As individual bodies age, the nerves and muscles begin to degenerate, especially in the lower spinal region. This can cause sciatic pain and muscle weakness. Elderly sciatica is very common as the nerves and muscles have gone through a lot. Bending, lifting, carrying, reaching, twisting, and natural wearing and tearing make the sciatic nerve and surrounding muscles prone to injury. For overweight seniors, the risk of developing sciatica is higher.
Elderly Sciatica
The main reason for elderly sciatica is that as the body ages, the discs/cartilage between the vertebrae/bones in the spine dry out, losing their cushioning ability, which can lead to the bones shifting out of place more easily, rubbing against each other, and compressing nerves. On average, the body loses about 1 centimeter in height every ten years after 40.
Risk Factors
Diabetes
Diabetes affects the entire body.
Not keeping blood sugar in check can cause widespread symptoms that affect the nerves and organs.
Individuals with diabetes have an increased risk of developing sciatica and other nerve-damaging disorders.
Genetics
If spinal conditions are part of family medical history, there is an increased risk of developing sciatica.
With chiropractic, elderly individuals can attain better quality sleep, improved mood, and increased energy levels.
A chiropractic physical therapy team can develop a specialized/customized treatment plan for preventive and palliative care.
Body Composition
Sarcopenia
Sarcopenia affects the elderly population’s mortality, cognitive function, and quality of life. As the elderly population is living longer, preservation of lean mass becomes an integral part of maintaining an individual’s independence. Loss of muscle in the arms and legs is linked to decreased mobility, increased risk of falls, and prolonged hospital stays. Falls and fractures often result in a cycle of muscle deterioration. InBody can help track body composition changes and help to minimize muscle wasting and risk of impaired mobility.
References
Aggarwal, Sameer, and Nityanand. “Calcium and vitamin D in postmenopausal women.” Indian journal of endocrinology and metabolism vol. 17,Suppl 3 (2013): S618-20. doi:10.4103/2230-8210.123549
Dougherty, Paul E et al. “The role of chiropractic care in older adults.” Chiropractic & manual therapies vol. 20,1 3. 21 Feb. 2012, doi:10.1186/2045-709X-20-3
Ferreira, Manuela L, and Andrew McLachlan. “The Challenges of Treating Sciatica Pain in Older Adults.” Drugs & aging vol. 33,11 (2016): 779-785. doi:10.1007/s40266-016-0404-z
Kherad, Mehrsa et al. “Risk factors for low back pain and sciatica in elderly men-the MrOS Sweden study.” Age and aging vol. 46,1 (2017): 64-71. doi:10.1093/ageing/afw152
Delayed Onset Muscle Soreness – DOMS is when muscle pain or stiffness develops a day or two after playing sports, weight lifting, exercise, or work that involves concentrated physical activity like lifting and carrying objects. DOMS is considered a normal response to extended exertion and is part of the adaptation process that the recovering muscles experience as they undergo hypertrophy or an increase in muscle size. It is common in individuals who have just started exercising, increased the duration or intensity of their workouts, or just beginning a physically demanding job.
DOMS
When muscle contracts as it lengthens is known as eccentric muscle contractions, which is most associated with DOMS. It is related to increased stress in muscle fibers as they are exerted excessively. This also happens when engaging in movements the muscles are not used to, like a new exercise or helping a friend move heavy boxes, furniture, etc. Examples include:
Individuals will not feel DOMS during the workout or physical activity. Delayed symptoms include:
Swelling in the affected muscles.
Muscles feel tender to the touch.
Muscle fatigue.
Reduced range of motion and movement.
Pain and stiffness when moving.
Decreased muscle strength.
Treatment Options
Time and waiting for the muscles to repair themselves is the natural healing process, but steps can be taken to ease the soreness, stiffness, and pain. This includes:
It is different for everybody; personal experience will determine which works best for the individual.
Active Recovery
Active recovery is a technique that uses low-impact aerobic exercise right after a workout to increase blood flow to the muscles.
The increased blood supply can help relieve the inflammation.
RICE
This technique is used for acute injuries but can be applied to delayed onset muscle soreness. It stands for:
Rest
Ice
Compression
Elevation
Chiropractic
A chiropractic massage is for healing sore muscles, tendons, ligaments after an intense game, workout, etc. Chiropractic increases the blood and nerve circulation around the muscles delivering added oxygen and nutrients. This type of massage helps loosen the muscles/connecting tissues allowing the body to recover and heal quicker.
