Can knowing about the health benefits of hot yoga help individuals decide if it is right for them?
Hot Yoga
The body has a system for ridding itself of what it can’t use or doesn’t need, called toxins. Individuals may have heard that they can sweat out toxins by doing various hot yoga styles. Hot yoga, practiced in a heated room, has become popular. The standard room temperature is around 105 degrees Fahrenheit with 40% humidity. (Mayo Clinic 2020) Because of the temperatures, hot yoga is not for everyone, and those with heart problems or dizziness are recommended to stick with regular classes. However, the detoxification medical benefits may not be there, or there is still insufficient research to confirm.
Body Detoxification
Broken down by the liver, the toxins in the blood or bile are filtered in the kidneys or intestines and removed in urine or stool. (Boyer J. L. 2013) Sweat is not part of the removal equation. The function of sweat is to cool the body down when it becomes overheated. This can happen during strenuous activity, when overdressed, or in summer. Sweat comprises primarily water with trace amounts of urea, lactic acid, and minerals. (Baker L. B. 2019) Except for water, none of the products in sweat are excreted in large enough quantities to alter or improve metabolic function. The sodium excreted in sweat is quickly re-absorbed through the skin’s epithelial sodium channels, which does little to alter the sodium levels in the blood. (Hanukoglu I. et al., 2017)
Environmental Toxins
The body is exposed to all sorts of toxins daily, including pollution and pesticides in the air, preservatives in our foods, and detergents and cosmetics on our skin. (Hunt P. 2011) Sweat-based exercise to remove these toxins is still unfounded.
Sweating In Hot Yoga
Many think that sweating in a hot yoga class will cleanse the alcohol or unhealthy foods. Yoga won’t help sweat these things out, but the practice still provides benefits that help burn some fat from the calories consumed. Exercising helps burn fat regardless of the temperature of the surroundings. (Swift, D. L. et al., 2014) The benefits include:
Increased circulation to deliver more oxygenated blood to the muscles.
Improved muscle tone and flexibility.
Stress relief.
Instead of sweating out the toxins, minimize exposure by eating a healthy, balanced diet, using natural products, and reading the labels of products placed on or in the body.
Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness program that fully benefits the individual to get back to normal. Using an integrated approach to treat injuries and chronic pain syndromes, the ability to relieve pain is improved through flexibility, mobility, and agility programs. Our providers create personalized care plans for each patient, including Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine. If other treatment is needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments.
Body Signals Decoded
References
Mayo Clinic. (2020). What is hot yoga? Mayo Clinic Orthopedics and Sports Medicine. https://sportsmedicine.mayoclinic.org/news/what-is-hot-yoga/
Boyer J. L. (2013). Bile formation and secretion. Comprehensive Physiology, 3(3), 1035–1078. https://doi.org/10.1002/cphy.c120027
Baker L. B. (2019). Physiology of sweat gland function: The roles of sweating and sweat composition in human health. Temperature (Austin, Tex.), 6(3), 211–259. https://doi.org/10.1080/23328940.2019.1632145
Hanukoglu, I., Boggula, V. R., Vaknine, H., Sharma, S., Kleyman, T., & Hanukoglu, A. (2017). Expression of epithelial sodium channel (ENaC) and CFTR in the human epidermis and epidermal appendages. Histochemistry and cell biology, 147(6), 733–748. https://doi.org/10.1007/s00418-016-1535-3
Hunt P. (2011). Toxins all around us. Exposure to the chemicals in everyday objects poses a hidden health threat. Scientific American, 305(4), 14.
Swift, D. L., Johannsen, N. M., Lavie, C. J., Earnest, C. P., & Church, T. S. (2014). The role of exercise and physical activity in weight loss and maintenance. Progress in cardiovascular diseases, 56(4), 441–447. https://doi.org/10.1016/j.pcad.2013.09.012
For individuals who sit at work for long hours, can years of practicing unhealthy posture be corrected through a step-by-step approach to ensure optimal body position while sitting?
