For individuals training for long distance walking marathons and/or events, can focusing on building a walking foundation, then increasing mileage progressively help condition the body for overall readiness?
Long Distance Walking Training
Training helps individuals be comfortable and safe for long-distance walking and events.
Training should focus on building a walking pace and increasing mileage gradually.
Individuals need endurance, not speed, and want to build mental stamina for walking for hours at a steady pace.
To reduce the risk of training injuries, increasing the total mileage per week/the distance of the longest walk per week to no more than 10% is recommended.
Individuals should also train to wear the gear worn during long-distance walks.
Training could last a few months.
Being methodical allows the body time to repair and build new muscle, blood supplies, and endurance.
Example Training Plans
Following a marathon training plan for mileage building and determining the proper hydration, nutrition, and gear for multi-day walks and treks is recommended. However, individuals must build back-to-back long days into their training sessions to assess any issues or problems resulting from walking long distances on back-to-back days.
Example Walking Training Plans
Multi-Day Walks/Treks Training Schedule
13 miles per day/21 kilometers
Use this plan for marathons or other multi-day walks with hills and natural surfaces requiring a backpack.
Training to Walk a Marathon
26.2 miles/42 kilometers
This will condition the body to go longer distances.
When training for distances of 31 to 100 miles/50 to 161 kilometers, the longest distance to train should not need to exceed 20 to 25 miles,
These should be performed at least twice two months before the marathon or event.
Taper down the month before the event to a 12.4-mile/20-kilometer distance.
Gear
All clothing, shoes, sunscreen, backpacks, etc., must be tested on the longer training days before the event.
Given the climate and terrain, plan for what will be needed and removed.
Try things out, as individuals don’t want to be surprised with something unfamiliar at the event. From head to toe, test the gear, including:
Shoes/boots, socks, underwear, bra, shirt, pants, hat, jacket, and rain gear.
Choose shoes or walking boots and wear them on long training days to break them in and ensure they perform.
Backpacks should be tested on longer training days to ensure they can be carried comfortably over long distances and have the necessary capacity.
Choose wicking fabrics that allow the skin to breathe and cool, especially under layers. (Justin De Sousa et al., 2014)
Individuals will want to wear gear similar to marathon walkers if the walk will mostly be on pavement or asphalt.
Individuals can modify their gear if the route is off-road or during different seasons. Find out what other long-distance walkers have worn on the same route or event.
Individuals can connect with fellow walkers via social media or find answers to frequently asked questions on the event’s or destination’s website.
Individuals can also contact the event director via the website or social media.
Nutrition
Proper sports nutrition will prepare the body for endurance activity.
For example, individuals are recommended to follow a diet comprising 70% carbohydrates, 20% protein, and 10% fat.
Avoid high-protein diets, as they can cause hydration problems and strain your kidneys under endurance walking conditions. (Marta Cuenca-Sánchez et al., 2015)
Train with the water, sports drinks, food, and snacks taken to the event, and do not deviate from them during the event.
Water is needed for 20 kilometers and under events, but an electrolyte replacement sports drink may be better for longer walks.
Diluting or leaving out some sugar can be easier on the stomach.
Have snacks pre-packaged and labeled for the times to be eaten.
Individuals need to eat fat and protein for ultramarathon distances – this can come from trail mix, peanut butter sandwiches, and chocolate bars with nuts.
Carbohydrates can be provided by sports gels or energy bars.
It is recommended to avoid products made for short distances and power sports as they can cause digestive problems when walking longer distances.
Planning a Walk
Planning begins by setting goals. Considerations include:
Time of year
Distance
Transportation to the event
Event pace requirements
Altitude and hill profile
Climate
Individuals are recommended to:
Prepare by researching routes and trails.
Study the course maps to know what services are provided along the way and what individuals must bring.
Walk a long distance without a supporting event.
Contact individuals who have walked the course.
Know the terrain and areas of total sun, hills, pavement, natural trails, and shade.
