How Head Injuries Steal Your Ability to Move — and How Chiropractic Care Gives It Back
Head injuries and traumatic brain injuries (TBIs) change lives in seconds. A fall, car crash, or sports hit can damage the brain and the nerves that control every step, stretch, and turn. This article explains how head injuries affect mobility and flexibility, why muscles tire quickly, why balance is compromised, and how chiropractic and integrative care help people regain the ability to walk, reach, and stand tall again.
The Hidden Cost of a Head Injury: Stiff Muscles and Shaky Balance
When the brain is shaken or struck, the signals that tell muscles to “go” or “stop” get scrambled. The result?
Muscle fatigue hits after just a few steps.
Coordination disappears — arms swing out of time with legs.
Balance fails — even a slight bump can cause a fall.
Even mild head injuries leave tiny scars on nerve pathways. These scars slow messages from the brain to the legs, arms, and core (Model Systems Knowledge Translation Center, 2023).
Dr. Alexander Jimenez, a chiropractor and nurse practitioner with over 30 years of experience, sees this every week. “Patients tell me, ‘Doc, my legs feel like cement after ten minutes.’ That’s the brain struggling to talk to the muscles,” he says (Jimenez, 2025).
Symptom Questionnaire:
From Limp to Lock-Up: How Immobility Creates Contractures
When a person stops moving, muscles shorten. Doctors call this contractures.
Ankles freeze in a pointed-toe position.
Knees and hips stiffen.
Shoulders round forward, making reaching painful.
Contractures start within two weeks of bed rest (Physiopedia, 2024). Pain and fatigue prompt people to guard their bodies, which accelerates the process.
Headway UK reports that 70 % of brain injury survivors have mobility problems (Headway, 2024). Many need canes, walkers, or wheelchairs just to cross a room.
Pain + Fatigue = A Vicious Cycle
Chronic pain is the silent partner of every TBI. Neck pain, shoulder pain, and headaches arrive the same day as the injury (Irvine, 2023). Pain makes people tense their muscles. Tense muscles tire faster. Tired muscles hurt more.
Dr. Jimenez notes, “I can adjust a spine in five minutes, but if the patient is still guarding because of pain, the adjustment won’t hold” (Jimenez, 2025).
The Chiropractic Answer: Re-Train the Brain and Free the Body
Chiropractic care is not just “cracking backs.” It is a brain-body reset.
1. Spinal Adjustments Restore Nerve Flow
A high-speed, low-force thrust to the neck or mid-back removes pressure on spinal nerves. Blood and cerebrospinal fluid move better. The brain receives clearer signals (Northwest Florida Physicians Group, 2024).
2. Soft-Tissue Therapy Melts Tension
Myofascial release and trigger-point work loosen tight neck and shoulder muscles. Less tension = less pain = more movement (Artisan Chiropractic Clinic, 2024).
3. Balance and Coordination Drills
Simple exercises — standing on one leg, walking heel-to-toe, or catching a ball — wake up the cerebellum. Patients graduate from wobbly to steady in weeks (Crumley House, 2024).
4. Posture Correction Stops Secondary Damage
Rounded shoulders after TBI strain the neck and pinch nerves. Chiropractors use mirror feedback and taping to teach upright posture (Pinnacle Health Chiropractic, 2024).
5. Headache Relief Without Drugs
Gentle cranial adjustments and upper-neck work can reduce tension headaches by 60–80% in many patients (Cognitive FX, 2024).
Real Stories, Real Steps
Maria, 34, suffered a TBI in a rear-end crash. Six months later, she still dragged her left foot. After 12 weeks of chiropractic care and balance drills, she was able to walk her dog three blocks without a cane.
Tom, 19, a high-school linebacker, lost coordination after a helmet-to-helmet hit. Chiropractic neurology exercises rebuilt his brain’s timing. Eight weeks later, he returned to light jogging (HML Functional Care, 2024).
Science Backs the Hands-On Approach
A 2022 review found that chiropractic spinal manipulation improves gait speed in TBI patients by 15% (Gyer et al., 2022).
Soft-tissue therapy reduces muscle stiffness scores by 30 % in four weeks (NR Times, 2024).
Balance training cuts fall risk by half (Brain Injury Association of America, 2024).
Do this under the supervision of a licensed chiropractor who accepts TBI cases.
When to Call a Chiropractor After a Head Injury
You feel dizzy when turning your head.
One leg drags or feels heavy.
Headaches start in the neck and shoot forward.
You drop objects or bump into door frames.
Early care prevents contractures and chronic pain.
The Bigger Picture: A Brain That Heals Itself
Every adjustment, stretch, and balance drill tells the brain, “You can still learn.” This sparks neuroplasticity — the brain’s ability to rewire itself. Chiropractic care is the spark; movement is the fire.
Dr. Jimenez puts it simply: “I don’t heal the brain. I remove the roadblocks so the brain can heal itself” (Jimenez, 2025).
Take the First Step Today
Search “[your city] chiropractic TBI” or ask your doctor for a referral. Most clinics offer free 15-minute phone consultations. One visit can significantly alter the course of your recovery.
Discover strategies for achieving functional wellness despite CPT2 deficiency and enhance your overall well-being.
Understanding CPT2 Deficiency: A Complete Guide to Symptoms, Causes, and Holistic Treatment Options
Introduction
The human body is like a well-designed machine, with various systems working together to maintain our health and keep us moving. Our body’ ability to turn food into energy is a vital component of this mechanism. When we need more energy, like as during physical activity or after a prolonged period of fasting, this mechanism is particularly crucial. One of the most important enzymes in this energy-producing process is carnitine palmitoyltransferase 2, or CPT2. The malfunction of this enzyme may result in a disorder known as CPT2 deficiency, which can affect bones, muscles, and overall health (MedlinePlus Genetics, 2008).
The definition of CPT2, its physiological function, and the consequences of a CPT2 deficit are all covered in this article. In addition to examining environmental factors that may exacerbate symptoms, we will also explore non-surgical therapy alternatives, including targeted exercises, acupuncture, chiropractic care, a balanced diet, and nutritional supplements. This article will integrate the clinical observations of Dr. Alexander Jimenez, DC, APRN, FNP-BC, a board-certified chiropractor and family practice nurse practitioner from El Paso, Texas, who specializes in functional medicine and holistic approaches to treating metabolic and musculoskeletal disorders (Jimenez, n.d.).
What Is CPT2 and How Does It Function in the Body?
The Basics of CPT2
CPT2 stands for carnitine palmitoyltransferase 2, an enzyme that plays a crucial role in enabling the body to utilize fat for energy (MedlinePlus Genetics, 2008). Enzymes are special proteins that speed up chemical reactions in the body, and CPT2 is one of the most important enzymes involved in a process called fatty acid oxidation.
Understanding Fatty Acid Oxidation
Fatty acid oxidation is the body’s way of breaking down fats to create energy. Think of it like burning wood to create heat—the body “burns” fats to create the energy it needs to function. This process is especially important during certain times (MedlinePlus Genetics, 2008):
During periods of fasting (when you haven’t eaten for several hours)
During long periods of exercise
When the body is stressed by illness or infection
During times when blood sugar levels are low
Fatty acids are a major source of energy for the heart and muscles. When we eat food, some of it gets stored as fat. Later, when the body needs extra energy, it can break down these stored fats to fuel important activities (MedlinePlus Genetics, 2008).
The Role of Mitochondria
Inside almost every cell in the body are tiny structures called mitochondria. These are often referred to as the “powerhouses” of cells because they produce most of the energy the body requires. For the body to use fats for energy, those fats must enter the mitochondria, where they can be broken down (MedlinePlus Genetics, 2008).
However, there’s a problem: long-chain fatty acids (the most common type of fat stored in the body) cannot enter mitochondria by themselves. This is where CPT2 becomes important.
The Carnitine Shuttle System
The body utilizes a specialized transport system called the carnitine shuttle to transport long-chain fatty acids into mitochondria. This system involves three main proteins (DiMauro & DiMauro, 2003):
Carnitine Palmitoyltransferase 1 (CPT1): Located on the outer mitochondrial membrane, this enzyme attaches fatty acids to a special molecule called carnitine. This allows the fatty acids to cross the first barrier.
Carnitine-Acylcarnitine Translocase (CACT): This protein acts like a shuttle, carrying the fatty acid-carnitine combination across the inner mitochondrial membrane.
Carnitine Palmitoyltransferase 2 (CPT2): Located on the inner mitochondrial membrane, this enzyme removes the carnitine from the fatty acids and adds a substance called coenzyme A. This final step prepares the fatty acids for breakdown into energy.
Think of this system like a relay race. CPT1 is the first runner who picks up the baton (attaches carnitine to the fatty acid). CACT is the second runner who carries the baton across the track (moves it through the membrane). CPT2 is the final runner who takes the baton to the finish line (removes carnitine and prepares the fatty acid for energy production) (DiMauro & DiMauro, 2003).
Why CPT2 Is So Important
Without CPT2 working properly, the final step in this relay race cannot happen. The fatty acids get stuck—they can make it into the mitochondria, but they cannot be converted into a form that can be used for energy. This backup can lead to several problems (MedlinePlus Genetics, 2008):
The body cannot use stored fats for energy efficiently
Long-chain fatty acids and their carnitine attachments build up in cells
This buildup can damage muscles, the heart, and the liver
The body has to rely more heavily on glucose (sugar) for energy
During times when glucose runs low, the body struggles to produce enough energy
What Is CPT2 Deficiency?
Defining the Condition
CPT2 deficiency is a genetic disorder that occurs when the CPT2 enzyme either doesn’t work properly or isn’t produced in sufficient amounts. This condition prevents the body from utilizing certain fats for energy, which can lead to serious health issues, particularly during periods when the body requires additional energy (MedlinePlus Genetics, 2008).
CPT2 deficiency is an autosomal recessive disorder, which means a person must inherit two copies of the faulty gene (one from each parent) to have the condition. People who inherit only one faulty gene are called carriers and usually don’t have symptoms (Baby Detect, 2022).
Types of CPT2 Deficiency
There are three main forms of CPT2 deficiency, each with different levels of severity (Baby Detect, 2022):
1. Lethal Neonatal Form
This is the most severe form and appears within the first few days after birth. Babies with this form may have (Baby Detect, 2022):
Severe liver failure
Heart problems (cardiomyopathy)
Seizures
Very low blood sugar (hypoglycemia)
Kidney problems
Brain development issues
Unfortunately, this form is often fatal within the first month of life
2. Severe Infantile Hepatocardiomuscular Form
This form usually appears within the first year of life and includes (Baby Detect, 2022):
Liver problems
Heart muscle disease
Seizures
Low blood sugar
Muscle weakness
Attacks triggered by fasting or illness
3. Myopathic Form (Muscle Form)
This is the most common form and is usually milder than the other two types. It typically appears anywhere from childhood to adulthood and is characterized by (Vladutiu, 1999):
Episodes of muscle pain (myalgia)
Muscle stiffness and weakness
Breakdown of muscle tissue (rhabdomyolysis)
Dark, rust-colored urine (myoglobinuria) caused by muscle proteins released into the bloodstream
Symptoms triggered by prolonged exercise, fasting, cold exposure, or stress
Normal health between episodes
The myopathic form is the most common disorder of fat metabolism affecting skeletal muscle and is the most frequent cause of inherited myoglobinuria. Men are more likely to be affected than women, though scientists aren’t entirely sure why (Baby Detect, 2022).
The Most Common Genetic Variant
About 60 percent of people with the myopathic form of CPT2 deficiency have a specific genetic change called S113L (or Ser113Leu). This variant reduces the activity of the CPT2 enzyme but doesn’t eliminate it completely, which is why this form tends to be less severe than the neonatal or infantile forms (MedlinePlus Genetics, 2008).
How CPT2 Deficiency Affects the Body and Musculoskeletal System
Energy Crisis in Muscles
Muscles are highly active tissues that require a lot of energy to function properly. Normally, muscles can switch between using glucose and fatty acids for fuel depending on what’s available. However, people with CPT2 deficiency cannot efficiently use fatty acids, which creates several problems (Rare Disease Advisor, 2021):
Limited Fuel Options: During prolonged exercise or fasting, when glucose stores are depleted, the muscles of individuals with CPT2 deficiency cannot tap into fat stores for energy. This leads to an energy crisis in the muscle cells.
