health benefits and these can also help encourage the following, including:
Avoiding processed foods
Eating nutritious, healthy whole foods
Exercising regularly and sweating accordingly
Drinking juices, teas, and water
Losing excessive fat; weight loss
Limiting stress, relaxing, and getting good sleep
Avoiding dietary sources of heavy metals and POPs
Following these guidelines is generally associated with improved health and wellness, regardless of whether you�re following a detox diet.
Bottom Line
Many detox diets are typically short-term diet and lifestyle changes made to help eliminate toxins from your body. A well-known detox diet may include a period of fasting and a diet of fruits, vegetables, juices, and water. A detox diet may also include teas, supplements, and enemas or colon cleanses. According to healthcare professionals, the role of a detox diet is to rest your organs, stimulate your liver function, promote toxin elimination, improve circulation, and provide healthy nutrients. Detox diets are recommended due to possible exposure to harmful compounds like heavy metals and pollutants.
Detox diets are also believed to help improve a variety of health issues, including digestive problems, bloating, inflammation, allergies, autoimmune diseases, obesity, and chronic fatigue. However, there currently aren’t enough research studies on detox diets in humans and those that exist are considered flawed. In the article above, we discussed the role of a detox diet on health and wellness.
Detox diets are made to help eliminate toxins from your body. A detox diet may include fasting, followed by a diet made up of fruits, vegetables, juices, and water. A detox diet may also include teas, supplements, and enemas. The role of a detox diet is to help your organs rest, promote liver function, support toxin elimination, improve circulation, and to offer various healthy nutrients. Detox diets are recommended when a person has been exposed to harmful compounds like heavy metals and pollutants. Detox diets are also believed to help improve digestive problems, bloating, inflammation, allergies, autoimmune diseases, obesity, and chronic fatigue, among a variety of other health issues. However, further research studies are still required. – Dr. Alex Jimenez D.C., C.C.S.T. Insight
Zesty Beet Juice
Servings: 1 Cook time: 5-10 minutes
� 1 grapefruit, peeled and sliced
� 1 apple, washed and sliced
� 1 whole beet, and leaves if you have them, washed and sliced
� 1-inch knob of ginger, rinsed, peeled and chopped
Juice all ingredients in a high-quality juicer. Best served immediately.
Just one carrot gives you all of your daily vitamin A intake
Yes, eating just one boiled 80g (2�oz) carrot gives you enough beta carotene for your body to produce 1,480 micrograms (mcg) of vitamin A (necessary for skin cell renewal). That’s more than the recommended daily intake of vitamin A in the United States, which is about 900mcg. It’s best to eat carrots cooked, as this softens the cell walls allowing more beta carotene to be absorbed. Adding healthier foods into your diet is a great way to improve your overall health.
The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas*& New Mexico*�
Dowden, Angela. �Coffee Is a Fruit and Other Unbelievably True Food Facts.� MSN Lifestyle, 4 June 2020, www.msn.com/en-us/foodanddrink/did-you-know/coffee-is-a-fruit-and-other-unbelievably-true-food-facts/ss-BB152Q5q?li=BBnb7Kz&ocid=mailsignout#image=24.
PODCAST: In today’s podcast, Dr. Alex Jimenez, chiropractor, and Kenna Vaughn, health coach, introduce Jeremy McGowan and Taylor Lyle, both experts in nutrition and strength training, as they discuss the differences between what is athletic strength training vs what is military strength training. By sharing a wide variety of nutrition and fitness recommendations, Jeremy McGowan and Taylor Lyle bring their knowledge and experience to El Paso, Tx where they offer performance improvements and injury recovery wherever they are needed. Dr. Alex Jimenez, Kenna Vaughn, Jeremy McGowan, and Taylor Lyle share what it is they do in their careers to provide overall health.� – Podcast Insight
[00:00:18] All right, guys, we’re here today. We’re excited. It’s a real special day for me here in El Paso because as you guys know, my job is to advance the science of wellness and fitness and to bring people that we have in El Paso to the forefront and to, you know, kind of show the individuals that are out there and the options we have. A lot of people don’t know. I’ve been out here for 30 years and I’ve seen El Paso kind of develop over the last three decades. And I’ve been nothing but proud to see the young kids and young men that are heading to the fitness programs all around the city, along with the insights that they’re bringing from where they come from people coming from all over the world. We have Olympians. We have specialists. We have top trainers, power trainers, fitness trainers, Crossfit trainers all around the world. These individuals bring a huge amount of talent and they all do the same thing. They get old. And as we get older, they were once the best in the world. And they come back and they share with. If you’re an Olympian and you know what? For the youth. So we bring certain individuals that have sciences and technologies. And some people are in the middle of their flight, in the beginnings and in the new starts of their lives where they actually bring us some great sciences. Today we have Jeremy McGowan and Taylor Lyle. These were two individuals that we brought in last time and we’re gonna hopefully have them come back and share with us their technologies. Jeremy brings a background. He works in the military, really smart guy. All these kids are really smarter than I am. It’s a beginning of time where we can see that the knowledge that the military has brought out has brought really great talent from around the world. [00:02:11][113.8]
[00:02:12] Jeremy is from Panama City, correct? Yes, sir. Yes. And Taylor, where are you from? Dallas. Fort Worth. [00:02:17][5.5]
[00:02:18] Dallas, Fort Worth. And one of the great things that I love about this, this whole story is that they’re here in El Paso and a lot of people don’t know this. And their expertise and knowledge are not only for us to to to benefit from, but they’re benefitting and they’re teaching the people that are here, the military, through their sciences and their techniques and their specialties and their licenses. So we really, really do have a moment in time where now the world is advancing in El Paso. So what I’d like to do is I’d like to say, introduce, you know, Kenna Vaughn. She’s over there on the side so you can see her. She’s there, she’s out. She’s anchoring on the side, making sure that my cameras work well and that I don’t stutter too much. Then we have Taylor Lyle and we have Jeremy. Jeremy McGowan. Correct. Yes. OK. And what we want to talk about a little bit about fitness training and the ideas about specifically about strength training, nutrition and as it pertains to collegiate sports and as well as power training for the military. So these kinds of sciences are very important for people to correlate. Now, do they cross lines? They cross lines for athletes in high school. So these sciences and these techniques are going to be good. But I like to know a little bit about Jeremy today. Jeremy, welcome to the show. And the people are here watching and they’re interested in understanding what it is that you do. So tell us a little bit about what you do and what you’ve done and where you came from. And we’ll leave it from there. Go ahead. [00:03:42][84.7]