If possible, drive the course to become familiar with it.
Individuals may be able to find apps designed for their route.
Taking Breaks and Resting
Regular breaks should be short – using the bathroom, eating a snack, rehydrating, tying shoes, or bandaging blisters.
The body can stiffen up quickly during breaks and take several minutes to regain walking pace after a long break.
Recommendations could be taking a walking break instead, which means continuing to walk but at a very slow pace.
Foot Care
Individuals will have found what works for them concerning shoes, boots, socks, etc., on the long training days to prevent blisters and injuries. It is recommended to try different strategies, which include:
Sports tape
Blister block pads
Sprays
Lubricants
Wicking and/or double-layered socks
Moleskin
Stop at the first sign of irritation along the walk and doctor the foot with tape, blister bandages, or whatever method works best.
The body was built for walking. Planning and training properly before taking a long-distance or multi-day walk will ensure a safe and enjoyable marathon.
Move Better, Live Better
References
De Sousa, J., Cheatham, C., & Wittbrodt, M. (2014). The effects of a moisture-wicking fabric shirt on the physiological and perceptual responses during acute exercise in the heat. Applied ergonomics, 45(6), 1447–1453. https://doi.org/10.1016/j.apergo.2014.04.006
Cuenca-Sánchez, M., Navas-Carrillo, D., & Orenes-Piñero, E. (2015). Controversies surrounding high-protein diet intake: satiating effect and kidney and bone health. Advances in nutrition (Bethesda, Md.), 6(3), 260–266. https://doi.org/10.3945/an.114.007716
For individuals dealing with knee pain symptoms from injury and/or arthritis, can incorporating an acupuncture and/or electroacupuncture treatment plan help in pain relief and management?
Acupuncture For Knee Pain
Acupuncture involves inserting very thin needles into the skin at specific acupoints on the body. It is based on the premise that the needles restore the flow of the body’s energy to activate and promote healing, relieve pain, and help the body relax.
Acupuncture can help address various health conditions, including knee pain caused by arthritis or injury.
Depending on the type and severity of pain, treatments can help reduce the pain for days or weeks.
Acupuncture is often used as a complementary therapy – treatment in addition to other treatment or therapy strategies like massage and chiropractic.
Acupuncture Benefits
Knee pain caused by osteoarthritis or injury can reduce flexibility, mobility, and quality of life. Acupuncture can help provide relief.
When the acupuncture needles are placed on the body, a signal is sent along the spinal cord to the brain, which triggers a release of endorphins/pain hormones. Medical researchers believe this helps reduce pain. (Qian-Qian Li et al., 2013) Acupuncture also helps decrease the production of cortisol, a hormone that helps control inflammation. (Qian-Qian Li et al., 2013) With reduced pain sensations and less inflammation after acupuncture treatments, knee function and mobility can be improved.
Various factors play a role in the pain relief experienced from acupuncture. Some evidence suggests that an individual’s expectations may impact the results of acupuncture treatment. (Stephanie L. Prady et al., 2015)
Researchers are currently assessing whether the expectation that acupuncture is beneficial contributes to a better outcome after treatment. (Zuoqin Yang et al., 2021)
In 2019, acupuncture was recommended in treating knee osteoarthritis in the American College of Rheumatology/Arthritis Foundation guidelines for hand, hip, and knee osteoarthritis pain management. (Sharon L. Kolasinski et al., 2020)
Research
Different clinical studies support acupuncture’s ability to help in knee pain relief and management.
One study found that acupuncture helps manage various conditions that cause chronic pain. (Andrew J. Vickers et al., 2012)
A scientific review analyzed previous studies on pain management interventions after knee surgery and found supporting evidence that the treatments delayed and reduced the use of medications for pain relief post-surgery. (Dario Tedesco et al., 2017)
Osteoarthritis
A systematic review analyzed randomized control studies to determine whether or not acupuncture reduced pain and improved joint function in individuals with chronic osteoarthritis knee pain. (Xianfeng Lin et al., 2016)
Individuals received six to twenty-three weekly acupuncture sessions for three to 36 weeks.
