When you don’t have breadcrumbs or want to try something else, what are healthy substitutes for breadcrumbs that may yield similar results without sacrificing flavor or texture?
Bread Crumbs
Various recipes call for bread crumbs. Adding bread crumbs to sauces and other dishes helps bind and thicken wet ingredients while sprinkling bread crumbs on top of casseroles can add a crispy, crunchy texture. Individuals who follow low-carb or gluten-free meal plans or those with allergies to wheat may choose to avoid bread crumbs and dishes made with them. Wheat-free substitutes can replace bread crumbs in recipes with similar results, though the recipe may vary slightly.
Why Use Substitutes?
Individuals with food allergies or dietary restrictions may seek a substitute for bread crumbs since they may contain common allergens like wheat and gluten. Wheat is among the most common food allergies in the U.S. (Asthma and Allergy Foundation of America, 2022)
For those with allergies or sensitivities, gluten- and wheat-free bread crumbs are available to purchase at some stores, and some use alternatives out of preference. Crushing different varieties of chips, crackers, and pretzels can be used instead of bread crumbs, adding a unique flavor and texture. However, these substitutes may not be an option for recipes that call for bread crumbs to bind or thicken wet ingredients.
Bread products like bread crumbs can be part of a balanced diet. Guidelines recommend between 3 and 5 servings of whole grains daily for adults, including whole-wheat bread. (United States Department of Agriculture, 2025)
The main macronutrient in bread crumbs is carbohydrates.
Bread crumbs are usually consumed in small amounts because they are not the main ingredient.
Substitutes
Rolled Oats or Oat Flour
Oats and oat flour are often used as gluten-free alternatives to wheat in baking. Oats by weight are:
Lower in calories
Provide more complex carbohydrates.
They are a richer source of dietary fiber than bread crumbs.
Like regular flour, oats can be a binder in meat-based recipes. For example, if a recipe for meatloaf or meatballs calls for bread crumbs, rolled oats or oat flour can be successfully substituted.
Ensure the oats are gluten-free for individuals with gluten allergies, celiac, or gluten sensitivity. Though oats are inherently gluten-free, they may be processed on shared equipment and exposed to cross-contamination.
Cornflakes
Cornflakes can also add a crunchy texture to baked recipes. While corn is inherently gluten-free, cornflakes may not be. For individuals who have allergies or sensitivities, ensure you use gluten-free cornflakes. To use cornflakes, crunch them up by adding them to a ziplock bag and pressing them on the outside.
Nuts
Try nuts like almonds, walnuts, pecans, and cashews to add crunch and nutrients to a recipe. They are rich in healthy fats, protein, vitamins, and minerals. Plain nuts are also gluten-free, but roasted nuts may contain a wheat-based coating. Be sure to read the labels before using them.
Seeds
Seeds are a nutritious substitute.
They offer a different crispy, crunchy texture.
Shredded Coconut
Shredded or desiccated coconut can be used for sweet or rich recipes. It is perfect for adding to baked goods, especially gluten-free varieties. The recipe may need to be adjusted slightly because coconut has more moisture than regular bread crumbs. Do a small sample first to see how the coconut works in the recipe.
Injury Medical Chiropractic & Functional Medicine Clinic
Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop highly effective treatment plans through an integrated approach for each patient and restore health and function to the body through nutrition and wellness, functional medicine, acupuncture, electroacupuncture, and integrated medicine protocols. We focus on what works for you to relieve pain, restore function, prevent injury, and mitigate issues through adjustments that help the body realign itself. The clinic can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.
Hypertension? There’s a Diet for That
References
Asthma and Allergy Foundation of America. (2022). Food allergies. https://aafa.org/allergies/types-of-allergies/food-allergies/
United States Department of Agriculture, FoodData Central. (2018). Bread crumbs, dry, grated, plain. Retrieved from https://fdc.nal.usda.gov/food-details/174928/nutrients
United States Department of Agriculture. Dietary Guidelines for Americans 2020-2025. (2020). Dietary Guidelines for Americans, 2020-2025. Retrieved from https://www.dietaryguidelines.gov/sites/default/files/2021-03/Dietary_Guidelines_for_Americans-2020-2025.pdf
Can understanding how leg cramps feel, their causes, and prevention help individuals with treatment options?
Leg Cramp Causes
A leg cramp is an involuntary contraction of the muscles in the leg, typically the calf muscle. It causes a sudden, sharp, and painful tightening of the muscle. They commonly occur from
Dehydration
Muscle overexertion
They can be a symptom of an underlying health condition, such as type 2 diabetes or kidney failure.
They can also be a side effect of certain medications.
Sensation
Leg cramps typically cause sudden, severe pain in the affected muscle. Individuals may also feel a hard knot or twitching of the muscle. The calf muscles are the most common site. (Harvard Health Publishing, 2024)
Causes
The underlying cause of leg cramps isn’t always known. However, work, lifestyle factors, and medical conditions can play a role. Common causes include:
Dialysis – treatment to remove excess fluid from the blood when kidneys fail.
Respiratory diseases of the lungs and airways
Amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease, a neurological condition affecting the brain, nerves, and muscles)
Self-Care
Leg cramps often go away on their own after a few minutes. However, other self-care can help. Recommendations: (Harvard Health Publishing, 2024)
Change Body Positions
Moving can help relieve tension and pain.
If the leg cramps happen at night, stand up and take a few steps.
Massage
Gently rubbing the cramped muscle can help it relax.
Stretch
Stretching the cramping muscle can help it relax.
Apply Heat
If the leg cramp lasts more than a few minutes, apply a heating pad or take a warm shower to increase blood circulation to and around the muscle to help it relax.
Treatment
There are no medications specifically for treating leg cramps. However, if symptoms are caused by another medical condition, treating the underlying condition might help reduce cramp frequency. Dehydration or low electrolytes can cause leg cramps; in these cases, drinking water or electrolyte-infused beverages can help. If cramps are related to overexercising, consider reducing the intensity of your activity or exercising in a cooler environment. (Maughan R. J. & Shirreffs S. M. 2019) Magnesium supplements are usually marketed to relieve muscle cramps; they are not proven to alleviate them. (Garrison, S. R. et al., 2020)
Exercises and Stretches
Knowing which muscle to target when stretching the leg is important. If the cramp does not resolve after the first stretch attempt, try again.
Place palms flat against the wall at shoulder height.
Step the cramping leg away from the wall around 12 to 18 inches.
Keep your heels flat on the floor.
Keeping the back leg straight, bend the front knee slowly and lean forward until you feel a stretch along the calf.
Hold for 30 to 60 seconds.
Prevention
They can’t always be prevented. However, if they are related to dehydration or other lifestyle factors, individuals may be able to prevent them from occurring or decrease the frequency. Try the following: (Harvard Health Publishing, 2024)
Drink plenty of water.
Stretch the leg muscles before you go to bed.
Try drinking a beverage with electrolytes for longer workouts or activities in hot weather.
Warm up before exercise, such as with a slow jog, before getting into more intense exercises.
Properly cool down after a workout.
Stretch the leg muscles before and after exercising.
Maintain a healthy body weight.
Contact a Healthcare Provider
Leg cramps can sometimes signify something more serious than a Charley horse. See a healthcare provider if any of the following symptoms present (National Library of Medicine, 2020)
Change in skin color, including redness or a deeper tone than normal
Cramps that last more than a few minutes or occur frequently
Muscle weakness
Severe pain from the cramps
Swelling
Warm skin
Injury Medical Chiropractic & Functional Medicine Clinic
Talk to a healthcare provider about leg cramps to learn what interventions would help the most. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.
Is Motion Key to Healing?