[00:03:43] So, like you said, first, I’m from close to Panama City, Florida, a little tiny, small town. I went to Troy University on a baseball scholarship. It’s a D1 University in Alabama, close to Montgomery. So southeast Alabama, played there for five years. Soon as I got done playing slid right into coaching, I coached there for a little bit over three years. I ran baseball and softball, mostly assisted with other sports, the football, volleyball, soccer. A lot of others. Got offered a job out here to slot into the military side of things to coach. Getting really turn it down. Really, really enjoy what I’m doing here, running the physical training programs or the PT programs for a battalion at Fort Bliss. So I’ve worked with two separate battalions. We run the PT program, reconditioning program and then we work hand-in-hand. Kind of help write their PT programs so that when we’re not with them, they have a better idea of what to do. [00:04:36][53.1]
[00:04:37] I got a question for you. And you said that you’re an athlete going back to that. What position did you play? I pitched. You pitched. Oh, so you’re the dude. You’re the man. [00:04:44][7.0]
[00:04:45] You know, I was a closer started a little bit, but mostly closed. I really just tried to throw as hard as I could. That’s about it. Were you good? I like to think so. But you know some people might tell you differently. [00:04:57][11.8]
[00:04:58] Well, don’t be modest. Don’t be modest. You gotta say that you’re good at what you do. You know where I came from when I was a little boy. We got to see this out here in Mexico. We got this guy named Fernando Valenzuela. Well, remember that guy. Yeah. [00:05:11][13.4]
[00:05:11] Man was he was a Dodgers. Oh, man. I remember this big chunky looking dude that just could rip the ball. Definitely it didn’t look like he was a pitcher. But really, you know. But here’s the thing. Here’s the thing that I know now that I didn’t know then that people who got strong cores can really, really propel their force. Right. And this dude had a thick core, he busted up some gloves. Oh, hey. So let me ask you, what did the military see in you that they wanted to provide for this local community? [00:05:44][32.8]
[00:05:45] So the way that it kind of worked this whole program started as a very small pilot. There were five strength conditioning coaches and that was the first people on the ground. So that was it. And then it expanded. Now there are 60 coaches across a few bases in the U.S. So basically they needed qualified coaches that had an experience. So they wanted guys that had been a strength coach, you know, three-plus years, whatever, to lead the way. The assistants could have a little bit less experience but had to be certified, had to have a little bit of experience in the field so that they could get some, you know, guys in the run PT programs that were used to running large groups. So they wanted guys mainly from the collegiate side because we’re a little more used to running large groups, the private sector as well, depending on where they were at. Obviously, if they’re, you know, only working there for a very small amount of time, it might not be as much, but… They really wanted to focus on, you know, the qualifications, so having that Master’s degree and having that call and having that certification was the main thing. [00:06:44][59.0]
[00:06:45] I’ll tell you what, I saw you’re, clearly that you’re a really, really smart that both of you guys have resumes that are just amazing. And I got to tell you, the talent that the military brings this town is amazing. So don’t feel shy. Go ahead and tell people you got the big ‘ol Masters because that’s huge because you’re only one step away from a Ph.D. Let me ask you this because that’s very curious. The military has different departments, different battalions. What is it? [00:07:07][22.2]
[00:07:07] How many people in the battalion, the one that we were in originally there was around 410, 450. This one’s larger. So there are five companies. Each company is comprised of around 100 people. So there’s upwards of 550 in the battalion right now that we work with. [00:07:22][14.3]
[00:07:22] I’ll tell you what, we’re used to running a little bit of a Crossfit center. We’re actually coming from the Push Fitness Center. And 20, 30 kids at one time is a lot. How can you manage the largeness or the immensity of those groups together? [00:07:34][12.2]
[00:07:35] We kind of set up circuit style training for the most part. So we try to run stations with them. Luckily, I do have another strength coach, it’s not just me. So that helps a lot. We split the group up into two. Normally we’ll run a lifting type station and then a running type station and one of us will run each and we get about the halfway point. We’ll switch. So he’ll come over if I’m running the training. The strength training station to begin with. We’ll just flip flop. So he’ll bring his group over the straight training. I’ll take my group of the running and we’ll do that for the last half. So we usually have around outside tops around 80 people in a group. It would be the most that we would have and we would have 40 and 40 apiece. [00:08:09][34.0]
[00:08:10] Jeremy so you can pretty much see all these guys in different, I guess, techniques whether this is a running area. This is a strength area. You can see them all line sight kind of in the distance. [00:08:19][8.8]
[00:08:19] Yeah. That’s the goal. So with the strength training sessions, we set up kind of a semicircle on those stations so that I can just walk around the semicircle and then be able to see everyone. [00:08:29][9.6]
[00:08:30] And then as far as the running goes, it’s normally we do more anaerobic style training, some more sprint type work so that we can be right there telling them, you know, running the rest times, telling them, you know what, Tom, we’re trying to be on the run, whatever might be so that we can actually manage it a little more. [00:08:44][13.8]
[00:08:44] Wow. Taylor, we’re gonna get with you in a second there, so go ahead and drink some water. We’re going to get to you in a minute. But I got to ask a question for you. When you look at as a strength coach, do you have a deep-seated philosophy and the way things are done? And I assume and I don’t know, it seems like you’re beginning’s were with baseball. Correct. How do you apply that? That science and the level of mechanical sciences to the different kinds of levels and different types of specialties in the military. Let’s say you got some. Right, you know. I don’t know what kind of things they do. Let’s say the mechanics versus the heavy-duty artillery gunners. How do you change that up for them? [00:09:20][35.9]
[00:09:21] So one thing that’s really, really changed over for me with baseball to this is obviously with baseball I worked, with a lot of overhead throwing athletes. So a lot of shoulder problems, a lot of shoulder stability, things like that, that I was really trying to work with something that I’ve noticed in this military sector because of the way they’ve trained for so long. There they have a lot of shoulder injuries. There’s a lot of shoulder problems, a lot of instabilities as far as their, you know, way overcompensating. Their shoulders are starting to round from doing push-ups for so many years and not getting the proper training along with that. So having that expertise on that side of things, it’s helped me a lot as far as training, you know, different types of people. So I work in a BSB right now, so I haven’t really worked a whole lot with infantry, BSB Brigade Support Battalion. [00:10:06][45.2]