The analysis determined that acupuncture can improve short and long-term physical function and mobility and provide up to 13 weeks of pain relief in individuals with chronic knee pain caused by osteoarthritis.
Rheumatoid Arthritis
Rheumatoid arthritis is a chronic disease that affects joints, including the knee joint, causing pain and stiffness.
Acupuncture is beneficial in treating rheumatoid arthritis/RA.
A review found that acupuncture alone and in combination with other treatment modalities benefits individuals with RA. (Pei-Chi, Chou Heng-Yi Chu 2018)
Acupuncture is believed to have anti-inflammatory and antioxidant effects to help regulate immune system function.
Chronic Knee Pain
Various conditions and injuries can cause chronic knee pain, making mobility difficult.
Individuals with joint pain often turn to complementary therapies for pain relief management, with acupuncture being one of the popular modalities. (Michael Frass et al., 2012)
Working with a licensed, professional acupuncture practitioner can reduce the risk of unwanted side effects and complications.
Types
Other acupuncture options that may be offered include:
Electroacupuncture
A modified form of acupuncture where a mild electrical current passes through the needles, providing additional stimulation to the acupoints.
In one research study, individuals with knee osteoarthritis reported significant improvements in their pain, stiffness, and physical function after electroacupuncture treatment. (Ziyong Ju et al., 2015)
Auricular
Auricular or ear acupuncture works on acupoints in the ear corresponding to the body’s different parts.
A research review analyzed several studies on auricular acupuncture for pain relief and found that it can provide relief within 48 hours of pain onset. (M. Murakami et al., 2017)
Battlefield Acupuncture
The military and veteran healthcare facilities use a unique form of auricular acupuncture for pain management.
Studies show that it is effective at providing immediate pain relief, but more research is necessary to determine long-term pain relief effectiveness. (Anna Denee Montgomery, Ronovan Ottenbacher 2020)
Before trying acupuncture, consult a healthcare professional for guidance, as it may be integrated with other therapies and lifestyle adjustments.
Overcoming an ACL Injury
References
Li, Q. Q., Shi, G. X., Xu, Q., Wang, J., Liu, C. Z., & Wang, L. P. (2013). Acupuncture effect and central autonomic regulation. Evidence-based complementary and alternative medicine : eCAM, 2013, 267959. https://doi.org/10.1155/2013/267959
Prady, S. L., Burch, J., Vanderbloemen, L., Crouch, S., & MacPherson, H. (2015). Measuring expectations of benefit from treatment in acupuncture trials: a systematic review. Complementary therapies in medicine, 23(2), 185–199. https://doi.org/10.1016/j.ctim.2015.01.007
Yang, Z., Li, Y., Zou, Z., Zhao, Y., Zhang, W., Jiang, H., Hou, Y., Li, Y., & Zheng, Q. (2021). Does patient’s expectation benefit acupuncture treatment?: A protocol for systematic review and meta-analysis. Medicine, 100(1), e24178. https://doi.org/10.1097/MD.0000000000024178
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. https://doi.org/10.1002/acr.24131
Vickers, A. J., Cronin, A. M., Maschino, A. C., Lewith, G., MacPherson, H., Foster, N. E., Sherman, K. J., Witt, C. M., Linde, K., & Acupuncture Trialists’ Collaboration (2012). Acupuncture for chronic pain: individual patient data meta-analysis. Archives of internal medicine, 172(19), 1444–1453. https://doi.org/10.1001/archinternmed.2012.3654
Tedesco, D., Gori, D., Desai, K. R., Asch, S., Carroll, I. R., Curtin, C., McDonald, K. M., Fantini, M. P., & Hernandez-Boussard, T. (2017). Drug-Free Interventions to Reduce Pain or Opioid Consumption After Total Knee Arthroplasty: A Systematic Review and Meta-analysis. JAMA surgery, 152(10), e172872. https://doi.org/10.1001/jamasurg.2017.2872
Lin, X., Huang, K., Zhu, G., Huang, Z., Qin, A., & Fan, S. (2016). The Effects of Acupuncture on Chronic Knee Pain Due to Osteoarthritis: A Meta-Analysis. The Journal of bone and joint surgery. American volume, 98(18), 1578–1585. https://doi.org/10.2106/JBJS.15.00620
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. https://doi.org/10.1155/2018/8596918
Frass, M., Strassl, R. P., Friehs, H., Müllner, M., Kundi, M., & Kaye, A. D. (2012). Use and acceptance of complementary and alternative medicine among the general population and medical personnel: a systematic review. Ochsner journal, 12(1), 45–56.
