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By Dr. Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP 0 Comments Acupuncture, Chiropractic Care, Therapy , , , , , , , , , , , , , , , ,

Cupping as Alternative Medicine for Pain Relief

For individuals experiencing musculoskeletal pain symptoms like lower back pain and shoulder pain, can incorporating cupping therapy help bring relief and manage pain?

Cupping Therapy

This ancient treatment is gaining public acceptance, and awareness has heightened, with various individuals and athletes being seen with round marks on their shoulders and backs. It is a pain treatment that, like acupuncture, comes from traditional Chinese medicine, or TCM. The therapy involves placing glass, silicone, or bamboo cups on the skin to create suction. The treatment is an alternative medicine technique used to relieve musculoskeletal pain. The suction is believed to promote healing (Cleveland Clinic, 2023)

Increasing Blood Circulation

  • The suction draws blood to the area, which can help reduce inflammation and promote healing.

Releasing Muscle Tension

  • The suction can stretch and pull on muscles, which can help relieve pain and tightness.

Breaking Up Adhesions

  • The suction can help break up scar tissue and adhesions that can cause pain and restricted movement.

Detoxifying the Body

  • Some practitioners believe that cupping can help remove toxins from the body.

It is typically performed by a trained practitioner who places the cups on the skin and leaves them in place for several minutes. The cups can be placed on various body areas, including the back, neck, shoulders, and legs. (Cleveland Clinic, 2023)

Benefits

  • Pain relief, especially for muscle and joint pain
  • Reduced inflammation
  • Improved circulation
  • Increased range of motion
  • Detoxification

Procedure

The medical practice involves creating skin suction using glass, ceramic, or plastic cups. How it’s done:

Preparation

  • The practitioner cleans the area where the cups will be placed.
  • They may apply oil or massage cream to the skin for easier movement of the cups.

Techniques

Dry

  • The practitioner heats the inside of the cup with a flame or pump, creating a vacuum.
  • The cup is then placed on the skin, which adheres due to the negative pressure.
  • The cup remains on the skin for several minutes, allowing the suction to draw blood and tissue into the cup.

Wet

  • Like the dry technique, the practitioner makes small incisions in the skin before applying the cup.
  • This allows blood to flow into the cup, creating a more intense suction.

Aftercare

  • The cups are removed, and the practitioner may apply pressure to the area to stop bleeding.
  • The patient is advised to avoid strenuous activity and hot showers for a few hours after the treatment.

The benefits of therapy include opening pores, stimulating blood flow, filtration, and balancing energy flow through the body. It’s often combined with massage and acupuncture. (Cleveland Clinic, 2023)

It also aims to alleviate symptoms of systematic diseases like diabetes and hypertension. However, more research is needed to see and fully analyze the effects of the treatment. (Aboushanab T. S., & AlSanad S. 2018)

Risks

The therapy is generally safe when done correctly and by a licensed professional. However, there is some risk of side effects like skin discoloration and scarring. Reports of rare side effects include bleeding inside the skull from cupping on the scalp and anemia from repeated wet techniques. (National Center for Complementary and Integrative Health, 2018) Other side effects can include:

Bruising

  • It can cause temporary bruising at the site of the cups.

Skin Irritation

  • Some people may experience skin irritation or burns from the suction.

Infection

  • There is a small risk of infection if the cups are not properly sterilized.

Who should avoid the therapy?

Those with skin conditions like eczema and psoriasis should avoid cupping, as it may worsen them. (National Center for Complementary and Integrative Health, 2018) 

Injury Medical Chiropractic & Functional Medicine Clinic

It is important to consult with a healthcare professional before trying any new treatment, especially if you have any underlying health conditions. 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 Medicine: The Power of Chiropractic Care

References

Cleveland Clinic. (2023). Cupping Therapy. https://my.clevelandclinic.org/health/treatments/16554-cupping

Aboushanab, T. S., & AlSanad, S. (2018). Cupping Therapy: An Overview from a Modern Medicine Perspective. Journal of acupuncture and meridian studies, 11(3), 83–87. https://doi.org/10.1016/j.jams.2018.02.001

National Center for Complementary and Integrative Health. (2018). Cupping. Retrieved from https://www.nccih.nih.gov/health/cupping

By Dr. Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP 0 Comments Exercises, Physio, Sporting , , , , , , , , , , , , , , , , , ,

Quadriceps Stretches: Essential for Leg Health

Can stretching quadriceps help relieve stiffness and pain and improve flexibility for individuals with consistently tight quadriceps?

Quadriceps Stretches

Walking, running, biking, and other daily activities can tighten the quadriceps muscles. The quadriceps are four muscles in the front of the thigh that extend the leg and strengthen the knee. Stretching the quadriceps may be a part of a home or gym exercise program or physical therapy treatment to maintain quadricep flexibility. Resting the quadriceps with an exercise program can greatly maximize mobility and prevent injury.

Tight quadriceps may sometimes result from injuries such as patellofemoral stress syndrome or iliotibial band friction syndrome. The quads may also become tight for individuals with spinal stenosis or other related problems with the lower back. (International Sports Sciences Association, 2023) Ely’s test, also known as the Duncan-Ely test, is one way to determine whether your quadriceps are tight. It is a physical examination used to assess the flexibility and potential spasticity of the rectus femoris muscle (a quadriceps muscle) by passively flexing the patient’s knee. Lie on your stomach and try to touch your foot to your buttocks. If you can’t, the rectus femoris, one of the main muscles, may be tight and benefit from quadricep stretches. (Olivencia, O. et al., 2020)

Safety and Precautions

Before trying this or any other exercise program, consult a healthcare provider to ensure exercise is safe for you and your conditions. A professional can help diagnose any overuse injury that might be causing tight quadriceps. Quadriceps stretches will be a little more comfortable after warming up. A few minutes of walking or biking will warm the quadriceps muscles to stretch more easily.

Stretches

To stretch the quadriceps, try the standing, side-lying, and prone quadriceps stretch once fully warmed up and after a workout. Individuals who frequently experience quadriceps tightness should stretch them daily. Incorporate all or some of these stretches into a cool-down or off-day flexibility routine.

Standing Stretch

The standing quadriceps stretch can be done anywhere in the office, gym, or outside. All you need is a place to stand. Here is how:

  • While standing, hold onto a countertop or back of a chair to help with balance.
  • Bend your knee by grasping your ankle.
  • Move your foot toward your buttocks.
  • Gently pull on your ankle to bend your knee as far as possible.
  • Maintain position for 30 seconds.
  • Return to the standing position.
  • Repeat the exercise 3 to 5 times with each leg.
  • Stop stretching if there are any sharp pains.

Side-Lying Stretch

The side-lying quad stretch lengthens the quadriceps. On the floor in a supported position can help focus on the stretch. Here’s how:

  • Lie on your side.
  • Bend the knee of your top leg as far as you can, gently pulling with your hand.
  • Maintain position for 30 seconds.
  • Return to the starting position.
  • Repeat the exercise 3 to 5 more times with each leg.