[00:10:06] Okay, got you. [00:10:07][0.4]
[00:10:07] We have a lot of mechanics, medics, communications people. It’s not a whole lot of high-speed guys. So we’re not really working with a lot of infantry type people. [00:10:17][9.7]
[00:10:17] We’re not working with a lot of guys that are really, really out there and really, really active. So a lot of the times, the people that we work with, the main things that we’re working on is landing mechanics, proper lifting technique, because we do have guys that have to lift some heavier stuff with transport and stuff like that. And in landing mechanics, guys jump out at trucks all the time. They’re in big, tall trucks, whatever might be. So those two things are something that we really try to work on so that in their day to day jobs, they don’t get hurt. [00:10:46][28.6]
[00:10:46] You know, when you say landing mechanics, whether it’s volleyball or anything, you know, that’s got to be the almost second nature. Oh, yeah. You know, I’ve seen that in the last couple of the last decade or two. I see the philosophy changing in the military, specifically in their ideas and their fitness goals. Recently, they’ve done some changes in their new programs where they actually if you don’t pass these certain things, you don’t even get the vacation time or even have even time to or migrate up in the ranks. But based on this performance, I’ve heard a lot about this ruck thing. What is this ruck thing? Yeah. Yeah, I heard. How much weight is it? Because they don’t care if you’re a 180-pound person or a ninety-five-pound lady, they’re still going to carry the same weight. [00:11:27][40.8]
[00:11:27] So there are different size rucksacks. It can be depending on really what your unit wants for that day or what type of thing you’re doing. So. Sure, you might have heard of the Baton Death March that happens here once a year. Yes, it did. So there are two separate standards for that. There’s a military light and the military heavy on the rucksacks are different. I don’t remember the exact way, but I want to say it’s 40 and 80 pounds. OK. If I remember right. Could be wrong on that. But it’s somewhere around that. And so that’s the light standard and the heavy standard as far as what they do in a normal setting for a rucksack. They kind of set it up for themselves. So basically, if a unit’s going on a ruck, they might tell you, hey, load it with as much as you want. Here’s how long we’re going, be able to do that in this fast. So they get to kind of pick their rucksack weight, depending on what they can handle. [00:12:13][45.6]
[00:12:13] Is it 40 through 80 or 40 and 80? [00:12:15][1.8]
[00:12:16] So in the baton it’s 40 and 80. But if they set it up themselves, they could do 40 through 80 as just depending on what they want to run with. [00:12:23][6.6]
[00:12:23] Yeah. You know, what do you look for in terms of an individual in order for them to say, oh, this dude’s going to just kind of wreck his back or he’s going to mess his shoulders up? What do you how do you tweak it so that you can kind of help them not get injured? [00:12:35][12.3]
[00:12:36] It’s, so posture’s a big part of it. Again, a lot of guys have rounded shoulders, so that translates over into the ruck as well. Well, they’ve got a heavy rucksack on their back. They start to hunch over round their back, their shoulders are already rounded. So you’re putting a lot of stress on the back, which I know you’re kind of the guy for that. [00:12:54][18.0]
[00:12:55] Oh, my God. I live with that every day, you know. Oh, you mean how we treat them? [00:13:05][10.2]
[00:13:05] You know what that can do to a back. And, you know, so there’s an issue that we try to fix. We do a lot of pulling, a lot of rows, a lot of rear delt work to try to get those shoulders back right. And stop the hunching. Stop the rolled shoulders. So that’s one thing that we try to do. And then again, as far as the lower body goes, proper gait is something that we try to work on, on the PTs work on that a little bit more than we do. But proper running mechanics, proper gait can obviously help with a lot of hip ankle knee issues. That a lot of guys have when they’re out there because they’re on uneven terrain. A lot of times rucking. They’re wearing their boots. You know, they’re not necessarily in the best running gear. So we try to do as much as we can to combat the problems that that can cause. [00:13:49][43.5]
[00:13:49] I find this to be so amazing that the both of you guys are here. Taylor, I know that you guys work together and I know we were introduced with you and the vast amount of expertise that you have and shared with us last time. But how do you guys interact? How does the diet world and the physical training world work together with Jeremy’s dynamics? [00:14:09][20.3]
[00:14:11] Yes. So we work hand in hand. I mean, you really can’t train without nutrition. So I’m out there a lot of times at the P.T. sessions, whether I’m trying to participate myself or just help the soldiers. So, you know, just making sure that they eat something in the morning, that’s a big issue that we see, is that they don’t have enough energy. And they wonder why they can’t finish their workout sometimes. So, you know, that is something that we both preach and then making sure that they eat something afterward, whether it’s going straight to breakfast or they’re getting some type of post-workout recovery modality. So we work with that. And then, you know, I do quite a bit of one on one counseling. And so a lot of times when I’m meeting with a variety of soldiers, you know, strength and conditioning come up in my conversation and we do a referral system. So I’ll refer them to Jeremy and, you know, follow up with him. And then, you know, a lot of times they’ll meet with them individually, give them a training program. And so we’re constantly urging communication with the best practices and, you know, how do we work towards the common goal. [00:15:25][74.0]
[00:15:26] So, you know, Jeremy, in terms of when you look at someone and you see them, they’re just they need help. You know, this kid is. He means well. But you can see him falling apart because you get that instinct like this kid’s going to blow out at something. He’s just not there. He looks ashy. He’s not eating well. How do you bring in Taylor in this dynamics, in that situation? [00:15:47][20.4]
[00:15:48] So a lot of the times I can really see it closer to the end of a workout as she said. Their energy levels are just low. You know, they can’t even, during the break period, they’re sitting down, they’re lying down. They’re trying to drink something and they can hardly drink as their stomach’s upset, you know. So I can tell pretty quickly if somebody has not eaten or is struggling with the nutrition side of things. And if that’s the case, then I’ll tell them, hey, you know, we’ve got a dietitian. We’ve got somebody that can help you. I can help a little bit in terms of telling you you need to eat something before you come out here. But she can help you, you know, in a better way than I can. [00:16:22][34.2]
[00:16:23] You guys coordinate a little bit. Kind of like this one is going to be a rough one. OK. We need to know where they’re going. They’re gonna be on the floor today. [00:16:29][6.4]
