For individuals experiencing lower back pain can understanding the anatomy and function of the multifidus muscle help in injury prevention and in the development of a highly effective treatment plan?
Multifidus Muscle
The multifidus muscles are long and narrow on either side of the spinal column, which helps stabilize the lower region of the spine or lumbar spine. (Maryse Fortin, Luciana Gazzi Macedo 2013) Sitting too much, practicing unhealthy postures, and lack of movement can progress to the multifidus muscle weakening or atrophy, which can lead to spinal instability, vertebral compression, and back pain. (Paul W. Hodges, Lieven Danneels 2019)
Anatomy
Known as the deep layer, it is the innermost layer of the three muscle layers of the back and controls the movement of the spine. The other two layers, known as the intrinsic and superficial, are responsible for the thoracic cage/rib cage and shoulder movement. (Anouk Agten et al., 2020) The multifidus has attachment points at:
The thoracic spine of the middle back.
The lumbar spine of the lower back.
The iliac spine – the base of the wing-shaped iliac bone of the pelvis.
Sacrum – series of bones at the base of the spine connected to the tailbone.
When standing or moving, the multifidus muscle works with the transversus abdominus and pelvic floor muscles to stabilize the lumbar spine. (Christine Lynders 2019)
Muscle Function
The main function is to stabilize the lower back, but it also helps extend the lower spine whenever reaching or stretching. (Jennifer Padwal et al., 2020) Because the muscle has numerous attachment points and is serviced by a specific branch of nerves known as the posterior rami, it allows each vertebra to work individually and more efficiently.
The multifidus muscle works with two other deep muscle groups to stabilize and move the spine. (Jeffrey J Hebert et al., 2015)
The rotatores muscle enables unilateral rotation, turning from side to side, and bilateral extension or bending backward and forward.
The semispinalis muscle above the multifidus allows extension and rotation of the head, neck, and upper back.
The multifidus muscle ensures spinal strength because it has more attachment points to the spine than the other layers, which reduces spinal flexibility and rotation but increases strength and stability. (Anouk Agten et al., 2020)
Lower Back Pain
A weak multifidus muscle destabilizes the spine and provides less support to the vertebra. This adds pressure on muscles and connective tissues between and adjacent to the spinal column, increasing the risk of lower back pain symptoms. (Paul W. Hodges, Lieven Danneels 2019) The loss of muscle strength and stability can cause atrophy or wasting away. This can cause compression and other back problems. (Paul W. Hodges et al., 2015) Back problems associated with multifidus muscle deterioration include (Paul W. Hodges, Lieven Danneels 2019)
Herniated discs – also bulging or slipped discs.
Nerve entrapment or compression pinched nerve.
Sciatica
Referred pain – nerve pain originating from the spine felt in other areas.
Osteoarthritis – wear-and-tear arthritis
Spinal osteophytes – bone spurs
Weak abdominal or pelvic floor muscles can compromise the core, increasing the risk of chronic lower back pain and injury.
Individuals are recommended to consult a physical therapist and chiropractor who can help develop the appropriate treatment, rehabilitation, and strengthening plan based on age, injury, underlying conditions, and physical abilities.
Can Core Exercises Help with Back Pain?