Prone Stretch

Stretch the quadriceps while lying on your stomach. In this position, the floor helps to stabilize the pelvis, minimizing rocking and maximizing the stretch. To do the stretch:

  • Lie on your stomach.
  • Bend your knee back as far as you are able.
  • Grab your ankle to pull your foot toward your buttocks.
  • Maintain position for 30 seconds.
  • Return to the starting position.
  • Repeat the exercise 3 to 5 more times with each leg.

If you have difficulty reaching your ankle, pull the leg up, wrap a towel or strap around the ankle, and use it to pull. This can help stretch the quadriceps effectively even if you cannot reach the ankle easily.

Injury Medical Chiropractic & Functional Medicine Clinic

Consult a healthcare provider or physical therapist to learn the recommended quadriceps stretches or other strengthening exercises. Keeping the quadriceps healthy will help keep the knees moving and maximize functional mobility. 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 For Leg Instability

References

International Sports Sciences Association. (2023). How to Release Tight Quads in 2 Simple Steps. ISSA. https://www.issaonline.com/blog/post/how-to-release-tight-quads-in-2-simple-steps

Olivencia, O., Godinez, G. M., Dages, J., Duda, C., Kaplan, K., Kolber, M. J., Kaplan, & Kolber (2020). THE RELIABILITY AND MINIMAL DETECTABLE CHANGE OF THE ELY AND ACTIVE KNEE EXTENSION TESTS. International journal of sports physical therapy, 15(5), 776–782. https://doi.org/10.26603/ijspt20200776

By Dr. Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP 0 Comments Physio, Sleep Hygiene, Therapy , , , , , , , , , , , , , , , , , , ,

Sleep Cervical Neck Roll for Better Rest

Could making their own cervical neck roll help relieve pain and improve sleep for individuals who have neck pain after sleeping or during sleep?

Sleep Cervical Neck Roll

Neck pain can lead to sleep loss, leading to various health problems. Neck pain and everything that comes with it can limit the ability to work, drive, or sleep normally. A cervical roll may be one way to keep your neck in the optimal position while sleeping. Many with neck pain require extra support from their pillow. A cervical pillow can provide that support.

For individuals who develop neck pain, a visit to a chiropractic physical therapist can help manage symptoms. Treatments and modalities like traction may be necessary to relieve pressure on cervical nerves. (Gudavalli M. R. et al., 2015) Steps to self-manage neck pain may include performing specific neck exercises and maintaining proper posture (Hesby B. B. et al., 2019). Using the right pillow with the right support can help keep the neck in correct alignment, decrease or eliminate neck pain, and get you back to normal activities.

Neck Support During Sleep

The neck comprises seven vertebrae bones, normally forming a slight curve called lordosis. Maintaining a forward curve in the neck is important when treating neck pain, as it can help relieve pressure on spinal discs and nerves. A cervical roll, also known as a neck roll or cervical pillow, is a small pillow placed in the pillowcase that supports the neck while sleeping. The cervical roll provides the right amount of support for the neck and maintains alignment while lying down. (Gross A. R. et al., 2013)

  • Individuals can purchase a cervical roll online or at a store or pharmacy.
  • Individuals can also contact a physical therapist to help them obtain a cervical roll.

Making Your Own

Making a cervical roll is simple to do. Here’s how:

  • Using a hand towel.
  • Fold it in half.
  • Slide the towel into the pillowcase along the lower edge.
  • Be sure the towel is tucked in so it doesn’t slip out.
  • Individuals can place tape around it so it stays in the rolled shape.

The towel roll will also help support the neck when lying on one side or the other, filling in the space between the head and shoulder. Sleeping on the stomach is usually not recommended for neck pain. Exercise and postural correction training are essential components of treatment for neck pain, and finding the right sleeping posture can help quickly eliminate pain. (Harvard Publishing, 2022)

If neck pain persists, worsens, or is accompanied by arm weakness or numbness and tingling, a visit to a healthcare provider may be necessary to assess the cause. A visit to a local chiropractic physical therapist can also help. They can immediately show you how to treat neck pain.

Injury Medical Chiropractic & Functional Medicine Clinic

A cervical roll can give your neck the right support while sleeping. This can help you quickly and safely manage neck pain and return to your previous level of function. 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.

The Road To Recovery: Chiropractic Care

References

Gudavalli, M. R., Salsbury, S. A., Vining, R. D., Long, C. R., Corber, L., Patwardhan, A. G., & Goertz, C. M. (2015). Development of an attention-touch control for manual cervical distraction: a pilot randomized clinical trial for patients with neck pain. Trials, 16, 259. https://doi.org/10.1186/s13063-015-0770-6

Hesby, B. B., Hartvigsen, J., Rasmussen, H., & Kjaer, P. (2019). Electronic measures of movement impairment, repositioning, and posture in people with and without neck pain-a systematic review. Systematic reviews, 8(1), 220. https://doi.org/10.1186/s13643-019-1125-2

Gross, A. R., Kaplan, F., Huang, S., Khan, M., Santaguida, P. L., Carlesso, L. C., Macdermid, J. C., Walton, D. M., Kenardy, J., Söderlund, A., Verhagen, A., & Hartvigsen, J. (2013). Psychological Care, Patient Education, Orthotics, Ergonomics, and Prevention Strategies for Neck Pain: A Systematic Overview Update as Part of the ICON Project. The open orthopaedics journal, 7, 530–561. https://doi.org/10.2174/1874325001307010530

Harvard Health Publishing. (2022). Say “good night” to neck pain. https://www.health.harvard.edu/pain/say-good-night-to-neck-pain

By Dr. Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP 0 Comments Diet , , , , , , , , , , ,

Pineapple Benefits: Nutritional Value and Uses



Find out why pineapple is a superfood, rich in nutrients and perfect for enhancing your health and wellness.

Introduction

In the pursuit of optimal health, diet plays a pivotal role in modulating inflammation, pain, and musculoskeletal function. A well-balanced diet rich in fruits and vegetables provides essential vitamins, minerals, and antioxidants necessary for cellular repair, immune function, and overall wellness. One fruit, in particular, has gained attention for its potent anti-inflammatory properties—pineapple (Ananas comosus L.). This tropical fruit is not only a delicious addition to a balanced diet but also a powerful natural remedy for inflammation-related conditions.

As a nurse practitioner specializing in physical medicine, functional medicine, and identity formation, I have observed firsthand the impact that dietary choices have on pain management and inflammation control. This article will explore the nutritional benefits of pineapple, its role in inflammation reduction, and how to incorporate it effectively into a patient’s diet.

The Nutritional Powerhouse: Pineapple

Pineapple is more than a refreshing fruit—it is a nutritional powerhouse loaded with essential vitamins, minerals, and bioactive compounds. This tropical fruit originated in South America and has been used in traditional medicine for centuries due to its potent medicinal properties. Pineapple is particularly rich in:

  • Vitamin C: An essential antioxidant that supports immune function, collagen synthesis, and tissue repair.
  • Manganese: Crucial for bone health, metabolic function, and enzymatic reactions.
  • B Vitamins (B1 & B6): Play a key role in energy production, brain function, and nervous system health.
  • Copper: Supports cardiovascular health and enzymatic reactions.