[00:16:30] There are some times that, you know, we can tell, you know, I can tell when I set up the circuit, like, okay. These guys are gonna get broke off a little bit, you know, and especially the ones that I’ve looked at and I know that she’s talked to, I’d make sure with them before those days. Hey, did you eat anything? And if not, then, you know, I’ll try to help out as much as I can, like, take breaks, you know, make sure you eat something next time, though, because this is how the sessions are going to continue to be for right now. [00:16:58][28.1]
[00:16:58] Guys, can you feel what I’m seeing, guys? And I’ve got to tell you when I started here in 1991, literally the military treated from my vantage point, again, I’m civilian and I don’t have to follow the rules, but like, they are set up there. But I could sense that the world was like Full Metal Jacket. It was really intense. It was a really harsh environment. And as you can tell, these two individuals are the forefront of the military to this day. So one of the things is I have to ask you both one question. Do you guys care about your guys? Oh, yeah, yeah, yes. You know what I got to tell you? You know what? I see this from the captains. Now, the world in the military is totally pro. There are people in a way that I have never seen go back two decades ago, three decades to 1991. I could not even get my hands on a military patient. They just would not let anyone outside the military take care of the people today. You guys are. Are you in the military? Both of you. No. No. [00:17:55][56.2]
[00:17:55] Contractors. See they’re bringing in the outside world. They’re also letting the inside go out. It’s awesome to see that because from my point of view, the caring that’s involved had to move from the top down and to have you guys from around the world, there’s got to be some amazing crew of people recruiting you guys. And I got to tell you, it makes me very proud because from the senators, you know, that actually made the Fort Bliss to become as big as it is now. And as it’s moved up, you see a lot of kind, caring sergeants, colonels, commanders that really care about their people. [00:18:33][38.1]
[00:18:34] And I got to tell you, it makes me feel really cool for an individual out there because I’ve got a kid who is your age. Right. So, you know, you guys got, you know, your guys taking care of him. So it’s a great thing. [00:18:43][9.8]
[00:18:44] Let me ask you, in terms of focusing on the dynamics of, let’s say over the shoulder, you had mentioned that shoulder thing going into that particular area is now for my vantage point, I’m a real lover of the shoulder girdle and the way the word and how it works together when you put something on the shoulder back in the day, there was one thing that really destroyed everyone’s shoulder. People didn’t realize this was this military. It was like a football jacket that had weights on it and they’d load it up in the front in the back, and you could put on, you know, some weights on it. These people had shoulder problems because of the pressure of the on the chromium, on the clavicle. And this happened. How is it that you kind of prevent a shoulder injury in terms of what you’ve seen when they wear things that are compressing them like a rucksack? [00:19:32][48.3]
[00:19:33] So part of that is the way they wear their rucksack. Our PTs do a really good job of demonstrating to them the proper technique of how to wear a rucksack, how to tie it down the right way so that it’s not putting a lot of pressure on their shoulders. That’s not something that necessarily I do, but that’s one way of combating it. As far as my role in it, I’m really just trying to strengthen the whole shoulder girdle and that whole area of the upper back, upper traps, whatever it might be done to try to take some load off so that they have a little bit of a shelf or something to sit it on. So we do a lot of like I said, we’re dealt work. We do a lot of rotator cuff work and a lot of trap work as well, so that they do get a little bit of that shelf. [00:20:15][41.7]
[00:20:15] All right. Well, that gives me a good understanding. I want to know the difference between an NCAA Division One athlete and the military athlete. How do you go about training and start like what are the similarities? And we’re going to try to look at the differences to contrast that specifically in that science. Go ahead and tell me a little bit about what you do for with your philosophies. [00:20:37][21.8]
[00:20:38] So similarities wise I would say the main things is their want to. A lot of times the military guys, the ones that are a little more high speed, they really want to get after it on PT. Right. So they’re one harder sessions. They want to sweat. They want to feel like they got something done. The NCAA guys are the same way. You know, they don’t want to come in and do one exercise and be done. They want to lift heavy. They want to get big. They want to get strong. And it’s the same way here. The only issue is here the training age is so much lower as compared to an NCAA Division One athlete. So when I would get a guy at college, you know, 18 years old. But he came straight out of high school. That was a 6A, 7A, 5A high school, you know, some bigger school played football for four years. He’s been working out since he was in eighth grade. These guys come here and, you know, I’ve got a lot of people that are 30 years old that didn’t play sports in high school, that have been in the military since they were 18. And they’ve been training wrong for 12 years since they got in the military. So their true training age is really nothing. [00:21:43][64.8]
[00:21:44] You know, they don’t really have good movement pattern. They don’t have an idea of really how to lift. They don’t have an idea of, you know, the right way to warm up, the right way to cool down anything like that. So it’s a lot more teaching here as compared to I could really get up and running at a Division One school like I was in about three or four weeks. I was up and running, had guys going full speed almost. So and here it’s a lot of teaching. [00:22:08][23.6]
[00:22:08] Jeremy, do you work with the reserves also? I do not. So we’re just with the active duty. Active duty. [00:22:14][5.6]
[00:22:15] So you mentioned 30 years old. OK. How does that work? And what’s your approach for a 30-year-old versus an 18-year-old? That’s got to do the same procedure. [00:22:22][7.6]
[00:22:23] The 18-year-olds are a little bit easier to teach. Their movement patterns are a little bit easier to pick up on because they haven’t been doing it wrong for so many years. Right. So if an 18-year-old and this is true across any population, whether it’s military or whatever, these guys, it kind of sticks a little faster. Right. So you teach them something two or three times they might have it, whereas this 30, 35-year-old guy that’s been doing this movement, but he’s been doing it wrong for 12 years. You know, when you try to teach him the correct way to do it, it might take eight, 10, 12, 15 sessions for him to finally get it down. And the issue with that is because of how many people are in the battalion, we might only get one or two sessions with him a week. So it might take four months for him to finally get this movement pattern down. And that slows down a lot of people in the process. [00:23:08][44.9]
