Individuals who have gone through recent low back surgery, like a lumbar laminectomy and discectomy, could they benefit from physical therapy for full recovery? (Johns Hopkins Medicine. 2008)
Rehabilitation Exercise Program
A lumbar laminectomy and discectomy is a surgical procedure performed by an orthopedic or neurologic surgeon to help decrease pain, relieve associated symptoms and sensations, and improve flexibility and mobility. The procedure involves cutting away disc and bone material that presses against, irritates, and damages the spinal nerves. (Johns Hopkins Medicine. 2023)
Post-Surgery
The therapist will work with the individual to develop a rehabilitation exercise program. The objective of a rehabilitation exercise program is to help the individual:
Relax their muscles to prevent muscle tensing and becoming over-cautious
Regain full range of motion
Strengthen their spine
Prevent injuries
A guide on what to expect in physical therapy.
Postural Retraining
After back surgery, individuals have to work to maintain proper posture when sitting and standing. (Johns Hopkins Medicine. 2008)
Postural control is important to learn as it maintains the lower back in the optimal position to protect and expedite the healing of lumbar discs and muscles.
A physical therapist will teach the individual how to sit with proper posture and use lumbar support.
Attaining and maintaining proper posture is one of the most important things to help protect the back and prevent future back problems.
Walking helps to improve cardiovascular health and blood circulation throughout the body.
This helps to provide added oxygen and nutrients to the spinal muscles and tissues as they heal.
It is an upright exercise that puts the spine in a natural position, which helps to protect the discs.
The therapist will help set up a program tailored to the individual’s condition.
Prone Press Up
One of the exercises to protect the back and lumbar discs is prone press-ups. (Johns Hopkins Medicine. 2008) This exercise helps keep the spinal discs situated in the proper position. It also helps to improve the ability to bend back into lumbar extension.
To perform the exercise:
Lie facing down on a yoga/exercise mat and place both hands flat on the floor under the shoulders.
Keep the back and hips relaxed.
Use the arms to press the upper part of the body up while allowing the lower back to remain against the floor.
There should be a slight pressure in the lower back while pressing up.
Hold the press-up position for 2 seconds.
Slowly lower back down to the starting position.
Repeat for 10 to 15 repetitions.
Sciatic Nerve Gliding
Individuals who had leg pain coming from the back prior to surgery may have been diagnosed with sciatica or an irritation of the sciatic nerve. Post-surgery, individuals may notice their leg feels tight whenever straightening it out all the way. This could be a sign of an adhered/trapped sciatic nerve root, a common problem with sciatica.
After lumbar laminectomy and discectomy surgery, a physical therapist will prescribe targeted exercises called sciatic nerve glides to stretch and improve how the nerve moves. (Richard F. Ellis, Wayne A. Hing, Peter J. McNair. 2012)
Nerve glides can help free the stuck nerve root and allow for normal motion.
To perform the exercise:
Lie on the back and bend one knee up.
Grab underneath the knee with the hands.
Straighten the knee while supporting it with the hands.
Once the knee is fully straightened, flex and extend the ankle about 5 times.
Return to the starting position.
Repeat the sciatic nerve glide 10 times.
The exercise can be performed several times to help improve how the nerve moves and glides in the lower back and leg.
Supine Lumbar Flexion
After surgery, gentle back flexion exercises can help safely stretch the low-back muscles and gently stretch the scar tissue from the surgical incision. Supine lumbar flexion is one of the simplest exercises to improve lumbar flexion range of motion.
To perform the exercise:
Lie on the back with the knees bent.
Slowly lift the bent knees towards the chest and grasp the knees with both hands.
Gently pull the knees toward the chest.
Hold the position for 1 or 2 seconds.
Slowly lower the knees back to the starting position.
Perform for 10 repetitions.
Stop the exercise if experiencing an increase in pain in the lower back, buttocks, or legs.
Hip and Core Strengthening
Once cleared, individuals can progress to an abdominal and core strengthening program. This involves performing specific motions for the hips and legs while maintaining a pelvic neutral position. Advanced hip strengthening exercises help generate strength and stability in the muscles that surround the pelvic area and lower back. A physical therapist can help decide which exercises are recommended for the specific condition.