Sitting Posture
Sitting up straight with a healthy posture requires the conscious alignment of the hips, pelvis, lower back, upper back, shoulders, neck, and head. Learning or retraining oneself to maintain correct sitting posture can relieve lower back pain, improve respiration and digestion, and reduce tension in the neck and shoulders. (Albarrati, A. et al., 2018) It starts by paying attention to posture throughout the day and correcting it whenever forward head posture, leaning, or slouching develops. Targeted exercises can also help build upper-body strength, and stretching can stabilize and strengthen the core muscles, lower back, and pelvic joints. (Albarrati, A. et al., 2018)
Sit Up Straight Guide
Sitting up straight can be uncomfortable because it is not a natural position for the body to be in for an extended time. Nowadays, work, school, appointments, and other activities require us to sit much longer than intended. The muscles also have to work against gravity, leading to muscle exhaustion, slouching, and slumping, which can cause chronic back, leg, neck, and/or shoulder pain. (Jung, K. S. et al., 2020)
Sitting up straight may seem simple, but the focus tends to be on straightening just the lower/lumbar spine. This posture is unsustainable and exhausts and stresses the upper and lower back. (Jung, K. S. et al., 2020) The whole body needs to be considered when protecting the stability and balance of the spine. Learning and maintaining the ability to sit up straight is a process that requires practice. Find a comfortable chair to sit in, and follow these steps to achieve the optimal postural alignment (Canadian Centre for Occupational Health and Safety, 2022)
Knee Spacing
The hips should be at a roughly 90-degree angle.
Knee Position
The knees should be at a 90-degree angle level with the hips.
Use a pillow to achieve the right knee position if the seat is too low.
Keep the Feet Flat on the Floor
If feet don’t reach the floor, place a footstool, box, book, or other flat object underneath them.
Sitting Bones
Also known as the ischial tuberosities, these are two knobby bones on the underside of the pelvis.
Feel around to find them.
Pelvis Adjustment
Shift the body so that the sitting bones are directly under the pelvis rather than situated too far back, stressing the lower back or too far forward, leading to slumping.
Spine Check
There should be a slight spinal curve, and one should be able to slip a hand between the lower back and the back of the chair.
Shoulder Check
The shoulders should be level and vertically aligned with the hips.
If the shoulder blades are pulled back or the shoulders are lifted or curled forward, relax them into a neutral position.
Head Positioning
The head tends to tilt too far forward while sitting as work and the day progresses.
Adjust the head position to align the neck with the upper spine.
The head should be slightly tilted forward, with the ears aligned with the shoulders.
Check for Pain and Discomfort
Pain may be due to structural imbalances of the spine, pelvis, or hips.
Use a lumbar chair support or place a rolled-up towel or cushion at the lower back to keep the back straight.
Added Tips
Tools and tricks to help prevent and avoid back, hip, and neck pain.
Chairs
All the bells and whistles for an ergonomic desk chair are unnecessary.
Focus on features like adjustable seat height and lumbar support. The correct seat depth recommendations are deeper if tall and shallower if short. (van Niekerk, S. M. et al., 2012)
Cushions
If sitting on a cushion or using one to bolster the back or hips, recommendations are not to go too soft.
Cushions that are too soft allow the ability to shift from one hip to the next, often without realizing it.
They usually eventually flatten and lose support.
Monitor Position
There is no point in sitting straight if the monitor is too high or too low.
The monitor should be at eye level to maintain the proper head and shoulder alignment.
If the monitor is too low, place a box or book underneath it.
If it is too high, raise the chair’s height and place a footrest under the feet to keep them flat.
Avoid Crossing Legs or Feet
Crossing the legs or feet places stress on the opposite hip, thigh, and knee and wears the body out faster.
If the hips or legs are tiring prematurely, the individual is not sitting correctly or in the wrong chair.
Use Comfortable Footwear
Maintaining flat feet on the floor while sitting is imperative.
This is not possible in high heels or platform shoes.
Change into a comfortable pair of flat shoes while sitting.
Take Regular breaks
Even with an ergonomic desk chair, the body is not meant to be sitting for hours and hours.
Get up at least every hour, walking and stretching to reactivate the muscles and circulation.
Sitting up straight requires body alignment awareness, stable core muscles, and balanced pelvis, hips, spine, shoulders, neck, and head positioning. It may take some time before these steps become normal, but they will become second nature with perseverance and practice. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution that fully benefits the individual to get back to normal. Using an integrated approach to treat injuries and chronic pain syndromes to improve ability through flexibility, mobility, and agility programs to relieve pain. Our providers create personalized care plans for each patient, including Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine principles. If other treatment is needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments.