[00:23:09] Do you separate them to kind of keep them on a different sack of or direction? [00:23:12][3.3]
[00:23:13] So we try to the issue with that is there. You know, if you’ve got one guy in Bravo Company and one guy, an Alpha company that is in the same boat, they don’t really do PT together. So it’s hard to separate within the same company, those people, because you might get that company once or twice a week. So if I’m really trying to separate the guys that are picking up on the guys that aren’t the groups, you’re going to be one of the really small. Or they’re just going to stop coming because they’re not getting enough out of it. [00:23:38][24.8]
[00:23:38] Taylor, in answering that same question, when you see those young kids that and versus the older or how do you approach the diet changes as well as just the approach of nutrition for them going through the same process in terms of the program? [00:23:55][16.3]
[00:23:56] Yes. Just what Jeremy said, you know, the 18-year-old scenario, they typically you know, they want to get better. They want to do what it takes to make it to the next level, which would be professional. And so I feel like they strive to want to get better. They’re a little bit more intuitive to that and receptive. And the, you know, 30-year-old, it’s not that they aren’t receptive. But, you know, a lot of them will have a family, whether that’s a spouse and children. And, you know, you have to take, you know, other factors that may be out of their control to have this success. So really, just in both scenarios, education component, there is so much room to grow, you know, unless someone maybe you went through like Ranger school a little bit more elite on the tactical side, you know, they might be a little bit more attuned to the nutrition and already know what to do around training and recovery. So they might not need as much education and guidance. But definitely there’s a lot of room to grow and both collegiate and military setting for nutrition. [00:25:09][73.5]
[00:25:10] All right. We’re gonna throw it to another gear here. Now, we’re dealing with in my thought process, as you take these young men to the next level, you’re going to deal with some elite guys. And that’s where a lot of my, you know, kids here, the Division one athletes, they correlate. And I got to tell you, from what I’ve seen, because I treat quite a few of the strange cats that go off to the journeys and they go into their, you know, the jungles, these are different kinds of characters. They have different mindsets. And there are at the highest level. Some of these guys are literally in their early, late 30s. And they’re just like that, you can see. In their eyes, they’re just ready to go climb trees, get in the jungle. [00:25:47][36.6]
[00:25:48] These individuals, these elite, these tactical guys, these ones that are that have percolated up to the highest level. How do you work with those individuals and what do you do in terms of trying to maintain them at their sharpest level? [00:26:01][13.5]
[00:26:03] So those guys are a little bit more obviously, like you said, they’re high speed. So they are more like working with a Division One athlete. Honestly, there’s been strength conditioning coaches in the special ops side of things for years and years. There are a lot more in tune with that side of things, with knowing the proper technique. Knowing how things are really supposed to work and knowing how they’re supposed to feel. So, you know, if they have a problem, they’re a lot more likely to either know if it’s actually pain or an actual injury. They can actually handle the two of them whereas guys that are not used to working out to them, you know, having pain and being sore the day after a workout, they’re hurt. You know, these guys are a little more in tune with their body and they’re a lot more likely to be able to push themselves through your workouts so you can go a lot heavier with them. You can do more of a, you know, true tier-based or strength-based or whatever it might be program that you want to do to get them better and better. [00:27:05][61.7]
[00:27:05] You know, when I was going to college, there were these programs that came out, strength training programs, where you could actually calculate how strong an individual was if they followed this tier, you know, go through these many deadlifts, do it this way, do it these reps. And over time, you were gonna go, you know, in a linear progression upwards. It was amazing that you could actually do it that way. Do you feel that if you push these athletes, you watch them improve, especially the top tier one that you can actually push them to, you know, an amazing level of accomplishment with tough training? [00:27:41][36.0]
[00:27:42] …�[00:32:55][48.8]
[00:32:56] Jeremy, how do you look at that stuff? And do you are you privy to that information and do you apply it to the flight that you’re doing? [00:33:02][6.0]
[00:33:02] So I don’t really get the actual numbers. Taylor is the one that gets those numbers and she would just share with me, hey, you know, this guy might need a little extra help. You know, as far as losing some weight goes, this guy is in the standards. He wants to gain a little bit of weight and he can, you know, that kind of thing, whatever it might be. So I don’t get the actual numbers, but I do get some information from her that I can help the guys with. [00:33:23][20.1]
[00:33:23] You know, one of the things that we realize in health care is the unification of data as well as integration of other sciences. You two guys met at a… Obviously, I’d like to know a little bit about how you guys introduce yourselves and how did you guys interact and how did you. Because, Taylor, you kind of talk to me about Jeremy. And I got to tell you, Jeremy seems to be an amazing guy. That’s got a lot of knowledge. And we and I really appreciate that. But how did you guys get to interact together? How did that process go in terms of for the purpose of the military? [00:33:56][33.1]
[00:33:58] Yes, so, yes, Jeremy is an excellent strength coach and it’s been a pleasure working with him. We actually work for two different contract companies, so we just were put together by chance, to be honest. And I mean, we just really clicked since day one, our personalities match really well. So that’s really where it began. And Jeremy has been here for almost two years and I’ve been here for almost a year. So he’s been here a lot longer than me. But so we met when I started. [00:34:28][29.3]
[00:34:28] Gotcha. In terms of your overall goals for the military and the dynamics for the athletes, let’s go back into the world of a little bit of the athletic division one. And now let’s also consider the fact that the sciences you have can also be applied to even the general public and even to kids at that level. And I know a lot of my patients have parents out there that want their kids to benefit from the best ideas and philosophies. And one of the things is that you realize that it’s not so much about knowledge. It’s about philosophy. It’s about your point of view. It’s the way you stand in what you think about how can we take what the military does in its sciences and its progression sciences to get these athletes and these individuals ready for battle. To our kids, how can we apply that if you can kind of reach into I don’t know if you’ve got kids, but if you do deal with kids, how would you apply those sciences to even the young, young high school, younger people population? [00:35:32][63.3]