Return-to-Work and Physical Activities
Once individuals have gained an improved lumbar range of motion, hip, and core strength, their doctor and therapist may recommend working on specific activities to help them return to their previous level of work and recreation. Depending on job occupation, individuals may need to:
Work on proper lifting techniques.
Require an ergonomic evaluation if they spend time sitting at a desk or workstation.
Some surgeons may have restrictions on how much an individual can bend, lift, and twist from two to six weeks after surgery.
Low-back surgery can be difficult to rehab properly. Working with a healthcare provider and physical therapist, individuals can be sure to improve their range of motion, strength, and functional mobility to return to their previous level of function quickly and safely.
Ellis, R. F., Hing, W. A., & McNair, P. J. (2012). Comparison of longitudinal sciatic nerve movement with different mobilization exercises: an in vivo study utilizing ultrasound imaging. The Journal of orthopaedic and sports physical therapy, 42(8), 667–675. doi.org/10.2519/jospt.2012.3854
Individuals with plantar fasciitis may experience consistent flare-ups. Can knowing the causes help to find pain relief?
Plantar Fasciitis Flare-Up
Plantar fasciitis is a common cause of heel and foot pain. The plantar fascia is a band of tissue that runs along the bottom of the foot and becomes inflamed. Certain factors can cause plantar fasciitis flare-ups, including:
Increased levels of physical activity.
Not stretching regularly.
Wearing shoes without proper support.
Weight gain.
Causes
A plantar fasciitis flare-up is often triggered by physical activity. (MedlinePlus. U.S. National Library of Medicine. 2022) It can also be brought on by underlying conditions, like increased body weight, arthritis, or the shape of the foot. (Johns Hopkins Medicine. 2023) Despite the root cause, there are activities and experiences that can contribute to and/or worsen the condition.
New Exercise Routine
Being highly physically active can exacerbate plantar fasciitis symptoms.
High heels, boots, or shoes that raise the heel above the toes.
Worn-out shoes like exercise workout shoes.
Not Stretching Properly or At All
Tight calves can increase pressure on the plantar fascia.
Stretching the calves, Achilles tendon/heel, and the bottom of the feet is highly recommended to help treat and prevent the condition. (Johns Hopkins Medicine. 2023)
Not stretching thoroughly or skipping stretches can worsen symptoms.
Individuals with plantar fasciitis are recommended to stretch before and after physical activities, exercise, before going to bed, and after waking up.
Working Through the Pain
Individuals may try to continue physical activities during a flare-up.
This is not recommended as doing so can cause more pain and worsen the condition.
When pain presents, it’s recommended to:
Stop all activities that strain the feet
Stay off the feet for at least a week.
Tearing the Plantar Fascia
The plantar fascia rarely tear completely from repeated stress known as a plantar fascia rupture.
Pascoe, S. C., & Mazzola, T. J. (2016). Acute Medial Plantar Fascia Tear. The Journal of orthopaedic and sports physical therapy, 46(6), 495. doi.org/10.2519/jospt.2016.0409
It can be difficult for individuals and athletes to stay motivated, manage stress and prevent becoming overwhelmed. Can mental toughness and a positive attitude help increase potential and performance levels?
Mental Toughness
Athletes and fitness enthusiasts work on conditioning, skills training, and perfecting techniques. Physical training can take individuals far but another necessary part of maximizing athletic potential is building mental toughness and having the right attitude. Like anything, mental training takes time, effort, and regular adjustments to find ways to shift a losing or bad attitude into a positive one that can bring out the best.
Attitude Is Important
If negativity begins to set in like dealing with an injury, getting rid of self-limiting beliefs can be difficult, as well as generate optimism to rise up and succeed. For athletes or individuals who enjoy competitive sports, developing a positive mental attitude will help with:
Emotions that can affect cognitive functioning strategies.
Energy levels.
Other aspects of physical performance.
Mental Strategies
Mood Improvement
Individuals frustrated by a pessimistic perspective tend to dwell on problems or issues. To shift into a positive mood do something to lift your spirits, even if you don’t think it will help.
Listen to your favorite or uplifting music.
Watch an inspirational movie.
Read a sports psychology book.
Get together or call a teammate or friend that are cheerful and upbeat.
Play different games just for fun.
Take a break, go to the park, walk around, and meditate.
Get into hobbies.