Nutritional Breakdown (Per One Cup of Fresh Pineapple, ~165g):

  • Calories: 82 kcal
  • Carbohydrates: 22g
  • Fiber: 2.3g
  • Sugars: 16g
  • Protein: 1g
  • Vitamin C: 131% of the Daily Value (DV)
  • Manganese: 76% of the DV
  • Vitamin B6: 9% of the DV
  • Copper: 9% of the DV
  • Thiamine (B1): 9% of the DV

Bromelain: The Anti-Inflammatory Enzyme

One of the key components that make pineapple an effective anti-inflammatory food is bromelain, a proteolytic enzyme found predominantly in the fruit’s core and stem. Bromelain has been widely studied for its ability to modulate immune function and reduce inflammation by inhibiting pro-inflammatory cytokines and mediators.

Mechanisms of Bromelain in Inflammation Reduction:

  1. Inhibits NF-KappaB Pathway: Suppresses the activation of NF-KappaB, a transcription factor responsible for promoting inflammatory gene expression.
  2. Reduces Pro-Inflammatory Cytokines: Downregulates IL-1β, IL-6, and TNF-α, key mediators in chronic inflammation.
  3. Enhances Fibrinolytic Activity: Facilitates the breakdown of fibrin, improving circulation and reducing edema formation.
  4. Supports Digestive Health: Aids in protein digestion, reducing gut inflammation and promoting better nutrient absorption.

Clinical Applications of Pineapple for Musculoskeletal Health

Pineapple’s anti-inflammatory effects make it a valuable addition to the diet for patients suffering from various musculoskeletal conditions, including:

  • Osteoarthritis & Rheumatoid Arthritis: Reduces joint swelling, stiffness, and pain by decreasing inflammatory markers.
  • Post-Exercise Recovery: Accelerates muscle repair and reduces soreness by mitigating exercise-induced inflammation.
  • Tendinitis & Bursitis: Aids in reducing localized inflammation and promoting faster healing.
  • Soft Tissue Injuries: Supports tissue regeneration in strains, sprains, and ligament injuries.

Additional Health Benefits of Pineapple

Beyond its anti-inflammatory properties, pineapple offers several other health benefits:

  1. Boosts Immune Function: High vitamin C content enhances immune defense against infections and oxidative stress.
  2. Supports Cardiovascular Health: Bromelain helps prevent blood clot formation and supports healthy circulation.
  3. Aids in Weight Management: Low in calories and rich in fiber, pineapple promotes satiety and supports metabolic function.
  4. Enhances Digestive Health: Bromelain improves protein digestion and reduces gut inflammation, aiding individuals with digestive disorders.
  5. Combats Oxidative Stress: Rich in antioxidants, pineapple protects cells from free radical damage, reducing the risk of chronic diseases.

Fighting Inflammation Naturally- Video

Incorporating Pineapple into a Healthy Diet

Pineapple is an incredibly versatile fruit that can be enjoyed in numerous ways to maximize its health benefits. Here are some simple and delicious ways to incorporate pineapple into a patient’s daily routine:

  • Fresh: Add chunks to salads, yogurt, or smoothies for an antioxidant boost.
  • Frozen: Freeze pineapple pieces for a refreshing snack or blend them into smoothies.
  • Grilled: Grilling pineapple enhances its natural sweetness and pairs well with lean proteins like chicken or fish.
  • Juiced: Fresh pineapple juice can be a hydrating and nutrient-rich beverage.
  • Stir-Fried: Incorporate pineapple into stir-fries for a touch of natural sweetness.

Best Practices for Maximizing Bromelain Benefits

To retain the highest level of bromelain and other beneficial compounds in pineapple, consider the following:

  • Consume Fresh Over Canned: Canned pineapple often contains added sugars and loses some enzyme activity due to processing.
  • Include the Core: The highest concentration of bromelain is found in the core, so consider blending or juicing it rather than discarding.
  • Pair with Anti-Inflammatory Foods: Combine pineapple with turmeric, ginger, or leafy greens for enhanced anti-inflammatory effects.

Considerations and Precautions

While pineapple offers numerous health benefits, some individuals should exercise caution:

  • Allergies: Some individuals may be allergic to bromelain, particularly those with latex allergies.
  • Acidic Nature: Pineapple’s acidity may cause discomfort in individuals with acid reflux or sensitive stomachs.
  • Medication Interactions: Bromelain may enhance the effects of blood thinners and certain antibiotics, requiring consultation with a healthcare provider before regular consumption.

Conclusion

Pineapple is more than just a tropical delight—it is a potent anti-inflammatory food with profound benefits for musculoskeletal health, digestion, and immune support. As a nurse practitioner with two decades of experience in physical and functional medicine, I strongly advocate for dietary interventions as a cornerstone of holistic patient care. Encouraging patients to incorporate pineapple into their diet can be a simple yet effective strategy for reducing inflammation, improving joint health, and enhancing overall wellness.

By making small, evidence-based dietary changes, patients can experience significant improvements in their health outcomes. When combined with other lifestyle modifications, such as physical activity, stress management, and adequate hydration, pineapple can play a crucial role in optimizing musculoskeletal function and quality of life.

For personalized dietary recommendations and integrative treatment plans, consult with a qualified healthcare provider who specializes in functional and physical medicine. By leveraging the power of nutrition, we can help patients achieve long-term health and vitality.

Injury Medical & Functional Medicine Clinic

We associate with certified medical providers who understand the importance of incorporating anti-inflammatory foods to reduce the inflammatory effects from affecting the body. When asking important questions to our associated medical providers, we advise patients to implement small changes to their daily routine, like incorporating pineapple into a healthy diet, which can reduce the inflammatory effects in the body. Dr. Alex Jimenez, D.C., utilizes this information as an academic service. Disclaimer.

References

Arulselvan, P., Fard, M. T., Tan, W. S., Gothai, S., Fakurazi, S., Norhaizan, M. E., & Kumar, S. S. (2016). Role of Antioxidants and Natural Products in Inflammation. Oxid Med Cell Longev, 2016, 5276130. https://doi.org/10.1155/2016/5276130

Hikisz, P., & Bernasinska-Slomczewska, J. (2021). Beneficial Properties of Bromelain. Nutrients, 13(12). https://doi.org/10.3390/nu13124313

Kansakar, U., Trimarco, V., Manzi, M. V., Cervi, E., Mone, P., & Santulli, G. (2024). Exploring the Therapeutic Potential of Bromelain: Applications, Benefits, and Mechanisms. Nutrients, 16(13). https://doi.org/10.3390/nu16132060

Kumar, V., Garg, V., & Dureja, H. (2023). Therapeutic Application of Pineapple: A Review. Recent Adv Food Nutr Agric, 14(2), 107-125. https://doi.org/10.2174/2772574X14666230522114039

Mohd Ali, M., Hashim, N., Abd Aziz, S., & Lasekan, O. (2020). Pineapple (Ananas comosus): A comprehensive review of nutritional values, volatile compounds, health benefits, and potential food products. Food Res Int, 137, 109675. https://doi.org/10.1016/j.foodres.2020.109675

Seenak, P., Kumphune, S., Malakul, W., Chotima, R., & Nernpermpisooth, N. (2021). Pineapple consumption reduced cardiac oxidative stress and inflammation in high cholesterol diet-fed rats. Nutr Metab (Lond), 18(1), 36. https://doi.org/10.1186/s12986-021-00566-z

Disclaimer

By Dr. Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP 0 Comments Exercises, Sleep Hygiene , , , , , , , , , , , , , , , , , ,

Exercising Before Bed: Impact on Your Sleep Cycle

What type of exercise is recommended for individuals who want to exercise before bed?