References
Fortin, M., & Macedo, L. G. (2013). Multifidus and paraspinal muscle group cross-sectional areas of patients with low back pain and control patients: a systematic review with a focus on blinding. Physical therapy, 93(7), 873–888. doi.org/10.2522/ptj.20120457
Hodges, P. W., & Danneels, L. (2019). Changes in Structure and Function of the Back Muscles in Low Back Pain: Different Time Points, Observations, and Mechanisms. The Journal of orthopaedic and sports physical therapy, 49(6), 464–476. doi.org/10.2519/jospt.2019.8827
Agten, A., Stevens, S., Verbrugghe, J., Eijnde, B. O., Timmermans, A., & Vandenabeele, F. (2020). The lumbar multifidus is characterised by larger type I muscle fibres compared to the erector spinae. Anatomy & cell biology, 53(2), 143–150. doi.org/10.5115/acb.20.009
Lynders C. (2019). The Critical Role of Development of the Transversus Abdominis in the Prevention and Treatment of Low Back Pain. HSS journal : the musculoskeletal journal of Hospital for Special Surgery, 15(3), 214–220. doi.org/10.1007/s11420-019-09717-8
Padwal, J., Berry, D. B., Hubbard, J. C., Zlomislic, V., Allen, R. T., Garfin, S. R., Ward, S. R., & Shahidi, B. (2020). Regional differences between superficial and deep lumbar multifidus in patients with chronic lumbar spine pathology. BMC musculoskeletal disorders, 21(1), 764. doi.org/10.1186/s12891-020-03791-4
Hebert, J. J., Koppenhaver, S. L., Teyhen, D. S., Walker, B. F., & Fritz, J. M. (2015). The evaluation of lumbar multifidus muscle function via palpation: reliability and validity of a new clinical test. The spine journal : official journal of the North American Spine Society, 15(6), 1196–1202. doi.org/10.1016/j.spinee.2013.08.056
Hodges, P. W., James, G., Blomster, L., Hall, L., Schmid, A., Shu, C., Little, C., & Melrose, J. (2015). Multifidus Muscle Changes After Back Injury Are Characterized by Structural Remodeling of Muscle, Adipose and Connective Tissue, but Not Muscle Atrophy: Molecular and Morphological Evidence. Spine, 40(14), 1057–1071. doi.org/10.1097/BRS.0000000000000972
For individuals looking to improve their diet, can knowing the different salt types help in food preparation and health?
Salt Types
Salt brings out the natural flavor of foods and can be used as a preservative. Salt types come in various colors and textures for cooking, flavor, and health. Some are considered healthier compared to regular table salt, like pink Himalayan salt and different sea salts. Some individuals prefer them because most go through less processing and can have more trace minerals like magnesium and potassium. However, all salts are healthy in moderation, as sodium is a necessary part of a balanced diet. Although essential for the body, sodium can be harmful when too much is consumed. A study examining consumer-grade pink Himalayan sea salts available in Australia determined that to receive the additional health benefits of the minerals from this type of salt, individuals must consume so much that it elevates the amount of sodium in the body to dangerous levels. (Flavia Fayet-Moore et al., 2020)
Salt
Salt is a mineral made from the combined elements:
Sodium – Na
Chlorine -Cl
Together, they form crystallized sodium chloride NaCl.
The majority of salt production comes from evaporated seawater and salt mines. Many salts used in food preparation are iodized. Iodine is added to various refined salt products to help meet nutritional requirements. Iodine intake levels that fall below the recommended values could result in a deficiency and develop goiter. Goiter is associated with hypothyroidism. (Angela M. Leung et al., 2021) Lack of iodine can also have adverse effects on growth and development. (National Institutes of Health Office of Dietary Supplements. 2023)
Essential for Health
Salt sustains life and optimal bodily function. Sodium and chlorine are important elements that maintain:
Cellular balance
Circulation
Blood sugar levels
Sodium is a mineral and an electrolyte. Common electrolytes include potassium, calcium, and bicarbonate. Without adequate sodium levels, the brain cannot send the necessary impulses to the rest of the body to function properly. However, consuming too much salt can cause health issues.
Higher salt intake in individuals who are sensitive to salt can increase blood pressure.
Doctors usually recommend that individuals with hypertension reduce sodium intake or follow a low-sodium diet.
Elevated sodium levels also cause water retention – considered a protective response as the body works to regulate serum sodium levels concentration in the blood to maintain balance.
If levels are too high, a condition known as hypernatremia can develop, which can cause:
Excessive thirst
Vomiting
Infrequent urination
Diarrhea
Sodium levels that are too low can lead to hyponatremia, which can cause:
Though there are different types of salt, they all contain roughly the same amount of sodium.
Types
The average sodium intake by adults is around 3,393mg per day, ranging between 2,000–5,000mg. Guidelines recommend a maximum intake of 2,300mg per day. (U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2020) Whether from unhealthy dietary choices like processed foods or incorrect knowledge of sodium content when cooking, an American Heart Association survey showed that more than half of respondents inaccurately stated that sea salt had a lower sodium content than table salt. (American Heart Association. 2024)
Refined – Table Salt
Refined/iodized salt is finely granulated and commonly used in cooking. This type is highly refined to remove impurities and eliminate trace minerals often found in specialty salts. Because the salt is finely ground, anti-caking agents are added to ensure the salt doesn’t clump. Some table salts also have added sugar and other additives.
Refined table salt is about 97–99% sodium chloride (NaCl).