[00:35:33] So I actually one of my papers or whatever for my masters was about strength training in kids because it was something that really, really interested me, because all my life I heard kids shouldn’t lift weights. Kids shouldn’t do this. It stunts their growth. It does. You know, it’s bad for them, whatever. [00:35:49][15.8]
[00:35:50] And honestly, everything that you read research-wise says otherwise. That’s just been a myth that’s been out there for so long that people started to believe it. So for me, as far as translating my side over to the general population. Younger kids all the way up to high school, it honestly starts with GPP, which is just general physical preparedness. So being able to handle their body weight, being able to learn movement patterns. So obviously push-ups, pull-ups, things like that for body weight, but then movement patterned on the squat, the landing mechanics like we talked about, things like that, and then just the general agility and movement stuff. So playing tag, doing things that are actually active outdoors. [00:36:29][38.9]
[00:37:12] So, you know, have him, you know, just practice squatting and making sure the knees are pointing out over the toes. He’s not getting valgus knee is not caving and he’s not you know, when he’s walking his gait pattern is good. When he’s running his gait pattern is good when he’s planting his foot. You know, stop and go playing tag with his friends. He’s, you know, actually planting sinking into that hip and driving off. You know, there’s little tiny things that you can look at that can help with those movement patterns as they get older and hopefully combat the chances of injuries as they get older. And then once as they get older and those movement patterns are more ingrained, then you can start adding some weight to stuff you can start doing. You know, even just goblet squats is where I would start. So a kettlebell or dumbbell holding a single thing. So you’re not actually loading the spine things like that and floor press and med ball throws and different things like that where you’re adding weight once those get learned more ingrained than you just are getting into the bigger lift. You know, you get to the big three, the squat bench deadlift, the Olympic lifting type stuff, whatever it is, Taylor, he is good. [00:38:12][59.6]
[00:38:13] ... [00:42:17][48.6]
[00:42:18] Taylor, you know you’re talking, right? I mean, this is amazing stuff in terms of its dynamics and specifically for recovery. How do you guys play into kids or young men that are injured in the nutrition component? How do you help them? How do you support the dynamics of the nutrition component? I know we talked about a little bit, but can you go back into it and talk about the things that you look at at the micronutrient level, as well as the macronutrient level to get these guys to be able to sustain the loads that they’re going to be under and provide them their best option? [00:42:53][34.6]
[00:42:54] Yes. So it goes back to recovery, nutrition, and the nutrient timing and making sure I mean, you’re breaking down your muscles when you’re working out and you’re trying to build them back up, grow. And so, you know, what’s going to do that is protein and carbohydrates. So making sure you have a three to one ratio of carbohydrates to protein. You know, that’s going to help them replenish their stores, their energy stores and also build muscle. And then from an injury standpoint, it’s just again, you know, making sure that depending on the injury will depend on the prescription for nutrition. But overall, you want to make sure that they have enough energy needs first and foremost, and they’re going to be less active typically. So, you know, you might not need as high of calorie needs that they would when they would be training. And the same with carbohydrates. It is your primary energy source, but you’re not going to be training as hard. So typically that is going to be lower. Now, your protein needs are going to be almost twice as high as they normally would be to really make sure that you’re, you know, getting the growth and nutrients you need for the protein and for the muscles to just recover from the injury, and then fat also plays a huge role as well. So and then micronutrients, you’re going to look at your B vitamins, zinc, vitamin C, vitamin A. You know, magnesium, those are all going to help in the wound healing injury recovery aspect as well. And then also immune support, which is really important. [00:44:36][101.9]
[00:44:37] Jeremy, thank you. Jeremy, they’re leaving now the day, they’re all exhausted. They’re all whooped on. Right. What are the words of advice that you give them about what they’re gonna eat tonight? You know, and let’s say you got an individual that’s just they just look bad. And what do you tell them? How do you tell them to rehab? Recover? I guess is a good word. [00:44:55][18.4]
[00:44:56] So for me, I’d try to preach high carb, high protein once after. So obviously, like she said, protein plays a big part in the recovery side of things. And they just depleted a lot of their carb sources during the workout. So that’s really what I try to preach, our sessions are in the morning. So a lot of times they’ve barely eaten anything as we’ve mentioned before. And if they have, it’s a lot of times not enough. So I try to preach. Get some carb sources, get some protein, get some eggs, get an omelet. They make you omelets in there. I know they do because I’ve been in there, eat one, you know, get something that can actually help you recover from this workout. [00:45:35][38.3]
[00:45:35] You mentioned, you know, they would sometimes show up without eating properly. You know, that’s a problem with a lot of the athletes. So they’re, you know, especially younger ones. They want to look good for some of the ones so they can volleyball. But some wrestlers, they got to, you know, have the basics, too. And for different types of athletes, different things for the population that you’re dealing with in order to get them better. What is the baseline good level of carbohydrates and what type of drinks or what kind of foods do you offer or recommend them at least get in that much so that they don’t end up totally running and being depleted by the end of the program. [00:46:12][36.3]
[00:46:13] So they’ll need 30 to 60 grams of carbohydrate, 30 minutes to an hour right before working now. And like Jeremy said, a lot of times, the workout is at six-thirty in the morning. So you’re not going to have the ideal scenario where people are eating three hours meal before they, you know, train. So. [00:46:30][17.7]
[00:46:31] So when you just wait. I’m sorry. When you said that 30 to 60 grams. So. So thirty-one twenty to 240 calories. Just a start up the engine. Right. Is that right? Is that a good fare. [00:46:40][9.0]
[00:46:41] Yeah. So that is fair. So what that looks like is 30 grams could be a banana or it could be a couple of slices of toast. You typically want something that is going to digest very well. So that’s going to be low in protein, low in fat and low in fiber. So that is going to be a carbohydrate source. You’re going to want to isolate that carbohydrate to avoid any digestion issues. So, you know, for people that can’t handle solid foods as well, I always recommend liquids. It’s already converted. So something as simple as a 20 ounce Gatorade. You know, if they can take something a little in between solid and liquid applesauce pouch, you know, there are so many varieties at the grocery store now for kids or adults. And, you know, just taking one of those apple sauces will also help meet that need. [00:47:33][51.8]