Hinman, R. S., McCrory, P., Pirotta, M., Relf, I., Forbes, A., Crossley, K. M., Williamson, E., Kyriakides, M., Novy, K., Metcalf, B. R., Harris, A., Reddy, P., Conaghan, P. G., & Bennell, K. L. (2014). Acupuncture for chronic knee pain: a randomized clinical trial. JAMA, 312(13), 1313–1322. https://doi.org/10.1001/jama.2014.12660
National Center for Complementary and Integrative Health. (2022). Acupuncture in depth. National Center for Complementary and Integrative Health. https://www.nccih.nih.gov/health/acupuncture-what-you-need-to-know
Harvard Medical School. (2023). Acupuncture: what is it? Harvard Health Publishing Harvard Medical School Blog. https://www.health.harvard.edu/a_to_z/acupuncture-a-to-z#:~:text=The%20most%20common%20side%20effects,injury%20to%20an%20internal%20organ.
Ju, Z., Guo, X., Jiang, X., Wang, X., Liu, S., He, J., Cui, H., & Wang, K. (2015). Electroacupuncture with different current intensities to treat knee osteoarthritis: a single-blinded controlled study. International journal of clinical and experimental medicine, 8(10), 18981–18989.
Murakami, M., Fox, L., & Dijkers, M. P. (2017). Ear Acupuncture for Immediate Pain Relief-A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Pain medicine (Malden, Mass.), 18(3), 551–564. https://doi.org/10.1093/pm/pnw215
Montgomery, A. D., & Ottenbacher, R. (2020). Battlefield Acupuncture for Chronic Pain Management in Patients on Long-Term Opioid Therapy. Medical acupuncture, 32(1), 38–44. https://doi.org/10.1089/acu.2019.1382
For individuals experiencing musculoskeletal issues and pain symptoms, can learning about biomechanics and how it applies to movement, physical training, and performance, help in injury treatment and prevention?
Biomechanics
Biomechanics studies all life forms and their mechanical workings. Many think of biomechanics in sports and athletic performance, but biomechanics helps create and improve technologies, equipment, and injury rehabilitation techniques. (Tung-Wu Lu, Chu-Fen Chang 2012) Scientists, sports medicine doctors, physiotherapists, chiropractors, and conditioning specialists utilize biomechanics to help develop training protocols and techniques to improve therapy outcomes.
Body Movement
Biomechanics studies the movement of the body, including how muscles, bones, tendons, and ligaments work together, especially when movement is not optimal or correct. It is part of the larger field of kinesiology, specifically focusing on motion mechanics and analysis of how all the individual parts of the body work together to make up athletic and normal movements. (José M Vilar et al., 2013) Biomechanics includes:
Structure of bones and muscles.
Movement ability.
Mechanics of blood circulation, renal function, and other functions.
The study of forces and the effects of these forces on the tissues, fluid, or materials used for diagnosis, treatment, or research. (Jose I. Priego-Quesada 2021)
Sports
Sports biomechanics studies motion in exercising, training, and sports, which incorporates physics and the laws of mechanics. For example, the biomechanics of a specific exercise looks at:
Body position.