Iodine is added to prevent iodine deficiency.
Individuals trying to reduce sodium intake but meet iodine levels can do so with foods like eggs, dairy products, and fish.
Kosher
Kosher salt is coarse and flakey and can add a crunchy texture to dishes and drinks. Pure kosher salt does not contain additives like anti-caking agents and iodine. The size of the salt crystals is ideal for drawing out moisture.
Per teaspoon, kosher salt generally has less sodium than 1 teaspoon of table salt.
Because it has a coarser grain, less salt fits in the measuring spoon.
Sea Salt
Sea salt is produced from evaporated seawater and comes as fine grains or large crystals. Examples include:
Black Sea
Celtic
French – fleur de sel
Hawaiian sea salt
Sea salt can have trace amounts of minerals like iron, potassium, and zinc, which can produce different flavors in cooking but no additional health benefits with normal consumption. Some sea salts may also contain trace amounts of microplastics. However, research indicates these amounts are too low to warrant public health concerns. (Ali Karami et al., 2017)
Himalayan Pink Salt
Himalayan pink salt is mined in the red salt range in Pakistan, the second-largest salt mine in the world, and in the Andes mountains of Peru. Trace amounts of iron oxide make the salt pink. It is typically used at the end of cooking to add flavor and a crunch. Himalayan salt is popular for its health benefits and mineral properties. However, using Himalayan salt over other types has no known health advantages. Researchers concluded that the potential health benefits provided by the higher nutrient content would be counteracted by the large amount of sodium that would need to be consumed. (Flavia Fayet-Moore et al., 2020)
Substitutes
Salt substitutes contain some or all sodium and potassium, magnesium, or other minerals. Substitutes can be half sodium chloride and half potassium chloride. Monosodium glutamate/MSG can also be used as an alternative. A study found that substituting salt with MSG is safe and comparable to salt flavor. (Jeremia Halim et al., 2020) Individuals often use substitutes on a sodium-restricted diet but should check with their doctor before using these products, especially if they have kidney conditions.
Body In Balance – Chiropractic+Fitness+Nutrition
References
Fayet-Moore, F., Wibisono, C., Carr, P., Duve, E., Petocz, P., Lancaster, G., McMillan, J., Marshall, S., & Blumfield, M. (2020). An Analysis of the Mineral Composition of Pink Salt Available in Australia. Foods (Basel, Switzerland), 9(10), 1490. doi.org/10.3390/foods9101490
Leung, A. M., Braverman, L. E., & Pearce, E. N. (2012). History of U.S. iodine fortification and supplementation. Nutrients, 4(11), 1740–1746. doi.org/10.3390/nu4111740
Karami, A., Golieskardi, A., Keong Choo, C., Larat, V., Galloway, T. S., & Salamatinia, B. (2017). The presence of microplastics in commercial salts from different countries. Scientific reports, 7, 46173. doi.org/10.1038/srep46173
Halim, J., Bouzari, A., Felder, D., & Guinard, J. X. (2020). The Salt Flip: Sensory mitigation of salt (and sodium) reduction with monosodium glutamate (MSG) in “Better-for-You” foods. Journal of food science, 85(9), 2902–2914. doi.org/10.1111/1750-3841.15354
Of this, 0.7 grams come from fiber, and 1.3 grams are natural sugars.
Fats
Tomatillos contain less than half a gram in one medium-sized tomatillo.
Protein
There is less than half a gram of protein per tomatillo.
Vitamins and Minerals
Tomatillos provide:
Vitamin A
Vitamin C
Potassium
And provide several other micronutrients in smaller doses.
Benefits
Tomatillo’s health benefits include the following.
Cardiovascular Health
Tomatillos provide a heart-healthy dietary addition. They are naturally low in sodium and rich in potassium, which could help regulate blood pressure. They provide vitamins A and C and antioxidants against free radicals.
The American Heart Association recommends the consumption of a variety of fruits and vegetables daily for various benefits. One of them is their fiber content. Fiber is the indigestible part of carbohydrates that can help decrease cholesterol by binding and removing cholesterol from the body. Tomatillos contain about one gram of fiber, a recommended addition to a heart-healthy diet. (American Heart Association. 2023)
Potentially Help Reduce Cancer Risk
Tomatillos have several antioxidants with cancer-preventing properties. They are a source of phytochemicals known as withanolides. These natural plant compounds have been shown to induce apoptosis/cell death in colon cancer cells. (Peter T. White et al., 2016) Diets high in fruits and vegetables have been associated with lower risks of cancer, making tomatillos a welcome addition to a high-antioxidant nutrition plan focused on cancer prevention.