Muscle Pain and Weakness: Without adequate energy, muscles cannot contract properly. This leads to muscle pain (myalgia), stiffness, and weakness during or after physical activity.
Rhabdomyolysis: When the energy shortage becomes severe, muscle cells begin to break down. This process, called rhabdomyolysis, releases muscle proteins (especially myoglobin) into the bloodstream. Myoglobin can damage the kidneys and cause the urine to turn dark brown or rust-colored (Adult-Onset CPT II Deficiency, 2023).
Effects on Different Body Systems
The Musculoskeletal System
The musculoskeletal system, which includes all the bones, muscles, tendons, and ligaments, is significantly affected by CPT2 deficiency. According to Dr. Alexander Jimenez’s clinical observations, patients with metabolic conditions affecting muscle function often experience (Jimenez, n.d.):
Muscle Fatigue: Muscles tire more easily during physical activity
Exercise Intolerance: Difficulty performing activities that require sustained muscle use
Muscle Stiffness: Particularly after periods of rest following exercise
Joint Pain: While CPT2 deficiency primarily affects muscles, the resulting muscle weakness can alter how a person moves, leading to compensatory patterns that stress joints
Postural Changes: Chronic muscle weakness may lead to poor posture, which can cause additional strain on the spine and other structures
The Cardiovascular System
Although the myopathic form of CPT2 deficiency primarily affects skeletal muscles (the muscles we control voluntarily), the heart muscle can also be affected in severe cases. The heart requires constant energy to pump blood throughout the body, and when fat metabolism is impaired, cardiac function may be compromised (Baby Detect, 2022).
The Liver and Metabolism
The liver plays a central role in regulating energy metabolism. In CPT2 deficiency, the inability to properly break down fatty acids can lead to fat accumulation in the liver and impaired production of ketones—molecules that can serve as an alternative energy source when glucose is low. This contributes to hypoketotic hypoglycemia (low blood sugar with low ketone levels), which can cause weakness, confusion, and other symptoms (MedlinePlus Genetics, 2008).
The Kidneys
During episodes of rhabdomyolysis, large amounts of myoglobin are released into the bloodstream. The kidneys must filter this protein, but too much myoglobin can clog the tiny filtering units in the kidneys, potentially leading to acute kidney injury or even kidney failure if not treated promptly (Adult-Onset CPT II Deficiency, 2023).
Biochemical Consequences
At the cellular level, CPT2 deficiency causes several biochemical problems (MedlinePlus Genetics, 2008):
Accumulation of Long-Chain Acylcarnitines: These are fatty acids still attached to carnitine. They build up because CPT2 cannot remove the carnitine. High levels of these substances can be toxic to cells.
Low Ketone Production: Normally, when fats are broken down, they produce ketones that can be used as fuel by the brain and other organs. When fat breakdown is blocked, ketone levels remain low (hypoketosis).
Hypoglycemia: With reduced ability to use fats and produce ketones, the body becomes more dependent on glucose. During fasting or prolonged exercise, blood sugar levels can drop dangerously low.
Oxidative Stress: The accumulation of unprocessed fatty acids and reduced energy production can lead to oxidative stress, which damages cells and tissues.
Environmental Factors That Can Cause and Show Signs of CPT2 Deficiency
One of the most important things to understand about the myopathic form of CPT2 deficiency is that symptoms usually don’t appear all the time. Instead, they are triggered by certain environmental and physiological factors that increase the body’s need for energy from fat metabolism. Understanding these triggers is crucial for preventing attacks and effectively managing the condition.
Prolonged Exercise
Exercise is one of the most common triggers of symptoms in people with CPT2 deficiency. However, not all types of exercise are equally likely to cause problems (MedLink Neurology, 2025):
Why Exercise Triggers Symptoms:
During exercise, muscles use large amounts of energy
After the first 15-30 minutes of sustained exercise, the body shifts from using primarily glucose to using more fatty acids for fuel
People with CPT2 deficiency cannot make this shift efficiently
As glucose stores deplete, an energy crisis develops in the muscles
This can lead to muscle pain, stiffness, weakness, and rhabdomyolysis
Types of Exercise Most Likely to Trigger Symptoms:
Endurance activities (running, cycling, swimming long distances)
Activities lasting more than 30-60 minutes
Exercise performed without adequate pre-fueling with carbohydrates
Activities that engage large muscle groups
Exercise Characteristics: According to research, the duration of exercise required to trigger an attack varies among individuals. In one study, exercise lasting 15-60 minutes was sufficient for attacks in 9 out of 13 patients, while 3 patients required 1-4 hours, and 1 patient needed more than 4 hours (Phenotype of CPT II Deficiency, 2018).
Dr. Jimenez emphasizes the importance of understanding each patient’s exercise tolerance and developing individualized activity plans that build strength and endurance without triggering metabolic crises (Jimenez, n.d.).
Fasting and Prolonged Periods Without Food
Fasting or going too long without eating is another major trigger for CPT2 deficiency symptoms (MedLink Neurology, 2025).
Why Fasting Is Problematic:
After several hours without food, blood glucose levels begin to drop
The body normally responds by breaking down stored fats to provide energy
People with CPT2 deficiency cannot efficiently use these fats
As glucose stores deplete without fat oxidation to compensate, energy levels plummet
This can lead to hypoglycemia, muscle weakness, and other symptoms
Fasting Scenarios That May Trigger Symptoms:
Skipping meals, especially breakfast
Sleeping late and delaying breakfast
Prolonged illness that reduces appetite
Medical procedures requiring fasting
Intentional fasting or very low-calorie diets
Dr. Jimenez’s Clinical Insight: Dr. Jimenez notes that in his functional medicine practice, understanding a patient’s eating patterns and timing is crucial for managing metabolic conditions. He often recommends frequent, small meals rich in complex carbohydrates to maintain stable blood sugar levels and prevent metabolic stress (Jimenez, 2022).
Cold Exposure
Exposure to cold temperatures is another environmental trigger for symptoms of CPT2 deficiency (MedLink Neurology, 2025; Nutrition and Exercise in CPT Deficiency, 2021).
Why Cold Triggers Symptoms:
When exposed to cold, the body must generate heat to maintain its core temperature
Heat production requires significant energy
The body increases fat metabolism to fuel this thermogenic response
People with CPT2 deficiency cannot efficiently increase fat oxidation
This creates an energy deficit that can trigger muscle breakdown
Cold Exposure Scenarios:
Winter sports and activities
Swimming in cold water
Working in cold environments
Inadequate clothing in cold weather
Sudden temperature changes
Infections and Illness
Infections and illnesses are particularly dangerous triggers for people with CPT2 deficiency because they can rapidly lead to severe complications (Battling Recurrent Rhabdomyolysis, 2024).
Why Infections Trigger Symptoms:
Infections increase the body’s metabolic demands
Fever further increases energy requirements
Illness often reduces appetite, leading to inadequate carbohydrate intake
The combination of increased energy needs and decreased food intake creates a metabolic crisis
Infections trigger inflammatory responses that can worsen muscle damage
Types of Infections That May Trigger Symptoms:
Respiratory infections (colds, flu, pneumonia)
Gastrointestinal infections
Urinary tract infections
Any infection causing fever
Clinical Importance: Research has shown that prompt identification and treatment of infections are crucial for minimizing muscle breakdown in individuals with CPT2 deficiency. Early intervention with appropriate antibiotics and supportive care can prevent severe complications (Battling Recurrent Rhabdomyolysis, 2024).
Emotional and Physical Stress
Both psychological and physical stress can trigger symptoms in susceptible individuals (MedLink Neurology, 2025; Nutrition and Exercise in CPT Deficiency, 2021).
How Stress Affects the Body:
Stress triggers the release of hormones like cortisol and adrenaline
These hormones mobilize energy stores, including fats
Dr. Jimenez incorporates stress management into his holistic treatment protocols, recognizing that the mind-body connection plays a significant role in managing metabolic and musculoskeletal conditions (Jimenez, n.d.).
Certain Medications
Some medications can trigger or worsen symptoms in people with CPT2 deficiency by interfering with energy metabolism or increasing muscle breakdown (MedLink Neurology, 2025).
Medications That May Trigger Symptoms:
Valproate (an anti-seizure medication)
High doses of diazepam (a sedative)
Ibuprofen and other NSAIDs
Certain anesthesia drugs
Statins (cholesterol-lowering drugs)
Why These Medications Are Problematic:
Some interfere with mitochondrial function
Others increase the breakdown of muscle tissue
Some may affect enzyme activity or energy metabolism pathways
Menstruation
Women with CPT2 deficiency may experience worsening of symptoms during menstruation (Carnitine Palmityl Transferase Deficiency, 2024).
Why Menstruation May Trigger Symptoms:
Hormonal changes affect metabolism
Increased energy demands during this time
Possible effects of hormones on enzyme regulation
Some women report increased muscle pain and weakness during their menstrual periods
Dehydration and Low Fluid Intake
Inadequate hydration can contribute to muscle problems in people with CPT2 deficiency (Nutrition and Exercise in CPT Deficiency, 2021).
How Dehydration Affects the Body:
Reduces blood flow to muscles
Decreases the body’s ability to remove metabolic waste products
Can impair kidney function, especially during rhabdomyolysis episodes
May worsen muscle cramping and pain
Combined Triggers
It’s important to note that many severe episodes of rhabdomyolysis occur when multiple triggers are present at the same time. For example (MedLink Neurology, 2025):
Exercising in cold weather without adequate food intake
Prolonged skiing while fasting
Working out while fighting off an infection
Strenuous activity combined with stress and inadequate sleep
Understanding and avoiding these environmental triggers is a cornerstone of managing CPT2 deficiency. Dr. Jimenez emphasizes patient education about trigger identification and avoidance as part of his comprehensive treatment approach (Jimenez, n.d.).
Thermal Instability of the S113L Variant
Recent research has provided important insights into why environmental factors, such as fever and prolonged exercise, trigger attacks in individuals with the most common genetic variant (S113L) of CPT2 deficiency.
Studies have shown that the S113L variant of the CPT2 enzyme is thermally unstable—meaning it loses its function more rapidly at higher temperatures compared to the normal enzyme. At body temperature (37°C/98.6°F), the mutated enzyme works reasonably well. However, at 40-45°C (104-113°F), which can occur during fever or intense exercise, the enzyme breaks down much more quickly (Stabilization of S113L Variant, 2016).
This thermal instability helps explain why fever and prolonged exercise are such potent triggers of symptoms. The combination of increased energy demands and decreased enzyme function creates the perfect storm for a metabolic crisis.
How Nonsurgical Treatments Like Chiropractic Care and Acupuncture Can Help Reduce CPT2 Deficiency Symptoms
While there is currently no cure for CPT2 deficiency, various nonsurgical treatments can help manage symptoms, improve quality of life, and reduce the frequency and severity of attacks. Dr. Alexander Jimenez’s clinical approach demonstrates how integrating chiropractic care, acupuncture, and other complementary therapies with conventional medical management can provide comprehensive support for people with metabolic myopathies like CPT2 deficiency.
Understanding the Role of Complementary Therapies
Before exploring specific treatments, it’s important to understand that CPT2 deficiency is a metabolic disorder that requires medical management. However, the symptoms of CPT2 deficiency—particularly muscle pain, weakness, stiffness, and decreased mobility—can be significantly improved with therapies that address musculoskeletal function, pain management, and overall wellness (Jimenez, n.d.).
Dr. Jimenez’s practice philosophy emphasizes treating the whole person, not just the underlying metabolic defect. His approach recognizes that people with CPT2 deficiency experience (Jimenez, n.d.):
Chronic muscle pain and stiffness
Reduced physical function and mobility
Poor posture due to muscle weakness
Joint problems from altered movement patterns
Anxiety and stress related to managing a chronic condition
Nutritional challenges
Difficulty maintaining physical fitness
Chiropractic Care for CPT2 Deficiency
Chiropractic care focuses on the diagnosis and treatment of musculoskeletal disorders, particularly those affecting the spine and nervous system. For people with CPT2 deficiency, chiropractic care can address several important issues.
How Chiropractic Care Helps
1. Spinal Alignment and Nervous System Function
The nervous system controls every function in the body, including muscle contraction, energy metabolism, and pain perception. When the spine is misaligned, it can interfere with nerve signals and contribute to muscle dysfunction, pain, and reduced mobility (Chiropractic BioPhysics, 2024).