Body Composition
When Muscles Are Not Rested
Not taking time to recover because of overtraining/working can have consequences on the body. Inflammation that is not given the time to heal can lead to:
Injuries.
Weakened immune system.
Muscle mass loss.
Mental health issues.
The body’s immune system cannot function at total capacity during intense physical stress. This causes difficulty when trying to fight off germs and viruses. Studies have found preventing inflammation and injury requires prioritizing rest. Constantly being on the go and under intense physical stress can take a toll not only on the body but the brain as well. This can lead to irritability, frustration, anger, which leads to other health problems generating a vicious cycle.
References
Cheung, Karoline et al. “Delayed onset muscle soreness: treatment strategies and performance factors.” Sports medicine (Auckland, N.Z.) vol. 33,2 (2003): 145-64. doi:10.2165/00007256-200333020-00005
Guo, Jianmin et al. “Massage Alleviates Delayed Onset Muscle Soreness after Strenuous Exercise: A Systematic Review and Meta-Analysis.” Frontiers in physiology vol. 8 747. 27 Sep. 2017, doi:10.3389/fphys.2017.00747
Reinke, Simon et al. “The influence of recovery and training phases on body composition, peripheral vascular function and immune system of professional soccer players.” PloS one vol. 4,3 (2009): e4910. doi:10.1371/journal.pone.0004910
Post spine surgery physical therapy or PT is the next phase after a discectomy, laminectomy, fusion, etc., to gain optimal mobility and ease the transition for a full recovery. A chiropractor and physical therapist team will help with proper muscle training and activation, pain and inflammation relief, postural training, exercises, stretches, and educate the individual on an anti-inflammatory diet. Physical therapy post spine surgery reduces:
Scar tissue
Inflammation
Muscle weakness
Muscle tightness
Joint stiffness
The therapy also identifies and treats any issues that caused or contributed to the spinal damage/injury. A study found physical therapy to improve postoperative ambulation, pain, disability, and decreased surgical complications.
Post Spine Surgery Physical Therapy Goals
Physical therapy goals are to return the individual to full function before chronic pain or injury. These include:
Decrease pain and stress around the surgical site.
Loosen and stretch the muscles surrounding the surgical site.
Strengthen the back and neck muscles.
Stabilize the back and neck muscles.
Learn to move around safely.
Prepare for everyday physical activities like standing up or sitting down, lifting, and carrying objects.
Improve posture.
The therapy team will develop a customized treatment/rehabilitation plan as well as post-surgical recovery at home to help the individual and family to understand what to expect, including psychological factors like not wanting to perform the exercises or stretches to avoid pain, frustration, anger, depression, and wanting to give up. However, individuals can maximize the benefits to ensure an optimal outcome before surgery by pre-conditioning identifying structural and functional issues contributing to the injury.
Physical Therapy Involves
Therapy can be done at home, in a hospital or rehab setting, or at a chiropractic/physical therapy clinic. Therapists use:
A physical therapy session can last 45 minutes to an hour. It’s essential to discuss hopes and expectations post-surgery and after the therapy has finished. The therapists will explain the healing process, the treatment progression, and any questions a patient may have. Understanding the treatment process will help the individual want to engage in the treatment plan. The therapist team will also interface with the surgeon to prevent adverse outcomes.
Optimal Health
The physical therapy team will help the individual feel better with each session and stay motivated. Having a solid relationship with the therapy team makes it easier to share goals, worries, and challenges that the team can adapt to as progress is made. To gain the most from the therapy:
Try working with a therapist that the surgeon recommends can be helpful as they already have a working relationship.
Keep communication open between the surgeon and team.
Adhere to any precautions and restrictions set by the surgeon and therapy team.
Maintain recommended exercises at home between sessions.
Ease into activity and avoid overexertion.
Post spine surgery physical therapy helps accelerate the healing process and serves to help individuals regain their quality of life.
Body Composition
Power Of Protein
Protein is an essential component of muscle development, bone density, muscle mass, and lean tissue when building a healthy body. Protein is necessary for all the body’s physiological functions.