Exercising Before Bed

Exercising sounds like a good way to tire the mind and body before bed. However, research shows that moderate to vigorous exercise later in the day can negatively impact sleep quality. (Alkhaldi E. H. et al., 2023)

  • To improve sleep, it is recommended that you exercise in the morning or earlier in the day, at least four hours before bed.
  • Individuals who exercise later should aim for lighter activities, such as non-strenuous walking or gentle, restorative yoga.
  • Light physical activity, like a slow walk after dinner, is OK.

Advantages

Daily exercise improves sleep quality. (Johns Hopkins Medicine, 2025) Mild exercise before bed and engaging in light activities like walking or stretching can positively affect health (Hijikata Y, Yamada S. 2011). These include:

  • Decrease muscle tension
  • Improve digestion
  • Improve blood sugar regulation
  • Relax the mind and body

Disadvantages

The nervous system naturally switches between active and calm. It is ready to work and engage in physical activities when it is active. When it is resting, sleep occurs. Activating the nervous system before bed can affect sleep, and exercising can affect body temperature, producing sleep challenges. Typically, body temperature decreases as the body prepares for sleep. Exercising before bed can increase core temperature and disrupt the process. (Szymusiak R. 2018) Moderate or vigorous physical activity close to going to sleep can: (Alkhaldi E. H. et al., 2023)

  • Make it more difficult to fall asleep
  • This leads to more waking up during the night.
  • Decrease sleep quality

Recommended Types of Exercise

Pre-bedtime activities should not be vigorous or engaging enough to make the body and mind more alert. Some exercises to calm the body and mind before bed include: (Sleep Foundation, 2023)

Restorative Yoga

  • Yoga Nidra and other low-intensity yoga can help promote sleep.
  • More intense forms of yoga, such as vinyasa/flow, should be done earlier.

Tai Chi

  • A Chinese practice that incorporates slow, gentle movements and focuses on breathing to promote peace and relaxation.

Slow Walking

  • Walking at a leisurely pace can help the body unwind and relax.

A slow heart rate and breathing indicate that the activity is calming and not stimulating.

Exercises to Avoid

Moderate to high-intensity workouts before bed that increase breathing and heart rate can disrupt sleep. Individuals who struggle to fall asleep or get restful sleep should try reducing the intensity of certain exercises or avoiding them one to two hours before bed. Examples of moderate to vigorous exercises include: (American Heart Association, 2024)

  • Gardening or heavy yard work
  • Running
  • Brisk walking
  • Cycling
  • Dancing
  • Sports activities

Working Out In The Evening

Sometimes, exercising later in the day or close to bedtime is the only time to get physical activity. If this is the case, late exercise is better than no exercise at all, but there are ways to lessen its impact on sleep, including:

  • Light physical activity, like walking, can be done up to an hour before bed.
  • Do more intense exercises at the beginning of the workout.
  • End the workout with a cooldown, like walking or stretching, to relax the mind and body.
  • Know how your workout schedule impacts your sleep, and adjust as necessary.

How Long After Working Out to Go To Sleep?

For individuals who want restful and uninterrupted sleep, experts recommend waiting one to two hours after a moderate or vigorous workout to go to bed. (Harvard Health Publishing, 2024) (Johns Hopkins Medicine, 2025)

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.

Optimizing Your Wellness

References

Alkhaldi, E. H., Battar, S., Alsuwailem, S. I., Almutairi, K. S., Alshamari, W. K., & Alkhaldi, A. H. (2023). Effect of Nighttime Exercise on Sleep Quality Among the General Population in Riyadh, Saudi Arabia: A Cross-Sectional Study. Cureus, 15(7), e41638. https://doi.org/10.7759/cureus.41638

Johns Hopkins Medicine. (2025). Exercising for better sleep. https://www.hopkinsmedicine.org/health/wellness-and-prevention/exercising-for-better-sleep

Hijikata, Y., & Yamada, S. (2011). Walking just after a meal seems to be more effective for weight loss than waiting for one hour to walk after a meal. International journal of general medicine, 4, 447–450. https://doi.org/10.2147/IJGM.S18837

Szymusiak R. (2018). Body temperature and sleep. Handbook of clinical neurology, 156, 341–351. https://doi.org/10.1016/B978-0-444-63912-7.00020-5

Sleep Foundation. (2023). Bedtime routines for adults. https://www.sleepfoundation.org/sleep-hygiene/bedtime-routine-for-adults

American Heart Association. (2024). American Heart Association recommendations for physical activity in adults and kids. https://www.heart.org/en/healthy-living/fitness/fitness-basics/aha-recs-for-physical-activity-in-adults

Harvard Health Publishing. (2024). Does exercising at night affect sleep? https://www.health.harvard.edu/staying-healthy/does-exercising-at-night-affect-sleep

By Dr. Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP 0 Comments Chiropractic Care, Physio, Therapy , , , , , , , , , , , , , , , , ,

Lidocaine Patch for Pain Relief: An Overview

For individuals experiencing lower back pain and sciatica symptoms, can using a lidocaine patch help?

Lidocaine Patch

Lidocaine patches are in a drug class called local anesthetics (MedlinePlus, 2025) (Food and Drug Administration, 2022). They relieve pain in small body areas by blocking the nerves from sending pain signals. The Food and Drug Administration approved lidocaine 5% or 1.8% patches for relieving postherpetic neuralgia (PHN) pain. These lidocaine patches are prescription-only (Food and Drug Administration, 2022). They are available either by prescription or over the counter and are commonly used for back pain and other areas. Over-the-counter lidocaine, 4% patches, can be used to relieve minor aches and pains, including back pain. However, further research is needed to recommend the use of lidocaine patches as an effective method of pain relief. (Department of Veterans Affairs/Department of Defense, 2022) (North American Spine Society, 2020)

The Patch

They are available in prescription and over-the-counter forms. Over-the-counter forms come as a 4% patch in various brands, such as (MedlinePlus, 2025)

  • Aspercreme
  • Lidocare
  • Salonpas

Prescription-only patches come in 5% or 1.8% patches and are approved to relieve long-term nerve pain from shingles in adults. Zlido is a brand name for a 1.8% lidocaine patch. Five percent lidocaine patches are available generically. (DailyMed, 2018) (Food and Drug Administration, 2021) The safety and effectiveness in children are unknown. (Food and Drug Administration, 2022)