Relax with a therapeutic massage.
Positive Self Talk
Continuing sports psychology research shows that practicing positive self-talk can improve athletic performance. (Nadja Walter, et al., 2019) Sports psychologists describe this through the idea that thoughts create beliefs, that drive actions.
Positive self-talk can take different forms.
For some reciting a specific phrase, sentence, or a single word can effectively manage thoughts, push out the negativity, and focus on taking care of business. Anything that inspires can include:
Focus
Remember the fundamentals!
You know what to do!
You can do it!
You got this!
Research shows that positive self-talk reduces anxiety and increases self-confidence, optimization, efficacy, and performance. (Nadja Walter, et al., 2019) However, self-talk needs to be practiced and part of a regular routine to be effective.
Visualization
Another strategy is using visualization exercises.
This could be using all the senses to imagine the venue where the tournament is taking place, the sound of the crowd, the smells, how the ground or court feels, and/or how the ball or specific sports object feels.
The wisdom is if you can think it, you can do it, once that is determined apply strategies to get there.
Sports Injury Rehabilitation
References
Walter, N., Nikoleizig, L., & Alfermann, D. (2019). Effects of Self-Talk Training on Competitive Anxiety, Self-Efficacy, Volitional Skills, and Performance: An Intervention Study with Junior Sub-Elite Athletes. Sports (Basel, Switzerland), 7(6), 148. doi.org/10.3390/sports7060148
Reiser, M., Büsch, D., & Munzert, J. (2011). Strength gains by motor imagery with different ratios of physical to mental practice. Frontiers in psychology, 2, 194. doi.org/10.3389/fpsyg.2011.00194
Individuals dealing with back pain problems could be suffering from a bulging disc. Could knowing the difference between slipped and herniated disc symptoms help with treatments and finding relief?
Bulging Disc Pain
Back pain can become debilitating if not treated properly. A bulging disc is a common cause of cervical, thoracic, and lower back pain symptoms. It happens when one of the fluid-filled cushions between the vertebrae begins to shift out of place. Instead of being aligned with the edges, the disc bulges over. This begins to generate pressure on the nerves causing pain and inflammation.
Bulging discs are often caused by age, but repetitive movements and/or lifting heavy objects can contribute to the condition.
Symptoms can resolve on their own, but individuals are recommended to consult with a physical therapist and/or chiropractor to make sure the disc healed properly, otherwise, it can lead to worsening and/or further injuries.
Bulging Disc vs. Herniated Disc
Bulging and herniated discs cause pain symptoms.
They both can be linked to injuries and degenerative disc disease but are not the same condition. (Penn Medicine. 2018)
This is because the lower back is subject to all kinds of pressure and movement with daily activities, increasing the chances of pain and injuries.
The next most common place is the neck/cervical spine where there are constant movements making it prone to injury and pain symptoms.
Causes
Bulging discs are most often caused by body aging and normal wear and tear. As time goes on the intervertebral discs naturally degenerate, known as degenerative disc disease. This can cause the discs to pull downward, causing them to bulge from their placement. (Penn Medicine. 2018) Factors that can cause or worsen the condition include:
Practicing unhealthy postures.
Repetitive motions.
Lifting heavy objects
Spinal injuries.
Medical history of spinal or disc disease in the family.
Individuals with back pain that interferes with daily functions or has lasted longer than six weeks, should see a healthcare provider for a diagnosis. They will order a magnetic resonance imaging scan/MRI, which can show where a disc is protruding. (American Academy of Neurological Surgeons. 2023)
Rest
For bulging disc pain, resting the back is necessary. However,
For individuals about to engage in physical activity or exercise, how does warming up the body help prepare for the work ahead?
Central Nervous System Activation
A proper warm-up before physical activity or working out prepares the mind and body to reduce risks of injury, mentally and physically transition to physical activity work, and enhance performance. A well-designed warm-up also primes the central nervous system/CNS for activity. The central nervous system transmits messages to the muscles to prepare them for action. Central nervous system activation increases motor neuron recruitment and engages the sympathetic nervous system so the body can better handle the physical stressors. The process may seem complex, but priming the nervous system is as simple as warming up with light aerobic activity before getting into more explosive movements.