References
Harvard Health Publishing. (2024). How to get rid of muscle cramps in your legs. https://www.health.harvard.edu/pain/how-to-get-rid-of-muscle-cramps-in-your-legs
National Library of Medicine. (2020). Muscle cramps. Retrieved from https://medlineplus.gov/musclecramps.html
Maughan, R. J., & Shirreffs, S. M. (2019). Muscle Cramping During Exercise: Causes, Solutions, and Questions Remaining. Sports Medicine (Auckland, N.Z.), 49(Suppl 2), 115–124. https://doi.org/10.1007/s40279-019-01162-1
Garrison, S. R., Korownyk, C. S., Kolber, M. R., Allan, G. M., Musini, V. M., Sekhon, R. K., & Dugré, N. (2020). Magnesium for skeletal muscle cramps. The Cochrane database of systematic reviews, 9(9), CD009402. https://doi.org/10.1002/14651858.CD009402.pub3
American Academy of Orthopaedic Surgeons. (2018). Knee conditioning program. https://orthoinfo.aaos.org/en/recovery/knee-conditioning-program/
Can understanding antinutrients and the importance of a balanced diet help individuals get the most out of their foods?
Antinutrients
Antinutrients are compounds in some plant foods that can reduce the body’s ability to absorb and use certain nutrients. (Petroski W., & Minich D. M. 2020) The purpose of these compounds is to protect the plants from infections and insects, which benefits the plant. It can also lower the human body’s ability to absorb nutrients properly. They are found in many grains, legumes, seeds, nuts, fruits, and vegetables. Plant-based foods high in antinutrients have beneficial nutrients, such as antioxidants, fiber, and other vitamins and minerals, and have been associated with a lower risk of chronic disease. The antinutrients may prevent the digestion and absorption of some minerals and have other negative effects that include:
Altered gut function
Increased inflammation
Endocrine disruption
Increased risk of calcium kidney stones
Common Types
Some of the main antinutrients of concern include phytates, lectins, oxalates, tannins, and phytoestrogens.
Phytates (phytic acid)
They are found in grains, legumes, nuts, and seeds.
They are found in various plant foods, including fruits, vegetables, nuts, and grains. (Mitchell T. et al., 2019)
Oxalates bind to certain minerals, such as calcium-forming calcium oxalate.
Tannins
They are found in many plant foods, such as legumes, cereal grains, nuts, cacao, leafy and green vegetables, coffee, and tea. (Ojo M. A. 2022)
Tannins are antioxidant-phenolic compounds that can reduce the absorption of some minerals and proteins in the body.
Phytoestrogens
They are found in various plant foods, such as fruits, vegetables, legumes, nuts, and seeds.
These estrogen-like compounds have many health benefits but may also act as endocrine disruptors (interfering with hormones). (Petroski W., & Minich D. M. 2020)
Effects on the Body
Antinutrient compounds typically bind to minerals or other nutrients, which inhibits digestion and absorption. For example,
How these foods containing antinutrient compounds are prepared and consumed can influence their impact on the body and the quantity consumed.
Advantages and Disadvantages
Plant foods have long been associated with improved health and a decreased risk of some chronic diseases, such as heart disease, diabetes, cancer, stroke, and others. (Craig W. J. et al., 2021) For most, the effects of antinutrients are not of major concern after processing and cooking. The benefits and drawbacks of consuming foods high in antinutrients include: (Petroski W., & Minich D. M. 2020)
Benefits
Some antinutrients act as antioxidants.
Some have cancer-fighting abilities.
Some may increase immune system function.
They are often sources of dietary fiber and other beneficial nutrients.
Drawbacks
It may be difficult for some individuals to digest.
Phytoestrogens may behave like endocrine disruptors.
High amounts of oxalates can contribute to kidney stones.
Cooking methods to minimize antinutrient content, like boiling, steaming
Autoclaving – a cooking process that uses high pressure and heat to cook and sterilize food.
Peeling the skins of fruits and nuts is effective for reducing tannins.
Combining foods to enhance nutrient absorption.
For example, pairing high-oxalate foods with high-calcium foods.
Combining different cooking and processing methods can completely degrade and reduce many antinutrient compounds. The exception is phytoestrogens, where boiling, steaming, and fermentation can increase antinutrients. (Petroski W. & Minich D. M., 2020)
Injury Medical Chiropractic & Functional Medicine Clinic
Individuals concerned about antinutrients in their diet and who want individualized advice on how to get the most out of the food they eat should consider consulting with a registered dietitian nutritionist or another healthcare professional. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution.
Smart Choices, Better Health
References
Petroski, W., & Minich, D. M. (2020). Is There Such a Thing as “Anti-Nutrients”? A Narrative Review of Perceived Problematic Plant Compounds. Nutrients, 12(10), 2929. https://doi.org/10.3390/nu12102929
Gupta, R. K., Gangoliya, S. S., & Singh, N. K. (2015). Reduction of phytic acid and enhancement of bioavailable micronutrients in food grains. Journal of food science and technology, 52(2), 676–684. https://doi.org/10.1007/s13197-013-0978-y
Adamcová, A., Laursen, K. H., & Ballin, N. Z. (2021). Lectin Activity in Commonly Consumed Plant-Based Foods: Calling for Method Harmonization and Risk Assessment. Foods (Basel, Switzerland), 10(11), 2796. https://doi.org/10.3390/foods10112796
Mitchell, T., Kumar, P., Reddy, T., Wood, K. D., Knight, J., Assimos, D. G., & Holmes, R. P. (2019). Dietary oxalate and kidney stone formation. American journal of physiology. Renal physiology, 316(3), F409–F413. https://doi.org/10.1152/ajprenal.00373.2018
Ojo, M. A. (2022). Tannins in Foods: Nutritional Implications and Processing Effects of Hydrothermal Techniques on Underutilized Hard-to-Cook Legume Seeds-A Review. Preventive nutrition and food science, 27(1), 14–19. https://doi.org/10.3746/pnf.2022.27.1.14
Craig, W. J., Mangels, A. R., Fresán, U., Marsh, K., Miles, F. L., Saunders, A. V., Haddad, E. H., Heskey, C. E., Johnston, P., Larson-Meyer, E., & Orlich, M. (2021). The Safe and Effective Use of Plant-Based Diets with Guidelines for Health Professionals. Nutrients, 13(11), 4144. https://doi.org/10.3390/nu13114144
Harvard T.H. Chan School of Public Health. (2022). Are anti-nutrients harmful? https://nutritionsource.hsph.harvard.edu/anti-nutrients/
U.S. Department of Agriculture. (2020). Dietary Guidelines for Americans, 2020-2025. Retrieved from https://www.dietaryguidelines.gov/sites/default/files/2021-03/Dietary_Guidelines_for_Americans-2020-2025.pdf
National Institutes of Health Office of Dietary Supplements. (2024). Iron. Retrieved from https://ods.od.nih.gov/factsheets/Iron-HealthProfessional/
Unlock the potential of gua-sha and chiropractic care. Learn how it can enhance your well-being and relieve tension.
Introduction: Rethinking Musculoskeletal Pain Through a Functional Medicine Lens
As a nurse practitioner with two decades of experience in physical and functional medicine, I’ve seen firsthand how musculoskeletal pain disrupts lives—whether it’s the desk-bound professional with chronic neck tension, the athlete recovering from overuse injuries, or the aging adult with persistent back discomfort. While pharmaceutical interventions may offer temporary relief, the key to long-term healing often lies in a more integrative approach.
Gua Sha therapy, a time-tested East Asian technique, combined with chiropractic care, offers a powerful, evidence-informed, and non-surgical strategy to alleviate musculoskeletal pain, restore function, and improve mobility. In this article, we’ll explore how these two modalities complement each other, the science behind their synergistic benefits, and how they can be integrated into a personalized treatment plan to support whole-body healing.