References
Adogwa, Owoicho et al. “Assessing the effectiveness of routine use of postoperative in-patient physical therapy services.” Journal of spine surgery (Hong Kong) vol. 3,2 (2017): 149-154. doi:10.21037/jss.2017.04.03
Atlas, S J, and R A Deyo. “Evaluating and managing acute low back pain in the primary care setting.” Journal of general internal medicine vol. 16,2 (2001): 120-31. doi:10.1111/j.1525-1497.2001.91141.x
Gellhorn, Alfred Campbell et al. “Management patterns in acute low back pain: the role of physical therapy.” Spine vol. 37,9 (2012): 775-82. doi:10.1097/BRS.0b013e3181d79a09
Jack, Kirsten et al. “Barriers to treatment adherence in physiotherapy outpatient clinics: a systematic review.” Manual therapy vol. 15,3 (2010): 220-8. doi:10.1016/j.math.2009.12.004
Lindbäck, Yvonne et al. “PREPARE: Pre-surgery physiotherapy for patients with degenerative lumbar spine disorder: a randomized controlled trial protocol.” BMC musculoskeletal disorders vol. 17 270. 11 Jul. 2016, doi:10.1186/s12891-016-1126-4
Flexibility and range of motion are essential elements for an individual’s overall health, physical fitness, and quality of life. Healthy flexibility helps the body:
Maintain a physically active lifestyle.
Maintain strength.
Improve endurance.
Prevent injury.
Flexibility and Range of Motion
Joint stiffness and pain can make it challenging to engage in everyday activities and maintain mobile, physical, emotional, and internal health. To keep the body flexible and moving, individuals need to use their entire body and range of movement. Becoming sedentary affects the body’s flexibility, leading to slowed/blocked blood circulation, nerve energy signal disruption, and sickness. To improve flexibility and range of motion, it is recommended to include:
Stretching the body
Regular exercise and physical activity
Yoga
Healthy diet
Healthy weight
Proper sleep
For individuals with stiffened muscles and joints, chiropractic medicine can increase the body’s flexibility, improving the range of motion in the joints. Chiropractic optimizes the function of the joints, improving mobility with less pain. When living with arthritis, chiropractic is an excellent therapy to decrease pain and activate the body’s natural healing abilities. Chiropractic adjustments align the spine and improve nervous system function.
Nerve Pressure
Nerve pressure can cause pain or tingling sensations that can become difficult to manage. A shifted misaligned spine can compress nerve endings, causing pain that presents with or without movement. Getting the body in motion and moving around is essential to treat stiffness and joint pain. The objective of chiropractic is to align the spine and body and relieve pressure on the nerves helping the body gain back its flexibility and range of motion. Once the body is adjusted, the nerve endings are no longer irritated, relieving the pain. Chiropractic uses various techniques to deal with areas of compression, including stretching, percussive massage, low-laser therapy, ultrasound, and strengthening exercises.
Chiropractic adjustments relieve pain and improve mobility.
Strengthening exercises to keep the spine in proper alignment.
Exercising keeps the adjustments in place.
A careful assessment of the condition will determine the cause of stiffness and joint immobility. Chiropractic can treat the joints, bones, and muscles to improve flexibility manage muscle spasms and soft tissue tenderness to alleviate symptoms restoring and improving range of motion. Chiropractic adjustments are combined with therapeutically designed stretches and exercises to perform at home, along with an anti-inflammation diet and supplements.
Body Composition
Zinc
Zinc is an essential nutrient that provides overall immune function. It is a powerful antioxidant that helps prevent and reduce oxidative stress and inflammation responses. Various bodily chemical reactions require Zinc. Zinc is necessary for muscle protein synthesisand hormone regulation. Zinc deficiency is common in older individuals and has been connected with degenerative diseases that include:
Green, S et al. “Physiotherapy interventions for shoulder pain.” The Cochrane database of systematic reviews vol. 2003,2 (2003): CD004258. doi:10.1002/14651858.CD004258
Hartvigsen, Jan et al. “What low back pain is and why we need to pay attention.” Lancet (London, England) vol. 391,10137 (2018): 2356-2367. doi:10.1016/S0140-6736(18)30480-X
Kavuncu, Vural, and Deniz Evcik. “Physiotherapy in rheumatoid arthritis.” MedGenMed: Medscape general medicine vol. 6,2 3. 17 May. 2004
Page, Carolyn J et al. “Physiotherapy management of knee osteoarthritis.” International journal of rheumatic diseases vol. 14,2 (2011): 145-51. doi:10.1111/j.1756-185X.2011.01612.x
Wessels, Inga et al. “Zinc as a Gatekeeper of Immune Function.” Nutrients vol. 9,12 1286. 25 Nov. 2017, doi:10.3390/nu9121286
When stress is placed on the shins with physical activity from walking, running, or exercise, the connective tissues attaching the leg muscles to the tibia can become inflamed, causing medial tibial stress syndrome, more commonly known as shin splints. This inflammation is caused by tiny tears in the muscles and tendons of the shin. Chronic shin pain could be related to foot arch problems, underlying issues with the muscles, or shoes that don’t support the feet properly. Although it usually goes away within a few days, it’s important to monitor to ensure that it does not progress into a stress fracture. A chiropractor can offer treatments to relieve the pain and help prevent shin splints from recurring.