Other Lidocaine Forms

As a local anesthetic, it is available in several other forms, including:

  • Spray
  • Topical cream
  • Lotion
  • Liquid
  • Ear drops
  • Eye gel
  • Injection
  • It is also available as a short-term intravenous infusion for abnormal heart rhythm. (DailyMed, 2025)

Effectiveness

Clinical trials have shown that the patches effectively relieve chronic low back pain. However, these studies were nonrandomized and did not include a control group to compare against the treatment group. (Santana J. A., Klass S., & Felix E. R. 2020) The results may be subject to potential biases. For this reason, further evidence is needed to support lidocaine patches’ effectiveness in reducing low back pain. (North American Spine Society, 2020) High-quality randomized and controlled clinical trials are necessary to study the effectiveness. (North American Spine Society, 2020) (Santana J. A., Klass S., & Felix E. R. 2020)

How to Use Safely

In general, keep the following in mind (MedlinePlus, 2025)

  • Use according to the directions on the box and the healthcare provider’s recommendations.
  • Do not use on broken or inflamed, swollen skin.
  • Do not apply heat like heating pads or electric blankets over patches.
  • Avoid getting water on or around the patch.
  • Avoid letting a patch near your eyes to limit eye irritation.
  • Fold the sticky sides of the used lidocaine patches together and safely throw them away, keeping them away from children and pets.

How to use (MedlinePlus, 2025)

  • Clean and dry the affected area before placing the patch.
  • Apply to the affected body area as directed.
  • Wash your hands after touching the patch.
  • Remove the patch after what is usually recommended after eight hours.

How Quickly Does It Work?

The amount of medication absorbed into the blood depends on how long the patch is placed on the body and how much is covered with the patch. In a study, healthy participants wore three lidocaine patches on their backs for 12 hours on and 12 hours off during 24 hours. Lidocaine levels were highest at 11 hours. At the end of the 24 hours, there was still some lidocaine left in the bloodstream. (Food and Drug Administration, 2022)

Individuals with PHN may notice a difference in pain intensity after four hours of using the patch. (Rowbotham, M. C. et al., 1996) (Food and Drug Administration, 2022) Experts may suggest using patches for four weeks for those who experience pain after their shingles rash disappears. However, if there is still pain after these four weeks, it is recommended to see a pain specialist. (Gross, G. E. et al., 2020)

Side Effects

Common side effects are typically mild skin reactions where the patch is.  These reactions are usually temporary and will disappear within a few minutes or hours. Examples include: (Food and Drug Administration, 2022)

  • Irritation
  • Itchiness
  • Abnormal or burning sensation
  • Redness
  • Swelling
  • Blisters
  • Bruises
  • Skin bumps
  • Skin color changes
  • Skin peeling

Potentially serious side effects include: (Food and Drug Administration, 2022)

Serious Allergic Reaction

  • Severe allergic reactions are rare, but it is possible.
  • Symptoms include breathing problems, itchiness, and rash.

Methemoglobinemia

  • Methemoglobinemia is a condition that makes it hard for red blood cells to carry oxygen.
  • Individuals may experience symptoms of blue-looking skin, headache, lightheadedness, shortness of breath, abnormal heart rhythm, or seizures.

Using too many lidocaine patches to cover large parts of the body or using the patches longer than 12 hours within 24 hours may cause side effects that may include heart-related effects, such as a slow heart rate and low blood pressure.  Individuals may also experience the following side effects (Food and Drug Administration, 2022)

  • Hot or cold sensation
  • Numbness
  • Dizziness
  • Ringing ears
  • Lightheadedness
  • Mood changes
  • Drowsiness to unconsciousness
  • Vision changes
  • Seizures
  • Tremors
  • Vomiting

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.

Sciatica Causes and Treatments

References

National Library of Medicine. MedlinePlus. (2025). Lidocaine transdermal patch. Retrieved from https://medlineplus.gov/druginfo/meds/a603026.html

Food and Drug Administration. (2022). Lidoderm label. Retrieved from https://www.accessdata.fda.gov/spl/data/eedfe43b-1019-19a0-e053-2995a90a7696/eedfe43b-1019-19a0-e053-2995a90a7696.xml

Department of Veterans Affairs/Department of Defense. (2022). VA/DoD clinical practice guideline for the diagnosis and treatment of low back pain. Retrieved from https://www.healthquality.va.gov/guidelines/Pain/lbp/VADoDLBPCPGFinal508.pdf

North American Spine Society. (2020). Evidence-based clinical guidelines for multidisciplinary spine care: diagnosis and treatment of low back pain. https://www.spine.org/Portals/0/assets/downloads/ResearchClinicalCare/Guidelines/LowBackPain.pdf

National Library of Medicine. DailyMed. (2018). Label: lidocaine patch. Retrieved from https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=5c66f3b9-6e04-47ab-8d94-21e89ceec154

Food and Drug Administration. (2021). Ztlido label. Retrieved from https://www.ztlido.com/wp-content/uploads/2022/12/ZTlido-LABEL.pdf

National Library of Medicine. DailyMed. (2025). Lidocaine-lidocaine hydrochloride injection, solution. Retrieved from https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=f1b26274-a55e-4321-b96c-ce0df830f205

Santana, J. A., Klass, S., & Felix, E. R. (2020). The Efficacy, Effectiveness and Safety of 5% Transdermal Lidocaine Patch for Chronic Low Back Pain: A Narrative Review. PM & R: the journal of injury, function, and rehabilitation, 12(12), 1260–1267. https://doi.org/10.1002/pmrj.12366

Rowbotham, M. C., Davies, P. S., Verkempinck, C., & Galer, B. S. (1996). Lidocaine patch: double-blind controlled study of a new treatment method for post-herpetic neuralgia. Pain, 65(1), 39–44. https://doi.org/10.1016/0304-3959(95)00146-8

Gross, G. E., Eisert, L., Doerr, H. W., Fickenscher, H., Knuf, M., Maier, P., Maschke, M., Müller, R., Pleyer, U., Schäfer, M., Sunderkötter, C., Werner, R. N., Wutzler, P., & Nast, A. (2020). S2k guidelines for the diagnosis and treatment of herpes zoster and postherpetic neuralgia. Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology: JDDG, 18(1), 55–78. https://doi.org/10.1111/ddg.14013

By Dr. Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP 0 Comments Advanced Practice Registered Nurses (APRN) , , , , , , , , , , ,

A Clinical Approach To Identity Formation and Its Benefits

Uncover insights into the clinical approach of identity formation and its impact on personal identity and therapeutic practices.