Dr. Jimenez explains that proper spinal alignment is foundational to optimal body function. Through gentle chiropractic adjustments, misalignments (subluxations) can be corrected, which (Jimenez, n.d.):
Reduces pressure on nerves
Improves communication between the brain and muscles
Enhances overall body function
Reduces pain
Improves mobility
For people with CPT2 deficiency, optimizing nervous system function is particularly important because their muscles are already compromised by metabolic dysfunction. Any additional stress on the neuromuscular system can worsen symptoms.
2. Muscle Pain and Tension Relief
People with CPT2 deficiency often experience chronic muscle pain, tension, and spasms, particularly after exercise or during metabolic stress. Chiropractic adjustments can help by (Understanding Soft Tissue Injuries, 2024):
Reducing muscle tension
Improving blood flow to muscles
Decreasing inflammation
Releasing trapped nerves that may contribute to pain
Studies have shown that chiropractic care can significantly reduce pain in people with musculoskeletal conditions. One study found that pain scores dropped from 55.3 to 24.5 following chiropractic treatment (Understanding Soft Tissue Injuries, 2024).
3. Improved Mobility and Function
Muscle weakness and pain in CPT2 deficiency can lead to reduced mobility and compensatory movement patterns that stress joints and other structures. Chiropractic care helps by (Chiropractors Treat Musculoskeletal Pain, 2025):
Restoring proper joint mobility
Correcting postural imbalances
Improving overall movement patterns
Enhancing functional capacity
Dr. Jimenez emphasizes that improved mobility allows patients to maintain appropriate levels of physical activity, which is important for overall health, muscle function, and metabolic control (Jimenez, n.d.).
4. Reducing Medication Dependence
Many people with chronic musculoskeletal pain rely on pain medications, which can have side effects and may interfere with metabolic function. Research shows that chiropractic care can help reduce the use of pain medications, including opioids and over-the-counter analgesics (Chiropractic Care and Medication Use, 2025).
For people with CPT2 deficiency, this is particularly important because some pain medications (like ibuprofen) can actually worsen symptoms or trigger rhabdomyolysis episodes (MedLink Neurology, 2025).
Dr. Jimenez’s Chiropractic Approach
Based on his clinical observations and integrative medicine training, Dr. Jimenez uses several chiropractic techniques in his practice (Jimenez, n.d.):
Specific Spinal Adjustments: Gentle, precise adjustments to correct misalignments and restore proper spinal function
Postural Assessment and Correction: Detailed analysis of posture and customized protocols to address imbalances
Functional Movement Assessment: Evaluation of how patients move and identification of dysfunctional patterns that may contribute to symptoms
Patient Education: Teaching patients about proper body mechanics, posture, and movement to prevent injury and optimize function
Soft Tissue Therapies
In addition to spinal adjustments, soft tissue therapies are a crucial component of chiropractic care for individuals with CPT2 deficiency.
Types of Soft Tissue Therapy
1. Myofascial Release
This technique involves applying sustained pressure to tight or restricted areas in muscles and fascia (the connective tissue surrounding muscles). Benefits include (Soft Tissue Manipulation in Chiropractic, 2022):
Reduced muscle tension
Improved circulation
Release of trigger points (tight knots in muscles)
Enhanced flexibility and range of motion
2. Trigger Point Therapy
Trigger points are hyper-irritable spots in muscles that can cause local and referred pain. Trigger point therapy targets these areas (10 Chiropractic Techniques, 2025):
Release muscle tension
Reduce pain
Improve muscle function
Prevent the formation of new trigger points
For people with CPT2 deficiency who experience frequent muscle pain and spasms, trigger point therapy can provide significant relief.
3. Muscle Energy Techniques
These techniques involve the patient actively using their muscles in specific directions against resistance provided by the practitioner. This helps to (Soft Tissue Therapy and Muscle Release, 2024):
Lengthen shortened muscles
Strengthen weak muscles
Improve joint mobility
Restore proper muscle balance
4. Instrument-Assisted Soft Tissue Mobilization
This technique uses specialized instruments to detect and treat areas of soft tissue restriction. Benefits include (Soft Tissue Therapy and Muscle Release, 2024):
Breaking up scar tissue
Reducing fascial restrictions
Improving blood flow
Enhancing tissue healing
Clinical Application for CPT2 Deficiency
Dr. Jimenez notes that soft tissue therapies must be carefully applied in people with metabolic myopathies. Because their muscles are more vulnerable to damage, techniques must be gentle and progressive. His approach includes (Jimenez, n.d.):
Starting with very gentle techniques and gradually increasing intensity as tolerated
Avoiding aggressive deep tissue work that could trigger rhabdomyolysis
Combining soft tissue therapy with appropriate nutrition to support muscle recovery
Monitoring for signs of excessive muscle breakdown
Acupuncture for CPT2 Deficiency
Acupuncture is an ancient healing practice that involves inserting very thin needles into specific points on the body to promote healing and reduce pain. Modern research has validated many of acupuncture’s benefits for musculoskeletal conditions and pain management.
How Acupuncture Helps
1. Pain Relief
Acupuncture is well-established as an effective treatment for various types of pain. Research shows it can (Acupuncture Promotes ATP Metabolism, 2025):
Activate the body’s natural pain-relieving systems
For people with CPT2 deficiency who experience chronic muscle pain, acupuncture can provide relief without the side effects of medications.
2. Improved Muscle Function
Studies have shown that acupuncture can improve muscle function through several mechanisms (Acupuncture Plus Low-Frequency Stimulation, 2016):
Increasing blood flow to muscles
Enhancing oxygen delivery to muscle tissue
Stimulating muscle regeneration
Preventing muscle atrophy (wasting)
Research has demonstrated that acupuncture combined with low-frequency electrical stimulation can counteract muscle atrophy and enhance muscle regeneration, making it potentially beneficial for individuals with muscle weakness resulting from metabolic conditions (Acupuncture Plus Low-Frequency Stimulation, 2016).
3. Enhanced Metabolism and Energy Production
Recent research has revealed that acupuncture can influence cellular metabolism and energy production. Studies show that acupuncture (Acupuncture Promotes ATP Metabolism, 2025):
Activates specific signaling pathways involved in energy metabolism
Promotes mitochondrial function
Increases ATP (energy) production in muscle cells
Enhances the body’s ability to use available fuel sources
This is particularly relevant for people with CPT2 deficiency, whose primary problem is impaired energy metabolism in muscles.
4. Stress Reduction and Nervous System Balance
Acupuncture has well-documented effects on the nervous system and stress response. It can (Evaluation of Acupuncture for Sepsis Myopathy, 2020):
Reduce cortisol and other stress hormones
Balance the autonomic nervous system
Improve sleep quality
Reduce anxiety
Enhance overall sense of well-being
Since stress is a known trigger for CPT2 deficiency symptoms, acupuncture’s stress-reducing effects may help prevent attacks.
5. Support for Muscle Recovery
Research has shown that acupuncture can (Effect of Acupuncture on Carnitine, 2012):
Reduce exercise-induced muscle soreness
Speed recovery after muscle injury
Reduce inflammation in muscle tissue
Support the body’s natural healing processes
Dr. Jimenez’s Integrated Approach with Acupuncture
Dr. Jimenez incorporates both traditional acupuncture and electro-acupuncture (which adds mild electrical stimulation) into his treatment protocols. His clinical observations suggest that acupuncture can be particularly helpful for patients with CPT2 deficiency (Jimenez, n.d.):
Providing safe, non-pharmaceutical pain relief
Supporting muscle function without triggering metabolic stress
Enhancing overall energy levels
Reducing the frequency of symptom flare-ups
Improving quality of life
Safety Considerations for Complementary Therapies
While chiropractic care and acupuncture can be beneficial for people with CPT2 deficiency, safety must always be the priority. Dr. Jimenez emphasizes several important considerations (Jimenez, n.d.):
Gentle Approach: All manual therapies should start gently and progress slowly. Aggressive treatment could potentially trigger rhabdomyolysis.
Communication: Patients should inform their practitioners about their CPT2 deficiency and any symptoms they experience during or after treatment.
Monitoring: Watch for signs of excessive muscle breakdown, such as severe muscle pain, weakness, or dark urine following treatment.
Integrated Care: These complementary therapies should be used in conjunction with, not instead of, conventional medical management.
Individualization: Treatment plans should be tailored to each person’s specific symptoms, the severity of their deficiency, and overall health status.
Timing: Avoid intensive manual therapies during acute attacks or periods of metabolic stress.
A Holistic Treatment Plan Incorporating Multiple Modalities
Dr. Jimenez’s clinical approach to CPT2 deficiency demonstrates the power of integrating multiple treatment modalities into a comprehensive, holistic plan. His functional medicine perspective recognizes that optimal management requires addressing multiple aspects of health simultaneously.
The Foundation: Conventional Medical Management
Any holistic treatment plan for CPT2 deficiency must be built on a foundation of appropriate conventional medical management, including (Myopathic CPT II Deficiency, 2023):
Proper diagnosis through genetic testing and metabolic studies
Regular monitoring by healthcare providers
Dietary modifications (discussed in detail below)
Emergency protocols for acute attacks
Avoidance of known triggers
Component 1: Spinal Adjustments and Postural Correction
As previously discussed, maintaining optimal spinal alignment is essential for the proper functioning of the nervous system and overall musculoskeletal health.
Dr. Jimenez’s Approach Includes:
Regular chiropractic adjustments to maintain spinal alignment
Postural assessments and corrections
Home exercises to support proper posture
Ergonomic recommendations for work and daily activities
Education about body mechanics
Frequency and Progression:
The frequency of adjustments is individualized according to each patient’s specific needs. Some people may initially benefit from weekly adjustments, then transition to monthly maintenance care. Others may need more or less frequent visits depending on their symptoms and response to treatment (Jimenez, n.d.).
Component 2: Soft-Tissue Therapies
Soft tissue work addresses the muscles, fascia, and other connective tissues that are directly affected by CPT2 deficiency.
Integrated Soft-Tissue Protocol:
Gentle myofascial release techniques
Trigger point therapy as needed
Muscle energy techniques to restore balance
Gradual progression in intensity as tolerated
Use of heat or cold therapy to support healing
Dr. Jimenez’s Clinical Insight:
In his practice, Dr. Jimenez has observed that patients with metabolic myopathies respond best to gentle, consistent soft tissue work rather than aggressive, infrequent treatments. He emphasizes the importance of “working with the body, not against it” (Jimenez, n.d.).
Component 3: Acupuncture and Electro-Acupuncture
Acupuncture is integrated into the treatment plan to address pain, support muscle function, reduce stress, and enhance overall energy metabolism.
Typical Acupuncture Protocol:
Initial assessment to identify specific patterns of imbalance
Selection of acupuncture points based on symptoms and traditional Chinese medicine principles
Treatment sessions typically last 20-30 minutes
Frequency usually ranges from once weekly to once monthly, depending on individual needs
May include electro-acupuncture for enhanced effects on muscle function
Point Selection for CPT2 Deficiency:
While specific point selection varies by individual, commonly used points for muscle weakness, pain, and metabolic support include points along the Spleen, Kidney, Liver, and Bladder meridians, which are associated with muscle function, energy metabolism, and overall vitality in traditional Chinese medicine (Jimenez, n.d.).
Component 4: Nutrition and Dietary Management
Nutrition is arguably the most important component of managing CPT2 deficiency. The right dietary approach can significantly reduce the frequency and severity of attacks while supporting overall health.
Fundamental Nutritional Principles
1. High Carbohydrate Intake
People with CPT2 deficiency should consume a diet rich in carbohydrates to provide readily available glucose for energy (CPT2 Fact Sheet, n.d.).
Recommendations:
Carbohydrates should make up 65-70% of total daily calories
Focus on complex carbohydrates that provide sustained energy
Since people with CPT2 deficiency cannot efficiently use long-chain fatty acids, dietary fat should be limited, typically to no more than 20-30% of total calories (Carnitine Palmitoyltransferase Deficiencies, 1999).