Medial Tibial Stress Syndrome
Medial tibial stress syndrome can impact anyone. It can come from walking far distances or in awkward positions like going downstairs with small steps, jumping rope, and playing with the kids on the playground can all cause burning, tightness, and pain in the shins. Shin splints affect individuals differently. For some, the pain recedes when the triggering activity is stopped. For others, the pain can become a chronic condition that results in continuous pain, even when at rest.
The Shin
The shin is a part of the tibia bone in the lower leg.
This bone absorbs the shocks when moving through daily activities.
The muscles that run along the shin support the foot’s arch and raise the toes during movement.
Medial tibial stress syndrome is caused by excessive force on the shinbone and the tissue around it, which causes the muscles to swell and increases pressure around the bone.
If left untreated, small tears in the muscle and the bone can form, leading to chronic pain and stress fractures.
Medial tibial stress syndrome is more likely to happen from:
Not stretching before physical activity or exercise.
Constantly walking or running on hard surfaces.
Wearing the wrong shoes that don’t provide enough cushioning or arch support.
Over-exertion on the body with activity and movement.
The body is not given the proper amount of time to recover.
Athletes often experience shin splints when they’ve intensified their training routine or changed it up.
Symptoms
Pain during exercise or activity.
Pain in the front of the lower leg.
Soreness in the lower leg.
Swelling in the lower leg.
Shin is hot to the touch.
Treatment
Whenever pain is being experienced, some muscles will either get tight or weak in response. By identifying the weak and/or tight muscles, a chiropractor can prescribe stretches and exercises that will help alleviate the pain and prevent it. One of the main principles of chiropractic is to treat the body as an interconnected system. A chiropractor may work on an unrelated part of the body to treat the symptomatic area. For example, they may work to align the spine and pelvis to lessen the impact on the lower legs.
Part of a treatment plan may include:
Soft Tissue Mobilization
A handheld instrument loosens tight tissues during soft tissue mobilization therapy and breaks scar tissue around the tibia.
Massaging tight muscles in the leg keeps them loose and alleviates the pain.
Percussion massage can be added to reduce muscle knots, improve blood flow, and loosen up scar tissue.
The treatment relieves pain and can help avoid shin splints when returning to normal activities.
Ultrasound and Low Laser Therapy
Ultrasound and low laser therapy use heat to warm the deep tissues in the lower leg gently.
The treatment eases pain, reduces inflammation, swelling, and increases blood flow.
Kinesio Taping
Applying flexible Kinesio tape to the foot and lower leg can reduce stress on the shins.
The chiropractor or physical therapist will show how to apply the tape correctly.
Foot Orthotics
Individuals may be more likely to develop shin splints if they have high or low arches or their feet tend to roll inward or outward when walking.
Prescription foot orthotics can be made to keep the feet properly balanced and supported.
Stretching Exercises
Shin splints could be related to tight muscles in the back of the calf and weak muscles in the front of the lower leg.
A chiropractor or physical therapist will show stretching and strengthening exercises to maintain muscle balance.
Body Composition
Retaining Water Due To Salt Intake
Salt/sodium is everywhere and hard to avoid.
It might not be a surprise that a single patty cheeseburger contains over 500 mg of sodium – almost a quarter of the daily recommended level, but it is a surprise to know that the ranch dressing on a salad contains as much as 270 mg or a tablespoon of soy sauce on a healthy, vegetable-only stir-fry has 879 mg of sodium. The Mayo Clinic estimates that the average individual consumes about 3,400 mg of sodium a day: close to double what is recommended. Sodium is linked with water retention, and it is the kidneys’ job to expel unneeded sodium out of the body. Until the kidneys activate, an individual will temporarily be retaining extra water. If daily water and sodium intake habits change daily, this can contribute to water retention, causing fluctuations in daily weight. So, if an individual was on a diet but flooded the body with more salt than usual, expect to see a temporary increase in weight.