Introduction

In the realm of physical and functional medicine, healthcare professionals often encounter patients grappling with musculoskeletal, autoimmune, and gastrointestinal issues that not only affect their physiological health but also influence their self-perception and identity. Identity formation is a crucial aspect of patient care, particularly when addressing chronic conditions that require long-term management. By fostering a patient-centered, integrative approach, we can enhance treatment adherence, improve patient satisfaction, and promote overall well-being. In this article, we will explore the theories of identity formation, its impact on health, and how physical and functional medicine practitioners can support patients through this complex process.

Understanding Identity Formation

Identity is a dynamic, evolving construct composed of personal beliefs, values, experiences, and social influences. It is not an imposed characteristic but rather a developmental process that begins in childhood and continues throughout life. According to Erik Erikson’s psychosocial theory, identity formation is a central challenge of adolescence but remains relevant across the lifespan as individuals face new challenges and experiences.

Erikson’s Stages and Role Confusion

Erikson (1968) described identity versus role confusion as a critical developmental stage during adolescence. Failure to establish a stable identity can result in uncertainty, anxiety, and difficulties in decision-making. In healthcare settings, patients experiencing chronic illness or injury may face disruptions in their self-concept, leading to emotional distress and noncompliance with treatment regimens.

The Four Identity Statuses

Building on Erikson’s work, James Marcia (1966) identified four identity statuses that describe how individuals respond to identity crises:

  1. Foreclosure – Commitment to an identity without exploration. Often seen in patients who unquestioningly accept medical diagnoses or treatment plans without personal reflection.
  2. Identity Diffusion – Lack of exploration or commitment. Patients in this category may struggle with treatment adherence and avoid making lifestyle changes.
  3. Moratorium – Active exploration without commitment. These individuals seek multiple opinions and alternative treatments before settling on a healthcare plan.
  4. Identity Achievement – A well-established sense of self after thorough exploration. Patients in this stage are more likely to actively participate in their healthcare and make informed decisions.

Understanding these identity statuses allows practitioners to tailor communication strategies and treatment plans to improve patient engagement and outcomes.

Understanding The Effects Of Personal Injury- Video

The Role of Identity Formation in Health and Medicine

Identity formation is intricately linked to health behaviors and treatment compliance. Several key areas of identity development impact a patient’s perception of illness and approach to recovery:

1. Religious Identity

Religious beliefs can shape health behaviors, including dietary choices, use of complementary and alternative medicine, and attitudes toward medical interventions. Patients with strong religious identities may require culturally sensitive approaches to treatment planning.

2. Political Identity

Political beliefs can influence trust in the medical system, perceptions of public health initiatives, and willingness to participate in preventative care programs. A nuanced understanding of a patient’s political stance can inform communication strategies.

3. Vocational Identity

For patients whose identities are closely tied to their professions, injury or chronic illness can lead to significant psychological distress. Functional medicine practitioners can help these individuals by providing rehabilitative strategies that align with their professional goals.

4. Ethnic and Racial Identity

Ethnic identity plays a role in health disparities, access to care, and patient-practitioner relationships. A culturally competent approach ensures that treatment plans are respectful and inclusive of a patient’s background and experiences.

5. Gender Identity

Gender identity can influence mental health, healthcare access, and responses to treatment. Functional medicine practitioners should adopt an inclusive and affirming approach to gender-diverse patients to foster trust and cooperation in care plans.

Self-Concept and Chronic Disease Management

Self-concept encompasses an individual’s self-perception, including self-esteem and self-efficacy. Patients with chronic conditions may experience a shift in self-concept as they adjust to new limitations and healthcare routines.

  • Self-Esteem: Patients with high self-esteem are more likely to take proactive steps toward their health, while those with low self-esteem may struggle with self-care and motivation.
  • Self-Efficacy: Belief in one’s ability to manage a condition correlates with better health outcomes. Encouraging self-efficacy through patient education and empowerment techniques is a cornerstone of functional medicine.

Strategies for Supporting Identity Formation in Healthcare

1. Patient-Centered Communication

Healthcare providers should engage in open, empathetic dialogue to understand a patient’s identity and how it shapes their health behaviors. Motivational interviewing techniques can help patients explore their values and commit to health-promoting behaviors.

2. Holistic Treatment Planning

Functional medicine emphasizes a personalized approach to care. By integrating lifestyle medicine, nutrition, physical rehabilitation, and mind-body interventions, practitioners can address both physical and psychological aspects of identity formation.

3. Behavioral and Cognitive Interventions

Chronic pain, autoimmune disorders, and other long-term conditions can lead to identity disruptions. Cognitive-behavioral strategies, mindfulness-based interventions, and resilience training can help patients adapt to their new realities while maintaining a positive self-concept.

4. Interdisciplinary Collaboration

Incorporating insights from psychology, physical therapy, nutrition, and chiropractic care creates a comprehensive support system for patients navigating identity shifts due to health changes.

Conclusion

Identity formation is an integral component of patient-centered care, particularly in physical and functional medicine. Understanding how identity shapes health perceptions and behaviors allows practitioners to design personalized, effective treatment plans that enhance both physical health and psychological resilience. By fostering self-awareness and empowering patients to take control of their health, we not only improve clinical outcomes but also contribute to a more holistic, human-centered healthcare model.

If you or a patient are navigating health-related identity challenges, consulting with a functional medicine practitioner who understands the complexities of identity formation can be an invaluable step toward healing and self-discovery.

Injury Medical & Functional Medicine Clinic

We associate with certified medical providers who understand the importance of identity formation when assessing individuals dealing with various pain-like symptoms within their bodies. When asking important questions to our associated medical providers, we advise patients to implement small changes to their daily routine to reduce the pain-like symptoms associated with body pains. Dr. Alex Jimenez, D.C., utilizes this information as an academic service. Disclaimer.

References

Kim-Spoon, J., Longo, G. S., & McCullough, M. E. (2012). Parent-adolescent relationship quality as a moderator for the influences of parents’ religiousness on adolescents’ religiousness and adjustment. J Youth Adolesc, 41(12), 1576-1587. https://doi.org/10.1007/s10964-012-9796-1

Koo, H.-Y., & Kim, E.-J. (2016). Vocational Identity and Ego Identity Status in Korean Nursing Students. Asian Nursing Research, 10(1), 68-74. https://doi.org/10.1016/j.anr.2015.11.001

Marcia, J. E. (1966). Development and validation of ego-identity status. J Pers Soc Psychol, 3(5), 551-558. https://doi.org/10.1037/h0023281

Marcia, J. E. (1967). Ego identity status: relationship to change in self-esteem, “general maladjustment,” and authoritarianism. J Pers, 35(1), 118-133. https://doi.org/10.1111/j.1467-6494.1967.tb01419.x

Stattin, H., Hussein, O., Ozdemir, M., & Russo, S. (2017). Why do some adolescents encounter everyday events that increase their civic interest whereas others do not? Dev Psychol, 53(2), 306-318. https://doi.org/10.1037/dev0000192

Wagner, J. A. (1987). Formal operations and ego identity in adolescence. Adolescence, 22(85), 23-35. https://www.ncbi.nlm.nih.gov/pubmed/3591499

Disclaimer

By Dr. Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP 0 Comments Acupuncture, Chiropractic Care, Therapy , , , , , , , , , , , , , , , , ,

What to Wear to Physical Therapy and Why It Matters

Individuals with difficulty with normal functional mobility after surgery, injury, or illness may be referred to physical therapy during recovery. A common question patients have before treatment is: What should they wear to the physical therapy appointment?