Posture and Mobility
References
Albarrati, A., Zafar, H., Alghadir, A. H., & Anwer, S. (2018). Effect of Upright and Slouched Sitting Postures on the Respiratory Muscle Strength in Healthy Young Males. BioMed research international, 2018, 3058970. https://doi.org/10.1155/2018/3058970
Jung, K. S., Jung, J. H., In, T. S., & Cho, H. Y. (2020). Effects of Prolonged Sitting with Slumped Posture on Trunk Muscular Fatigue in Adolescents with and without Chronic Lower Back Pain. Medicina (Kaunas, Lithuania), 57(1), 3. https://doi.org/10.3390/medicina57010003
Canadian Centre for Occupational Health and Safety. (2022). Working in a sitting position – good body position. Retrieved from https://www.ccohs.ca/oshanswers/ergonomics/sitting/sitting_position.html
van Niekerk, S. M., Louw, Q. A., & Hillier, S. (2012). The effectiveness of a chair intervention in the workplace to reduce musculoskeletal symptoms. A systematic review. BMC musculoskeletal disorders, 13, 145. https://doi.org/10.1186/1471-2474-13-145
Can incorporating tonic water benefit individuals who want to drink more water?
Tonic Water
Tonic water is more than just water. Its bitter taste comes from quinine, a natural substance found in the bark of the Peruvian cinchona tree. Most store-bought tonic water contains quinine, with natural or artificial flavors from fruits or herbs to temper the bitterness, varying from brand to brand.
Tonic water calories can be high. Some brands can have up to 114 calories per bottle. The reason is they use a sweetener. Some brands have a diet version with zero calories and no sugar but may contain more sodium.
Fats and Protein
There is no fat or protein in tonic water.
Sugar
Some brands use high fructose syrup, while others use cane sugar or sugar from the other ingredients. For example, adding an alcoholic ingredient to make a tonic cocktail can significantly increase the calorie count.
Sodium
Depending on the variety and the amount drunk, tonic water can be a source of sodium. However, sodium intake should be 1500 milligrams per day.
Carbohydrates
There are 33 grams of carbohydrates per serving with the estimated glycemic load or the numerical value that estimates how much a food will raise an individual’s blood sugar to around four.
Micronutrients
There are no significant vitamins or minerals but a small amount of sodium, zinc, and copper.
Health
Quinine is FDA-approved in specific doses to treat malaria. However, the quinine in tonic water is less than prescribed for medicinal purposes. (Achan, J. et al., 2011) Some individuals have tried to use quinine for leg cramps. However, the FDA has warned that this is not recommended and can cause harm. (U.S. Food and Drug Administration. 2017)
Other Water Beverages
There are other water alternatives to reduce calories, sodium, and added sugar.
Seltzer
Seltzer is carbonated water, similar to club soda, with no calories or added sweeteners.
Add lemon or other fruit for flavor.
Mineral water
Mineral water tastes like seltzer, but the carbonation is usually natural.
Flavored water
Flavored water provides some nutrients and antioxidants from the vegetables and fruits.
It is a great alternative if the other options don’t work.
Allergies
It is possible to have an allergy to quinine that could cause a reaction when drinking tonic water. (Winter F. D., Jr. 2015) In these cases, the research suggests, the allergy may cause:
Individuals can make tonic water with online recipes using different herbs and flavors. Tonic water made at home may or may not be lower in calories than store-bought brands, but the ingredients can be controlled to create beverages that cater to personal tastes. Using tonic or sparkling water, keep the bottled water tightly capped and chilled to maintain carbonation and ready to serve.
Injury Medical Chiropractic and Functional Medicine Clinic focuses on and treats injuries and chronic pain syndromes through personalized care plans to restore health and function to the body through Nutrition and Wellness, Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine protocols. If the individual needs other treatment, they will be referred to a clinic or specialist best suited for them, as Dr. Jimenez has teamed up with the top surgeons, clinical specialists, medical researchers, nutritionists, and health coaches to provide the most effective clinical treatments.
Learning About Food Substitutions
References
U.S. Department of Agriculture. FoodData Central. (2018). Beverages, carbonated, tonic water. Retrieved from https://fdc.nal.usda.gov/fdc-app.html#/food-details/171869/nutrients
Achan, J., Talisuna, A. O., Erhart, A., Yeka, A., Tibenderana, J. K., Baliraine, F. N., Rosenthal, P. J., & D’Alessandro, U. (2011). Quinine, an old anti-malarial drug in a modern world: role in the treatment of malaria. Malaria journal, 10, 144. https://doi.org/10.1186/1475-2875-10-144
U.S. Food and Drug Administration. (2017). FDA drug safety communication: New risk management plan and patient medication guide for Qualaquin (quinine sulfate). Retrieved from https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/fda-drug-safety-communication-new-risk-management-plan-and-patient-medication-guide-qualaquin
Howard, M. A., Hibbard, A. B., Terrell, D. R., Medina, P. J., Vesely, S. K., & George, J. N. (2003). Quinine allergy causing acute severe systemic illness: report of 4 patients manifesting multiple hematologic, renal, and hepatic abnormalities. Proceedings (Baylor University. Medical Center), 16(1), 21–26. https://doi.org/10.1080/08998280.2003.11927884
Winter F. D., Jr (2015). Immune thrombocytopenia associated with consumption of tonic water. Proceedings (Baylor University. Medical Center), 28(2), 213–216. https://doi.org/10.1080/08998280.2015.11929233
For individuals wanting to try Pilates for back pain and exercise, can learning how to find their neutral spine help improve flexibility and increase the range of motion in the joints?