[00:47:33] You know, as you start your training program in the morning, what kind of things do you do? How do you ramp up the training program? Jeremy, I’d like to know a little bit about that, like take me through a day in your world. [00:47:45][11.7]
[00:47:46] So with ramping it up goes. As I said, we might get guys once or twice a week. So it’s a very, very slow process. It’s also dependent upon their battle rhythm. So, you know, we might get guys say twice a week. So we do have to get a group twice a week, which is what we were that whole battalion. We get every company twice a week. We might get them for six weeks and then they’re gone for three weeks doing a field training exercise and they completely detrain. Right. They’re doing nothing but sitting there for a lot of the time and, you know, practice in military type stuff, they’re not getting any physical training in. It’s not mandatory out there. It’s not necessary. And nobody does it and they can’t really shower. So nobody really wants to get sweaty and stuff. Right. So those three weeks when they come back, we kind of have to reset. There’s not really that much of a ramp-up. It’s a lot of general physical preparedness stuff. We do a lot of bodyweight stuff. And then a lot of the big three, we try to progress those as much as we can. So like right now, because we just kind of restarted with this battalion, with the whole COVID thing going on. We’re doing a lot of goblet squats. We’re doing trap bar. Deadlifts are extremely important. That’s going to be in their new PT test. [00:48:58][71.9]
[00:48:59] What was that? Trap bar deadlift. A different name for it, but we do that. And then right now, we’re doing floor press and we’re planning to progress the goblet squad into a front squat, front squat to back squat. Right. So that’ll be the progression there. The floor press will progress into the bench press. [00:49:16][17.6]
[00:49:17] Are those the three that you’re talking about? The three? [00:49:18][1.3]
[00:49:19] Yeah. So those are kind of the big three is your deadlift, your squat, and your bench. And so that’s your main three strength lift, right. That’s what everybody wants to be good at. So that’s the three that we kind of focus on. But we’ll set up circuits around that. So if we’re doing so, you have floor press, right? We’ll try to do some kind of a pull with that, whether it’s rear delt or an actual row. So it might be a kettlebell row, dumbbell row. Some like that. And then we’ll do a lower body exercise with that. So we try to go full body every workout session. So we’re getting upper, lower-end core. We try to do the main lift is for strength. So if it’s floor press, squats, or deadlifts, it’s more of your strength-based stuff. So it’s more that max effort. So it might be sets of four sets of five. Some like that with a heavier weight. We try to work up to a heavy load. Then everything else is more hypertrophy based. So it’s more work capacity. We’re trying to do, you know, a little bit of a lighter weight, but it’s still going to be heavy not to where it makes them work for those eight to 12 to 15 reps, whatever we might do. [00:50:21][61.6]
[00:50:21] Do you mix it? Like, do you have some hypertrophy versus agility and versus body mechanics stuff or do you have like certain days. Today’s Body Mechanic Day today is power today. This today is Hypertrophy Day. [00:50:30][9.3]
[00:50:31] So right now, because we don’t really know what group we’re going to get every day with stuff going on so they’re, kind of work in shifts. They’re not there every day. So we might have one group one day. It might be the same exact people, you know, for a full week. It might be. They come every other day. So the plan right now basically is we go up there, we set up three lifts. Monday was a Friday or lift days, Tuesday a more run day, though. And like I said, the running is more anaerobic stuff. So sprint stuff. But on those sprint days, we do more. We do lift more. But it’s more bodyweight work capacity stuff. So we’ll do a lot of push-ups, pull-ups, sit-ups, squats, lunges. But it’s all bodyweight type stuff and that’ll be all in a circuit with some running involved. And then on the lift days, it’s, you know, like I said, that one lift strength. Everything else is more hypertrophy/work capacity. So it’s all high reps and. [00:51:24][53.2]
[00:51:26] It’s kind of tough to get a lot of hypertrophy type stuff in because of the box that we’re working out of. So we have a gym that’s inside a box. You had to pull all the weight out. There’s not really enough weight to load up a lot of stuff if we want to do a lot of squats. We need weights for that. Right. So we need weights. But on the barbell, well, there’s only eight forty-fives. Eight thirty-five, eight twenty-five, and eight tenths. So if I have four stations of squats like that up, I’d need almost all of that weight to be able to handle that. So I can’t use that weight on anything else, whether it’s the sleds, the trap bars, whatever it might be. So I have to come up with stuff with bands and kettlebells is really I see an invention there. [00:52:02][36.8]
[00:52:03] I think there’s an invention in there and what I’m hearing is, is that your gym doesn’t go out to the outside that easy. So is that what I’m getting? Like you want to be able to have a piece of equipment, has all your stuff on it, so you just drag it off that thing. [00:52:14][11.5]
[00:52:14] … [00:56:58][62.0]
[00:56:59] I really believe that what he just said was a huge component? Now he has spent his whole life understanding body dynamics. And he ended up understanding and now the military gets it in a different level. The translation of force comes from the core. It is huge. When you hear med ball slams, that is a body that’s going to its fullest out and slamming at a full range of motion. When you’re seeing hip flexes, you’re pulling that hip to the furthest, deepest dungeon of movement, to the furthest extreme on the outside. So to be able to do that, to be able to translate, weight and slowed and sled movements, you’re gonna need a powerful core. The dynamics of it are the ability to move it through time and space at a certain rate of speed. How long you do it, you can do it a little bit, that’s strength. But power means you can translate it over twenty-five feet or so and hit back and forth. So we’re really pushing the body to a level that is amazing. I have sat down with certain patients of mine and they find that that theory. And I found it to be very interesting that deep tuck, the knee tuck, and the deep flexion movements. Where did that philosophy come from and you have as a physiologist and the nutrition strength coach? How did that come in? Where did that come from that they realized that those particular movements, the slam ball, as well as the deep tuck, became a crucial component in the military action? [00:58:26][86.2]
[00:58:27] So I know the people are well, Major Matthews’, that actually used to run H two F, she’s transferred over to a different side of the military now, but she used to work at the Olympic training facility in Colorado. And I know she helped develop the test. So I would guess I don’t know for sure, but I would guess she played a big role in that. Yeah, because she, you know, does know a lot more about that side of things. I know she helped create, you know, with the power throw and stuff. [00:58:57][29.5]