References
Bates, P. “Shin splints–a literature review.” British journal of sports medicine vol. 19,3 (1985): 132-7. doi:10.1136/bjsm.19.3.132
Chiropractic Economics: The Science Behind Percussion Massage.
Gross, ML et al. “Effectiveness of orthotic shoe inserts in the long-distance runner.” The American journal of sports medicine vol. 19,4 (1991): 409-12. doi:10.1177/036354659101900416
Heer, Martina et al. “Increasing sodium intake from a previous low or high intake affects water, electrolyte and acid-base balance differently.” The British journal of nutrition vol. 101,9 (2009): 1286-94. doi:10.1017/S0007114508088041
McClure, Charles J. and Robert Oh. “Medial Tibial Stress Syndrome.” StatPearls, StatPearls Publishing, 11 August 2021.
Calf pain is common in individuals who spend a lot of time on their feet, whether standing at work, school, or training athletes. The calf muscle/s take on a tremendous amount of load throughout the day. Climbing stairs, jogging, running, and hiking increase strain on the muscles. In most cases, calf pain results from an overuse injury of the calf muscles. Improper footwear can also contribute to issues around the foot and ankle that include:
Tightness
Loss of strength of the foot
Decreased mobility
Short or tight calves can lead to dysfunctional movement, cramping symptoms, chronic pain, and stiffness. A combination of chiropractic active release treatment and physical therapy can help quickly eliminate calf pain.
Anatomy
The calves are comprised of two muscles, the gastrocnemius, and soleus.
The gastroc originates just above the knee.
The soleus is below the knee.
They both insert on the back of the ankle as they join to form the Achilles tendon. The gastrocnemius is the power muscle used for explosive movements like jumping. The soleus muscle is predominately a slow-twitch muscle. This means it is very active during extended activities, like standing, walking, exercising, and running. When dealing with calf and ankle issues, other muscles can also contribute. These include:
The posterior tibialis lies deep in the inner portion of the calf and plays a role in foot and ankle function.
Most commonly, calf pain is caused by the overuse of the calf muscles. This is often the result of the consistent pounding of the feet and lower legs from standing, walking, and working. Over time, the repetitive pounding can cause tiny tears in the muscles of the lower legs and calves. If detected, early rest and recovery are recommended to allow the muscles to relax, loosen, and heal. However, repeated use can lead to more severe injury without proper treatment, like compartment syndrome. Certain types of calf pain can signify a medical emergency that requires immediate treatment.
Compartment Syndrome
A tough and fibrous covering surrounds the calf called the fascia. During physical activity or exercise, blood flows into these muscles, causing them to increase in size. If the fascia cannot stretch enough when these muscles enlarge, pain and tightness can develop. This is known as chronic posterior compartment syndrome. The discomfort typically goes away when the activity stops but is likely to return without proper treatment.
Calf Overuse Injury
Soreness, tightness, and pain are usually felt along the back or inside of the lower leg. The calf muscles are generally not painful to touch but maybe tender when deep pressure is applied. Calf pain and tightness often come with extended physical activity, exercise and disappear once the activity is stopped. If the injury becomes chronic, calf stiffness can present even when not active, along with numbness and/or tingling in the lower leg or foot.
Treatment
It is recommended not to ignore any discomfort, pain, and stiffness in the calves. Continued overuse can lead to scar tissue formation and chronic pain potential without proper care. Active Release – ART, and chiropractic effectively treat this type of injury. ART breaks up scar tissue, returning normal function to the calf muscles. And chiropractic loosens up stiff joints in the hips, ankles, and feet that may be contributing to wear and tear on the calves. Together they can quickly and eliminate calf pain. Part of a treatment plan includes:
Aerobic exercise substantially impacts the body’s muscles’ energy production system and cardiovascular adaptation. The blood delivers oxygen to the muscle cells to produce energy that powers all the exercise being done. Aerobic exercise primarily relies on oxidative energy production, which takes place within the cells called mitochondria. Aerobic exercise also breaks down fat molecules for energy, which can only happen within mitochondria.
Aerobic exercise training improves the muscle cells’ ability to burn fat by generating more mitochondria and enhancing their functionality. Specifically, the body burns more fat than usual in the hours following each training session.
With more precise quality and quantity of fat-burning machinery, aerobic training can increase the resting metabolic rate, resulting in more calories burned.
High-intensity aerobic exercise also increases the excess post-exercise oxygen consumption – EPOC, resulting in increased calorie burn in addition to what was burned during the exercising.