What Is Gua Sha Therapy? A Functional Medicine Perspective
Gua Sha (pronounced “gwah-shah”) is a traditional healing modality rooted in Traditional Chinese Medicine (TCM), involving the use of a smooth-edged instrument—often made of jade, rose quartz, or stainless steel—to gently scrape the skin in targeted areas. The goal? To release stagnation, promote microcirculation, and activate the body’s innate healing response.
The term “Gua” means “to scrape” and “Sha” refers to the reddish marks that appear on the skin, signifying the release of stagnant blood and toxins. These marks typically fade within a few days and are a normal part of the healing process.
In the modern clinical setting, Gua Sha has evolved into a sophisticated tool used by physical therapists, chiropractors, acupuncturists, and functional medicine providers. It’s particularly effective in addressing myofascial tension, trigger points, chronic inflammation, and reduced mobility due to soft tissue adhesions.
How Gua Sha Alleviates Musculoskeletal Pain
Musculoskeletal pain is often multifactorial—stemming from overuse, injury, postural imbalances, or systemic inflammation. When these factors are left unaddressed, they can lead to myofascial restrictions, scar tissue formation, and neuromuscular dysfunction, perpetuating a cycle of pain and immobility.
Gua Sha works by:
Disrupting fascial adhesions and encouraging tissue remodeling
Enhancing microvascular circulation, accelerating the delivery of oxygen and nutrients to the affected tissues
Activating the parasympathetic nervous system, shifting the body from “fight or flight” to “rest and repair”
Reducing pro-inflammatory cytokines and promoting anti-inflammatory responses (Chu et al., 2021)
Stimulating lymphatic flow, helping to reduce edema and clear metabolic waste
Releasing trigger points in hypertonic muscle groups, particularly in the neck, shoulders, lower back, and limbs
These mechanisms align well with the goals of functional medicine: identifying and treating root causes rather than masking symptoms.
Chiropractic Care: Aligning Structure and Function
Chiropractic care focuses on restoring proper spinal alignment and joint mobility through manual manipulation techniques. It is based on the principle that optimal nervous system function depends on structural integrity, particularly of the vertebral column.
Common benefits of chiropractic care include:
Pain reduction in the back, neck, and extremities
Improved range of motion and posture
Decompression of nerve roots, reducing radiculopathy and referred pain
Enhanced proprioception and neuromuscular coordination
Prevention of degenerative joint changes through biomechanical correction
A growing body of research supports chiropractic adjustments as an effective, evidence-based option for managing musculoskeletal conditions, especially when integrated into a multimodal treatment approach (Trager et al., 2024).
Discovering the Benefits of Chiropractic Care- Video
Gua Sha and Chiropractic Care: A Synergistic Duo
When Gua Sha is combined with chiropractic care, the result is a comprehensive therapeutic approach that targets both soft tissue restrictions and structural misalignments. This synergy accelerates healing and maximizes outcomes by preparing the body for more effective manual adjustments.
Here’s how the two modalities work together:
Gua Sha Therapy
Chiropractic Care
Breaks down adhesions in fascia and muscle tissue
Restores joint alignment and spinal biomechanics
Stimulates lymphatic and circulatory systems
Reduces nerve impingement and improves neural signaling
Releases tension in overactive muscle groups
Restores balance and mobility in underactive joints
Supports parasympathetic activation
Reinforces proprioceptive and neuromuscular patterns
One specific chiropractic application of Gua Sha is the Graston Technique, a modern adaptation that uses stainless steel instruments to identify and treat areas of soft tissue fibrosis. The goal is similar—restore mobility, reduce pain, and promote tissue healing (Deshmukh & Phansopkar, 2023).
Clinical Applications: When to Consider Gua Sha + Chiropractic Integration
As a nurse practitioner in functional medicine, I often incorporate both Gua Sha and chiropractic care for patients with:
These patients often report improved mobility, reduced inflammation, and greater pain relief when Gua Sha is included in their care plan—especially when timed before or after a chiropractic adjustment to reduce soft tissue guarding and enhance adjustment efficacy.
The Science: What Does the Research Say?
Numerous studies support the physiological effects of Gua Sha on circulation, inflammation, and pain modulation:
A 2021 study by Chu et al. found that Gua Sha therapy significantly increased microcirculation and decreased inflammatory markers in patients with chronic muscle pain.
Wang et al. (2020) highlighted Gua Sha’s role in stimulating the du meridian (governing vessel) and clearing blood stasis, promoting faster soft tissue recovery.
Knezevic et al. (2021) emphasized that musculoskeletal pain often arises from the interplay between soft tissue dysfunction, trigger points, and neural sensitization—areas where Gua Sha can provide targeted relief.
Trager et al. (2024) affirmed that chiropractic care continues to show promise as a cost-effective, non-pharmacological solution to chronic spinal pain and joint dysfunction.
Together, these therapies create a healing environment that supports the body’s biomechanical, neurological, and energetic systems.
Safety Considerations and Contraindications
While Gua Sha is a safe and gentle therapy, it is not suitable for everyone. Contraindications include:
Bleeding disorders or anticoagulant use
Severe varicose veins or vascular fragility
Active skin infections, open wounds, or dermatologic conditions
Recent surgeries with unhealed incisions
Always consult with a licensed provider trained in both modalities to determine appropriateness and ensure personalized, safe care.
Optimizing Results: A Functional Medicine Approach to Musculoskeletal Recovery
Incorporating Gua Sha and chiropractic care into a broader functional medicine care plan often yields the most sustainable results. Complementary strategies may include:
The body is a system of systems. Addressing musculoskeletal dysfunction holistically allows patients to heal not just their symptoms but the root cause of imbalance.
Conclusion: Empowering Patients With Integrative Pain Solutions
Musculoskeletal pain is one of the most common complaints in modern healthcare, yet the solution doesn’t have to be invasive, pharmaceutical, or surgical. By combining the ancient wisdom of Gua Sha with the mechanical precision of chiropractic care, we unlock a deeply therapeutic pathway toward healing, function, and resilience.
As a nurse practitioner grounded in both physical and functional medicine, I encourage patients and providers alike to explore the synergistic power of these modalities. When integrated skillfully and applied with intention, Gua Sha and chiropractic care can dramatically improve musculoskeletal health, restore balance, and empower patients to reclaim their active lives.
Injury Medical & Functional Medicine Clinic
We associate with certified medical providers who understand the importance of assessing individuals dealing with musculoskeletal pain by incorporating Gua-Sha and chiropractic care. When asking important questions to our associated medical providers, we advise patients to utilize Gua-Sha combined with chiropractic care to reduce musculoskeletal pain and restore soft tissue mobility in the extremities. Dr. Alex Jimenez, D.C., uses this information as an academic service. Disclaimer.