[00:58:57] What’s her name, shout out again? Major Matthews. Major Matthews. OK. [00:58:59][2.7]
[00:59:00] So you know we met her, she came down I think it was a little bit before Taylor got here so she came down to talk to us and explained about the test and why they were doing it and whatever. And she played a big part in developing a test because of her background. [00:59:18][18.4]
[00:59:19] Have you guys gone to Colorado Springs before to take a look at the Olympic Center? I have not. I have not either. You know what? I got to go there. But there, you know, I got to watch from the outside inward. And you got to I got to tell you that you can see top athletes from around the world. I mean, from powerlifters. But you can see that they’re not very big in the sense of muscular build. But you can see that every athlete had a trainer with them and usually it’s a physical therapist that was right with them. And they were talking mechanics and movements. And these athletes and all the sports that they have, you see this amazing. It’s almost like watching something out of an amazing superpower show where you see these athletes running from all different directions…
And these are the top athletes in the world training centers from swimmers to high bolt whatever the sport is, I can imagine, but you can see them training in the center and they really focus on the range of motion. And you can see the physical therapist showing the motion. And actually the intensity of the movement is really, really important. So that science of Deep Tuck and translation of force is huge now. And it’s amazing that now to be able to do that is at the forefront of the military’s progression. Let me ask you this. Now that you know and you’re in your science and understanding is about the youth. How do you correlate that and take me into the progression of how to get kids, let’s say, a high school kid into doing that particular component of translation of forces so that we can make them great at being a lineman or just torquing the heck out of someone in wrestling. You know, kind of that deal. [00:00:54][54.1]
…
You know, I’ve got to tell you, you know, I could sit here and talk for over an hour. This is it. We’ve been over at least 60 minutes here. People are gonna look at me and YouTube is going to shut me out. But I’ve got to tell you, this has been literally an exciting moment because, between the both of you, I feel like I’m in a show of Jumanji of knowledge. You know, it’s like I just opened up a Pandora and you guys are full of knowledge. That is great. Again, I got to tell you, El Paso has these individuals. And if you, again, I don’t yield, the information will be on there for them if you want to communicate with them. I’ve got to tell you, we have them. We have such great talents, such smart individuals out there. Birds of a feather flock together. So for both of you, I can see how you guys migrated into appreciating the levels of vast knowledge and in the direction that you have for both of you. I honestly see you guys being Ph.D.s and whatever you guys do. So it’s only one step away from being Ph.D.s I will say that strength coaches are different kinds of characters, huh? They’re just different, man. They just there’s no joke. There’s serious. This is life-threatening. And when you’re under that bar, they want to take care of you. So they’re the most compassionate people. And they’re the most serious of all people. And as you said in the gym, basically everyone seeks out, both of you guys, for the greater order. That is what you guys do. You guys have great knowledge. And I’ve been a big proponent of great order rules. So you guys have been pulled in through whatever the sources are to bring you to create great order for these young kids and young men so that they can perform the best that they can in the world that they have to go into. So I got to tell you. Thank you, guys. Thank you. I know that this information was something that correlates to children. I could open up each one of those conversations and open it up for another hour each. So, Taylor, I got to tell you. Thank you so much for bringing us some knowledge. And I look forward to talking to you guys some more in the future and bringing you in and breaking it up into a different. Because we talked about the leg. We talked about the knees. We talked about nutrition. Each one of these are directions that we can spend hours talking about. And it’s out there. And just to let you know, my goal is to bring it out so that the parents can also see what’s important. I think all we got here is good nutrition, good body mechanics, range of motion, dynamic transfer of power, and also the progression from even young that, you know, you can’t be accused of abusing your children when you put them under a weight machine. If you have the understanding is the proper mechanics and the right age and the right dynamics of it. So nutrition plays a huge role. I always knew that the core held the secret. Now, I’m not the smartest guy in the world, but when God put the baby, he put it where? He put it in the core. OK. So when you look at it, the Orientals called it the Chi, the center of the power right in kung fu. Watch the hips. Watch the hips where you can see where the guy’s going because of the center of the order rules in sports in translating. And when your life depends on it, your core, it has to be one of the most important components as to where you translate force and reaction time comes from there. As a matter of fact, it’s the basis of what the body dynamics are. The pelvis, the hips, the range of motion, and the knees. Those are the sciences that these young individuals have brought in the nutrition of it. Because when it comes down to circulation, you know, what’s in the circulation, the food, the stuff that you put in that hole in your face and the rest and the sleep and the water and hydration. What I’m very pleased about is that I’m a lot older and I appreciate the level of youth and youngness in them, so to speak, that is going to be changing the world for the future individuals and families around El Paso and in the regions that this kind of can reach. So thank you, guys. I appreciate your information. And I’m a fan of both of you guys, by the way, OK, because you guys are an amazing talent that I got to tell you, I do have a window. Before you were here in the 1990s where there was a different world, El Paso is different. And Sylvester Reyes, by the way, that’s the senator that I wanted to call out, it was his dream to make that military force out here and make it as big as it was. It’s got a long history. But in that impact of those big centers, those training centers was this dream. So I got to tell you for that, Senator, I don’t know if he anticipated you guys come in, but he did create the great order so that you guys would come and share your knowledge. So I wish you the best and thank you guys for everything you guys have offered. And I look forward to hearing from you best. And thank you, Kenna. Thank you for everything.
IFM's Find A Practitioner tool is the largest referral network in Functional Medicine, created to help patients locate Functional Medicine practitioners anywhere in the world. IFM Certified Practitioners are listed first in the search results, given their extensive education in Functional Medicine