References
Alfredson, H et al. “Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis.” The American journal of sports medicine vol. 26,3 (1998): 360-6. doi:10.1177/03635465980260030301
Bright, Jacob Michael et al. “Ultrasound Diagnosis of Calf Injuries.” Sports health vol. 9,4 (2017): 352-355. doi:10.1177/1941738117696019
Campbell, John T. “Posterior calf injury.” Foot and ankle clinics vol. 14,4 (2009): 761-71. doi:10.1016/j.fcl.2009.07.005
Green, Brady, and Tania Pizzari. “Calf muscle strain injuries in sport: a systematic review of risk factors for injury.” British journal of sports medicine vol. 51,16 (2017): 1189-1194. doi:10.1136/bjsports-2016-097177
The body is a connected whole and more than just separate parts and regions. When back pain presents, it might not be the back muscles or spine but could be tense, tight hips, and hamstrings causing low back pain. How it happens, how to stretch and loosen up, and target these areas could help alleviate the pain.
The Hips and Hamstrings
When the hip flexors and hamstrings become tense, the tightness can alter the pelvic alignment. This affects spinal alignment leading to discomfort and low back pain. The hip flexors are a group of muscles around the front of the hips, and they activate when moving the leg and knee upward. The hamstrings are the muscles in the back of the thighs that allow for flexion of the knees and hip extension. Muscle tightness in the hips and/or hip joint stiffness can also contribute to low back pain. Not being able to rotate, flex, or extend the hip forward or backward can affect:
Walking
Running
Swinging
Twisting movements
This increases mechanical strain on the lower back.
Losing the ability to function through the entire length of motion can also indicate muscle weakness and a lack of joint movement where the joint around the muscle becomes stiff. This can be caused by:
A lack of movement
Arthritis
Age-related changes
Stretching and Treatment
Stretching exercises can be the first line of treatment. It is recommended to start with gentle stretches targeting these areas. What works best for the individual is the stretch they are comfortable repeating enough to make a difference. Warming up the muscles first will generate the best results. An easy place to begin is a gentle forward fold stretch.
Stand up straight, or sit with the legs extended out in front.
Then, reach with the fingers toward the toes. Don’t worry if you can’t reach them.
If the stretching does not bring relief, it is recommended to progress to a personalized treatment and stretching program with a chiropractor or physical therapist. Chiropractic and physical therapy can relieve the problems without medication, injections, or surgery and provide lifelong techniques for maintaining optimal flexibility, mobility, and strength. The hands-on treatment loosens and relieves the tense tightness, reinforcing the flexibility and range of motion. Treatment includes:
Joint mobilization to the hips and spine.
Soft tissue mobilization.
A personalized strengthening program with stretches and exercises that target the specific muscles.
Health coaching.
Anti-inflammatory diet recommendations.
Body Composition
Monounsaturated Fats
Monounsaturated fat is considered healthy fat. This type of fat makes up a significant component of the Mediterranean diet. Studies have shown monounsaturated fats like extra-virgin olive oil can help prevent adverse events related to cardiovascular disease. A meta-analysis evaluating diets high in monounsaturated fats indicated a significant reduction in:
Triglycerides
Bodyweight
Systolic blood pressure in individuals with type II diabetes.
A significant increase in HDL or good cholesterol.
Another study showed the protective effects of monounsaturated fatty acids reduced the risk factors associated with metabolic syndrome and cardiovascular disease. Monounsaturated fats can have a positive impact on overall health. Monounsaturated fat sources include:
Olive, peanut, and canola oil
Avocados
Almonds
Pecans
Hazelnuts
Sesame and pumpkin seeds
References
Estruch, Ramón et al. “Retraction and Republication: Primary Prevention of Cardiovascular Disease with a Mediterranean Diet. N Engl J Med 2013;368:1279-90.” The New England journal of medicine vol. 378,25 (2018): 2441-2442. doi:10.1056/NEJMc1806491
Gillingham, Leah G et al. “Dietary monounsaturated fatty acids are protective against metabolic syndrome and cardiovascular disease risk factors.” Lipids vol. 46,3 (2011): 209-28. doi:10.1007/s11745-010-3524-y
American College of Physicians. (February 2017) “American College of Physicians issues guideline for treating non-radicular low back pain” https://www.acponline.org/acp-newsroom/american-college-of-physicians-issues-guideline-for-treating-nonradicular-low-back-pain
MedlinePlus. (2019) Hip flexor strain – aftercare https://medlineplus.gov/ency/patientinstructions/000682.htm
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