Arthritis Symptoms Improvement
The withanolide antioxidants are also anti-inflammatory. Research on withanolides demonstrates clinical benefits in the alleviation of symptoms of osteoarthritis and rheumatoid arthritis. (Peter T. White et al., 2016) Tomatillos may help reduce inflammation, which can make arthritis more manageable.
Vision Loss Prevention
Tomatillos provide a healthy source of key nutrients for eye health. Lutein and zeaxanthin are antioxidants that concentrate in the retina and help protect against environmental deterioration. Tomatillos provide:
Tomatillos are a low-calorie whole food ingredient. Because of their high water content, it’s possible to fill up without adding excess calories. Fresh salsa made with tomatoes or tomatillos is a healthy, flavorful choice that is virtually free of added sugars. (The National Kidney Foundation. 2014)
Adverse Effects
Tomatillos are part of the nightshade family. While there is no conclusive evidence confirming any harmful effects, some individuals report experiencing sensitivity to them. (Cleveland Clinic. 2019) Individuals who believe they may be sensitive to tomatillos should consult a registered dietitian to determine the root cause and ways to improve tolerance.
Allergies
Although rare, serious reactions, including anaphylaxis, are possible even if the individual shows no signs of a tomato allergy.
Individuals unsure about an allergy to tomatillos should see an allergist for testing.
Varieties
Different varieties include yellow, green, and purple. (MacKenzie J. 2018)
Rendidora is a green variety that grows upright with a high yield.
Gulliver Hybrid, Tamayo, Gigante, and Toma Verde are also green but grow in a sprawling pattern.
Choose tomatillos that are firm and green but large enough that they fill up the husks.
When they ripen too long, their flavor becomes bland. (MacKenzie J. 2018)
Storage and Safety
Tomatillos can last months in their husks, spread out in a well-ventilated area. (MacKenzie J. 2018)
Keep them in a paper bag in the refrigerator for no longer than 2 weeks if using sooner.
Do not store in plastic, as this can cause spoilage.
For extended storage, tomatillos may be frozen or canned.
Remove the husks, wash them, and dry them before eating or preparing them for long-term storage.
Preparation
Tomatillos have a distinct flavor and firm texture. They can be eaten whole with no need to seed or core them. (Drost D, Pedersen K. 2020) Use tomatillos for:
White, P. T., Subramanian, C., Motiwala, H. F., & Cohen, M. S. (2016). Natural Withanolides in the Treatment of Chronic Diseases. Advances in experimental medicine and biology, 928, 329–373. doi.org/10.1007/978-3-319-41334-1_14
For individuals wanting to improve and/or maintain health research shows evidence that acupuncture may help promote weight loss. Can incorporating acupuncture into an overall health plan help achieve this goal?
Acupuncture Weight Loss
Acupuncture is a traditional medical therapy that inserts thin, flexible needles into the body at specific points. It has been around for more than 2,500 years. The practice is believed to stimulate the body’s energy/circulation, and research suggests that it could improve various factors known to contribute to weight gain and obesity. (Kepei Zhang et al., 2018)
Acupuncture regulates energy flow and helps restore the body’s balance, which is believed to promote homeostasis and self-healing. (Ning-Cen Li et al., 2019)
Acupuncture stimulates connective tissue, which affects blood circulation, nerves, and the immune system.
It has been used to help manage conditions like migraines, infertility, pain management, and weight loss.
At the first appointment, the acupuncturist will take a general medical history and identify weight loss goals.
They will help identify the root causes contributing to weight gain, e.g., slow metabolism, thyroid issues, and overeating, to develop an effective personalized treatment plan.
A trained and licensed practitioner may also be able to provide nutritional and health coaching in addition to acupuncture treatments.
Procedure
The needles are thin and designed to work effectively without causing pain or bleeding.
The needles are left in for 15 to 30 minutes per session, depending on the treatment stage.
The practitioner may lift or rotate the needles as part of the technique during a session.
Many individuals report that acupuncture treatments are relaxing and pain-free.