References
Chu, E. C., Lin, A. F. C., & Chu, V. (2023). The Inclusion of Chiropractic Care in the Healthy China Initiative 2030. Cureus, 15(8), e43068. https://doi.org/10.7759/cureus.43068
Chu, E. C. P., Wong, A. Y. L., Sim, P., & Kruger, F. (2021). Exploring scraping therapy: Contemporary views on ancient healing – A review. J Family Med Prim Care, 10(8), 2757-2762. https://doi.org/10.4103/jfmpc.jfmpc_360_21
Deshmukh, N. S., Jr., & Phansopkar, P. (2023). Effect of the Graston Technique and Cupping Therapy on Pain and Functions in Individuals With Medial Tibial Stress Syndrome: A Randomized Clinical Trial. Cureus, 15(11), e48246. https://doi.org/10.7759/cureus.48246
Knezevic, N. N., Candido, K. D., Vlaeyen, J. W. S., Van Zundert, J., & Cohen, S. P. (2021). Low back pain. The Lancet, 398(10294), 78-92. https://doi.org/10.1016/s0140-6736(21)00733-9
Trager, R. J., Bejarano, G., Perfecto, R. T., Blackwood, E. R., & Goertz, C. M. (2024). Chiropractic and Spinal Manipulation: A Review of Research Trends, Evidence Gaps, and Guideline Recommendations. J Clin Med, 13(19). https://doi.org/10.3390/jcm13195668
Wang, Y. W., Xi, Z. W., Pu, B., Chen, G. Y., Ma, Y. F., Liu, D. L., & Xu, X. (2020). Gua sha therapy for chronic low back pain: A protocol for systematic review. Medicine (Baltimore), 99(40), e20606. https://doi.org/10.1097/MD.0000000000020606
For individuals with lower back pain when walking, could they have injured a muscle or have an underlying condition affecting the joints, ligaments, or nerves?
Back Pain When Walking
Lower back pain when walking can occur for a variety of reasons. It can result from poor posture, injuries, muscle fatigue, or an underlying condition. Specific injuries, like muscle strains, can affect the ligaments in the spine and cause pain. Muscles that have not been used often can result in fatigue and pain. Specific health conditions, such as degenerative disc disease, spinal stenosis, herniated discs, sciatica, or even sacroiliac joint dysfunction, can cause lower back pain. Factors like overexertion or improper gait can exacerbate it.
Muscle Issues
Muscle strains, ligament sprains, or fatigue can cause lower back pain when walking. Pain can occur after walking or come on gradually from wear and tear without an apparent cause, as follows (American Association of Neurological Surgeons, 2024)
Strains
Occur when the fibers in the back are overstretched or torn.
Pain from muscle strains is usually worse during activity and better when resting.
Sprains
It occurs when the ligaments that connect bone to bone become detached.
If the muscles do not adequately support the spine, the spinal joints absorb more pressure, which can lead to injury to the spinal ligaments.
Fatigue
It can happen from overexertion and lead to lower back pain when walking.
It could occur when walking longer than the body is used to, on uneven surfaces that make the muscles work harder to help maintain balance, or climbing hills that cause you to lean forward while walking.
Degenerative Disc Disease
Between each vertebra is a disc that provides cushioning between the bones.
As the disc wears down, surrounding muscles, ligaments, joints, and nerves in the spine absorb more pressure, causing damage.
Degenerative disc disease is a wear-and-tear condition that becomes more common as individuals age and is a common cause of lower back pain.
Healthcare providers recommend walking as a low-impact activity for individuals with the disease. However, if the condition is more severe, individuals could experience pain from this exercise, especially when walking on hard surfaces. (Hospital for Special Surgery, 2024)
Sciatica
Sciatica pain occurs when a nerve exiting the spine in the lower back becomes compressed or pinched. It is a common symptom of a herniated disc, in which a disc moves out of place and puts pressure on nearby nerves. In addition to lower back pain, sciatica can cause pain in the hip, the back of the thigh, and down the leg. Sciatica can also cause: (American Academy of Orthopaedic Surgeons, 2021)
Numbness
Tingling
Muscle cramps
Leg muscle weakness
Healthcare providers often recommend walking as a safe form of physical activity for individuals with sciatica. However, individuals should avoid twisting or bending forward. (American Academy of Orthopaedic Surgeons, 2021) To decrease pain, avoid walking on uneven surfaces or uphill.
Lumbar Spinal Stenosis
Spinal stenosis is a wear-and-tear condition that often affects the lumbar spine/five vertebrae in the lower back.
It causes the space surrounding the spinal cord to narrow.
Lumbar spinal stenosis typically causes pain when standing upright, including when walking.
Many with this condition find that leaning slightly forward helps to reduce the pain by opening up the compressed areas.
Hyperlordosis
Lordosis describes the normal curve in the spine in the lower back. However, when this curve is exaggerated, it causes hyperlordosis or swayback. (American Academy of Orthopaedic Surgeons, 2020) Hyperlordosis affects the range of motion, putting abnormal pressure on the muscles, ligaments, and joints. It also reduces the spine’s ability to absorb shock correctly when walking, leading to pain. (Cedars-Sinai, 2025)
Prevention Strategies
Individuals can take steps to reduce their risk of lower back pain when walking, even if they’ve been diagnosed with a condition that can potentially cause this symptom. Walking can decrease chronic low back pain for some. (Suh J. H. et al., 2019) As with any new exercise program, check with a healthcare provider to ensure that walking for exercise is appropriate for the injury, condition, or disease and is safe. Recommended tips: (Harvard Health Publishing, 2015)
Wear shoes made for walking.
Perform gentle lower back stretches before walking.
Start slowly by walking for a few minutes, then gradually increase the time.
Walk on a smooth surface, such as a sidewalk or athletic track, or indoors, such as in a shopping center or mall.
Warm up and cool down by walking slowly at the beginning and end of the walk.
This allows the back and leg muscles to warm up before exercise and recover afterward.
Walk at a slow to moderate pace/speed that allows one to converse.
Standing up straight while walking or standing upright reduces pressure on the lower back.
Alternative Exercise
If there is still back pain when walking, it might not be an appropriate exercise for the individual and/or how their condition presents symptoms. Alternate activities can include: (Hospital for Special Surgery, 2023)
Elliptical Trainer
This exercise keeps the feet in contact with the pedals, putting less shock-absorbing pressure on the spine than walking.
Recumbent Biking
will keep the back upright, which is recommended if there is more pain when bending forward.
Upright Stationary Biking
This is recommended if the back pain improves when bending forward.
Walking In A Pool
This activity provides benefits while reducing pressure on the spine.
To target different muscles, try walking laps in waist-deep water in multiple directions (forward, backward, and side to side).
Water Aerobics
This activity provides cardiovascular health benefits with decreased pressure on the back.
Injury Medical Chiropractic & Functional Medicine Clinic
See a physical therapist for a personalized exercise program to reduce back pain and appropriate for your condition. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.
Beyond Adjustments: Chiropractic and Integrative Healthcare
References
American Association of Neurological Surgeons. (2024). Low back strain and sprain. https://www.aans.org/patients/conditions-treatments/low-back-strain-and-sprain/
Hospital for Special Surgery. (2024). Degenerative disc disease. https://www.hss.edu/condition-list_degenerative-disc-disease.asp
American Academy of Orthopaedic Surgeons. (2021). Sciatica. https://orthoinfo.aaos.org/en/diseases–conditions/sciatica
American Academy of Orthpaedic Surgeons. (2021). Lumbar spinal stenosis. https://orthoinfo.aaos.org/en/diseases–conditions/lumbar-spinal-stenosis/
American Academy of Orthopaedic Surgeons. (2020). Spine basics. https://orthoinfo.aaos.org/en/diseases–conditions/spine-basics/
Suh, J. H., Kim, H., Jung, G. P., Ko, J. Y., & Ryu, J. S. (2019). The effect of lumbar stabilization and walking exercises on chronic low back pain: A randomized controlled trial. Medicine, 98(26), e16173. https://doi.org/10.1097/MD.0000000000016173
Harvard Health Publishing. (2015). 5 tips for getting started with a walking program. https://www.health.harvard.edu/exercise-and-fitness/get-started
Hospital for Special Surgery. (2023). Best types of exercise for back pain. https://www.hss.edu/article_best-exercise-lower-back-pain.asp
What are some leg-strengthening exercises that will expedite recovery for athletes and physically active individuals who have undergone leg surgery?