Important Considerations:
Avoid very low-fat diets, as some fat is essential for health
Include essential fatty acids (omega-3 and omega-6)
Focus on easily metabolized fats
3. Medium-Chain Triglyceride (MCT) Oil
MCT oil is a special type of fat that can be more easily metabolized by people with CPT2 deficiency. Medium-chain fatty acids (typically 6-12 carbons long) can enter mitochondria without requiring the CPT system (North Dakota CPT-2 Fact Sheet, 2008).
MCT Oil Benefits:
Provides an alternative fat source that doesn’t require CPT2
Can help meet essential fat needs
May provide sustained energy
Generally well-tolerated in moderate amounts
How to Use MCT Oil:
Start with small amounts (1 teaspoon) and increase gradually
Can be added to foods like oatmeal, smoothies, or used in cooking
Should be introduced under medical supervision
Too much can cause digestive upset
Important Note: Some research suggests that while MCTs can be beneficial, care should be taken as the body’s capacity to metabolize medium-chain fatty acids through CPT-independent pathways may still be limited (Characterisation of CPT, 1997).
4. Frequent, Regular Meals
To prevent hypoglycemia and maintain stable energy levels, individuals with CPT2 deficiency should eat regularly and on a consistent schedule (CPT2 Deficiency Treatment, 2023).
Meal Timing Recommendations:
Eat every 3-4 hours during the day
Never skip breakfast
Include a bedtime snack to prevent overnight fasting
May need to wake during the night for a snack in severe cases
Plan ahead for situations that might delay meals
5. Adequate Protein
Protein is important for maintaining muscle mass and supporting overall health. People with CPT2 deficiency should consume adequate protein from lean sources (North Dakota CPT-2 Fact Sheet, 2008).
Protein Recommendations:
Include lean protein sources at each meal
Good choices include chicken, turkey, fish, lean beef, eggs, low-fat dairy, and legumes
Protein should make up about 15-20% of total calories
Dr. Jimenez’s Nutritional Philosophy
Dr. Jimenez’s approach to nutrition in metabolic conditions emphasizes personalization and the principles of functional medicine. He notes that while general dietary guidelines are important, each person’s nutritional needs may vary based on (Jimenez, 2022):
Severity of their enzyme deficiency
Activity level
Other health conditions
Food preferences and cultural considerations
Metabolic testing results
His nutritional counseling includes:
Detailed dietary assessment
Personalized meal planning
Education about reading food labels
Strategies for dining out and social situations
Regular monitoring and adjustments
Component 5: Vitamins and Supplements
Specific vitamins and supplements can support metabolic function, muscle health, and overall well-being in people with CPT2 deficiency.
Evidence-Based Supplements for Metabolic and Musculoskeletal Support
1. L-Carnitine
L-carnitine is the compound that CPT enzymes use to shuttle fatty acids into mitochondria. Supplementation with L-carnitine is sometimes recommended for people with CPT2 deficiency, though its benefits remain somewhat controversial (Carnitine Palmitoyltransferase Deficiencies, 1999).
Potential Benefits:
May help maintain normal carnitine levels
Could support the remaining functional enzyme activity
May help with overall energy metabolism
Considerations:
Should only be used under medical supervision
Dosing varies but typically ranges from 1-3 grams per day
Not all studies show clear benefits
May not be helpful for all forms of CPT2 deficiency
2. Coenzyme Q10 (CoQ10)
CoQ10 is a compound that plays a crucial role in the production of energy within mitochondria. It acts as an antioxidant and supports the electron transport chain (the final step in energy production) (Dietary Supplements for Mitochondrial Disorders, 2025).
Potential Benefits:
Supports mitochondrial function
Provides antioxidant protection
May improve energy production
It could help reduce muscle fatigue
Typical Dosing:
100-300 mg daily
Should be taken with fat-containing meals for better absorption
Ubiquinol form may be better absorbed than ubiquinone
3. B-Complex Vitamins
B vitamins play essential roles in energy metabolism and are particularly important for people with metabolic disorders (Folate, Vitamin B6, and Vitamin B12, 2023).
Vitamin B2 (Riboflavin): Involved in energy production and fatty acid metabolism
Vitamin B3 (Niacin): Supports energy metabolism
Vitamin B6 (Pyridoxine): Important for amino acid and carbohydrate metabolism
Vitamin B12 (Cobalamin): Essential for energy production and nervous system function
Folate: Works with B12 in various metabolic processes
Benefits for CPT2 Deficiency:
Support optimal metabolism of carbohydrates (the primary fuel source)
Help the body efficiently use available energy sources
Support nervous system health
May reduce homocysteine levels
Support muscle function
4. Vitamin D
Vitamin D is essential for maintaining muscle function, promoting bone health, and supporting the immune system (Natural Products for Metabolic Syndrome, 2024).
Benefits:
Supports muscle strength and function
Important for bone health (especially important if activity is limited)
Modulates inflammation
Supports immune function
Typical Dosing:
Based on blood level testing
Often 1,000-4,000 IU daily for maintenance
Higher doses may be needed if deficient
5. Magnesium
Magnesium is involved in more than 300 enzymatic reactions in the body, including many related to energy metabolism and muscle function (The 5 Best Vitamins to Boost Metabolism, 2024).
Benefits:
Supports muscle relaxation and reduces cramping
Important for energy production
Supports nervous system function
May help reduce muscle pain
Typical Dosing:
200-400 mg daily
Different forms have different absorption rates (magnesium glycinate is often well-tolerated)
6. Alpha-Lipoic Acid
This antioxidant supports mitochondrial function and glucose metabolism (Dietary Supplements for Mitochondrial Disorders, 2025).
Benefits:
Supports mitochondrial function
Provides antioxidant protection
May improve glucose metabolism
Supports nerve health
Typical Dosing:
200-600 mg daily
7. Vitamin E
As a fat-soluble antioxidant, vitamin E can help protect cell membranes from oxidative damage (Natural Products for Metabolic Syndrome, 2024).
Benefits:
Antioxidant protection
Supports muscle health
May reduce oxidative stress
8. Omega-3 Fatty Acids (DHA and EPA)
While overall fat intake should be limited in CPT2 deficiency, essential fatty acids, such as omega-3s, are important for health (Natural Products for Metabolic Syndrome, 2024).
Benefits:
Reduce inflammation
Support cardiovascular health
Support brain function
May help with muscle recovery
Important Note: Omega-3 supplements should be used cautiously and in consultation with a healthcare provider, as they are long-chain fatty acids. However, in small amounts, their anti-inflammatory and other health benefits may outweigh concerns.
9. Vitamin C
This water-soluble antioxidant supports immune function, collagen synthesis, and may help with muscle recovery (Natural Products for Metabolic Syndrome, 2024).
Benefits:
Antioxidant protection
Supports immune function
Important for connective tissue health
May help with muscle recovery
Dr. Jimenez’s Supplement Protocol
Based on his clinical experience and functional medicine training, Dr. Jimenez typically recommends (Recommended Chiropractic Supplements, 2022; Jimenez, n.d.):
Foundation Supplements:
High-quality multivitamin-multimineral complex to cover basic nutritional needs
B-complex vitamins to support energy metabolism
Vitamin D (dose based on blood levels)
Magnesium for muscle and metabolic support
Targeted Supplements (based on individual needs):
CoQ10 for mitochondrial support
L-carnitine (if recommended by physician)
Alpha-lipoic acid for antioxidant and metabolic support
Omega-3 fatty acids in appropriate amounts
Vitamin E for antioxidant protection
Important Considerations:
All supplements should be pharmaceutical-grade and third-party tested for quality
Dosing should be individualized based on blood testing and individual needs
Regular monitoring is important to assess effectiveness and adjust as needed
Supplements should never replace a healthy diet
Always inform all healthcare providers about supplements being taken
Component 6: Targeted Exercise and Physical Therapy
While exercise can trigger symptoms in CPT2 deficiency, engaging in appropriate physical activity is essential for maintaining muscle strength, cardiovascular health, and overall well-being. The key is finding the right type, intensity, and duration of exercise.
Principles of Exercise for CPT2 Deficiency
1. Focus on Short-Duration, High-Intensity Activities
Research has shown that exercise relying primarily on anaerobic metabolism (which doesn’t require fat oxidation) is safer for people with CPT2 deficiency (Nutrition and Exercise in CPT Deficiency, 2021).
Why This Works:
During the first few minutes of intense exercise, muscles use stored ATP and phosphocreatine
Glycolysis (breaking down glucose) provides energy for roughly 5-30 seconds to 2-3 minutes of intense activity
These energy systems don’t require fat oxidation
After about 30 minutes of continuous moderate exercise, the body shifts toward greater fat utilization, which is problematic for people with CPT2 deficiency
Safe Exercise Types:
Resistance training (weight lifting with appropriate rest between sets)
High-intensity interval training (HIIT) with short work periods (30 seconds to 2 minutes) and adequate rest
Sprint intervals
Power-based activities
Activities that can be performed in short bursts with rest
2. Avoid Prolonged Endurance Exercise
Activities that require sustained effort for more than 30 minutes are more likely to trigger symptoms because they increasingly rely on fat metabolism (Nutrition and Exercise in CPT Deficiency, 2021).
Activities to Approach with Caution:
Long-distance running
Cycling for extended periods
Swimming long distances
Extended aerobic exercise classes
3. Ensure Adequate Carbohydrate Fueling
Never exercise on an empty stomach or in a fasted state. Pre-exercise nutrition is crucial (Home-Based Aerobic Training in Metabolic Myopathies, 2016).
Pre-Exercise Nutrition:
Eat a carbohydrate-rich snack or meal 1-2 hours before exercise
Good choices include oatmeal, bananas, whole grain toast, and energy bars
Stay well-hydrated
During Exercise:
For activities lasting more than 30 minutes, consider consuming fast-acting carbohydrates during exercise
Sports drinks, gels, or easily digestible carbohydrate snacks can help
Post-Exercise Nutrition:
Consume carbohydrates and protein within 30-60 minutes after exercise
This supports muscle recovery and replenishes energy stores
4. Start Slowly and Progress Gradually
For individuals who have been sedentary or are just starting an exercise program, it’s essential to begin slowly and increase intensity and duration gradually (Home-Based Aerobic Training in Metabolic Myopathies, 2016).
Progression Guidelines:
Begin with very short-duration activities (5-10 minutes)
Gradually increase duration by no more than 10% per week
Monitor symptoms carefully
If symptoms occur, reduce intensity and duration
5. Monitor for Warning Signs
Stop exercise immediately if any of the following occur:
Excessive muscle pain or cramping
Unusual muscle weakness
Dark or rust-colored urine
Extreme fatigue
Dizziness or confusion
Research-Supported Exercise Protocols
Several studies have demonstrated that appropriately designed exercise programs can be safe and beneficial for people with metabolic myopathies, including CPT2 deficiency.
Case Study: Interval and Resistance Training
A 14-year-old patient with CPT2 deficiency underwent a 6-month supervised exercise program consisting of (Nutrition and Exercise in CPT Deficiency, 2021):
Interval training: 1 minute running alternating with 5 minutes walking, gradually progressed from 15 to 30 minutes total
Resistance training: Upper and lower body exercises, 3 sets of 8 repetitions with 2 minutes rest between sets
Frequency: 3 days per week
Heart rate maintained above 70% maximum
Proper dietary support with adequate carbohydrates
Results:
Resting metabolic rate increased by 8.1%
Respiratory quotient improved to the normal range
Peak oxygen uptake increased by 8.3%
Aerobic performance improved
No muscle pain or rhabdomyolysis occurred
Blood creatine kinase levels remained normal
This study demonstrates that when exercise is properly designed and combined with appropriate nutrition, people with CPT2 deficiency can safely improve their fitness and metabolic function.