For weight loss, the ear points will be the focus.
Research suggests that stimulating certain outer ear points may help balance hormones that help decrease cravings and suppress appetite. (Li-Hua Wang et al.,2019)
Two hormones that help in weight loss and acupuncture may help rebalance include: (Li-Hua Wang et al.,2019)
Ghrelin
Controls appetite and meal stimulation.
Leptin
Regulates fat storage and metabolism.
Acupuncture Weight Loss can help:
Decrease food cravings
Suppress appetite
Improve digestion
Increase metabolism
Research
Acupuncture weight loss recent research:
One study compared the effectiveness of auricular/ear acupuncture to body acupuncture in obese women and found that those who received ear acupuncture lost more weight than the individuals who received acupuncture in other body areas. (Cayir Yasemin et al., 2017)
Another study found that overweight females between 20 and 30 years of age who received six weekly treatments of ear acupuncture experienced a reduction in waist circumference. (Felicity Lillingston et al., 2019)
Many individuals gain weight as a result of stress.
Research suggests that acupuncture therapy helps stimulate the release of endorphins or the body’s natural pain-relieving hormones.
This helps create calming, relaxing effects that counteract stress eating caused by tension, frustration, and anxiety. (Laila Ahmed Abou Ismail et al., 2015)
When incorporated with lifestyle adjustments, like regular exercise, improved sleep, stress management, and a balanced diet, a review of studies concluded that acupuncture is effective for weight loss. (S-Y Kim et al, 2018)
Safety
The risks of acupuncture are low when performed by a licensed and certified practitioner. The most common side effects include:
Soreness
Bruising
Minor bleeding where the needles were inserted
Fatigue
Before seeking acupuncture treatment, consult your healthcare provider about consideration. They may recommend a reputable practitioner if the treatment is right for you.
Chiropractic Care and Metabolism
References
Zhang, K., Zhou, S., Wang, C., Xu, H., & Zhang, L. (2018). Acupuncture on Obesity: Clinical Evidence and Possible Neuroendocrine Mechanisms. Evidence-based complementary and alternative medicine : eCAM, 2018, 6409389. doi.org/10.1155/2018/6409389
Li, N. C., Li, M. Y., Chen, B., & Guo, Y. (2019). A New Perspective of Acupuncture: The Interaction among Three Networks Leads to Neutralization. Evidence-based complementary and alternative medicine : eCAM, 2019, 2326867. doi.org/10.1155/2019/2326867
Wang, L. H., Huang, W., Wei, D., Ding, D. G., Liu, Y. R., Wang, J. J., & Zhou, Z. Y. (2019). Mechanisms of Acupuncture Therapy for Simple Obesity: An Evidence-Based Review of Clinical and Animal Studies on Simple Obesity. Evidence-based complementary and alternative medicine : eCAM, 2019, 5796381. doi.org/10.1155/2019/5796381
Yasemin, C., Turan, S., & Kosan, Z. (2017). The Effects of Auricular and Body Acupuncture in Turkish Obese Female Patients: A Randomized Controlled Trial Indicated Both Methods Lost Body Weight But Auricular Acupuncture Was Better Than Body Acupuncture. Acupuncture & electro-therapeutics research, 42(1), 1–10. doi.org/10.3727/036012917×14908026364990
Lillingston, F., Fields, P., & Waechter, R. (2019). Auricular Acupuncture Associated with Reduced Waist Circumference in Overweight Women-A Randomized Controlled Trial. Evidence-based complementary and alternative medicine : eCAM, 2019, 6471560. doi.org/10.1155/2019/6471560
Ismail, L. A., Ibrahim, A. A., Abdel-Latif, G. A., El-Haleem, D. A., Helmy, G., Labib, L. M., & El-Masry, M. K. (2015). Effect of Acupuncture on Body Weight Reduction and Inflammatory Mediators in Egyptian Obese Patients. Open access Macedonian journal of medical sciences, 3(1), 85–90. doi.org/10.3889/oamjms.2015.010
Kim, S. Y., Shin, I. S., & Park, Y. J. (2018). Effect of acupuncture and intervention types on weight loss: a systematic review and meta-analysis. Obesity reviews : an official journal of the International Association for the Study of Obesity, 19(11), 1585–1596. doi.org/10.1111/obr.12747
For individuals who have decided to start exercising for fitness and health, walking is a great place to start. Can planning a walking exercise schedule help individuals maintain a fitness routine and improve endurance and speed quicker?