Post Surgery Leg Strengthening
Leg muscles may weaken after hip, knee, ankle, or foot surgery. This happens because those muscles are not used as much during recovery. Gaining back strength and muscle endurance after an injury or surgery is an important step in recovery. Leg exercises can help regain mobility and prevent complications like blood clots and pressure sores after surgery or an injury, which is why engaging in post-surgery leg strengthening is important once the doctor gives the ok.
Benefits
post-surgery leg strengthening exercises have several benefits, including
Rebuilds strength and confidence
Retraining for optimal mobility and flexibility
Prevents pressure sores
Prevents blood clots
When the leg muscles are contracted, they move blood like a pump, maintaining proper circulation. Moving in a bed after surgery also helps prevent pressure sores from forming and blood clots. A physical therapy team will determine the right leg exercises for each individual and their injury/condition. This is an important step when moving forward after surgery. (Hoogeboom T. J. et al., 2014)
This isometric exercise means the muscles contract while no motion occurs at the hip joints. To perform:
Lie on your back and tighten your buttock muscles.
Hold the muscles tight for 5 seconds, then relax.
Repeat 10 or 15 times.
Gluteal sets can be done several times per day.
Heel Slide
Heel slides can help regain strength in the major muscles of the leg. To perform:
Lie on your back.
Bend the knee of the surgical leg and slowly slide the heel toward your butt.
Slide as far as possible and hold for 5 seconds.
Slowly return to the starting position and repeat.
Short Arc Quad
The short arc quad, or SAQ, is a simple way to get the quadricep muscles working. To perform:
Lie on your back with a towel roll, small ball, or something similar under the knee.
Slowly straighten the knee.
Tighten the quad muscle on the top of the thigh.
Hold for 3 seconds, then relax.
Repeat 10 to 15 times.
Quad Set
This exercise helps get the quad muscles working. It also helps control the position of the kneecap. To perform:
Lie on your back.
Place a small towel roll under the knee.
Try to press the back of the knee flat against the floor.
Hold for 10 seconds and release.
Repeat 10 to 15 times.
Individuals can complete quad sets bilaterally or with both knees simultaneously. This makes the stronger leg help strengthen the weaker side.
Straight Leg Raise
To perform:
Lie on your back.
Lift your leg straight off the floor until it is at the height of the opposite bent knee.
Hold for 10 seconds and slowly lower.
Repeat 10 to 15 times.
Be sure to keep the knee straight for the entire exercise. Keep the opposite knee bent for comfort. To ensure the knee is straight, individuals can complete a quad set first and then the straight leg raise. The exercise can be more challenging by increasing repetitions or adding a 2- to 3-pound ankle weight on the thigh. For even more challenge, add the ankle weight to the ankle.
Hamstring Strengthening
Working out the hamstrings after injury or surgery is important. The hamstring muscles bend the knee and extend the hip backward. To perform:
Lie on your stomach.
Bend one knee to raise the lower limb straight in the air.
Hold for 5 seconds and lower slowly.
Repeat 10 to 15 times.
Once the exercise is easy to do, increase the repetitions to 30. Individuals can also try adding a 2- to 3-pound ankle weight.
Physical therapy can help individuals regain mobility after injury or surgery. A therapist may prescribe exercises as part of an at-home exercise program. Over time progress will go from simple exercises to more challenging ones to improve balance and mobility. (Madara K. C. et al., 2019)
Injury Medical Chiropractic & Functional Medicine Clinic
Before starting this or any other exercise program, consult a doctor and a physical therapist to find the right exercises for your situation. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.
Are You Recovering From Ankle Sprains?
References
Hoogeboom, T. J., Dronkers, J. J., Hulzebos, E. H., & van Meeteren, N. L. (2014). Merits of exercise therapy before and after major surgery. Current opinion in anaesthesiology, 27(2), 161–166. https://doi.org/10.1097/ACO.0000000000000062
Madara, K. C., Marmon, A., Aljehani, M., Hunter-Giordano, A., Zeni, J., Jr., & Raisis, L. (2019). PROGRESSIVE REHABILITATION AFTER TOTAL HIP ARTHROPLASTY: A PILOT AND FEASIBILITY STUDY. International Journal of Sports Physical Therapy, 14(4), 564–581.
For individuals managing chronic pain conditions, can incorporating a personal TENS device help?
Personal TENS Device
Almost all physical therapy, chiropractic, acupuncture, and massage clinic healthcare providers offer TENS (transcutaneous electrical nerve stimulation) therapy. Individuals can buy a TENS unit for on-the-go and home care use. A personal TENS unit is a small, battery-powered device that uses low-voltage electrical currents delivered through electrodes placed on the skin to help relieve pain.
How It Works
TENS units work by stimulating nerve fibers in pain, which can help block pain signals from reaching the brain or by stimulating the release of endorphins, the body’s natural pain-killing chemicals.
Uses
TENS units are used to treat a variety of conditions, including:
Arthritis
Muscle cramps
Neck pain
Back pain
Pelvic pain
Knee pain
Osteoarthritis
Fibromyalgia
Tendinitis
Bursitis
Diabetes-related neuropathy
Pelvic pain from periods or endometriosis
Features
Portability
TENS units are small, lightweight, and portable, making them convenient for home or on the go. It can be held in a pocket or clipped to a belt. (National Health Service UK, 2025)
Electrodes
The unit is connected to a series of electrodes placed on the skin to deliver the electrical charge.
Adjustable Settings
Many TENS units allow users to adjust the electrical pulses’ intensity, frequency, and duration.
Benefits
Non-Invasive
TENS therapy is a non-invasive method for relieving pain.
Drug-Free
It can provide pain relief without the need for medication.
Convenient
TENS units are small, portable, and relatively discrete.
Precautions
Consult a healthcare provider before using a TENS device to ensure its safety for you and your injury/condition. The treatment should not be used for individuals who are pregnant, have epilepsy, poor sensation, a heart problem, a pacemaker, or another electrical or metal implant in their body. (National Health Service UK, 2025) The electrodes should not be placed on certain areas of the body, including (Teoli D, Dua A, An J. 2025)
Head
Eyes
Mouth
Front of the Neck
Chest and upper back at the same time
Numb areas
Broken skin
Tumors
There is a minor risk of skin irritation, particularly if allergic to the adhesive pads.
Effectiveness
Researchers are still determining how effective TENS units are for relieving and reducing pain. A study found that TENS was effective in relieving pain for patients with fibromyalgia. (Dailey D. L. et al., 2013) Another study suggested that TENS may improve bone pain for cancer patients, but the results were inconclusive because of the limited number of randomized trials. (Vance C. G. et al., 2014)
Research suggests that some factors can impact the effectiveness of the intervention. Varying the intensity and frequency may help it be more effective so the body doesn’t develop a tolerance to it. In addition, using the electrodes in areas that are acupuncture points may help to reduce pain. While further study is needed, TENS is considered a safe pain-relief option for many conditions because it’s non-invasive and doesn’t require medication. (Vance C. G. et al., 2014)
Injury Medical Chiropractic & Functional Medicine Clinic
Individuals interested in trying a personal TENS unit should consult their healthcare provider. They may be able to refer them to a physical therapist, who can show them which type and how to use it for their particular condition. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.