CNS
The CNS consists of the brain and spinal cord. This central communication system uses another part of the nervous system known as the peripheral nervous system or PNS to transmit and receive messages throughout the body. The PNS is connected to the entire body and the brain and spinal cord (CNS).
Nerves run throughout the body, receiving signals from the CNS to the muscles, fibers, and organs, transmitting various information back to the brain. (Berkeley University. N.D.)
There are two types of systems within the peripheral nervous system – somatic and autonomic.
Somatic nervous system actions are those controlled by the person through voluntary actions like choosing to pick something up.
Properly preparing the body for an intense strength training session or other physical activity needs the correct messages to be sent through the autonomic nervous system.
Parasympathetic and Sympathetic States
The autonomic nervous system consists of two subcategories, which are parasympathetic and sympathetic.
The sympathetic nervous system helps the body get ready to face stress which includes physical stress. (R. Bankenahally, H. Krovvidi. 2016)
The fight, flight, or freeze response describes the sympathetic nervous system’s aspect.
The parasympathetic nervous system is responsible for relaxation and de-stressing.
Individuals are recommended to perform a few calming movements and actions after a workout to return the body to a parasympathetic state. This can be:
Activating the CNS can increase performance and prevent injuries. The process wakes up and alerts the body for the activity. Individuals are recommended before beginning a training session, to communicate to the body about the physical stress it is about to endure and to prepare for the work ahead. This is a concept known as post-activation potentiation/PAP. (Anthony J Blazevich, Nicolas Babault. 2019) PAP helps increase force and power production, which enhances physical performance.
Whenever an individual trains, the brain adapts and learns what the body is doing and the purpose of the training.
Muscle memory describes this interaction.
Individuals who have started up a new strength training routine or after an extended break report feeling awkward for the first few sessions, or even weeks, depending on their experience. (David C Hughes, Stian Ellefsen, Keith Baar, 2018)
However, after a few sessions, the body is more adept at performing the movements and ready to increase resistance, repetitions, or both.
This has to do with the neural drive and muscle memory than it has to do with true potential physical abilities. (Simon Walker. 2021)
The first step is a general warm-up that should use large muscle groups and be of low intensity so as not to exhaust the body before beginning the actual training. General warm-up benefits central nervous system activation and the entire body include: (Pedro P. Neves, et al., 2021) (D C. Andrade, et al., 2015)
Increases blood circulation.
Assists the release of oxygen from hemoglobin and myoglobin.
Warms the muscles, so they contract more effectively.
Increases nerve impulse speed.
Increases nutrient delivery.
Lowers joints’ resistance through increased synovial fluid/joint lubrication.
Increases joint range of motion.
Improves joint resiliency.
Removes metabolic waste quicker.
Reduces risk of injury.
A general warm-up can be simple as any aerobic activity will work. This can include:
Performing bodyweight movements – light jumping jacks or jogging in place.
Treadmill
Rowing machine
Stair climber
Elliptical trainer
It is recommended to use the rating perceived exertion scale/RPE to determine the general warm-up effort. An exertion rating of between 5 to 6 is equivalent to moderate walking or a slow jog. Individuals should be able to speak clearly without taking a pause.
Try this strategy before the next workout to see increased performance and reduced injury risks.
Blazevich, A. J., & Babault, N. (2019). Post-activation Potentiation Versus Post-activation Performance Enhancement in Humans: Historical Perspective, Underlying Mechanisms, and Current Issues. Frontiers in physiology, 10, 1359. doi.org/10.3389/fphys.2019.01359
Hughes, D. C., Ellefsen, S., & Baar, K. (2018). Adaptations to Endurance and Strength Training. Cold Spring Harbor perspectives in medicine, 8(6), a029769. doi.org/10.1101/cshperspect.a029769
Walker S. (2021). Evidence of resistance training-induced neural adaptation in older adults. Experimental gerontology, 151, 111408. doi.org/10.1016/j.exger.2021.111408
Andrade, D. C., Henriquez-Olguín, C., Beltrán, A. R., Ramírez, M. A., Labarca, C., Cornejo, M., Álvarez, C., & Ramírez-Campillo, R. (2015). Effects of general, specific, and combined warm-up on explosive muscular performance. Biology of sport, 32(2), 123–128. doi.org/10.5604/20831862.1140426
While a healthy, sustainable lifestyle for one individual may not be the best option for another, can experts point out signs of a healthy life?