Walking Exercise Planning Schedule
While any amount of walking benefits health, individuals can increase the benefits by walking more per week or by increasing the pace. Brisk walking for 30 minutes per day, totaling 150 minutes per week, is recommended by health experts to decrease risks for heart disease, stroke, diabetes, and other conditions. (Centers for Disease Control and Prevention. 2022)
Individuals with ongoing health conditions should talk to their doctor before starting any new exercise program.
Beginners are encouraged to focus on using proper walking posture and technique to steadily improve strength and endurance.
The increased duration or intensity can help if weight loss is a goal.
Improving diet is also necessary for the best results.
Individuals can build healthy walking habits by tracking walks.
Schedule
Checklist
Individuals can walk outdoors, indoors, or on a treadmill.
Wear proper athletic shoes and clothing.
Check walking posture.
Walk at an easy pace for a couple of minutes before picking up speed.
First Week
An example of what a walking exercise schedule can look like, but it’s advised to consult a professional trainer to develop a personalized fitness plan.
Start with a 15-minute walk at an easy pace.
Walk five days the first week.
Building a healthy habit is the goal, so consistency is important.
Spread out rest days, like making days 3 and 6 rest days.
Weekly goal – 60 to 75 minutes
Second Week
Add five minutes, so the walk time increases gradually.
Or, individuals can extend more on some days, followed by a rest day.
Weekly goal – 80 to 100 minutes
Third Week
Add five more minutes with each session, so the walk increases to 25 minutes.
Weekly goal – 100 to 125 minutes
Fourth Week
Add another five minutes to increase the walk to 30 minutes.
Weekly goal – 120 to 150 minutes
Individuals who find any week to be difficult are suggested to repeat that week instead of adding time until they are able to progress naturally. Once able to walk for 30 minutes at a time comfortably, individuals are ready for a variety of different walking exercise workouts to add intensity and endurance. A weekly walking plan can include:
Longer walks
Higher-intensity walks
Speed-building walks
Beginner Walking Speed
An individual’s objective should be brisk walking to achieve a moderate-intensity workout. This is the intensity that is associated with the most health benefits.
Mahmod, S. R., Narayanan, L. T., & Supriyanto, E. (2018). Effects of incremental cardiorespiratory exercise on the speech rate and the estimated exercise intensity using the counting talk test. Journal of physical therapy science, 30(7), 933–937. doi.org/10.1589/jpts.30.933
For individuals with arthritis, can incorporating acupuncture with other therapies help manage pain and other symptoms?
Acupuncture For Arthritis
Acupuncture has been around for thousands of years and is a form of traditional Chinese medicine that utilizes needles inserted into various parts of the body to relieve pain and inflammation. The practice is based on the concept of life energy that flows throughout the body along pathways called meridians. When the energy flow becomes disrupted, blocked, or injured, pain or illness can present. (Arthritis Foundation. N.D.) Further research is needed to determine how the acupuncture therapeutic mechanisms work and the overall effectiveness. However, there is emerging evidence suggesting that acupuncture can provide symptom relief for individuals with joint pain, especially those with osteoarthritis and rheumatoid arthritis. (Pei-Chi Chou, Heng-Yi Chu. 2018)
Benefits
The actual method that reduces the pain and inflammation is still unclear. Theories include that the needles suppress inflammatory responses, improve blood flow, and relax muscles. Although acupuncture cannot cure or reverse arthritis, it may be useful for managing pain and decreasing associated symptoms, especially in combination with other therapies. (Pei-Chi Chou, Heng-Yi Chu. 2018)
Rheumatoid Arthritis
A systematic review of 43 studies, including humans and animals with rheumatoid arthritis, demonstrated varied results. Several studies showed improvement in symptoms and decreased biological markers of rheumatoid arthritis following one to three sessions of acupuncture for four weeks or more. (Sharon L. Kolasinski et al., 2020) Beneficial outcomes following acupuncture treatment for rheumatoid arthritis include:
Reduced pain
Reduced joint stiffness
Improved physical function
The results of the human and animal studies suggested that acupuncture has the potential to down-regulate:
Levels of interleukins
Levels of tumor necrosis factor
Specific cell signaling proteins/cytokines involved in the inflammatory response, which become elevated in autoimmune conditions like rheumatoid arthritis. (Pei-Chi Chou, Heng-Yi Chu. 2018)
Most of the study subjects were also receiving other forms of treatment, especially medication. Therefore, it is difficult to conclude how beneficial acupuncture is alone or as a supplemental addition to other medical treatments. (Pei-Chi Chou, Heng-Yi Chu. 2018)
Osteoarthritis
Acupuncture for osteoarthritis of the hand, hip, and knee is recommended, according to the American College of Rheumatology and Arthritis Foundation, meaning that it may be worth trying, although more research is needed to confirm its effectiveness. However, since the risk is relatively minor, acupuncture is generally considered a safe alternative treatment option for managing the symptoms. (Sharon L. Kolasinski et al., 2020)
Chronic Pain
As clinical trials suggest that acupuncture may be effective in providing pain relief, it may be a recommended option for individuals suffering from chronic pain. A recent systematic review of 20,827 patients and 39 trials concluded that acupuncture is effective for the treatment of chronic musculoskeletal pain, headache, and osteoarthritis pain. (Andrew J. Vickers et al., 2018)
Triggering the release of endorphins/hormones that help reduce pain.