Movement of the feet, hips, knees, back, shoulders, and arms.
Knowing the correct movement patterns helps make the most of the exercise while preventing injuries, correcting form mistakes, informing training protocols, and increasing positive results. Understanding how the body moves and why it moves the way it does helps medical professionals prevent and treat injuries, alleviate pain symptoms, and improve performance.
Equipment
Biomechanics is used in the development of physical and sports equipment to improve performance. For example, a shoe can be designed for optimal performance for a skateboarder, long-distance runner, or soccer player. Playing surfaces are also studied for this purpose, such as how the surface stiffness of artificial turf affects athletic performance. (Jose I. Priego-Quesada 2021)
Individuals
Biomechanics can analyze an individual’s movements for more effective movement during training and games.
For example, an individual’s running gait or swing can be filmed with recommendations on what to change to improve.
Injuries
The science studies the causes, treatment, and prevention of neuromusculoskeletal injuries.
The research can analyze the forces that cause injuries and provide information for medical professionals on how to reduce the risk of injury.
Training
Biomechanics studies sports techniques and training systems to develop ways to improve efficiency.
This can include research on positioning, release, follow-through, etc.
It can analyze and help design new training techniques based on the mechanical demands of the sport, aimed at resulting in better performance.
For example, muscle activation is measured in cycling using electromyography and kinematics, which helps researchers analyze factors like posture, components, or exercise intensity that affect activation. (Jose I. Priego-Quesada 2021)
Motions
In biomechanics, the body’s motions are referred to from anatomical positioning:
Standing upright, with the gaze straight ahead
Arms at the sides
Palms facing forward
Feet spaced slightly apart, toes forward.
The three anatomical planes include:
Sagittal – median – Dividing the body into right and left halves is the sagittal/median plane. Flexion and extension occur in the sagittal plane.
Frontal – The frontal plane divides the body into front and back sides but also includes abduction, or moving a limb away from the center, and adduction, or moving a limb towards the center in the frontal plane.
Transverse – horizontal. – The upper and lower parts of the body are divided by the transverse/horizontal plane. Rotating movements occur here. (American Council on Exercise 2017)
Moving the body in all three planes occurs with daily activity. This is why performing exercises in each plane of motion to build strength, function, and stability is recommended.
Tools
Various tools are used to study biomechanics. Studies are usually performed using a device known as electromyography or EMG sensors. Sensors are placed on the skin and measure the amount and degree of muscle fiber activation in certain muscles during test exercises. EMGs can help:
Researchers understand which exercises are more effective than others.
Therapists know whether patients’ muscles are properly operating and functioning.
Dynamometers are another tool that helps measure muscle strength.
They measure the force output generated during muscle contractions to see if the muscles are sufficiently strong.
They are used to measure grip strength, which can be an indicator of overall strength, health, and longevity. (Li Huang et al., 2022)
Beyond Adjustments: Chiropractic and Integrative Healthcare
References
Lu, T. W., & Chang, C. F. (2012). Biomechanics of human movement and its clinical applications. The Kaohsiung journal of medical sciences, 28(2 Suppl), S13–S25. https://doi.org/10.1016/j.kjms.2011.08.004
Vilar, J. M., Miró, F., Rivero, M. A., & Spinella, G. (2013). Biomechanics. BioMed research international, 2013, 271543. https://doi.org/10.1155/2013/271543
Priego-Quesada J. I. (2021). Exercise Biomechanics and Physiology. Life (Basel, Switzerland), 11(2), 159. https://doi.org/10.3390/life11020159
American Council on Exercise. Makeba Edwards. (2017). Planes of Motion Explained (Exercise Science, Issue. https://www.acefitness.org/fitness-certifications/ace-answers/exam-preparation-blog/2863/the-planes-of-motion-explained/
Huang, L., Liu, Y., Lin, T., Hou, L., Song, Q., Ge, N., & Yue, J. (2022). Reliability and validity of two hand dynamometers when used by community-dwelling adults aged over 50 years. BMC geriatrics, 22(1), 580. https://doi.org/10.1186/s12877-022-03270-6
Knee injuries can present in physically active individuals that lift weights. Can understanding the types of weightlifting knee injuries help in prevention?