Study: Home-Based Aerobic Training
A study of patients with various metabolic myopathies showed that 12 weeks of home-based moderate-intensity aerobic training (cycle ergometer, 4 days/week, 65-70% maximum heart rate) resulted in (Home-Based Aerobic Training in Metabolic Myopathies, 2016):
Improved peak oxygen uptake
Enhanced skeletal muscle oxygen extraction
Faster oxygen uptake kinetics
Reduced the oxygen cost of exercise
Improved exercise tolerance
No adverse events
Dr. Jimenez’s Exercise Prescription
Based on his clinical experience and review of the research, Dr. Jimenez recommends an individualized exercise approach for patients with CPT2 deficiency (Jimenez, n.d.):
Initial Assessment:
Comprehensive evaluation of current fitness level
Review of past experiences with exercise
Identification of any exercise-related symptoms or attacks
Assessment of movement patterns and any compensatory issues
Baseline strength and flexibility testing
Exercise Program Components:
Resistance Training (Primary Focus):
2-3 days per week
Focus on major muscle groups
8-12 repetitions per set
2-3 sets per exercise
2-3 minutes rest between sets
Progressive overload applied carefully
Emphasis on proper form and controlled movements
Interval Training (As Tolerated):
1-2 days per week
Short work intervals (30 seconds to 2 minutes)
Active recovery periods (3-5 minutes)
Total session duration: 15-30 minutes
Heart rate monitored to ensure appropriate intensity
Flexibility and Mobility Work:
Daily gentle stretching
Yoga or tai chi (modified as needed)
Focus on maintaining joint mobility
Helps reduce muscle tension and improve movement quality
Balance and Coordination:
Important for preventing falls and injuries
Can be incorporated into other workouts
Particularly important if any neuropathy is present
Progression and Monitoring:
Start conservatively with very manageable loads and durations
Increase demands by no more than 10% per week
Regular check-ins to assess response
Blood work (creatine kinase levels) as needed
Adjust the program based on the individual response
Safety Protocols:
Always exercise with proper carbohydrate fueling
Stay well-hydrated
Avoid exercise during illness or metabolic stress
Stop immediately if warning signs appear
Have a plan for managing potential attacks
Component 7: Stress Management and Mind-Body Therapies
Since stress is a known trigger for CPT2 deficiency symptoms, stress management is an important component of a comprehensive treatment plan.
Stress and Metabolic Function
Stress affects the body in multiple ways that can worsen CPT2 deficiency (Jimenez, 2022):
Increases metabolic demands
Triggers release of stress hormones that mobilize fat stores
Support groups for people with metabolic conditions
Health coaching
Unlocking Vitality: Chiropractic Wisdom and the Science of Functional Healing-Video
Dr. Jimenez’s Integrative Approach
Dr. Jimenez emphasizes that managing CPT2 deficiency requires addressing not just the physical aspects but also the emotional and psychological dimensions. His practice incorporates (Jimenez, n.d.):
Education about the stress-symptom connection
Teaching practical stress management techniques
Encouraging patients to prioritize self-care
Providing ongoing support and encouragement
Helping patients develop realistic expectations and goals
Component 8: Patient Education and Empowerment
A critical component of any treatment plan is educating patients about their condition and empowering them to take an active role in their care.
Key Educational Topics
Understanding CPT2 Deficiency:
Basic genetics and inheritance
How the enzyme deficiency affects the body
Why symptoms occur
Prognosis and long-term outlook
Trigger Identification and Avoidance:
Recognizing personal triggers
Strategies for avoiding triggers
Planning ahead for situations that might be challenging
Dietary Management:
Understanding nutritional needs
Meal planning and preparation
Reading food labels
Dining out strategies
Special situations (travel, social events)
Exercise Guidelines:
Safe exercise principles
How to monitor intensity
Warning signs to stop
Progressive training principles
Emergency Management:
Recognizing signs of an acute attack
When to seek medical care
What to tell emergency personnel
Emergency contacts and medical information cards
Empowerment Through Knowledge
Dr. Jimenez believes that educated patients achieve better outcomes. His practice includes (Jimenez, n.d.):
Detailed explanations of all aspects of the condition
Written materials that patients can reference at home
Access to reliable online resources
Encouragement to ask questions
Collaborative decision-making about treatment plans
Regular follow-up to reinforce education and address new questions
Clinical Observations from Dr. Alexander Jimenez, DC, APRN, FNP-BC
Dr. Alexander Jimenez brings a unique perspective to the management of CPT2 deficiency and other metabolic conditions through his dual credentials as both a Doctor of Chiropractic and a board-certified Family Practice Nurse Practitioner. His practice in El Paso, Texas, specializes in functional medicine and integrative approaches to complex chronic conditions.
Dr. Jimenez’s Philosophy of Care
Dr. Jimenez’s approach is grounded in several core principles (Jimenez, n.d.; A4M Profile, 2016):
1. Treat the Whole Person, Not Just the Disease
He recognizes that people with CPT2 deficiency are more than their diagnosis. His assessments include evaluation of:
Physical symptoms and functional limitations
Nutritional status and dietary patterns
Emotional and psychological well-being
Social support and life circumstances
Environmental factors
Genetic predispositions
Lifestyle factors
2. Address Root Causes
While CPT2 deficiency itself is caused by a genetic mutation that cannot currently be cured, Dr. Jimenez focuses on addressing all the factors that contribute to symptom expression and overall health. This includes (Jimenez, 2022):
Optimizing nutrition to compensate for metabolic limitations
Correcting musculoskeletal imbalances that may worsen symptoms
Reducing inflammation throughout the body
Supporting optimal mitochondrial function with targeted nutrients
Balancing the nervous system
Addressing any concurrent health issues
3. Use Natural, Non-Invasive Therapies First
Consistent with both chiropractic and functional medicine principles, Dr. Jimenez prioritizes natural approaches that support the body’s innate healing abilities. This means (Jimenez, n.d.):
Using spinal adjustments to optimize nervous system function
Employing dietary modifications before resorting to medications when possible
Teaching lifestyle modifications that support long-term health
Using supplements to address nutritional deficiencies and support metabolic function
Incorporating mind-body therapies for stress management
However, he also recognizes when conventional medical interventions are necessary and works collaboratively with other healthcare providers to ensure comprehensive care.
4. Empower Patients
Dr. Jimenez believes that patients who understand their condition and actively participate in their care achieve the best outcomes. He invests a significant amount of time in education and works to establish strong therapeutic relationships with his patients (Jimenez, n.d.).
Key Clinical Observations
Based on his years of clinical experience treating patients with metabolic and musculoskeletal conditions, Dr. Jimenez has made several important observations about CPT2 deficiency and similar conditions:
1. The Importance of Individualization
No two patients with CPT2 deficiency are exactly alike. Even people with the same genetic mutation may have very different symptom patterns, triggers, and responses to treatment. Dr. Jimenez emphasizes that treatment plans must be highly individualized (Jimenez, n.d.).
2. Nutrition Is the Foundation
Of all the interventions available, appropriate nutrition has the most profound impact on symptoms and quality of life for people with CPT2 deficiency. Dr. Jimenez notes that patients who strictly adhere to dietary recommendations, particularly maintaining adequate carbohydrate intake and avoiding prolonged fasting, experience far fewer attacks and better overall function (Jimenez, 2022; Nutrition Drives Health Recovery, 2025).
3. Spinal Health Affects Overall Function
Dr. Jimenez has observed that patients with CPT2 deficiency often develop secondary musculoskeletal problems due to muscle weakness, altered movement patterns, and reduced activity levels. Maintaining optimal spinal alignment and nervous system function through chiropractic care can help minimize these secondary issues and optimize the function of an already compromised musculoskeletal system (Jimenez, n.d.).
4. Chronic Inflammation Is Common
Many patients with metabolic conditions, including CPT2 deficiency, show signs of chronic low-grade inflammation. This inflammation can worsen symptoms and contribute to other health problems. Dr. Jimenez’s treatment protocols often include anti-inflammatory strategies such as (Treating Inflammation Naturally, 2020; Jimenez, 2022):
An anti-inflammatory diet emphasizing whole foods, colorful vegetables, and omega-3 fatty acids
Supplements with anti-inflammatory properties (omega-3s, curcumin, antioxidants)
Stress reduction
Adequate sleep
Regular gentle movement
5. The Mind-Body Connection Matters
Dr. Jimenez emphasizes that there is a strong connection between psychological stress and physical symptoms in metabolic conditions. Patients who effectively manage stress through various techniques tend to experience fewer symptom flare-ups and achieve better overall outcomes (Jimenez, n.d.).
6. Early Intervention Is Key
When patients are diagnosed early and begin appropriate management strategies before significant complications develop, their outcomes are significantly improved. Dr. Jimenez advocates for newborn screening and early intervention when CPT2 deficiency is suspected (Jimenez, n.d.).
7. Patient Support and Education Improve Adherence
Managing CPT2 deficiency requires significant lifestyle modifications that can be challenging to maintain. Dr. Jimenez has found that patients who receive ongoing support, education, and encouragement are more likely to adhere to treatment recommendations in the long term (Jimenez, n.d.).
Dr. Jimenez’s Metabolic Syndrome Research
Dr. Jimenez has also studied metabolic syndrome extensively, which shares some features with CPT2 deficiency in terms of metabolic dysfunction. His research has emphasized (Jimenez Presents: Effects of Metabolic Syndrome, 2022):
The importance of looking at metabolic health comprehensively
How inflammation, insulin resistance, and metabolic dysfunction interconnect
The value of functional medicine approaches in addressing root causes
How dietary modifications can significantly impact metabolic health
The role of exercise in improving metabolic function
These insights inform his approach to all metabolic conditions, including CPT2 deficiency.
Integrative Medicine Framework
Dr. Jimenez utilizes the Institute for Functional Medicine’s clinical approach, which involves (Jimenez, n.d.; A4M Profile, 2016):
Detailed Assessment:
Comprehensive health history
Timeline of symptoms and health events
Assessment of all body systems
Evaluation of lifestyle factors
Review of environmental exposures
Genetic information, when available
Advanced laboratory testing, including:
Comprehensive metabolic panels
Inflammatory markers
Nutritional status
Hormone levels
Mitochondrial function markers
Personalized Treatment Plans: Based on the comprehensive assessment, Dr. Jimenez develops individualized treatment plans that address multiple aspects of health simultaneously, typically including:
Dietary modifications
Targeted supplementation
Chiropractic care and manual therapies
Exercise recommendations
Stress management strategies
Sleep optimization
Environmental modifications as needed
Ongoing Monitoring and Adjustment:
Regular follow-up visits
Repeat laboratory testing to track progress
Adjustment of treatment plans based on response
Patient education and support throughout the process
Collaboration and Referral
Dr. Jimenez emphasizes that managing complex conditions like CPT2 deficiency requires a team approach. He collaborates with (Jimenez, n.d.):
Primary care physicians
Metabolic specialists and geneticists
Nutritionists and dietitians
Physical therapists
Mental health professionals
Other specialists as needed
When a patient’s needs exceed his scope of practice or would be better served by another specialist, he promptly provides referrals while continuing to provide supportive care in his areas of expertise.
Emergency Management and When to Seek Medical Care
While the focus of this article is on nonsurgical management and prevention, it’s crucial that people with CPT2 deficiency and their families understand how to recognize and respond to acute attacks.