Pilates Neutral Spine
Pilates is a functional exercise modality emphasizing core stability, which is fundamental to developing a balanced body. The exercises strengthen the muscles, improve flexibility, and increase the range of motion in the joints. (Kloubec J. 2011) It is considered a functional fitness method because its principles work to establish more graceful, efficient movements from everyday life, such as improving posture. Pilates has shown its effectiveness in that it is often used in physical therapy and rehabilitation settings. (Byrnes, K., Wu, P. J., and Whillier, S. 2018) However, knowing how to find the neutral spine is essential for performing various Pilates exercises correctly. (Barbosa, A. C. et al., 2018) This subtle adjustment during practice may help prevent injury and increase overall performance. A neutral spine is the natural position of the spine when all three curves:
Cervical (neck)
Thoracic (middle)
Lumbar (lower)
Are active and in healthy alignment.
This is the strongest position for the spine when standing or sitting, allowing the body to move more naturally.
Alignment
The following exercise can help find the Pilates neutral spine.
Basic Position
Lie on the back with knees bent and feet flat on the floor.
Ensure the legs are parallel to the hips, knees, heels, and toes.
Let the arms rest at your sides.
Relax
Relax the body, including the shoulders, neck, and jaw.
Allow the back to melt into the floor.
The rib cage will drop when the lower ribs are released to the floor.
Breathe Deep
Inhale all the way into the body, allowing it to move into the back and sides of the rib cage and all the way to the pelvis.
Pelvic Tilt
Exhale and use the abdominals to press the lower spine into the floor in a pelvic tuck. (Eickmeyer S. M. 2017)
Inhale to release.
Exhale and pull the lower spine off the floor, creating a pelvic tilt.
Inhale to release.
Pilates exercises don’t use excess energy or tension. Proper alignment and a neutral spine position can ensure that tension is released and excess energy is not exerted. (Byrnes, K., Wu, P. J., and Whillier, S. 2018) When performing the exercise, ensure that the shoulders, neck, and legs are relaxed and not involved in the movement.
When Exercising
Once a neutral spine is achieved, the goal is to maintain this spinal position during the exercises and when changing positions.
Start by lifting the right leg and placing it back down without letting the hips move.
Then, repeat the motion with the left leg.
Engage the abdominal muscles to help stabilize the pelvis, keeping it from moving and maintaining a neutral spine.
Repeat this process with each leg.
Once each leg can be lifted easily, test with both legs.
Exhale deeply and lift the legs while keeping the core and pelvis stable.
Then, lower them back down.
When performing this progression, there may be a want to release the abs and let the back arch.
This will cause a tuck and tilt position away from the neutral spine position.
If this progression is difficult, keep practicing until you can maintain a neutral spine.
Once this basic progression feels easy, try additional progressions and positioning.
Visualization Tips
Most people have their spines in one of two positions: tucked or tilted. A neutral spine requires individuals to be in between, with the lower abdominals flat and the lower spine’s natural curve slightly off the floor. The following visualization can help establish a neutral spine.
Balanced Pelvic Placement
Imagine a cup of water sitting on the lower abdomen, a couple of inches below the belly button.
Allow the abdominal muscles to drop toward the spine, flattening the belly.
You don’t want the water to spill, so the pelvis cannot be tipped forward or tucked under.
Body Scan Meditation
Once the body is relaxed with a balanced alignment on the floor.
Allow breathing to become deep and full and the abdominals to drop toward the floor.
The natural neck and lower spine curves should be off the floor.
Ensure the lower spine is not pressed into the floor, as this indicates a pelvic tilt.