Don’t Ignore Post-Accident Pain
References
National Health Service UK. (2025). TENS (transcutaneous electrical nerve stimulation). https://www.nhs.uk/conditions/transcutaneous-electrical-nerve-stimulation-tens/
Teoli, D., Dua, A., & An, J. (2025). Transcutaneous Electrical Nerve Stimulation. In StatPearls. https://www.ncbi.nlm.nih.gov/pubmed/30725873
Dailey, D. L., Rakel, B. A., Vance, C. G. T., Liebano, R. E., Amrit, A. S., Bush, H. M., Lee, K. S., Lee, J. E., & Sluka, K. A. (2013). Transcutaneous electrical nerve stimulation reduces pain, fatigue, and hyperalgesia while restoring central inhibition in primary fibromyalgia. Pain, 154(11), 2554–2562. https://doi.org/10.1016/j.pain.2013.07.043
Vance, C. G., Dailey, D. L., Rakel, B. A., & Sluka, K. A. (2014). Using TENS for pain control: the state of the evidence. Pain management, 4(3), 197–209. https://doi.org/10.2217/pmt.14.13
Explore the clinical approach to reproductive health and understand its significance in comprehensive care and treatment methods.
As a Nurse Practitioner with over two decades of experience in physical and functional medicine, I’ve seen firsthand how reproductive health and sexual wellness intersect with musculoskeletal conditions. While often discussed as separate domains, the truth is that hormonal fluctuations, aging, and lifestyle-related stressors deeply influence not only fertility and libido but also pain perception, muscular integrity, and skeletal alignment.
This article explores how reproductive health—particularly in the context of menopause, andropause, and hormonal transitions—affects the musculoskeletal system, and how a functional medicine approach can help patients reclaim vitality and wellness at every stage of life.
Understanding the Hormone-Musculoskeletal Connection
The human body is a symphony of interconnected systems, and hormones are among the most powerful conductors. In both men and women, sex hormones like estrogen, progesterone, and testosterone regulate far more than reproductive function. They influence bone mineral density, muscle mass, inflammatory responses, and even the body’s perception of pain.
Common Symptoms of Hormonal Changes in Middle Adulthood
As women approach perimenopause and menopause, or as men experience a decline in testosterone (commonly referred to as andropause), they often report symptoms such as:
Chronic fatigue
Weight gain or redistribution, particularly in the abdomen and hips
Muscle and joint pain
Insomnia or sleep disturbances
Decreased libido
Mood fluctuations and cognitive fog
From a functional medicine standpoint, these symptoms are not isolated. They often indicate systemic dysregulation affecting the neuroendocrine-immune axis, which can directly or indirectly cause musculoskeletal dysfunctions like chronic back pain, pelvic instability, or myofascial tension.
Menopause and Musculoskeletal Changes: A Deeper Dive
Estrogen’s Role in Joint and Bone Health
Estrogen has a protective effect on connective tissue, cartilage, and bone mineral density. As levels decline during menopause, women often experience:
Osteopenia or osteoporosis
Increased joint laxity leading to instability
Heightened pain sensitivity
Loss of lean muscle mass (sarcopenia)
Estrogen modulates inflammatory cytokines and supports the health of collagen-based tissues. When estrogen diminishes, chronic inflammatory responses may escalate, contributing to generalized musculoskeletal pain, especially in the low back and pelvic regions.
Weight Gain and Load Distribution
The redistribution of fat to the abdomen and hips during menopause is not merely a cosmetic concern—it alters the body’s biomechanics. Excess abdominal adiposity increases the lumbar lordosis and places additional strain on the sacroiliac joints, leading to persistent low back pain. This is one of the most frequently overlooked causes of spinal discomfort in postmenopausal women.
Andropause: Testosterone’s Impact on Musculoskeletal Integrity
While often less discussed, male reproductive aging plays a significant role in musculoskeletal health. Testosterone influences:
Skeletal muscle mass and strength
Bone mineral density
Fat metabolism
Mood and energy levels
A gradual decline in testosterone, typically beginning in the 30s and accelerating in the 50s, is associated with:
Muscle wasting (sarcopenia)
Chronic joint and tendon pain
Increased risk of osteoporosis
Erectile dysfunction and reduced sexual satisfaction
From a functional medicine perspective, testosterone deficiency is not simply a reproductive issue—it is a whole-body imbalance affecting resilience, mobility, and pain processing.
Hormone Replacement Therapy (HRT): Considerations and Cautions
For Women
Hormone Replacement Therapy (HRT) remains one of the most effective tools for alleviating menopause-related symptoms, including vasomotor instability, vaginal atrophy, and osteoporosis. However, from a musculoskeletal perspective, its role in maintaining:
Bone density
Muscle tone
Pain modulation
is equally important. Estrogen interacts with central nervous system receptors involved in pain perception and inflammation control. When appropriately administered and monitored, HRT can significantly reduce chronic pain associated with menopausal transition.
For Men
Testosterone Replacement Therapy (TRT) has shown promise in improving:
Muscle strength and performance
Bone health
Mood and mental clarity
Sexual function
However, it must be approached with caution. A full assessment—including hormone panels, cardiovascular risk, and metabolic health—is critical to ensure safety and efficacy. Unchecked testosterone supplementation can lead to erythrocytosis, liver strain, and hormonal suppression.
Testosterone Deficiency In Men- Video
Sexual Wellness and Age-Related Changes
Female Sexual Health and Pelvic Musculoskeletal Pain
As estrogen levels drop, the vaginal epithelium becomes thinner, drier, and less elastic. This can lead to:
Dyspareunia (painful intercourse)
Pelvic floor dysfunction
Increased risk of urinary tract infections
These symptoms not only affect sexual satisfaction but often lead to compensatory musculoskeletal tension patterns. Over time, guarding and postural changes can create chronic pelvic or sacral pain. Pelvic floor physical therapy, along with targeted hormonal support, can be transformative.
Erectile Dysfunction and Musculoskeletal Implications
Erectile dysfunction (ED), a common issue in aging males, can stem from vascular insufficiency, endocrine disruption, or psychological factors. However, musculoskeletal contributions—such as lumbosacral nerve compression or poor pelvic alignment—are often overlooked. Restoring structural alignment and reducing nerve impingement may improve erectile function when paired with lifestyle and hormonal interventions.
Surgical and Non-Surgical Reproductive Interventions
Sterilization and Hormonal Impact
While surgical sterilization (tubal ligation in women, vasectomy in men) is often considered hormonally neutral, some women report changes in menstrual patterns and pelvic pain post-ligation. Scar tissue formation, changes in pelvic organ motility, or subtle hormonal shifts may be contributing factors. A thorough preoperative and postoperative assessment of pelvic alignment and function is crucial.
Non-Surgical Alternatives
Hormonal contraceptives, in addition to preventing pregnancy, offer musculoskeletal benefits such as:
Stabilizing hormonal fluctuations
Reducing menstrual-associated joint laxity
Preserving bone density in younger women
From a functional medicine viewpoint, it’s essential to evaluate how birth control methods interact with nutritional status, liver detoxification pathways, and systemic inflammation.
Functional Medicine Strategies for Optimizing Reproductive and Musculoskeletal Health
Lifestyle Interventions with Dual Benefits
Many of the strategies used to balance hormones also enhance musculoskeletal function. These include:
Anti-inflammatory nutrition
Emphasize cruciferous vegetables, lean protein, omega-3s, and phytoestrogens.
Reduce processed sugar and inflammatory oils.
Targeted movement therapies
Incorporate strength training to preserve muscle mass and bone health.
Add yoga or Pilates to support pelvic alignment and reduce chronic tension.
Stress reduction techniques
Chronic cortisol elevation impairs hormonal balance and collagen integrity.
Practices like meditation, breathwork, and adequate sleep promote recovery.
Supplemental support
Magnesium, D3, boron, zinc, and adaptogenic herbs can enhance hormonal and musculoskeletal resilience.
Environmental detoxification
Endocrine disruptors from plastics, pesticides, and personal care products can sabotage hormonal balance.