Recognizing an Acute Attack
Seek immediate medical attention if any of the following occur (Battling Recurrent Rhabdomyolysis, 2024; Myopathic CPT II Deficiency, 2023):
Symptoms of Rhabdomyolysis:
Severe muscle pain and weakness
Muscle swelling
Dark brown or rust-colored urine (myoglobinuria)
Reduced urine output
Extreme fatigue
Confusion or altered mental status
Fever
Rapid heartbeat
Nausea and vomiting
Symptoms of Hypoglycemia:
Shakiness
Sweating
Confusion
Dizziness
Weakness
Rapid heartbeat
Irritability
Blurred vision
Emergency Treatment
If rhabdomyolysis is suspected, immediate medical treatment is essential to prevent kidney damage and other complications. Emergency treatment typically includes (Battling Recurrent Rhabdomyolysis, 2024; Myopathic CPT II Deficiency, 2023):
1. Intravenous Glucose
Rapid administration of IV glucose to stop lipolysis (fat breakdown)
Typically 10% dextrose solution
Started immediately, even if blood sugar appears normal
Prevents further muscle breakdown
2. Aggressive Fluid Resuscitation
Large volumes of IV fluids to flush myoglobin through the kidneys
Helps prevent kidney damage
Maintains adequate urine output
3. Monitoring
Creatine kinase (CK) levels to assess the severity of muscle breakdown
Kidney function tests
Electrolyte levels (especially potassium, which can rise to dangerous levels)
Urine output
Cardiac monitoring
4. Treatment of Complications
Correction of electrolyte imbalances
Management of acute kidney injury if present
Treatment of any infections or other triggers
Possible dialysis if kidney failure develops
5. Discontinuation of Triggering Medications
Stop any drugs that may have contributed to the attack
Medical Alert Information
People with CPT2 deficiency should (CPT2-CACT Emergency Protocol, n.d.):
Wear a medical alert bracelet or necklace
Carry a medical information card
Inform all healthcare providers about their condition
Have an emergency action plan
Educate family members about recognizing symptoms and seeking help
While CPT2 deficiency requires careful management, many individuals with the condition lead full and active lives. Here are practical tips for daily living:
Meal Planning
Plan meals and snacks in advance
Prep carbohydrate-rich snacks to have readily available
Never leave home without portable snacks (granola bars, fruit, crackers)
Set phone alarms as reminders to eat regularly
Keep emergency snacks in your car, office, and bag
Exercise and Physical Activity
Start any new exercise program gradually
Always eat before exercising
Carry fast-acting carbohydrates during longer activities
Exercise with a buddy who knows about your condition
Stop immediately if you experience warning symptoms
Keep an exercise log to identify your personal tolerance
Travel
Pack plenty of appropriate snacks
Plan for regular meal times even when traveling
Carry a letter from your doctor explaining your condition
Research restaurants and food options at your destination
Bring a cooler for perishable snacks on long trips
Social Situations
Don’t be embarrassed to eat when you need to
Educate close friends and family about your needs
Offer to bring a dish to potlucks to ensure appropriate options
Check menus ahead of time when going out
Speak up about your dietary needs
Work and School
Educate supervisors, teachers, or coaches about your condition
Have snacks available in your workspace or locker
Take regular breaks to eat
Adjust physical education or work demands as needed
Have an emergency plan in place
Managing Stress
Practice regular stress management techniques
Get adequate sleep
Maintain work-life balance
Seek support when needed
Prioritize self-care
Conclusion
CPT2 deficiency is a genetic metabolic disorder that affects the body’s ability to use long-chain fatty acids for energy. This can lead to MCPT2 deficiency, a hereditary metabolic condition that makes it hard for the body to utilize long-chain fatty acids as fuel. This may cause muscular soreness, weakness, and, in severe cases, rhabdomyolysis, especially when it occurs after prolonged periods of activity, fasting, exposure to cold, illness, or stress. CPT2 deficiency mostly affects the musculoskeletal system, but it may also damage the heart, liver, and kidneys. To manage CPT2 deficiency, it’s essential to identify and avoid environmental triggers that can exacerbate the condition, as well as to support the body in various ways. A complete and all-encompassing treatment plan should have:
Good medical care means that healthcare workers regularly check on you, perform the necessary tests, and use standard medical treatments as needed.
A diet high in carbs and low to moderate in fat, consumed at regular intervals to maintain stable blood sugar levels and high energy levels, is referred to as nutritional optimization. You might also use medium-chain triglyceride oil as a source of fat.
Chiropractic Care: Making adjustments to the spine to improve the function of the neurological system, align the musculoskeletal system, relieve pain, and improve general function. Soft tissue therapy may help relieve muscular tension and address trigger points.
Acupuncture, whether traditional or electroacupuncture, may help alleviate pain, improve muscular function, reduce stress, and potentially even enhance cellular metabolism.
Targeted Supplementation: Vitamins and supplements, including B-complex vitamins, CoQ10, magnesium, vitamin D, L-carnitine (with a doctor’s approval), and antioxidants, may help support a healthy metabolism and muscle function.
Exercise that is safe: Short, high-intensity activities that utilize anaerobic metabolism are generally safer than prolonged, low-intensity exercises. When done correctly and with sufficient carbohydrates, resistance training and interval training can help you stay strong and healthy without triggering attacks.
Stress Management: Mind-body treatments, getting sufficient sleep, and utilizing effective stress-reduction methods may help prevent symptoms from worsening.
Patient Education: Understanding the problem, its causes, when to seek medical help, and being involved in treatment decisions all contribute to better outcomes.
Dr. Alexander Jimenez’s clinical approach demonstrates the effectiveness of integrating traditional medical therapy with functional medicine, chiropractic care, acupuncture, nutritional interventions, and lifestyle modifications. He can treat both the musculoskeletal symptoms and the metabolic problems that cause CPT2 insufficiency since he is both a chiropractor and a family nurse practitioner. Holistic therapy options that treat the body as a whole system instead of just the enzyme deficiency may greatly enhance the quality of life, lower the number and severity of attacks, and let individuals with CPT2 deficiency live active, full lives. CPT2 deficiency is a genuine problem, but with the right care, education, and support, most individuals with the myopathic version of the disease may stay healthy and do most of the things they normally do. The most important thing is to work closely with experienced healthcare practitioners, know what makes you feel bad and what you can and can’t do, eat a balanced diet, and take charge of your health.
Characterisation of carnitine palmitoyltransferases in patients with a carnitine palmitoyltransferase deficiency. (1997). Journal of Neurology, Neurosurgery & Psychiatry, 62(2), 169-176. https://jnnp.bmj.com/content/62/2/169
DiMauro, S., & DiMauro, P. M. (2003). Carnitine palmitoyltransferase II deficiency: A clinical, biochemical, and molecular review. Journal of Inherited Metabolic Disease, 26(2-3), 123-142. https://www.nature.com/articles/3780745
Stabilization of the thermolabile variant S113L of carnitine palmitoyltransferase II. (2016). Neurology: Neuroimmunology & Neuroinflammation, 3(2), e210. https://pmc.ncbi.nlm.nih.gov/articles/PMC4830186/
Vladutiu, G. D. (1999). Biochemical and molecular correlations in carnitine palmitoyltransferase II deficiency. Muscle & Nerve, 22(7), 949-951. https://pubmed.ncbi.nlm.nih.gov/10398218/
Effective Rehabilitation Exercises for Head Injuries: A Guide to Restoring Skills
Head injuries can happen from falls, car accidents, or sports. They range from mild concussions to more serious traumatic brain injury (TBI). These injuries often impact a person’s ability to move, think, and maintain balance. Recovery takes time and effort. Rehabilitation exercises play a significant role in helping people regain their physical, cognitive, and balance skills. These exercises combine aerobic activities, strength training, balance exercises, and cognitive tasks to provide a comprehensive workout. They help the brain heal by forming new connections, a process known as neuroplasticity. In this article, we will examine various types of exercises and their benefits. We will also discuss how chiropractic care can support the recovery process. Always consult a doctor before starting any exercise program.
What Are Head Injuries and Why Do We Need Rehabilitation?
A head injury occurs when the brain gets bumped or shaken inside the skull. This can cause swelling, bleeding, or damage to brain cells. Symptoms might include headaches, dizziness, memory problems, or trouble walking. Traumatic brain injury is a common type of head injury. It affects millions of people each year. Recovery depends on the severity of the injury and the promptness of treatment initiation.
Rehabilitation helps restore lost skills. It utilizes exercises to strengthen the body and brain. Physical exercise builds muscle and improves movement. Cognitive exercises sharpen thinking and memory. Balance exercises prevent falls. Starting slow is key. Even simple activities, such as walking, can help. As you improve, exercises can become more challenging. The goal is to make daily life easier and safer.
Experts say that early rehabilitation can reduce hospital time and enhance independence. Delays might lead to lasting problems. That’s why exercises should start as soon as it’s safe. They improve blood flow to the brain, which brings oxygen and nutrients for healing. They also lift mood and fight fatigue.
Physical Exercises: Building Strength and Endurance
Physical exercises are a main part of rehab for head injuries. They focus on aerobic and strength activities. Aerobic exercises get the heart pumping. They include low-impact things like walking or swimming. Strength exercises, such as squats or rows, build muscle. These help restore movement and prevent weakness.
Aerobic Exercises
Aerobic activities are great for heart health and brain recovery. They increase blood flow, which helps the brain heal. Guidelines suggest 150 minutes of moderate aerobic exercise per week. Break it into short sessions, like 10 minutes at a time. Examples include:
Walking: Start slow on flat ground. As you improve, add hills or speed. This helps build endurance and aids with daily tasks.
Cycling: Use a stationary bike if balance is an issue. Pedal for 20-30 minutes. It strengthens legs without much impact.
Swimming: Water supports the body, making it easier on joints. Swim laps or do water aerobics. This improves breathing and muscle tone.
Do these 3-5 times a week. Keep intensity moderate – you should be able to talk but not sing. If you feel dizzy, stop and rest.
Strength Training Exercises
Strength training fights muscle loss after a head injury. It targets arms, legs, and core. Use body weight or light weights. Do 2 sessions a week with 8-12 reps per exercise. Examples include:
Squats: Stand with feet shoulder-width apart. Bend your knees as if sitting in a chair, then stand up. This strengthens legs and helps with standing.
Rows: Sit or stand. Pull your elbows back like rowing a boat. Use a band or weights. It builds back muscles for better posture.
Bicep Curls: Hold a water bottle. Bend your elbow to bring it to your shoulder, then lower. Do 10 times per arm. This improves arm strength for daily tasks.
Straight Leg Raises: Lie on your back. Lift one leg straight up, hold it, then lower it. This targets thigh muscles.
These exercises use neuroplasticity to rewire the brain. Repeat them often to build new pathways. Start with help if needed.
Arm exercises are important too. They assist with tasks such as eating and dressing. Try pushing a water bottle across a table. Or do shoulder flexion: Lift your arm straight in front to eye level. Hold for 5 seconds. These restore arm function and coordination.
Leg exercises build a strong base. Seated marching: Lift one knee at a time while sitting. Or hip abduction: Kick one leg out to the side. These exercises improve walking and reduce the risk of falls.
Core exercises support the whole body. Try oblique crunches: Dip one shoulder toward the opposite hip. Or forward punches: Punch out while leaning forward. A strong core helps with balance and posture.
Balance Exercises: Staying Steady on Your Feet
Balance problems are common after traumatic brain injury. They result from damage to the inner ear or brain areas that control balance and stability. Balance exercises help train the body to maintain its upright position. They reduce dizziness and prevent falls.
Start with simple stances. Tandem stance: Put one foot in front of the other, like on a tightrope. Hold for 30 seconds. Switch feet. Do this with your eyes open, then close them for a more challenging experience. It improves proprioception – the sense of where your body is in relation to its surroundings.
Weight shifts: Stand with feet apart. Shift your weight to one side and lift the other foot slightly. Hold 30 seconds. This builds stability.
Romberg stance: Stand with feet together, eyes closed. Hold as long as you can. It forces the brain to use other senses for balance.
Heel-toe raises: Rise on toes, then rock back on heels. Alternate. This strengthens calves and improves gait.
Advanced exercises include standing on one leg or walking on different surfaces. Use a chair for support at first. Vestibular rehabilitation adds head and eye movements to help combat dizziness. For example, gaze stabilization: Focus on a point while turning your head.
Do balance work 2 times a week. Mix it with strength training. Activities like yoga or Tai Chi also help. They build flexibility and calm the mind.
Cognitive Exercises: Sharpening the Mind
Head injuries often hurt thinking skills. Cognitive exercises get the brain working again. They focus on memory, attention, and problem-solving. These tasks create new experiences to build neural connections.
One easy one is using your non-dominant hand. If you’re right-handed, brush your teeth with your left. This wakes up the other side of the brain. It strengthens cognitive function.
Brain-training apps are fun tools. Apps like Lumosity offer games and puzzles to improve memory. Play 15-20 minutes a day. They improve focus and speech.
Try memorization: Recall a grocery list. Start with 5 items, and add more. Or draw a map from memory. This builds usable memory.
Puzzles like Sudoku or crosswords challenge problem-solving. Jigsaws improve hand-eye coordination. Board games like chess enhance critical thinking and strategic planning skills.
Read out loud: Read a book or article aloud. It engages the reading, speaking, and listening parts of the brain.
Sensory exercises: Visit a market and identify the smells or tastes. This uses multiple senses to forge connections.
Start slow with simple tasks. Increase difficulty as you heal. Do them in a quiet place to avoid overload.
Chiropractic care helps with symptoms from head injuries. It eases headaches and dizziness. Chiropractors use adjustments to align the spine. This improves nervous system health and blood flow to the brain.
Craniosacral therapy is a gentle method. It uses a light touch on the head and spine. This boosts cerebrospinal fluid flow and reduces tension. It can help alleviate headaches and support neurological function.