If there is any discomfort or pain when working to increase endurance, seek advice from a healthcare professional. Injury Medical Chiropractic and Functional Medicine Clinic uses an integrated approach to treating injuries and chronic pain syndromes. It offers personalized care plans that improve ability through flexibility, mobility, and agility programs to relieve pain. Our providers use an integrated approach to create personalized care plans for each patient, including Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine principles. Our goal is to relieve pain naturally by restoring health and function to the body. If other treatment is needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments.
Is Motion Key to Healing?
References
Kloubec J. (2011). Pilates: how does it work and who needs it?. Muscles, ligaments and tendons journal, 1(2), 61–66.
Byrnes, K., Wu, P. J., & Whillier, S. (2018). Is Pilates an effective rehabilitation tool? A systematic review. Journal of bodywork and movement therapies, 22(1), 192–202. https://doi.org/10.1016/j.jbmt.2017.04.008
Barbosa, A. C., Vieira, E. R., Silva, A. F., Coelho, A. C., Martins, F. M., Fonseca, D. S., Barbosa, M. A., & Bordachar, D. (2018). Pilates experience vs. muscle activation during abdominal drawing-in maneuver. Journal of bodywork and movement therapies, 22(2), 467–470. https://doi.org/10.1016/j.jbmt.2017.05.002
Eickmeyer S. M. (2017). Anatomy and Physiology of the Pelvic Floor. Physical medicine and rehabilitation clinics of North America, 28(3), 455–460. https://doi.org/10.1016/j.pmr.2017.03.003
Can increasing endurance help individuals who want to improve their physical abilities or extend the time they perform these activities?
Endurance
Individuals tend to think of endurance in terms of exercise and fitness, such as running, biking, swimming, and strength training. While this is true, endurance is involved in nearly every task we perform. For example, an individual has to have enough endurance to complete a full day of activities. This includes:
Carpooling the kids
Professional responsibilities
Home chores
Preparing dinner
Helping out kids with homework, etc.
Nearly every activity requires some level of endurance, which means the ability to maintain activity for an extended period of time. When endurance begins to wane, it usually results from not performing certain activities regularly. The body gets used to daily routines and activities. When it stops engaging in certain activities, like walking and exercising regularly, endurance slowly declines, and the ability to perform at the same caliber.
What Is It?
Endurance is an ability that is acquired after extensive physical and mental training. Physiological and psychological factors reinvigorate individuals to continue doing what they are doing longer. Factors include:
Fatigue
Individuals who didn’t sleep well the night before or are worn out may have difficulty following through with certain activities that require extensive output or stamina.
Fitness Levels
Current fitness levels are also a predictor of endurance.
How physically fit an individual is, coupled with their level of training, will impact endurance abilities.
Genetics is another factor, as everybody has different muscle fibers that can influence physical capabilities. While research shows that individuals can gradually alter the amount of these fibers, it also emphasizes the role of genetics in determining one’s muscle makeup. (de Souza, E. O. et al., 2014)
Individuals who constantly challenge themselves mentally and physically are continually building endurance.
Endurance and Stamina Difference
Endurance is often used interchangeably with stamina. However, the two are very different.
Stamina refers to how long an individual can perform a certain activity at maximum capacity or without getting tired.
Endurance revolves around an individual’s ability to perform a certain activity without performing at maximum capacity.
Types
Endurance can be divided into classifications defined by type. Here are the main types of endurance in physical fitness and what they mean.
Cardiovascular
Cardiovascular endurance is the stress an individual’s heart can take during physical activity.
When building cardiovascular endurance, the body becomes more efficient at pumping blood while performing a specific activity.
Individuals with more cardiovascular endurance can sustain longer and more intense overall training.
Muscular
Muscular endurance is the length of time muscles can continue to contract enough to allow the body to finish a certain activity.
An individual lacking in muscular endurance will succumb faster to excess lactic acid build-up, causing cramps.
An individual with significant muscular endurance can lift a weight for more repetitions before failure.
Anaerobic
Anaerobic means without oxygen, so anaerobic endurance refers to how long a muscle can continue working at a certain physical level without much or any oxygen.
Weightlifting is a great example of this.
Anaerobic exercise tends to be shorter in duration but more intense than aerobic exercise, like swimming or cycling.
Improvement
Through endurance training, individuals can improve their ability to carry out certain activities longer. Recommendations for how to improve include.
Interval Training
Interval training, or high-intensity interval training, involves increasing the intensity of the workout for a short period of time.
If running, intentionally push the pace harder than normal for 20-second intervals.
Followed by a slower recovery pace for about a minute.
This increases endurance and improves insulin sensitivity.
Pedaling on an air bike is another recommended activity to build strength and endurance.