Healthy Life
Being or living a healthy life is a phrase that can be confusing. Researchers examine some major areas of concern with constant imagery like social media’s role in shaping what behaviors people consider important to reach a physical fitness/health goal. These behaviors prioritize physical appearance and are often linked with negative psychological effects and worsening physical health outcomes. (Binder A, et al., 2021) Studies routinely show that someone’s body shape is not a good indicator of how healthy they really are. (Uhlmann LR, et al., 2018)
Living a healthy life is a multi-faceted endeavor that requires maintaining a balance. New research has shown that “adhering to both quality diet and sufficient physical activity is important for optimally reducing the risk of mortality from all causes, CVD and PDAR cancers.” (Ding D, et al., 2022) Individuals do not need to make extreme changes to these areas of their lifestyle. Studies show that making small adjustments, little by little, prepares the individual to develop long-term sustainable habits. (Adhikari P, Gollub E. 2021)
Nutritional Health
Too much salt, sugar, and saturated fat increases the risk of diseases like diabetes, heart disease, and stroke. (National Institutes of Health, 2017) It can be easy to overlook balanced nutrition and it is not all about what should be restricted and avoided. It is about making sure the body gets the proper amount of nutrient-rich foods essential to overall health. Examples include:
Deficiency of nutrients like magnesium, calcium, and vitamins A, C, D, E, and K are with sleep problems. (Ikonte CJ, et al., 2019)
Not acquiring enough protein can lead to slowed metabolism and weight gain. (Pezeshki A, et al., 2016)
Healthy fats are essential to protect against heart disease and can help maintain high energy levels. (Gammone MA, et al., 2018)
Research has found that depression and nutrition are linked.
Incorporating a diet like the Mediterranean has been associated with a reduced risk of depression symptoms. (Oddo VM, et al., 2022)
Physical Activity
Regular physical activity helps with weight management, reduces the risk of chronic diseases, maintains healthy bones and joints, and contributes to positive mental health and mood.
The Centers for Disease Control and Prevention estimates around 60 percent of the population does not get enough daily physical activity. (Surgeon General Report, CDC. 1999)
According to the research, individuals don’t exercise for consistent reasons that include: not having enough time, no access to resources, and being too tired to work out. (Yen Sin Koh, et al., 2022)
Increasing the heart rate for only 12 minutes a day can protect the cardiovascular system. (Matthew Nayor, et al., 2020)
Signs
A few signs that an individual is healthy.
Stable Energy Levels
Having energy throughout the day is a sign you’re getting high-quality sleep.
Energy levels can also offer clues on nutritional intake, particularly of fats, carbohydrates, and proteins. (Yohannes Adama Melaku, et al., 2019)
The right combination of macronutrients can be different for everyone, especially depending on factors like age, job, medical history, and physical activity.
Paying attention to energy levels at different times of the day can help guide fitness and health goals.
One sign that the mind and body are dealing with stress well is the ability to set boundaries.
Setting boundaries shows recognition and priority for their needs.
This could be boundaries for respect of thoughts and ideas, physical space, emotional needs, the time spent on certain things, sex life, and material possessions.
Fresh Breath
The mouth can show what is going on as far as the health of the body.
Poor oral hygiene can lead to a buildup of bacteria that can spread throughout the respiratory and digestive tracts.
Chronic bad breath is a common sign of poor oral health.
Studies suggest that increased bacteria entering the body can lower immune system response and increase the development of general health problems. (NIH. 2018)
Time to Change
Signs that the mind and body are not healthy include:
Always sick or feel as if you’re coming down with something.
The stomach is constantly feeling like it is bloated, backed up, or dealing with acid reflux or indigestion.
The human body, organs, and tissues are complex structures, and the signals they transmit about underlying issues can be subtle which individuals tend to not notice until the little problems become major ones. It’s important to look at life habits and be honest about changes that may need to be implemented to improve health, lessen the risk of chronic health conditions, and improve quality of life.