What To Wear To Physical Therapy?

Individuals referred to physical therapy usually have questions about what to expect and how to prepare. What to wear is a common question and is important because patients want to wear the right physical therapy outfit for their specific condition and feel comfortable and safe at their physical therapy appointments. A treatment plan may include exercise and stretching. Clothing recommendations may vary slightly depending on the type of physical therapy the patient is receiving; it is recommended to wear:

  • Athletic wear like t-shirts, shorts, yoga pants, and comfortable shoes like sneakers.
  • Sometimes, exercises are performed, and modalities such as heat, cold, or electrical stimulation are applied.
  • Comfortable, loose-fitting clothing allows for a full range of motion and easy access to the affected area.

Physical Therapy

  • The therapist will examine the patient’s mobility and flexibility.
  • Exercises may be prescribed, and therapeutic modalities, like ice or heat, may be applied.
  • Wearing the right clothing can make the therapy experience highly effective and productive.

This way, therapy sessions go smoothly, and there is a level of comfort and confidence to reach goals quickly.

Upper Body Neck, Shoulders, Arms, Back

For upper body injuries, wear clothing that provides access and mobility to the areas affected, such as the neck, shoulders, arms, or back.

  • For neck pain, wear a shirt that allows the therapist to see the neck, shoulders, and upper back, such as a loose, open T-shirt with a scoop neck, V-neck, or tank top.
  • For long hair, bring a hair tie.
  • Women are recommended to wear a sports bra.
  • For an arm, wrist, or hand injury, wear a loose-fitting shirt with the arms exposed.
  • Tight shirts like those made from Lycra are not advisable because the therapist cannot effectively evaluate and treat the injury if the patient wears something tight.

Lower Body, Hips, Legs, Knees

For lower extremity problems and injuries, wear clothing that allows free movement to exercise while allowing the therapist to visualize and examine the back, hips, knees, and legs.

  • Wear a T-shirt, sports bra, and shorts or pants with an elastic waistband for back, lower spine, or pelvis injuries.
  • For hip pain, the therapist should be able to see and adjust the spine and hips.
  • Avoid wearing tight-fitting pants that don’t allow for full movement.
  • Shorts with an elastic waistband are recommended.
  • Leggings may not roll up easily.

Feet and Ankles

For a foot or ankle injury, the therapist will want to observe the patient walk in shoes and bare feet for conditions like plantar fasciitis or ankle sprains. For any lower extremity condition, expect some light or heavy exercise. Wear socks to absorb sweat and odor and sneakers or athletic shoes. Avoid open-toed sandals, high heels, or casual lightweight footwear like Crocs.

Other Considerations

Avoid

  • Bracelets and necklaces
  • Turtleneck shirts
  • Tight-fitting long-sleeved shirts
  • Leggings
  • Sandals

When preparing for appointments, consider your specific condition. Remember that you will likely be exercising, so wear loose, comfortable clothing that allows you to move around freely. If you are coming directly from work or a formal event, ask the office staff if there is a changing room that you can use. It may also be a good idea to avoid wearing dangling jewelry. A necklace or bracelet may get in the way, so be prepared to remove it for your appointments. Therapists can also use draping with towels or pillowcases/sheets to help you feel comfortable when certain body areas are exposed. That way, you can be relaxed and more able to focus on recovery and rehabilitation to return to normal activities.

Injury Medical Chiropractic & Functional Medicine Clinic

If you are unsure if what you plan to wear is appropriate, call the office and ask. If you’re leaving work and need to change, make sure your therapist’s office has a place for you to do that. 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.

Unlocking Pain Relief: How We Assess Motion To Alleviate Pain

By Dr. Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP 0 Comments Diet, Gut Health , , , , , , , , , , , , , , , ,

Apple Cider Vinegar for Health and Wellness

Can individuals take one tablespoon of apple cider vinegar daily and see its health benefits?

Apple Cider Vinegar

Apple cider vinegar is a fermented liquid made from crushed apples. The sugars in the apples are converted to alcohol by yeast and then to acetic acid by bacteria, resulting in a sour-tasting liquid used in cooking and as a health supplement. Research suggests that consuming one tablespoon diluted in 8 ounces of water may offer various potential health benefits. (University of Texas MD Anderson Cancer Center, 2024)

Daily Consumption

A study found that drinking one tablespoon is enough to provide health benefits (Samad A, Azlan A, Ismail A. 2016)

Digestion

  • Acetic acid may help improve digestion and promote a healthy gut environment.

Weight Management

  • It may help increase feelings of fullness, potentially reducing overall calorie intake.

Blood Sugar Regulation

  • Some studies suggest it can improve insulin sensitivity and help manage blood sugar levels.

Antimicrobial

  • The vinegar possesses antimicrobial effects that may help fight off harmful bacteria.

Heart Health

  • Research indicates it might lower cholesterol and triglycerides or fats in the blood.

Skin Benefits

  • It may help balance skin pH and reduce acne when used in topically diluted form.

Safe Limit

  • Do not exceed two tablespoons daily to avoid side effects such as digestive discomfort. (MedlinePlus, 2024)

The recommended consumption time varies, but the consensus is to drink it before or during mealtime.

Safely Diluting

Apple cider vinegar is considered safe when consumed in small quantities. However, it should not be drunk straight. It is recommended that it be diluted in water before drinking. Each tablespoon should be diluted in 8 ounces of water. Ways to incorporate into your diet include: (University of Texas MD Anderson Cancer Center, 2024)

  • Add it to dishes when cooking
  • Salad dressings
  • Marinades
  • Sauces
  • Pickling

Risks and Side Effects

Apple cider vinegar is a supplement that should not replace prescribed medications or be used to cure any condition. One of the most significant considerations is its interactions with other substances that can alter the effects of one or more substances. Medications that can interact include: (MedlinePlus, 2024)

Insulin

  • Insulin regulates blood sugar levels.
  • Apple cider vinegar can decrease potassium levels.
  • Combined, they can cause potassium levels to be too low, affecting nerve and muscle function, including the heart.

Antidiabetic Meds

  • Both antidiabetic medications and apple cider vinegar lower blood sugar levels.
  • Taking these two together can cause unsafe blood sugar levels.

Diuretic Meds

  • Both apple cider vinegar and diuretic medications lower potassium levels.
  • These medications can cause potassium levels to drop too low when taken together.

Digoxin Heart Medication

  • Apple cider vinegar can lower potassium levels, increasing digoxin’s side effects.

Other side effects can include: (University of Texas MD Anderson Cancer Center, 2024)

  • Upset stomach
  • Esophagus irritation 
  • Tooth enamel erosion

In addition, individuals with kidney conditions may be unable to handle the excess acid from the vinegar. (University of Chicago Medicine, 2018)

Injury Medical Chiropractic & Functional Medicine Clinic

Always contact a healthcare provider before starting a new supplement to ensure it is safe for the individual and their health. 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.