Rest Less Between Sets
Resting in between certain types of physical activity is beneficial, it can also lower heart rate and endurance threshold.
Taking less rest between workout sets so that the heart rate stays elevated increases endurance with each workout.
Perform a Few More Reps On Each Set
Whatever the type of exercise being done, one way to enhance endurance is to add one more rep, one more mile, or a few more minutes to the fitness schedule.
The body will slowly adapt to that level, making it the new norm.
Increase Core Strength
No matter the workout—running, swimming, cycling, or weight lifting—it’s important to focus on strengthening the core. This will help improve endurance in any activity and prevent injuries.
Individuals having trouble taking their workouts to the next level and feeling that their endurance has flattened should consider enlisting the help of a certified personal trainer. If there is any discomfort or pain when working to increase endurance, seek advice from a healthcare professional. Injury Medical Chiropractic and Functional Medicine Clinic uses an integrated approach to treating injuries and chronic pain syndromes. It offers personalized care plans that improve ability through flexibility, mobility, and agility programs to relieve pain. Our providers use an integrated approach to create personalized care plans for each patient, including Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine principles. Our goal is to relieve pain naturally by restoring health and function to the body. If other treatment is needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments.
Unlocking Athletic Potential
References
de Souza, E. O., Tricoli, V., Aoki, M. S., Roschel, H., Brum, P. C., Bacurau, A. V., Silva-Batista, C., Wilson, J. M., Neves, M., Jr, Soares, A. G., & Ugrinowitsch, C. (2014). Effects of concurrent strength and endurance training on genes related to myostatin signaling pathway and muscle fiber responses. Journal of strength and conditioning research, 28(11), 3215–3223. https://doi.org/10.1519/JSC.0000000000000525
Can understanding the nucleus pulposus help in body positioning and prevention for individuals wanting to practice spinal hygiene and protect their discs from injury?
Nucleus Pulposus
The spinal discs are located between the spine’s vertebrae and are the body’s natural impact and shock absorbers. Within the disc is the nucleus pulposus, which plays a major role in providing the spine with shock absorption during movement. (Zhou Z. et al., 2014) The discs have a tough outer portion and a soft inner core. They are the:
It forms the tough circular exterior and comprises concentric sheets of collagen fibers or lamellae surrounding the inner core.
It has cartilaginous endplates that firmly attach to the vertebrae above and below.
Nucleus Pulposus
The nucleus pulposus is the inner core soft filling of the discs.
It contains a network of fibers suspended in a mucoprotein gel with a water base to maintain strength and pliability.
The near-liquid consistency makes it responsive to movement to handle the body’s axial load.
It helps maintain spinal suspension to prevent pressure on the bones and prevent bone-to-bone contact, reducing the potential for injuries and pain.
Shock Absorber
Each intervertebral disc is a shock-absorbing cushion, with the nucleus pulposus providing shock-absorbing properties (Zhou Z. et al., 2014). The intervertebral discs move as the body moves. For example, when arching the back, the disc moves forward slightly, and when twisting, the disc twists as well.
Spinal Action
The intervertebral disc supports spinal movements. When bending, twisting, arching, or tilting the spine, the nucleus pulposus swivels to accommodate these actions. These repeated spinal actions, which occur throughout the day and night, contribute to shifting positions while sitting, working, playing sports, carrying groceries, performing house chores, etc. An example is bending forward to pick something up. This action involves forward spinal flexion, which is bending the spine forward, flattening, or rounding. When bending using flexion, the spinal bones come closer together, pushing the nucleus pulposus toward the back.
Injuries
The disc can be pushed too far back with persistent or excessive spinal flexion. If the fibers of the annulus fibrosus become weak, they can tear, causing the nucleus pulposus to leak out and disc herniation. Generally, the nucleus pulposus will leak to the side and back; however, this corresponds to the location of the very sensitive nerve root/s with which it can come into contact, causing pain and other symptoms. The most common causes of disc herniation are degenerative wear and tear changes of the disc and trauma. Disc degeneration occurs as the body ages; it weakens the annulus fibers, allowing the nucleus pulposus to distend, bulge, or herniate.
Aging
Disc degeneration occurs with age but can also occur with injuries to the area. In young individuals, the nucleus pulposus is mostly water. For this age group, a herniation from trauma is more likely than in older individuals. (Ucar, D. et al., 2021) But as the body ages, the discs, especially the nucleus pulposus, begin to dry out. This dehydration leads to a significant loss of disc height. (UCLA Health, 2024) By age 60 or 70, the discs may be composed entirely of fiber, which can cause the shock absorption function not to work and disappear.