Multidisciplinary Evaluations and Treatment
References
Binder, A., Noetzel, S., Spielvogel, I., & Matthes, J. (2021). “Context, Please?” The Effects of Appearance- and Health-Frames and Media Context on Body-Related Outcomes. Frontiers in public health, 9, 637354. doi.org/10.3389/fpubh.2021.637354
Uhlmann, L. R., Donovan, C. L., Zimmer-Gembeck, M. J., Bell, H. S., & Ramme, R. A. (2018). The fit beauty ideal: A healthy alternative to thinness or a wolf in sheep’s clothing? Body image, 25, 23–30. doi.org/10.1016/j.bodyim.2018.01.005
Ding, D., Van Buskirk, J., Nguyen, B., Stamatakis, E., Elbarbary, M., Veronese, N., Clare, P. J., Lee, I. M., Ekelund, U., & Fontana, L. (2022). Physical activity, diet quality and all-cause cardiovascular disease and cancer mortality: a prospective study of 346 627 UK Biobank participants. British Journal of sports medicine, bj sports-2021-105195. Advanced online publication. doi.org/10.1136/bjsports-2021-105195
Adhikari, P., & Gollub, E. (2021). Evaluation of the Small Changes, Healthy Habits Pilot Program: Its Influence on Healthy Eating and Physical Activity Behaviors of Adults in Louisiana. European journal of investigation in health, psychology, and education, 11(1), 251–262. doi.org/10.3390/ejihpe11010019
How dietary factors influence disease risk. National Institutes of Health (NIH)
Ikonte, C. J., Mun, J. G., Reider, C. A., Grant, R. W., & Mitmesser, S. H. (2019). Micronutrient Inadequacy in Short Sleep: Analysis of the NHANES 2005-2016. Nutrients, 11(10), 2335. doi.org/10.3390/nu11102335
Pezeshki, A., Zapata, R. C., Singh, A., Yee, N. J., & Chelikani, P. K. (2016). Low protein diets produce divergent effects on energy balance. Scientific reports, 6, 25145. doi.org/10.1038/srep25145
Gammone, M. A., Riccioni, G., Parrinello, G., & D’Orazio, N. (2018). Omega-3 Polyunsaturated Fatty Acids: Benefits and Endpoints in Sport. Nutrients, 11(1), 46. doi.org/10.3390/nu11010046
Oddo, V. M., Welke, L., McLeod, A., Pezley, L., Xia, Y., Maki, P., Koenig, M. D., Kominiarek, M. A., Langenecker, S., & Tussing-Humphreys, L. (2022). Adherence to a Mediterranean Diet Is Associated with Lower Depressive Symptoms among U.S. Adults. Nutrients, 14(2), 278. doi.org/10.3390/nu14020278
Adults, Surgeon General Report, CDC.
Koh, Y. S., Asharani, P. V., Devi, F., Roystonn, K., Wang, P., Vaingankar, J. A., Abdin, E., Sum, C. F., Lee, E. S., Müller-Riemenschneider, F., Chong, S. A., & Subramaniam, M. (2022). A cross-sectional study on the perceived barriers to physical activity and their associations with domain-specific physical activity and sedentary behavior. BMC public health, 22(1), 1051. doi.org/10.1186/s12889-022-13431-2
Saint-Maurice, P. F., Graubard, B. I., Troiano, R. P., Berrigan, D., Galuska, D. A., Fulton, J. E., & Matthews, C. E. (2022). Estimated Number of Deaths Prevented Through Increased Physical Activity Among US Adults. JAMA internal medicine, 182(3), 349–352. doi.org/10.1001/jamainternmed.2021.7755
Nayor, M., Shah, R. V., Miller, P. E., Blodgett, J. B., Tanguay, M., Pico, A. R., Murthy, V. L., Malhotra, R., Houstis, N. E., Deik, A., Pierce, K. A., Bullock, K., Dailey, L., Velagaleti, R. S., Moore, S. A., Ho, J. E., Baggish, A. L., Clish, C. B., Larson, M. G., Vasan, R. S., … Lewis, G. D. (2020). Metabolic Architecture of Acute Exercise Response in Middle-Aged Adults in the Community. Circulation, 142(20), 1905–1924. doi.org/10.1161/CIRCULATIONAHA.120.050281
Melaku, Y. A., Reynolds, A. C., Gill, T. K., Appleton, S., & Adams, R. (2019). Association between Macronutrient Intake and Excessive Daytime Sleepiness: An Iso-Caloric Substitution Analysis from the North West Adelaide Health Study. Nutrients, 11(10), 2374. doi.org/10.3390/nu11102374
Jamieson, J. P., Black, A. E., Pelaia, L. E., Gravelding, H., Gordils, J., & Reis, H. T. (2022). Reappraising stress arousal improves affective, neuroendocrine, and academic performance outcomes in community college classrooms. Journal of experimental psychology. General, 151(1), 197–212. doi.org/10.1037/xge0000893
Vernia, F., Di Ruscio, M., Ciccone, A., Viscido, A., Frieri, G., Stefanelli, G., & Latella, G. (2021). Sleep disorders related to nutrition and digestive diseases: a neglected clinical condition. International journal of medical sciences, 18(3), 593–603. doi.org/10.7150/ijms.45512
Gender transitioning is the process of affirming and expressing an individual’s internal sense of gender rather than the one assigned at birth. How can learning the aspects of gender and gender transitioning help support the LGBTQ+ community?