Weightlifting Knee Injuries
Weight training is very safe for the knees as regular weight training can improve knee strength and prevent injury as long as the correct form is followed. For Individuals with knee injuries from other activities, incorrect weight-training exercises could worsen the injury. (Ulrika Aasa et al., 2017) As well as, sudden twisting movements, poor alignment, and pre-existing injuries can increase the risk of worsening or creating further injuries. (Hagen Hartmann et al, 2013) The body and the knees are designed to support vertical forces on the joints.
Common Injuries
Weightlifting knee injuries occur as the knee joints endure a wide range of stresses and strains. In weight training, the ligaments that attach to the complex bone system of the knee joint can be damaged by incorrect movements, overloading the weight, and increasing the weight too soon. These injuries can result in pain, swelling, and immobility that can range from minor to severe, from a sprain or a slight tear to a complete tear in serious cases.
Anterior Cruciate Ligament – ACL – Injury
This ligament attaches the thigh’s femur bone to the lower leg’s shin bone/tibia and controls excessive rotation or extension of the knee joint. (American Academy of Family Physicians. 2024)
Anterior means front.
ACL injuries are seen mostly in athletes but can happen to anybody.
Severe damage to the ACL usually means surgical reconstruction and up to 12 months of rehabilitation.
When weightlifting, try to avoid twisting knee movements, intentionally or accidentally, under excessive load.
Posterior Cruciate Ligament – PCL – Injury
The PCL connects the femur and tibia at different points to the ACL.
It controls any backward motion of the tibia at the joint.
Injuries occur most with high-impact forces as a result of accidents and sometimes in activities where forceful trauma to the knee occurs.
Medial Collateral Ligament – MCL – Injury
This ligament maintains the knee from bending too far to the inside/medially.
Injuries mostly occur from impact to the outside of the knee or from accidental bodyweight force on the leg that bends at an unusual angle.
Lateral Collateral Ligament – LCL – Injury
This ligament connects the smaller bone of the lower leg/fibula to the femur.
It is opposite to the MCL.
It maintains excessive outward movement.
LCL injuries occur when a force pushes the knee out.
Cartilage Injury
Cartilage prevents bones from rubbing together and cushions impact forces.
Knee menisci are cartilage that cushions the knee joints inside and outside.
Other types of cartilage protect the thigh and shin bones.
When cartilage gets torn or damaged, surgery may be required.
Tendonitis
Aggravated and overused knee tendons can lead to weightlifting knee injuries.
A related injury known as iliotibial band syndrome/ITB causes pain to the outside of the knee, usually in runners, but it can occur from overuse.
Rest, stretching, physical therapy, and anti-inflammatory medication are a common treatment plan.
The condition causes the cartilage to deteriorate and bones to rub together, resulting in pain and stiffness.
Prevention
Individuals can minimize their risk of weightlifting knee injuries and pain by following their doctor’s and personal trainers’ recommendations.
Individuals with an existing knee injury should follow their doctor’s or physical therapist’s recommendations.
A knee sleeve can keep the muscles and joints secure, providing protection and support.
Stretching the leg and knee muscles can maintain joint flexibility.
Avoid sudden lateral movements.
Possible recommendations can include:
Avoiding Certain Exercises
Isolation exercises like leg curls, standing, or on a bench, as well as using the leg extension machine, can stress the knee.
Deep Squat Training
Research shows that the deep squat can protect against lower leg injury if the knee is healthy. However, this is when done with proper technique, under expert supervision, and with a gradual progressive load. (Hagen Hartmann et al, 2013)
Individuals should talk to their doctor before beginning a new exercise routine. A personal trainer can provide training in learning the proper technique and weightlifting form.