Chiropractic therapy is among the more conservative treatment options for a herniated disc and may be tried first before proceeding with more invasive treatments. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution that fully benefits the individual to get back to normal.
The Science of Functional Healing
References
Zhou, Z., Gao, M., Wei, F., Liang, J., Deng, W., Dai, X., Zhou, G., & Zou, X. (2014). Shock absorbing function study on denucleated intervertebral disc with or without hydrogel injection through static and dynamic biomechanical tests in vitro. BioMed research international, 2014, 461724. https://doi.org/10.1155/2014/461724
Nosikova, Y. S., Santerre, J. P., Grynpas, M., Gibson, G., & Kandel, R. A. (2012). Characterization of the annulus fibrosus-vertebral body interface: identification of new structural features. Journal of anatomy, 221(6), 577–589. https://doi.org/10.1111/j.1469-7580.2012.01537.x
Ucar, D., Duman, S., Bayram, Y., & Ucar, B. Y. (2021). Extruded disc herniations are experienced earlier by inactive young people in the high-tech gaming era. Journal of medicine and life, 14(3), 402–407. https://doi.org/10.25122/jml-2021-1059
Can physical therapies help relieve muscle contractures in individuals who have endured prolonged bed rest, inactivity, or lack of use of certain muscle groups?
Muscle Contracture
A muscle contracture, or contracture deformity, is caused when a muscle loses elasticity. This causes permanent shortening and tightening of muscle fibers, which reduces flexibility and makes movement difficult. Muscles that cannot move and stretch cause the surrounding joints to lose mobility and develop pain symptoms. When trying to stretch the contracted muscle, the individual will feel the muscle become very rigid, which can increase pain. (Lieber, R. L., and Fridén, J. 2019) Delaying treatment can potentially cause irreversible and chronic symptoms.
Commonly Affected Muscles
Flexor muscles bend the joints and are those most affected by contractures. The stiffening and tightening prevent the body parts from moving out and away. The most common include:
Wrist and Finger Flexors
Muscle groups that bend the wrist and fingers.
Biceps
The primary elbow flexor that bends the arm.
Gastrocnemius and Soleus
The calf muscles which allow the ankle to point the foot/plantarflexion.
Hamstrings
A group of three muscles behind the thigh that bend the knee.
Causes
The permanent shortening of muscle fibers and changes in muscle structure cause muscle contractures or stiffer-than-normal tissue that is difficult to stretch. Sarcomeres are structural units of muscles that cause fibers to contract.
With contractures, the sarcomeres overly lengthen when the muscle fibers tighten. This increase in sarcomere length prevents the muscle from contracting normally, resulting in weakness. Muscle fibers are encased in an extracellular matrix, a mesh composed of collagen and other proteins that help transmit force and provide muscle contraction. Muscle contractures cause the amount of collagen within the extracellular matrix to increase, causing a stiffening of fibers that restricts movement. (Lieber, R. L., and Fridén, J. 2019)
Muscle contractures also form from decreased satellite cells. Satellite cells are specialized stem cells that can rebuild muscle and are necessary for muscle regeneration and repair. Without the proper amount of satellite cells, other cells like fibroblasts significantly increase in the muscle tissue, causing the fibers to become stiff and fibrotic or more fibrous. These changes to the sarcomeres, collagen within the extracellular matrix, and decreased satellite cells all result from conditions in which neurological input to the brain and spinal cord muscles becomes reduced. This is caused by lack of use, injury, or neurological and neuromuscular conditions. (Lieber, R. L., and Fridén, J. 2019)
Cerebral Palsy
Contractures often occur from upper motor neuron lesions, which prevent signals from the brain and spinal cord from reaching the motor neurons that control muscle contraction. When these signals are weakened or blocked, muscles become stiff and weak from lack of stimulation. (Lieber, R. L., and Fridén, J. 2019)
Cerebral palsy is a group of disorders affecting mobility caused by an upper motor neuron lesion that is present at birth and is the most common motor disability in children. It causes:
Cognitive impairment
Decreased muscle strength
Problems with movement, coordination, and functional motions.