Gender Transitioning
Gender transitioning or gender affirmation is a process through which transgender and gender-nonconforming individuals align their internal gender identity with their external gender expression. It can be described as a binary – male or female – but can also be non-binary, meaning an individual is neither exclusively male nor female.
The process can involve aesthetic appearances, changes in social roles, legal recognitions, and/or physical aspects of the body.
Social affirmation – dressing differently or coming out to friends and family.
Legal affirmation – changing name and gender on legal documents.
Medical affirmation – using hormones and/or surgery to change certain physical aspects of their body.
Transgender individuals can pursue some or all of these.
Barriers
Gender transitioning can be obstructed by various barriers that can include:
Cost
Lack of insurance
Lack of family, friends, or partner support.
Discrimination
Stigma
Addressing All Aspects
The process does not have a specific timeline and is not always linear.
Many transgender and gender-nonconforming individuals prefer gender affirmation to gender transitioning because transitioning is often taken to mean the process of medically transforming the body.
An individual does not have to undergo medical treatment to affirm their identity, and some transgender people avoid hormones or gender-affirming surgery.
Transitioning is a holistic process that addresses all aspects of who a person is inwardly and outwardly.
Certain aspects of transitioning may be more important than others, like changing one’s name and gender on their birth certificate.
Reevaluation and revision of gender identity can be continual rather than a step-by-step, one-way process.
Exploring Gender Identity
Gender transitioning often starts in response to gender dysphoria which describes the constant sense of uneasiness that occurs when the gender an individual was assigned at birth does not match how they experience or express their gender internally.
Some individuals have experienced symptoms of gender dysphoria as early as 3 or 4 years of age. (Selin Gülgöz, et al., 2019)
Gender dysphoria can be largely informed by the culture that surrounds the individual, specifically in cultures where strict codes determine what is masculine/male and feminine/female.
Unease Expressed in Different Ways
Dislike of one’s sexual anatomy.
A preference for clothes typically worn by the other gender.
Not wanting to wear clothes typically worn by their own gender.
A preference for cross-gender roles in fantasy play.
A strong preference for engaging in activities that are typically done by the other gender.
Dysphoria
Gender dysphoria can fully emerge during puberty when awareness about how an individual’s body defines them creates internal distress.
Feelings may be amplified when an individual is described as a tomboy, or a sissy, or is criticized and attacked for acting like a girl or acting like a boy.
During puberty, the physical changes can cause long-standing feelings of not fitting in and may evolve into feelings of not fitting in their own body.
This is when individuals can undergo a process referred to as internal transitioning and begin to change how they see themselves.
Gender transitioning/affirmation becomes the next step. Transitioning is not about changing or recreating oneself but about expressing their authentic self and asserting who they are socially, legally, and/or medically.
Social
Social transitioning involves how a person publicly expresses their gender. The transition can include:
Changing pronouns.
Using chosen name.
Coming out to friends, family, coworkers, etc.
Wearing new clothes.
Cutting or styling hair differently.
Changing mannerisms like moving, sitting, etc.
Changing voice.
Binding – strapping the chest to hide breasts.
Wearing breast and hip prosthetics to accentuate feminine curvature.
Packing – wearing a penile prosthesis to create a penile bulge.
Tucking – tucking the penis to conceal a bulge.
Playing certain sports
Pursuing different lines of work.