How I Tore my ACL Part 2
References
Aasa, U., Svartholm, I., Andersson, F., & Berglund, L. (2017). Injuries among weightlifters and powerlifters: a systematic review. British journal of sports medicine, 51(4), 211–219. https://doi.org/10.1136/bjsports-2016-096037
Hartmann, H., Wirth, K., & Klusemann, M. (2013). Analysis of the load on the knee joint and vertebral column with changes in squatting depth and weight load. Sports medicine (Auckland, N.Z.), 43(10), 993–1008. https://doi.org/10.1007/s40279-013-0073-6
American Academy of Family Physicians. ACL injury. (2024). ACL injury (Diseases and Conditions, Issue. https://familydoctor.org/condition/acl-injuries/
Mellinger, S., & Neurohr, G. A. (2019). Evidence based treatment options for common knee injuries in runners. Annals of translational medicine, 7(Suppl 7), S249. https://doi.org/10.21037/atm.2019.04.08
Driban, J. B., Hootman, J. M., Sitler, M. R., Harris, K. P., & Cattano, N. M. (2017). Is Participation in Certain Sports Associated With Knee Osteoarthritis? A Systematic Review. Journal of athletic training, 52(6), 497–506. https://doi.org/10.4085/1062-6050-50.2.08
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. https://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. https://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. https://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. https://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. https://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. https://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. https://doi.org/10.1097/BRS.0000000000000972
For individuals suffering from back pain, can knowing basic chiropractic terminology help in understanding diagnosis and treatment plan development?
Chiropractic Terminology
The chiropractic principle is that a properly aligned spine positively affects an individual’s overall health. One of the main aspects of chiropractic care is applying calculated force to the spinal joints to restore correct spinal alignment. Chiropractic terminology describes specific types of techniques and care.
General Subluxation
A subluxation can mean different things for various doctors. In general, a subluxation is a significant structural displacement or an incomplete or partial dislocation of a joint or organ.
To medical doctors, a subluxation refers to a partial dislocation of a vertebrae.
This is a serious condition, usually brought on by trauma, that can result in a spinal cord injury, paralysis, and/or death.
X-rays show a conventional subluxation as an obvious disconnect between the vertebrae.
Chiropractic Subluxation
The chiropractic interpretation is more subtle and refers to the misalignment of adjacent spinal vertebrae.
Subluxation in this context refers to position changes in the joints and soft tissues of the spine.
Vertebral misalignment is believed to lead to pain and abnormal intervertebral joint motion.
This difference between the serious subluxation medical condition and the chiropractic version may cause individuals to dismiss seeking back pain treatments.
Motion Segment
Chiropractors and surgeons use it as a technical term.
Motion segment refers to two adjacent vertebrae and the intervertebral disc between them.
This is the area chiropractors assess and adjust.
Adjustment
The chiropractor performs a spinal manual adjustment to realign joint subluxations.
Adjustments involve applying force to motion segments to bring them back into a centered alignment.
The goal for adjustments and realigning the vertebrae includes:
Spinal manipulation is a technique used by chiropractors to provide relief for musculoskeletal pain related to the back and neck. Manipulation provides mild to moderate relief and works as well as some conventional treatments like pain-relieving medications. (Sidney M. Rubinstein et al., 2012)
Spinal manipulation is divided into grades of mobilization.
Depending on their training, practitioners of various medical disciplines may be licensed to perform grade 1 to grade 4 mobilizations.
Only physical therapists, osteopathic physicians, and chiropractors are licensed to perform grade 5 mobilizations, which are high-velocity thrust techniques.
Most massage therapists, athletic trainers, and personal trainers are not licensed to perform spinal manipulations.