Support liver detoxification and eliminate xenoestrogens where possible.
Reclaiming Sexual Wellness Through an Integrative Lens
Sexuality is not merely a function of hormonal output—it reflects our overall health, vitality, and emotional connection. As individuals move through midlife, open communication, body literacy, and collaborative care models are essential for navigating changes with grace and strength.
Functional and physical medicine offer powerful tools for enhancing sexual health:
Manual therapy and pelvic floor rehab
Customized bioidentical hormone therapy
Personalized nutrition and movement programs
Integrative sexual counseling
Final Thoughts: A Systems-Based Approach to Whole-Body Vitality
Whether it’s low back pain triggered by hormonal shifts or decreased libido rooted in chronic inflammation, reproductive health and musculoskeletal function are intricately linked. As clinicians, we must approach these issues not in isolation but as interconnected expressions of systemic health.
By embracing an integrative, functional approach, we empower our patients—not just to reduce pain or restore hormonal levels—but to reclaim their vitality, deepen intimacy, and thrive throughout the aging process.
Injury Medical & Functional Medicine Clinic
We associate with certified medical providers who understand the importance of assessing individuals dealing with reproductive and sexual health associated with body pain. When asking important questions to our associated medical providers, we advise patients to implement various approaches to their reproductive and sexual health associated with their pain. Dr. Alex Jimenez, D.C., utilizes this information as an academic service. Disclaimer.
References
Allen, R. H., Cwiak, C. A., & Kaunitz, A. M. (2013). Contraception in women over 40 years of age. CMAJ, 185(7), 565-573. https://doi.org/10.1503/cmaj.121280
Barbonetti, A., D’Andrea, S., & Francavilla, S. (2020). Testosterone replacement therapy. Andrology, 8(6), 1551-1566. https://doi.org/10.1111/andr.12774
Barone, B., Napolitano, L., Abate, M., Cirillo, L., Reccia, P., Passaro, F., Turco, C., Morra, S., Mastrangelo, F., Scarpato, A., Amicuzi, U., Morgera, V., Romano, L., Calace, F. P., Pandolfo, S. D., De Luca, L., Aveta, A., Sicignano, E., Trivellato, M.,…Crocetto, F. (2022). The Role of Testosterone in the Elderly: What Do We Know? Int J Mol Sci, 23(7). https://doi.org/10.3390/ijms23073535
Chen, D., Zhou, J., Lin, C., Li, J., Zhu, Z., Rao, X., Wang, J., Li, J., Chen, H., Wang, F., Li, X., Gao, M., Zhou, Z., Xi, Y., & Li, S. (2024). A causal examination of the correlation between hormonal and reproductive factors and low back pain. Front Endocrinol (Lausanne), 15, 1326761. https://doi.org/10.3389/fendo.2024.1326761
Hwang, W. J., Lee, T. Y., Kim, N. S., & Kwon, J. S. (2020). The Role of Estrogen Receptors and Their Signaling across Psychiatric Disorders. Int J Mol Sci, 22(1). https://doi.org/10.3390/ijms22010373
Ko, S. H., & Kim, H. S. (2020). Menopause-Associated Lipid Metabolic Disorders and Foods Beneficial for Postmenopausal Women. Nutrients, 12(1). https://doi.org/10.3390/nu12010202
What are the recommendations for a pulled muscle injury to fully recover?
Pulled Muscle Recovery Time
A pulled muscle, medically known as a strain, occurs when muscle fibers are stretched too far and sometimes tear. A pulled muscle injury typically starts to heal within days. Mild injuries can heal completely in one to three weeks, but more serious strains or tears, depending on the severity, can take six to 12 weeks or longer. (Fernandes T. L., Pedrinelli A., & Hernandez A. J. 2015) Rest, hydration, healthy foods, and slowly returning to activity can help expedite healing time.
Timeline
The timeline for recovering from a pulled muscle depends on the injury’s severity.
Pulled muscles are typically categorized into three grades based on the degree and size of pulled muscle fibers, as follows (Hospital for Special Surgery, 2024)
Grade 1 (mild)
Heals in a few days.
A microscopic tear or stretch in the muscle fiber.
It might feel sore, but you can still use the muscle.
Grade 2 (moderate)
Heals in four to six weeks.
A partial tear in the muscle causes noticeable pain and swelling, making it harder to move or use the injured muscle.
Grade 3 (severe)
Heals in several months
This type of muscle strain causes a complete tear, also known as a rupture.
It results in intense pain, significant swelling, and inability to use the muscle.
Surgery may be required in some cases.
Larger muscles, such as the hamstrings and quadriceps, may take longer to heal than smaller muscles due to their increased size and greater weight-bearing loads.
Body Parts More Susceptible To Injury
The following are more susceptible to muscle strains, pulls, or tears (Nölle L. V. et al., 2022)
Neck – levator scapulae and trapezius
Shoulders – rotator cuff muscles
Lower back – erector spinae
Groin – adductors
Front of the thigh – quadriceps
Behind the thigh – hamstrings
Calves – gastrocnemius and soleus
Healing Stages and Factors
Pulled muscles heal in three predictable stages, though the timing and progression may vary by individual and injury severity (Baoge L. et al., 2012).
Inflammatory Stage (zero to three days)
When pulling a muscle, the body reacts instantly with an inflammatory response that may include swelling, redness, bruising, and pain.
Rest is important during this stage to prevent the injury from getting worse.
Repair Stage (three to 21 days)
Damaged muscle fibers are repaired and regrow during this stage.
Collagen fills in any tears to rebuild damaged muscle tissue.
Gentle movement and easy activity can help the fibers line up properly and reduce stiffness.
Start slowly moving a pulled muscle as soon as possible, but avoid too much activity too soon, as it can delay and prolong healing.
Remodeling Stage (three weeks to one year)
Repaired tissue gets stronger and adapts to regular movement.
Scar tissue may form.
Gradually adding more activity, stretching, and strengthening exercises helps treat a pulled muscle and return to full strength and function but should be done carefully to avoid re-injury.
Avoid activities that cause pain, but move the muscle gently to prevent stiffness.
Prolonged rest can slow healing, so maintain a balance between rest and exercise.
Ice
Add ice for 10–20 minutes for the first 48 hours to reduce swelling and pain.
Ice helps control inflammation by limiting blood flow to the injured area.
Compression
Use compression stockings or wrap the injured part in bandages to help reduce swelling.
Ensure the binding is not too tight so circulation is not cut off.
Elevation
Raise the injured area above heart level throughout the day.
This helps reduce swelling by allowing fluids to drain away from the injury site.
Heat
After the first two to three days, heat therapy increases blood circulation and improves flexibility, helping the muscle heal.
Eat Healthy
Get enough protein for muscle repair.
Maintain Hydration
Drink plenty of water to help with circulation and muscle lubrication.
Massage and Physical Therapy
These hands-on interventions can improve circulation, help reduce scar tissue, and restore range of motion.
Over-the-counter Medications
If needed, over-the-counter nonsteroidal anti-inflammatory medications like Advil or Motrin (ibuprofen) and Aleve (naproxen sodium) can help with pain and swelling.
Only use as directed.
These steps can help promote faster healing and expedite returning to normal daily activities.
When to Resume Normal Activity
Individuals may need one to two weeks to recover before resuming normal activity for mild strains. However, for more severe injuries, it could take four to six weeks or longer to return to all daily activities. (Harvard Health Publishing, 2023) It’s essential to gradually return to daily activities to avoid reinjury, which can delay and prolong healing. Follow these recommendations to recover from a pulled muscle safely and quickly (Kraemer W., Denegar C., & Flanagan S. 2009)
Once the pain has subsided, the swelling has decreased, and the muscle feels better, start with low-impact exercises.