Because cerebral palsy prevents the muscles of the legs from being sufficiently stimulated, contractures commonly develop in the hips, knees, and ankles. Individuals can have a 75% decrease in satellite cells to repair muscle tissue and prevent muscle fibrosis or stiffening. Specific genes linked to collagen production are also altered, causing irregular changes to the extracellular matrix of muscles. (Lieber, R. L., and Fridén, J. 2019)
Muscular Dystrophy
Muscular dystrophy is a group of inherited neuromuscular disorders characterized by muscle weakness and wasting. Deficient nerve supply to muscles causes them to become stiff and tight, inhibiting the functional range of motion needed to move joints and activate muscles to move. Clinical research suggests that individuals with muscular dystrophy have decreased levels of satellite cells to repair, increasing the risk of developing muscle contracture. (Lieber, R. L., and Fridén, J. 2019)
Disuse-induced Muscle Wasting or Disuse Atrophy
When muscles are not used for some time because of hospitalization, prolonged bed rest, or immobilization from wearing braces, splints, or casts after injuries, the blood circulation and electrical signaling from nerves to muscles decreases. This results in weakness, increased muscle tightness and stiffness, and muscle wasting/atrophy. Over time, stiff and tight muscles can progress to contractures that become extremely difficult to stretch.
Trauma or Injury
Muscle or tendon injuries can cause contractures as scar tissue develops, joining muscle fibers and joints together. This can significantly restrict movement. Large burns can also cause skin, muscles, and joint contractures. The range of motion can become significantly limited, and the changes can become irreversible if not aggressively treated.
Other Causes
Other forms of upper motor neuron lesions that can cause contractures because of weak or blocked electrical input to muscles as a result of brain or spinal cord damage include:
Neuromuscular disorders like spinal muscular atrophy – SMA.
Conditions that cause inflammation and joint stiffening, like juvenile rheumatoid arthritis.
A history of diabetes also increases the risk of developing contractures affecting finger flexors, like Dupuytren’s contractures and stenosing tenosynovitis
or trigger finger. (Lieber, R. L., and Fridén, J. 2019)
Symptoms
Symptoms include:
Extremely stiff and tight muscles resistant to stretching.
Pain from the inability to stretch.
Loss of range of motion.
Impaired joint mobility.
Severe contractures can interfere with the functional range of motion needed to move joints to complete normal tasks and movements, such as standing up from a chair and walking.
Treatment
Physical Therapy
Physical therapies can help reduce the severity through stretching and soft tissue mobilization to decrease tightness. (Lieber, R. L., and Fridén, J. 2019)
Specialized braces or splints can be custom-made to fit different body parts.
These provide a prolonged low-intensity stretch over a period of time to increase muscle length.
Once the muscle has stretched, a new brace or splint may be needed to adjust to the increased range of motion. (Lieber, R. L., and Fridén, J. 2019)
Surgery
In severe cases where muscle contractures limit the functional range of motion needed for activities of daily living or ADLs, surgical release of the contracted tissue may be recommended. This surgery can improve functional movements like walking, getting in and out of bed, and standing up from chairs. The tight muscles can be surgically cut, and the tendons can be lengthened to allow more mobility. (Lieber, R. L., and Fridén, J. 2019)
The causes of muscle contracture are not always avoidable, but various treatment options are available to help loosen up tight muscles and preserve or restore the range of motion. It’s important to move daily and stretch common areas like the fingers, arms, and legs to reduce the risk of muscle tightness and prevent contractures from developing. It is imperative to seek medical treatment for severe contractures resulting from neuromuscular disorders, including physical and occupational therapy, to prevent contractures from worsening and regaining as much functional range as possible.
Injury Medical Chiropractic and Functional Medicine Clinic uses an integrated approach personalized to the individual that focuses on what works for them and treats injuries and chronic pain syndromes through personalized care plans that improve ability through flexibility, mobility, and agility programs to relieve pain. Our providers use an integrated approach to create personalized care plans for each patient, including Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine principles. Our goal is to relieve pain naturally by restoring health and function to the body. If other treatment is needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments.
Chiropractic Treatment for Cerebral Palsy
References
Lieber, R. L., & Fridén, J. (2019). Muscle contracture and passive mechanics in cerebral palsy. Journal of applied physiology (Bethesda, Md. : 1985), 126(5), 1492–1501. https://doi.org/10.1152/japplphysiol.00278.2018
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With contractures, the sarcomeres overly lengthen when the muscle fibers tighten. This increase in sarcomere length prevents the muscle from contracting normally, resulting in weakness. Muscle fibers are encased in an extracellular matrix, a mesh composed of collagen and other proteins that help transmit force and provide muscle contraction. Muscle contractures cause the amount of collagen within the extracellular matrix to increase, causing a stiffening of fibers that restricts movement. (