Based on a systematic review, the effectiveness of these treatments found that there is quality evidence that manipulation and mobilization can help reduce pain and improve function for individuals with chronic low back pain, with manipulation appearing to produce a more profound effect than mobilization. Both therapies are safe, with multimodal treatments potentially being an effective option. (Ian D. Coulter et al., 2018)
As with any treatment, results vary from person to person and with different chiropractors. There are also potential risks with spinal manipulation. Though rare, cervical, carotid, and vertebral artery dissections have occurred with cervical/neck manipulation. (Kelly A. Kennell et al., 2017) Individuals with osteoporosis may be advised to avoid chiropractic adjustments or manipulation because of the increased risk of injury. (James M. Whedon et al., 2015)
Many individuals choose chiropractic treatment for a variety of conditions. Understanding chiropractic terminology and reasoning allows individuals to ask questions as they discuss their symptoms to develop a personalized treatment plan and restore function and wellness.
What Causes Disc Herniation?
References
Henderson C. N. (2012). The basis for spinal manipulation: chiropractic perspective of indications and theory. Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology, 22(5), 632–642. https://doi.org/10.1016/j.jelekin.2012.03.008
Blanchette, M. A., Stochkendahl, M. J., Borges Da Silva, R., Boruff, J., Harrison, P., & Bussières, A. (2016). Effectiveness and Economic Evaluation of Chiropractic Care for the Treatment of Low Back Pain: A Systematic Review of Pragmatic Studies. PloS one, 11(8), e0160037. https://doi.org/10.1371/journal.pone.0160037
Rubinstein, S. M., Terwee, C. B., Assendelft, W. J., de Boer, M. R., & van Tulder, M. W. (2012). Spinal manipulative therapy for acute low-back pain. The Cochrane database of systematic reviews, 2012(9), CD008880. https://doi.org/10.1002/14651858.CD008880.pub2
Coulter, I. D., Crawford, C., Hurwitz, E. L., Vernon, H., Khorsan, R., Suttorp Booth, M., & Herman, P. M. (2018). Manipulation and mobilization for treating chronic low back pain: a systematic review and meta-analysis. The spine journal : official journal of the North American Spine Society, 18(5), 866–879. https://doi.org/10.1016/j.spinee.2018.01.013
Kennell, K. A., Daghfal, M. M., Patel, S. G., DeSanto, J. R., Waterman, G. S., & Bertino, R. E. (2017). Cervical artery dissection related to chiropractic manipulation: One institution’s experience. The Journal of family practice, 66(9), 556–562.
Whedon, J. M., Mackenzie, T. A., Phillips, R. B., & Lurie, J. D. (2015). Risk of traumatic injury associated with chiropractic spinal manipulation in Medicare Part B beneficiaries aged 66 to 99 years. Spine, 40(4), 264–270. https://doi.org/10.1097/BRS.0000000000000725
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. https://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. https://doi.org/10.3390/nu4111740
National Institutes of Health Office of Dietary Supplements. (2023). Iodine: Fact Sheet for Professionals. Retrieved from https://ods.od.nih.gov/factsheets/Iodine-HealthProfessional/
U.S. National Library of Medicine. MedlinePlus. (2022). Sodium blood test. Retrieved from https://medlineplus.gov/lab-tests/sodium-blood-test/
U.S. Department of Agriculture. FoodData Central. (2020). Salt. Retrieved from https://fdc.nal.usda.gov/fdc-app.html#/food-details/1112305/nutrients
U.S. Department of Health and Human Services and U.S. Department of Agriculture. (2020). 2020–2025 Dietary Guidelines for Americans. Retrieved from https://www.dietaryguidelines.gov/sites/default/files/2020-12/Dietary_Guidelines_for_Americans_2020-2025.pdf
American Heart Association. (2024). Sea Salt vs. Table Salt (Healthy Living, Issue. https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/sodium/sea-salt-vs-table-salt
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. https://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. https://doi.org/10.1111/1750-3841.15354
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