Slowly resume normal activities, avoiding overexerting the injured area.
Gradually increase activity levels and stop if there is any pain.
Avoid strenuous activities that place excessive stress on the injured muscle until the muscle is completely healed.
Contact a Healthcare Provider
While most pulled muscles heal with home care, seek medical attention if: (Penn Medicine, 2023)
Pain persists or worsens after seven to 10 days.
This can indicate a more serious injury, such as a severe torn muscle.
Significant pain, loss of motion and strength, and swelling disrupt daily activities or show signs of worsening despite rest and self-care.
It is difficult to move the affected area, or the muscle cannot bear weight, suggesting a more severe injury.
There are signs of infection, including redness, warmth, increased swelling, or fever, especially if the skin is cut or broken near the injured area.
There is unusual bruising or a visible deformity, which could indicate a bone fracture requiring professional evaluation.
A healthcare provider may recommend imaging studies, such as MRI, ultrasound, or X-rays, to assess the extent of the injury, rule out fractures, or check for muscle tears.
Injury Medical Chiropractic & Functional Medicine Clinic
Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.
Say Goodbye to Pain with Chiropractic Care
References
Fernandes, T. L., Pedrinelli, A., & Hernandez, A. J. (2015). MUSCLE INJURY – PHYSIOPATHOLOGY, DIAGNOSIS, TREATMENT, AND CLINICAL PRESENTATION. Revista brasileira de ortopedia, 46(3), 247–255. https://doi.org/10.1016/S2255-4971(15)30190-7
Hospital for Special Surgery. J. N. R., MD. (2024). Muscle Strain: Causes, Symptoms, Treatment. https://www.hss.edu/conditions_muscle-strain.asp
Nölle, L. V., Mishra, A., Martynenko, O. V., & Schmitt, S. (2022). Evaluation of muscle strain injury severity in active human body models. Journal of the mechanical behavior of biomedical materials, 135, 105463. https://doi.org/10.1016/j.jmbbm.2022.105463
Baoge, L., Van Den Steen, E., Rimbaut, S., Philips, N., Witvrouw, E., Almqvist, K. F., Vanderstraeten, G., & Vanden Bossche, L. C. (2012). Treatment of skeletal muscle injury: a review. ISRN orthopedics, 2012, 689012. https://doi.org/10.5402/2012/689012
Laumonier, T., & Menetrey, J. (2016). Muscle injuries and strategies for improving their repair. Journal of Experimental Orthopaedics, 3(1), 15. https://doi.org/10.1186/s40634-016-0051-7
Harvard Health Publishing. (2023). Muscle strain. https://www.health.harvard.edu/staying-healthy/muscle-strain-a-to-z
Kraemer, W., Denegar, C., & Flanagan, S. (2009). Recovery from injury in sport: considerations in the transition from medical care to performance care. Sports Health, 1(5), 392–395. https://doi.org/10.1177/1941738109343156
Penn Medicine. (2023). Strains. https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/strains
Enzymes’ function is to help trigger bodily processes ranging from digestion to blood clotting to growth. What is the best way to support enzyme production?
Enzymes
Enzymes are proteins that act as biological catalysts. They cause and speed up crucial chemical reactions and help the body complete necessary chemical reactions. They are vital for many biological processes, including digestion, metabolism, and molecule building and breaking down. This includes breaking down food, facilitating growth, and forming blood clots. Too little of a certain type can lead to serious health implications like a fatal buildup of toxins. Individuals missing a certain kind of enzyme or having too little of it can develop serious health conditions.
Function
They help speed up chemical reactions in the body (National Human Genome Research Institute, 2025). They facilitate chemical reactions in everything from digesting food to muscle growth. Enzymes facilitate this by binding to a cell, creating the reactions needed. With enzyme binding, chemical reactions can occur without destroying the cell. (Nemours KidsHealth, 2023) Each cell in the body has thousands of enzymes to help facilitate all the complex reactions to maintain health. (National Human Genome Research Institute, 2025)
Factors Affecting Production
In healthy individuals, the body produces the enzymes it needs. However, metabolic disorders can occur if the body does not produce enough of a certain type. (Kennedy Krieger Institute, 2025) These disorders can be serious and are usually caused by a genetic malfunction that impacts production.
Types
There are thousands of different types. Digestive enzymes, for example, aid in the breakdown of food and convert it into energy. Common enzymes that are critical for health include (Nemours KidsHealth, 2023)
Amylase
Digestive helps break down starches.
Aspartate aminotransaminase (AST) and Alanine Aminotransaminase (ALT)
Help the liver convert sugar into energy.
Creatine Kinase (CK)
Helps muscles create energy.
DNA Polymerase
Facilitates growth by allowing DNA to duplicate.
Glucose-6-Phosphate Dehydrogenase
Keeps red blood cells healthy by preventing damage to the cell.
Lipase
A digestive enzyme that helps break down fats and oils.
Protease
Digestive helps break down proteins.
Thrombin
Causes blood to clot.
Deficiencies
If the body doesn’t make enough of a certain enzyme, it cannot undergo the bodily processes that the enzyme helps facilitate. This can lead to a variety of symptoms. Some are minor, like not being able to eat lactose. Others are serious, like developmental delays caused by the build-up of toxins. (Kennedy Krieger Institute, 2025) Usually, these deficiencies are caused by genetics.
Types
There are various deficiencies. Some are very rare, while others can lead to conditions such as: (Nemours KidsHealth, 2023)
Lactose Intolerance
This is caused by not having enough of the enzyme that breaks down lactose, a sugar found in milk, leading to gas and bloating.
Tay-Sachs Disease
An often fatal disease caused by a missing hexosaminidase, which is responsible for breaking down fats
Gilbert’s Syndrome
This is caused by a missing enzyme that removes waste product (bilirubin) from the blood, leading to bilirubin buildup and
Jaundice or yellowing of the skin and whites of the eyes
Galactosemia
This leads to slow growth and trouble gaining weight, which is caused by the missing galactose-1-phosphate uridylyltransferase (GALT), which helps break down a sugar called galactose.
Phenylketonuria (PKU)
This is caused by having too little phenylalanine hydroxylase, which breaks down a protein called phenylalanine, causing brain damage.
Morquio Syndrome
This is caused by having too few enzymes that break down glycosaminoglycans, a type of sugar molecule.
This leads to bone and growth abnormalities.
Wilson’s Disease
A liver disease is caused by a missing protein that helps break down copper in the body.
Enzyme Production Support
Eat a healthy, well-balanced diet of fruits and vegetables to support enzyme production. Avoid processed foods, especially those that are very fatty (Johns Hopkins Medicine, 2025). The body produces all the necessary enzymes unless the individual has a genetic condition. Supplements aren’t usually required, but they can help with lactose intolerance or digestion in cystic fibrosis patients. (Nemours KidsHealth, 2023)
One supplement type, pancreatic enzyme replacement therapy (PERT), is available. PERT is an FDA-regulated prescription medication prescribed to patients with serious illnesses such as cystic fibrosis. (U.S. Food and Drug Administration, 2019)
Injury Medical Chiropractic & Functional Medicine Clinic
Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.
Chiropractic Care and Metabolism: The Hidden Link
References
National Human Genome Research Institute. (2025). Enzyme. Retrieved from https://www.genome.gov/genetics-glossary/Enzyme
U.S. Food and Drug Administration. (2019). FDA approves new breakthrough therapy for cystic fibrosis. Retrieved from https://www.fda.gov/news-events/press-announcements/fda-approves-new-breakthrough-therapy-cystic-fibrosis