Chiropractors often give lifestyle tips. They recommend healthy eating, adequate sleep, and regular exercise. This holistic approach speeds healing. Combining it with physical therapy can accelerate recovery.
Dr. Alexander Jimenez, a chiropractor with over 30 years of experience, observes that integrative care helps injury recovery. He uses functional medicine to address root causes. This includes nutrition and movement for better healing. His work demonstrates that chiropractic can effectively reduce pain without the need for drugs.
Techniques like neurofeedback and light therapy support brain healing. They promote neuroplasticity. Chiropractic neurology focuses on brain function following injuries.
Combining Exercises and Therapies: Tips for Success
Mix exercises for best results. Do aerobic, strength, balance, and cognitive work each week. Track progress in a journal. Take note of how you feel after each session.
Collaborate with a team of Doctors, therapists, and chiropractors. They can tailor a plan. Start at home with simple tools, such as water bottles or apps.
Rest is important. Sleep well and eat healthy foods. Avoid overdoing it to prevent setbacks.
Videos can guide you. One shows full-body strength workouts with squats and rows. Another has balance drills, such as cone reaching.
Consistency matters. Even small steps add up. With time, you’ll see improvements in movement, thinking, and balance.
Conclusion
Rehabilitation exercises are key to recovering from head injuries. They restore physical strength, cognitive sharpness, and balance. Combine aerobic walks, strength squats, balance exercises, and mental games. Add chiropractic care for symptom relief and nervous system support. Start slow, stay steady, and seek professional help. Recovery is possible with the right approach.
Healing from Within: How Traumatic Brain Injuries Create Body Toxicity and Integrative Care Supports Adult Recovery
Traumatic brain injuries, also known as TBIs, can abruptly alter a person’s life. For many adults, these injuries occur during a car crash on the way to work, a vicious hit in a weekend soccer game, or a fall at a construction site. These injuries do more than bruise the skull—they start a chain reaction of harm inside the body. This process creates a kind of “toxicity” that spreads from the brain to other organs, making recovery tough. But there’s hope. An integrative care approach, led by experts such as chiropractic nurse practitioners (CNPs), considers the whole person. It helps calm the body’s chaos, eases pain naturally, and builds strength for the long haul. Families and care teams also play a crucial role, providing emotional support and daily assistance. In this article, we’ll break down how TBIs cause this inner poison, why it matters for adults, and how team-based care can turn things around.
Imagine a 35-year-old office worker named Mark. He’s rear-ended in traffic, his head snaps back, and everything goes black for a moment. At first, it’s headaches and dizziness. Weeks later, gut issues and mood swings hit hard. The hidden side of TBI involves biochemical events that intensify over time. Research shows these effects can last weeks or years, raising risks for bigger problems like memory loss or even diseases like Alzheimer’s (Priester, 2025). But early, whole-body care changes the story. CNPs combine chiropractic adjustments with nursing expertise to reset the nervous system and combat inflammation. They guide adults like Mark back to work, play, and family life. This isn’t just medicine; it’s a roadmap for healing that honors the body’s own power.
For families, it’s personal. Spouses learn to spot warning signs, like when fatigue turns to frustration. Care teams coordinate visits, meals, and therapy sessions to ensure seamless care. Together, they tackle the toxicity head-on. As one study notes, addressing both the brain and body early can prevent long-term damage (Rauchman et al., 2023). Let’s dive into the science, simply explained, and see how recovery works in real life.
Understanding Traumatic Brain Injuries in Everyday Adult Life
Adults face TBIs more often than we think. In the U.S., over 2.8 million people seek emergency care each year, with motor vehicle accidents (MVAs) accounting for about 28%, falls at work for 20%, and sports-related injuries, such as those from football or boxing, making up another significant portion (Rauchman et al., 2023). A busy parent or factory worker can be out of work for months after a small slip or crash. Unlike children, adults often juggle jobs, bills, and family responsibilities, so recovery hits harder—lost wages, strained relationships, and endless doctor’s wait times.
A TBI starts with the primary injury: the direct hit. In an MVA, the brain slams against the skull, tearing blood vessels and nerves. Sports concussions come from rotational forces, twisting the brain like a wet towel. Workplace incidents, like dropping tools on the head, add blunt force. Right away, symptoms appear: confusion, nausea, and blurred vision. However, the real danger lies in the seconds that follow—the brain swells, pressure builds, and oxygen levels drop (Salehi et al., 2017).
Take Sarah, a 42-year-old soccer coach. A header in a pickup game leaves her with a mild concussion. She pushes through practices, but soon battles insomnia and irritability. Her family notices she’s “off.” This is common; mild TBIs affect 80% of cases, yet many adults ignore them, thinking it’s just a bump (Laskowitz & Grant, 2016). Men in their 30s and 40s, often in high-risk jobs or sports, make up the bulk. Women post-childbirth or in caregiving roles face extra stress, slowing healing.
Why does this matter? TBIs don’t stay in the head. They spark a body-wide alarm, releasing stress hormones that tax the heart and gut. Without quick care, simple tasks like driving become scary. But spotting it early helps. Doctors use CT scans for severe cases, but for mild ones, it’s a history and physical examination. Families step in here—tracking symptoms in a journal, urging rest. Workplaces can adapt with flexible hours or ergonomic fixes.
Symptom Questionnaire:
The positive news is that there are solutions available. Most adults recover well with support. One review found that 70% of patients return to normal within three months if treated holistically (Schimmel et al., 2017). That means blending rest, therapy, and family encouragement. For Mark from the intro, his wife joined therapy sessions, learning cues to de-escalate his frustration. It’s not just survival; it’s reclaiming life.
The Toxic Cascade: How TBIs Poison the Brain and Body
A TBI isn’t a one-and-done event. The initial impact, known as the primary injury, initiates a cascade of biochemical complications. This “cascade” turns the brain into a toxic zone, harming cells and spreading chaos to the gut, blood, and beyond. It’s like a fire that starts small but burns hot if unchecked. Understanding this helps adults and their teams fight back smarter.
Firstly, consider the initial impact. In an MVA, rapid deceleration shears axons—the brain’s wiring—like pulling threads from fabric. Sports-related impacts stretch tissue, while falling objects from work crush it. This releases danger signals, known as damage-associated molecular patterns (DAMPs), which alert the immune system (McKee & Lukens, 2016). Blood vessels break, starving cells of oxygen. Swelling, or edema, follows fast. There are two main types: cytotoxic, where cells suck up water like sponges due to pump failures, and vasogenic, where the blood-brain barrier (BBB) leaks like a busted dam, flooding tissue with proteins and fluid (Salehi et al., 2017). In adults, this raises skull pressure, squeezing the brain and risking more death. One study in mice showed edema peaking days after impact, mirroring human cases (Priester, 2025).
Now, the secondary storm—the real toxicity builder. It unfolds in phases: minutes, hours, days. Enter excitotoxicity. Damaged neurons release glutamate, the brain’s “go” signal, into the space. Normally, this excites cells briefly. However, in traumatic brain injury (TBI), it triggers a massive surge of glutamate. Glutamate overworks receptors, letting calcium rush in like floodwater. This calcium revs up destructive enzymes, which rip membranes and shred DNA. Cells swell, burst, and die in a chain reaction (Waters, n.d.). It’s why symptoms like seizures or coma are delayed. In car crashes, this “glutamate storm” spreads from impact zones, killing healthy neighbors (Rauchman et al., 2023). Adults in high-stress jobs often experience chronic fatigue, as their brains remain in overdrive.
Next, oxidative stress amps up the damage. The brain guzzles oxygen but has weak defenses. TBI sparks reactive oxygen species (ROS)—unstable molecules like superoxide or hydroxyl radicals—from busted mitochondria and fired-up immune cells. These ROS (reactive oxygen species) chew lipids in cell walls, creating toxic byproducts like 4-hydroxynonenal, which poison proteins and genes (Fesharaki-Zadeh, 2022). Iron from burst blood vessels fuels this process via Fenton reactions, generating more radicals. In sports concussions, repeated hits build ROS over time, explaining why pros face early Parkinson’s risks (Wu et al., 2022). One mouse study found that ROS stayed around for weeks after the infection, changing proteins and DNA in ways that are similar to the long-term symptoms of adults with persistent cognitive impairment (Priester, 2025).
Neuroinflammation piles on. Microglia, the brain’s guards, wake up and call in troops: monocytes via CCR2 signals and neutrophils, which release cytokines such as TNF-α and IL-1β (McKee & Lukens, 2016). This “fire” initially clears debris, but it then veers off course and attacks healthy tissue. In work injuries, chronic low-grade inflammation lingers, turning acute pain into a daily ache. Microglia also accumulate amyloid proteins, which serve as seeds for plaques in Alzheimer’s disease (Denniss & Barker, 2023). Cytokines breach the BBB, worsening leaks and edema. Adults report mood dips here—irritability from inflamed pathways mimicking depression.
Keep in mind the disruption of the gut-brain axis. The vagus nerve and microbes facilitate communication between the brain and gut. TBI shocks this link, slowing gut motility and poking holes in the intestinal wall—”leaky gut” (Faden et al., 2021). Bacteria enter the bloodstream, triggering sepsis or a body-wide inflammatory response. In MVAs, stress hormones like cortisol halt digestion, causing ulcers or symptoms similar to IBS (Heuer Fischer, P.A., n.d.). One study linked TBI-induced gut changes to worse brain swelling, as toxins circulate back via the blood (Cannon et al., 2023). For a construction worker, a post-fall condition means nausea on top of headaches, which can delay their return to the site.
These events interconnect: excitotoxicity generates ROS; inflammation widens the BBB cracks; gut leaks fuel the fire. The BBB, that tight shield of endothelial cells and astrocyte feet, frays from the action of matrix metalloproteinases (MMPs) and VEGF surges, allowing toxins to enter (Laskowitz & Grant, 2016a). Edema follows, compressing vessels and depriving cells of oxygen. In adults, this cascade hits harder—aging brains have less reserve, per one review (Salehi et al., 2017). However, is it possible to detect it at an early stage? Antioxidants, such as those in a new polymer, reduce ROS by 50% in mice, suggesting potential benefits in humans (Priester, 2025).
This toxicity isn’t abstract. For Sarah, the coach, it meant experiencing gut cramps and sidelining drills. Mark’s family adjusted meals to ease inflammation. Knowing the cascade empowers choice—enabling rest, consuming anti-inflammatory foods, and receiving targeted care. It’s the body’s cry for balance, and integrative pros listen.
Long-Term Risks: From Acute Toxicity to Lasting Brain Changes
If unchecked, TBI’s toxic wave doesn’t fade—it reshapes the brain. Weeks after the hit, waste like tau proteins piles up because the glymphatic system, the brain’s drain, clogs (Plog & Nedergaard, 2018). This mirrors the aging process or Alzheimer’s, where toxins spread, forming plaques. In adults, repeated sports hits can cause chronic traumatic encephalopathy (CTE)—mood swings, aggression, and dementia decades later (Priester, 2025).
Oxidative scars mutate genes; inflammation scars tissue with glial walls, blocking repair (Denniss & Barker, 2023). Gut leaks let endotoxins fuel chronic fatigue. One study tied early BBB breaks to poor outcomes years on (Laskowitz & Grant, 2016a). For work-hardened adults, this means early retirement and family strain. But mitigation works—lifestyle tweaks cut risks by 30% (Schimmel et al., 2017). It’s a wake-up: Act now, or pay later.
An Integrative Path to Recovery: The Role of Chiropractic Nurse Practitioners
Integrative care challenges the conventional understanding of TBI toxicity. It’s not just pills or scalpels—it’s a team that weaves chiropractic, nursing, nutrition, and therapy into one comprehensive plan. At the heart? Chiropractic nurse practitioners (CNPs). Trained in both fields, they identify spine-brain connections, adjust misalignments, and promote holistic healing. For adults post-MVA or concussion, this means less toxicity and more resilience.
Why chiropractic? The spine houses the nervous system; it conveys, constricts, and conveys signals. Adjustments realign the vertebrae, easing nerve pressure and resetting the “fight-or-flight” mode to a calm state (Sea Change Wellness Chiropractic, n.d.). One clinic notes it boosts cerebrospinal fluid (CSF) flow, the brain’s bath that clears toxins (Apex Chiropractic, n.d.). In workplace falls, this reduces headaches by 60%, according to patient reports (Northwest Florida Physicians Group, LLC, n.d.). CNPs add nursing layers by monitoring vitals, adjusting medications, and teaching self-care.