Safety
Acupuncture is considered a safe procedure by a licensed and certified professional.
To practice acupuncture in the United States, an acupuncturist needs a minimum of a master’s degree from a program accredited by the American Academy of Acupuncture and Oriental Medicine and a license in the state where they received their acupuncture treatment.
Doctors with an MD or DO degree licensed in the United States to practice medicine can also be licensed by the American Academy of Medical Acupuncture after additional training.
Risks
Risks associated with acupuncture are bleeding and bruising, especially for individuals who have a bleeding disorder like hemophilia or take a blood thinning medication. Individuals are recommended to talk to their healthcare provider to determine if acupuncture is a safe option.
Side Effects
Most individuals do not experience any side effects, although possible reactions can include: (Shifen Xu et al., 2013)
Soreness
Bruising
Scarring
Needle shock: a vasovagal response that presents as feeling faint, clammy hands, chills, and slight nausea.
Acupuncture Session
During the initial treatment, individuals will discuss their medical history and what joints and areas of their bodies are presenting with symptoms.
After a physical exam, the individual will lie on a treatment table.
Individuals may be face up or down depending on what areas of the body the acupuncturist needs to access.
It is recommended to wear loose clothing that can be rolled up or moved out of the way to access different areas easily.
Depending on what areas need to be accessed, individuals may be asked to change into a medical gown.
The acupuncturist will use alcohol swabs to disinfect the area before inserting the needles.
The needles are made of stainless steel and are extremely thin.
Individuals may feel a slight pinch in sensitive areas like the hands and feet, but needle insertion should be comfortable and well-tolerated without significant discomfort.
For electroacupuncture, the acupuncturist will pass a mild electric current through the needles, typically 40 to 80 volts.
The needles stay in place for 20 to 30 minutes.
After the treatment is finished, the acupuncturist will remove the needles and dispose of them.
Frequency
The frequency of acupuncture sessions will vary depending on the severity of the symptoms and whether the visits are approved and reimbursed by the health insurance company.
Cost and Insurance
Costs for acupuncture can vary from $75 to $200 per session.
The first session, which involves an initial assessment and evaluation, usually costs more than follow-up visits.
Whether the health insurance will cover some or all of the costs of acupuncture sessions depends on the individual insurance company and the condition being treated.
Medicare currently covers acupuncture services up to 12 visits within a 90-day period for chronic low back pain only.
Medicare will not cover acupuncture for other conditions. (Medicare.gov. N.D.)
Acupuncture is not a cure for arthritis, but it may be a useful tool to help manage pain and other symptoms. Make sure to consult a healthcare provider if acupuncture is safe to try based on medical history.