Healthy Diet and Chiropractic

References

University of Texas, MD Anderson Cancer Center. (2024). What are the health benefits of apple cider vinegar? https://www.mdanderson.org/cancerwise/what-are-the-health-benefits-of-apple-cider-vinegar.h00-159696756.html

Samad A, Azlan A, Ismail A. (2016). Therapeutic effects of vinegar: a review. Current Opinion in Food Science, 8, 56-61. https://doi.org/https://doi.org/10.1016/j.cofs.2016.03.001

National Library of Medicine. MedlinePlus. (2024). Apple cider vinegar. Retrieved from https://medlineplus.gov/druginfo/natural/816.html

University of Chicago Medicine. (2018). Debunking the health benefits of apple cider vinegar. https://www.uchicagomedicine.org/forefront/health-and-wellness-articles/debunking-the-health-benefits-of-apple-cider-vinegar

By Dr. Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP 0 Comments Chiropractic Care, Physio , , , , , , , , , , , , , , , , ,

Cobb Angle: From Measurement to Treatment Decisions

The Cobb angle is a mathematical measurement tool for assessing the curvature of the spine. Along with physical exams and other tests, how is it used to evaluate scoliosis and kyphosis of the spine?

Cobb Angle

The Cobb angle is used to quantify the curvature of the spine, particularly in conditions like scoliosis. It measures the degree of side-to-side spinal curvature, a deformity called scoliosis. The angle’s size helps determine what kind of treatment is needed. Monitoring may be all that’s necessary for mild curvature. With severe scoliosis, treatment may require spinal fusion surgery. Named for orthopedic surgery pioneer John Robert Cobb, it describes the distance a scoliotic curve may deviate from being straight. (Botterbush K. S. et al., 2023) Generally, it takes at least 10 degrees of deviation from straight before scoliosis is confirmed.

X-Ray and Interpretation

An X-ray is taken to measure the Cobb angle. Side and back views are taken. The healthcare provider or examiner then views the X-rays and locates the most affected vertebra in the curve, called the apical vertebra. In a scoliotic curve, the apical vertebra is the spinal bone with the greatest degree of rotation that takes the biggest curve away from the center of a normal spine column.

Visualizing the Angle

The apical vertebra is where two lines drawn from the X-rays meet. Two lines are drawn along the edge of the top and bottom bones of the curve. The lines extend out as follows:

  • On the top bone, the line starts on the high side, continues along the top edge, and then slopes down according to the angle of the vertebra. (Jin, C. et al., 2022)
  • On the bottom vertebra, the line starts on the low side, continues along the bottom edge, and slopes upward.
  • The Cobb angle is found by measuring the angle of the two intersecting lines where they meet.

Then, the top and bottom vertebrae of the side-to-side curve are identified to create a number for the Cobb angle. These bones have the most tilt but the least rotation and displacement and are located above and below the apical vertebra. Computer software is commonly used to calculate the Cobb angle. (Jin, C. et al., 2022) Treatment is based on the:

10 Degrees Cobb Angle 

Scoliosis is diagnosed when the Cobb angle reaches 10 degrees or more. However, this is not generally considered a significant curvature (American Association of Neurological Surgeons, 2024). In around 80% of cases, the scoliosis is considered idiopathic or without congenital or other underlying causes.

Less Than 25 Degrees Cobb Angle

If a scoliotic curve is less than 25 degrees, individuals may only need to visit their healthcare provider periodically so long as the scoliosis is monitored. These are mild cases, often without symptoms, but there is a chance that the curvature can progress. This usually means reassessing the Cobb angle every four to six months in a growing child or adolescent. (National Scoliosis Foundation, 2015) A 5-degree or more progression can change the diagnosis and treatment. (Jin, C. et al., 2022)

Between 25 and 40 Degrees Cobb Angle

A Cobb angle of 25 to 40 degrees usually requires wearing a back brace and intensive physical therapy. The goal of these treatments is to help halt the curve’s progression. Braces are generally worn 16 to 23 hours every day. (National Scoliosis Foundation, 2015) The healthcare provider will provide a referral for physical therapy. Many report excellent results with the Schroth or other scoliosis-specific exercise methods. A study found that core stabilization exercise programs can decrease Cobb angles in adolescents with idiopathic scoliosis. (Ko K. J. & Kang S. J. 2017)

Scoliosis in Adults

Scoliosis is diagnosed in adults, usually in those who have had the condition, treated or not, that was identified in their youth. A study that followed various cases for 20 years found disease progression occurred in 40% of adults but was usually less than one degree per year. However, degenerative scoliosis can also occur in individuals aged 65 and older. (American Association of Neurological Surgeons, 2024)

40 Degrees or More Cobb Angle

Surgery may be recommended once the Cobb angle reaches 40 to 50 degrees. A spinal fusion is often used to force the curve to stop developing. In adults, surgery may be needed if the angle reaches 50 degrees and they experience complications, such as nerve damage or bowel/bladder dysfunction. Risk factors in adults include older age, a history of smoking, and a diagnosis of other conditions, including being overweight. (American Association of Neurological Surgeons, 2024)

Variations

Variations occur in measuring scoliosis, and it is important to understand the difference between a change in scoliosis and a change in the tools or measurement. Equipment errors, imaging errors, and the subjective reading of the healthcare provider can change the values. (Jin, C. et al., 2022) Scoliosis measurement software and intelligent medical devices continue to improve how scoliosis is evaluated and treated. Physical exams, symptoms, and careful monitoring of changes in posture or function are still critical to an accurate diagnosis. The healthcare provider will explain the Cobb angle and other test results.

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.

Academic Low Back Pain: Impact and Chiropractic Solutions

References

Botterbush, K. S., Zhang, J. K., Chimakurty, P. S., Mercier, P., & Mattei, T. A. (2023). The life and legacy of John Robert Cobb: the man behind the angle. Journal of neurosurgery. Spine, 39(6), 839–846. https://doi.org/10.3171/2023.7.SPINE23146

Jin, C., Wang, S., Yang, G., Li, E., & Liang, Z. (2022). A Review of the Methods on Cobb Angle Measurements for Spinal Curvature. Sensors (Basel, Switzerland), 22(9), 3258. https://doi.org/10.3390/s22093258

National Scoliosis Foundation. (2015). Scoliosis Media & Community Guide. https://www.scoliosis.org/nsf2/wp-content/uploads/2015/06/ScoliMediaGuide_9June3.pdf

American Association of Neurological Surgeons. (2024). Scoliosis. https://www.aans.org/patients/conditions-treatments/scoliosis/

Ko, K. J., & Kang, S. J. (2017). Effects of 12-week core stabilization exercise on the Cobb angle and lumbar muscle strength of adolescents with idiopathic scoliosis. Journal of Exercise Rehabilitation, 13(2), 244–249. https://doi.org/10.12965/jer.1734952.476