Participating in activities that might typically be seen as male or female.
Legal
Legal transitioning involves changing legal documents to reflect the individual’s chosen name, gender, and pronouns. This includes governmental and non-government documents that can include:
Birth certificates
Social Security ID
Driver’s license
Passport
Bank records
Medical and dental records
Voter registration
School ID
Provisions allowing for changes can vary by state.
Some states only allow changes if bottom surgery – genital reconstruction is performed.
Others will allow the changes without any form of gender-affirming surgery.
Medical transitioning typically involves hormone therapy to develop some of the male or female sex characteristics. It can also involve surgery to change certain physical aspects combined with hormone therapy.
Hormone therapy assists individuals to physically look more like the gender they identify as.
They can be used on their own and can also be used before gender-affirming surgery.
Hormone therapy takes two forms:
Transgender Men
Testosterone is taken to help deepen the voice, increase muscle mass, promote body and facial hair, and enlarge the clitoris. (M S Irwig, K Childs, A B Hancock. 2017)
Transgender Women
Estrogen is taken as well as testosterone blockers to redistribute body fat, increase breast size, reduce male-pattern baldness, and reduce testicle size. (Vin Tangpricha 1, Martin den Heijer. 2017)
Surgery
Gender affirmation surgery aligns an individual’s physical appearance to their gender identity. Many hospitals provide gender-affirming surgery through a transgender medicine department. Medical procedures include:
Facial surgery – Facial feminization surgery.
Breast augmentation – Increases breast size with implants.
Chest masculinization – Removes contours of breast tissues.
Tracheal shaving – Reduces the Adam’s apple.
Phalloplasty – Construction of a penis.
Orchiectomy – Removal of the testicles.
Scrotoplasty – Construction of a scrotum.
Vaginoplasty – Construction of a vaginal canal.
Vulvoplasty – Construction of the outer female genitalia.
Roadblocks
Transgender individuals are protected from public and private insurance discrimination under federal and state laws, including Medicare and Medicaid. (National Center for Transgender Equality. 2021)
Medicaid programs in nine states do not cover gender-affirming medical treatments, and only Illinois and Maine offer comprehensive standard care recommended by the World Professional Association for Transgender Health/WPATH. (Kaiser Family Foundation. 2022)
Medicare also has no consistent policy regarding the approval of gender-affirming surgery.
Others report family or partner disapproval as the main reason why they discontinue gender affirmation. (Jack L. Turban, et al., 2021)
If you know someone who is transgender or is considering transitioning, learning about gender and gender transitioning and how to be supportive is a great way to be an ally.
Enhancing Your Lifestyle
References
Gülgöz, S., Glazier, J. J., Enright, E. A., Alonso, D. J., Durwood, L. J., Fast, A. A., Lowe, R., Ji, C., Heer, J., Martin, C. L., & Olson, K. R. (2019). Similarity in transgender and cisgender children’s gender development. Proceedings of the National Academy of Sciences of the United States of America, 116(49), 24480–24485. doi.org/10.1073/pnas.1909367116
Irwig, M. S., Childs, K., & Hancock, A. B. (2017). Effects of testosterone on the transgender male voice. Andrology, 5(1), 107–112. doi.org/10.1111/andr.12278
Tangpricha, V., & den Heijer, M. (2017). Estrogen and anti-androgen therapy for transgender women. The Lancet. Diabetes & endocrinology, 5(4), 291–300. doi.org/10.1016/S2213-8587(16)30319-9
National Center for Transgender Equality. Know Your Rights in Health Care.
Kaiser Family Foundation. Update on Medicaid coverage of gender-affirming health services.
Center of Medicare and Medicaid Services. Gender dysphoria and gender reassignment surgery.
Transgender Legal Defense and Education Fund. Health insurance medical policies.
National Center for Transgender Equality and National Gay and Lesbian Task Force. Injustice at Every Turn: A Report of the National Transgender Discrimination Survey.
Turban, J. L., Loo, S. S., Almazan, A. N., & Keuroghlian, A. S. (2021). Factors Leading to “Detransition” Among Transgender and Gender Diverse People in the United States: A Mixed-Methods Analysis. LGBT health, 8(4), 273–280. doi.org/10.1089/lgbt.2020.0437
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