Chou, P. C., & Chu, H. Y. (2018). Clinical Efficacy of Acupuncture on Rheumatoid Arthritis and Associated Mechanisms: A Systemic Review. Evidence-based complementary and alternative medicine : eCAM, 2018, 8596918. doi.org/10.1155/2018/8596918
Kolasinski, S. L., Neogi, T., Hochberg, M. C., Oatis, C., Guyatt, G., Block, J., Callahan, L., Copenhaver, C., Dodge, C., Felson, D., Gellar, K., Harvey, W. F., Hawker, G., Herzig, E., Kwoh, C. K., Nelson, A. E., Samuels, J., Scanzello, C., White, D., Wise, B., … Reston, J. (2020). 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis care & research, 72(2), 149–162. doi.org/10.1002/acr.24131
Vickers, A. J., Vertosick, E. A., Lewith, G., MacPherson, H., Foster, N. E., Sherman, K. J., Irnich, D., Witt, C. M., Linde, K., & Acupuncture Trialists’ Collaboration (2018). Acupuncture for Chronic Pain: Update of an Individual Patient Data Meta-Analysis. The journal of pain, 19(5), 455–474. doi.org/10.1016/j.jpain.2017.11.005
Xu, S., Wang, L., Cooper, E., Zhang, M., Manheimer, E., Berman, B., Shen, X., & Lao, L. (2013). Adverse events of acupuncture: a systematic review of case reports. Evidence-based complementary and alternative medicine : eCAM, 2013, 581203. doi.org/10.1155/2013/581203
Individuals who participate in physical and sports activities could suffer an Achilles tendon tear. Can understanding the symptoms and risks help in treatment and return the individual back to their sports activity sooner?
Achilles Tendon
This is a common injury that occurs when the tendon attaching the calf muscle to the heel gets torn.
About the Tendon
The Achilles tendon is the largest tendon in the body.
In sports and physical activities, intense explosive movements like running, sprinting, quickly shifting positions, and jumping are exerted on the Achilles.
The injury often occurs without any contact or collision but rather the running, starting, stopping, and pulling actions placed on the feet.
Certain antibiotics and cortisone shots can increase the likelihood of Achilles tear injuries.
A specific antibiotic, fluoroquinolones, has been shown to increase the risk of Achilles tendon problems.
Cortisone shots are also associated with Achilles tears, which is why many healthcare providers don’t recommend cortisone for Achilles tendonitis. (Anne L. Stephenson et al., 2013)
Symptoms
A tendon tear or rupture causes sudden pain behind the ankle.
Individuals may hear a pop or a snap and often report the feeling as being kicked in the calf or heel.
Individuals have difficulty pointing their toes downward.
Individuals may have swelling and bruising around the tendon.
A healthcare provider will examine the ankle for continuity of the tendon.
Squeezing the calf muscle is supposed to cause the foot to point downwards, but in individuals with a tear, the foot will not move, resulting in positive results on the Thompson test.
A defect in the tendon can usually be felt after a tear.
X-rays may be used to rule out other conditions, including ankle fracture or ankle arthritis.
Fluoroquinolone antibiotics are commonly used for the treatment of respiratory infections, urinary tract infections, and bacterial infections. These antibiotics are associated with Achilles tendon rupture, but further research is needed to determine how they affect the Achilles tendon. Individuals taking these medications are advised to consider an alternative medication if Achilles tendon problems begin to develop. (Anne L. Stephenson et al., 2013)
Treatment
Depending on the severity of the injury, treatment can consist of non-surgical techniques or surgery.
The benefit of surgery is there is usually less immobilization.
Individuals can often return to sports activities sooner, and there is less chance of re-rupturing the tendon.
Thevendran, G., Sarraf, K. M., Patel, N. K., Sadri, A., & Rosenfeld, P. (2013). The ruptured Achilles tendon: a current overview from biology of rupture to treatment. Musculoskeletal surgery, 97(1), 9–20. doi.org/10.1007/s12306-013-0251-6
Stephenson, A. L., Wu, W., Cortes, D., & Rochon, P. A. (2013). Tendon Injury and Fluoroquinolone Use: A Systematic Review. Drug safety, 36(9), 709–721. doi.org/10.1007/s40264-013-0089-8
Pedowitz, D., & Kirwan, G. (2013). Achilles tendon ruptures. Current reviews in musculoskeletal medicine, 6(4), 285–293. doi.org/10.1007/s12178-013-9185-8
Yasui, Y., Tonogai, I., Rosenbaum, A. J., Shimozono, Y., Kawano, H., & Kennedy, J. G. (2017). The Risk of Achilles Tendon Rupture in the Patients with Achilles Tendinopathy: Healthcare Database Analysis in the United States. BioMed research international, 2017, 7021862. doi.org/10.1155/2017/7021862
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