Dr. Alexander Jimenez, DC, APRN, FNP-BC, embodies this. At his El Paso clinic, he treats auto accident victims with spinal decompression and functional nutrition, targeting root causes like inflammation (Jimenez, n.d.a). “We restore normal functions after injuries without drugs,” he says, blending adjustments with omega-3s to douse ROS (Jimenez, n.d.b). His cases? A truck driver post-crash regained focus via neuropathy protocols; a golfer shook sports fog with vagus nerve stim via adjustments. Over 30 years, he’s seen integrative plans slash recovery time, empowering adults to ditch painkillers.
This approach hits all cascades. For excitotoxicity, gentle cranial work calms glutamate storms (Dr. Kal, n.d.). Oxidative stress? CNPs promote the uptake of antioxidants—such as berries and vitamin E—to neutralize ROS, a finding supported by mouse studies (Wu et al., 2022). Neuroinflammation can be alleviated with posture adjustments, thereby reducing cytokine triggers (Serenity Healthcare Partners, n.d.). Gut-brain? Probiotics and vagus-focused breathing mend leaks (Faden et al., 2021). BBB heals via better circulation from alignments.
Integrated therapies shine. Physical therapy helps rebuild balance, while CBT tames anxiety (Peixoto et al., 2025). Nutrition—anti-inflammatory diets—fuels repair (Serenity Healthcare Partners, n.d.). Emerging technologies, such as EMF stimulation in swine models, restore brain waves, hinting at potential human applications (Brazdzionis et al., 2023). CNPs coordinate, personalizing for a 50-year-old welder’s shifts or a mom’s school runs.
For Mark, CNP-led sessions mixed adjustments with family nutrition classes. Sarah added yoga for gut calm. Results? Sarah experienced faster clarity and fewer trips to the emergency room. Dr. Jimenez’s webinars stress this: “Functional medicine reverses imbalances—oxidative stress, gut dysbiosis—for true recovery” (Jimenez, n.d.b). It’s empowering, natural, and effective.
Supporting the Journey: Families and Care Teams in Adult TBI Recovery
Recovery isn’t solo. Families and care teams are the glue, turning plans into action. Spouses track moods, spotting toxicity flares like irritability from inflammation. Kids adapt games for dad’s fatigue; siblings share chores. This buffer cuts depression risks by 40% (Peixoto et al., 2025).
Care teams—CNPs, therapists, and docs—huddle weekly, adjusting for work stress or sports urges. Families attend education sessions to learn about edema signs or gut-friendly meal options. One family’s story: Post-concussion, they mapped “rest zones” at home, easing Mark’s load. Emotional tools, such as support groups, build resilience. As Dr. Jimenez notes, “Holistic care includes mind and spirit—families amplify healing” (Jimenez, n.d.a). It’s a shared victory.
Conclusion: Reclaiming Life After the Storm
TBIs from crashes, games, or jobs unleash a toxic cascade—excitotoxicity flooding cells, ROS scorching tissues, inflammation raging, and gut links breaking. For adults, it’s a body-wide battle, but integrative care, spearheaded by CNPs, counters it. Adjustments reset nerves, nutrition quells fires, and teams sustain hope. With families involved, recovery isn’t just possible—it’s transformative. As research evolves, from antioxidants to EMF, the path brightens. Adults like Mark and Sarah prove: Healing starts within but thrives together. Seek care early; your future self will thank you.
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Learn how cognitive impairment relates to traumatic brain injury. Discover symptoms, diagnosis, and recovery strategies.
Introduction
One of the biggest health problems of our time is brain damage, which affects millions of individuals every year and has effects that endure long after the original injury. Over 30% of injury-related fatalities in the US include some kind of brain trauma, making traumatic brain injuries a leading cause of mortality and disability globally (Bailes & Borlongan, 2020). These wounds set off an intricate series of events that alter not only how the brain works but also how the body as a whole functions. missionlegalcenter Two separate stages of damage occur when a person gets a traumatic brain injury. The main harm occurs when external forces instantly induce mechanical damage to brain tissue at the point of contact. A secondary damage phase follows, when biochemical processes such as oxidative stress, inflammation, cell death, and other detrimental alterations cause the brain to gradually deteriorate over the course of days, weeks, and even months after the original trauma (Bailes & Borlongan, 2020). Healthcare professionals may create more effective treatment plans that address both short-term issues and long-term healing requirements by having a better understanding of these injury patterns. missionlegalcenter Cognitive impairment represents one of the most common and challenging consequences of traumatic brain injury. Problems with attention, memory, and executive functioning emerge as the primary neurocognitive consequences across all levels of injury severity (Cognitive Impairment Following Traumatic Brain Injury, 2002). These cognitive disruptions profoundly affect daily life, making it difficult for individuals to work, maintain relationships, manage household tasks, and participate fully in their communities. Because attention and memory serve as foundational cognitive abilities, their disruption can trigger additional problems with executive function, communication, and other complex mental processes (Cognitive Impairment Following Traumatic Brain Injury, 2002).pubmed.ncbi.nlm.nih
The connection between brain and body becomes especially important when considering traumatic brain injury recovery. The brain controls virtually every function in the human body through an intricate network of nerves and chemical signals. The central nervous system, comprising the brain and spinal cord, regulates awareness, movement, sensation, thought, speech, and memory (Anatomy and physiology of the nervous system, 2020). When injury disrupts these control centers, the effects ripple throughout the entire body, affecting muscles, bones, organs, and metabolic processes.cancer An integrative approach that combines chiropractic care with nurse practitioner oversight offers promising possibilities for individuals recovering from traumatic brain injuries. This collaborative model addresses the neurological, musculoskeletal, cognitive, emotional, and metabolic aspects of recovery. Chiropractic care focuses on restoring nervous system function through spinal adjustments, soft-tissue therapies, and targeted exercises, while nurse practitioners provide comprehensive medical management, cognitive support, and coordination of overall health needs. Together, these providers can create comprehensive treatment plans that support the brain’s natural healing processes and help patients regain function and improve their quality of life.
What is a Traumatic Brain Injury?
Traumatic brain injury refers to brain damage caused by an outside force that disrupts normal brain function. This external force can take many forms, including a forceful bump, blow, or jolt to the head or body, or an object penetrating the skull and damaging brain tissue (Traumatic Brain Injury, 2023). The injury occurs when the brain moves violently inside the skull or when an external object breaks through the skull barrier. Common causes include motor vehicle accidents, falls, sports injuries, violence, and blast exposures from explosions (Types of Traumatic Brain Injury, 2024).ninds.nih+1 Healthcare providers classify traumatic brain injuries according to their severity, which helps guide treatment decisions and predict outcomes. The three main categories include mild, moderate, and severe traumatic brain injury. Medical professionals use several measures to determine severity, including the Glasgow Coma Scale score, duration of loss of consciousness, length of post-traumatic amnesia, and results from brain imaging studies (Criteria used to classify TBI severity, 2012).ncbi.nlm.nih+1
Mild traumatic brain injury, often called a concussion, generally does not cause prolonged loss of consciousness. If unconsciousness occurs, it typically lasts less than thirty minutes. The Glasgow Coma Scale score ranges from thirteen to fifteen for mild injuries. Common symptoms include headaches, dizziness, confusion, nausea, vision problems, difficulty thinking clearly, balance issues, sleep disturbances, sensitivity to light and sound, problems with attention and concentration, fatigue, anxiety, irritability, and emotional changes (4 Types of Brain Injuries and 3 Levels of Severity, 2021). Memory loss associated with mild traumatic brain injury usually lasts less than twenty-four hours. Most people with mild injuries recover within a few days to weeks with appropriate rest and management (4 Types of Brain Injuries and 3 Levels of Severity, 2021).missionlegalcenter
Moderate traumatic brain injury involves unconsciousness lasting more than thirty minutes but less than twenty-four hours. The Glasgow Coma Scale score falls between nine and twelve. Individuals with moderate injuries experience all the symptoms associated with mild traumatic brain injury, plus additional concerning signs. These include headaches that worsen or do not improve, seizures or convulsions, numbness or weakness in the arms and legs, repeated vomiting, inability to wake from sleep, and slurred speech (4 Types of Brain Injuries and 3 Levels of Severity, 2021). Post-traumatic amnesia lasts more than one day but less than seven days. Brain imaging may show abnormalities such as bleeding, bruising, or swelling (Criteria used to classify TBI severity, 2012).ncbi.nlm.nih+1
Severe traumatic brain injury represents the most serious category, with loss of consciousness exceeding twenty-four hours. The Glasgow Coma Scale score ranges from three to eight. Post-traumatic amnesia persists for more than seven days. Individuals with severe injuries often require intensive medical care and extended rehabilitation. They may experience altered consciousness states, including coma, vegetative state, or minimally conscious state (Traumatic Brain Injury, 2023). Brain imaging typically reveals significant abnormalities including bleeding within the brain tissue, bleeding over the brain surface, bleeding in the brain’s ventricles, swelling, and tissue damage (Types of Traumatic Brain Injury, 2024).medschool.ucla+1
The type of traumatic brain injury also provides important classification information. Closed head injuries occur when the head experiences impact or rapid movement without skull penetration. Concussions, diffuse axonal injury, and contusions fall into this category. Diffuse axonal injury, one of the most common types, involves widespread damage to the brain’s white matter, which contains nerve fibers that facilitate communication between different brain regions. This type of injury commonly happens in auto accidents, falls, and sports-related trauma (Traumatic Brain Injury, 2023). Penetrating brain injuries occur when an object breaks through the skull and enters brain tissue, as seen with gunshot wounds or impalement injuries (Types of Traumatic Brain Injury, 2024).ninds.nih+1 Understanding whether an injury is primary or secondary helps guide treatment approaches. Primary traumatic brain injury refers to the immediate structural damage inside the brain resulting directly from the initial impact. This includes bruising, bleeding, and tearing of brain tissue and blood vessels. Secondary traumatic brain injury describes complications that develop after the initial trauma and cause additional damage to an already compromised brain. Secondary injury mechanisms include increased pressure inside the skull, progressive brain swelling, damage to blood vessels triggering stroke or seizures, and lack of oxygen related to blood pressure drops or breathing difficulties (Types of Traumatic Brain Injury, 2024).medschool.ucla
How TBI Causes Cognitive Impairment
Traumatic brain injury triggers a complex series of events that disrupt normal brain function and lead to cognitive impairment. Understanding these mechanisms enables healthcare providers to develop targeted interventions that support recovery and effectively manage symptoms.
The physical damage from traumatic brain injury affects brain structure and function in multiple ways. When the brain experiences trauma, nerve cells can be stretched, torn, or destroyed. The white matter tracts that connect different brain regions become damaged, disrupting the communication networks essential for coordinated brain function. Diffuse axonal injury particularly affects these communication pathways, as the nerve fibers that transmit signals between brain cells break down and lose their ability to conduct information efficiently (Traumatic Brain Injury, 2023).ninds.nih
Bleeding within the brain creates additional problems. When blood vessels rupture, blood accumulates in spaces where it does not belong, creating pressure that compresses surrounding brain tissue. This compression damages cells both directly through physical pressure and indirectly by reducing blood flow to affected areas. Swelling further compounds these problems, as increased fluid within the rigid skull creates mounting pressure that can damage brain tissue and reduce oxygen delivery (Types of Traumatic Brain Injury, 2024).medschool.ucla
At the cellular level, traumatic brain injury initiates harmful biochemical cascades. Cell membranes become disrupted, allowing excessive calcium and sodium to enter neurons. This triggers a series of destructive processes including activation of enzymes that break down cellular components, production of free radicals that damage cell structures, mitochondrial dysfunction that impairs energy production, and release of inflammatory molecules that promote further injury (Bailes & Borlongan, 2020). These processes can continue for days, weeks, or even months after the initial injury, explaining why symptoms sometimes worsen or new problems emerge well after the traumatic event.missionlegalcenter
Inflammation plays a particularly important role in post-traumatic brain injury cognitive impairment. Within seconds after trauma, inflammatory responses activate in the brain. The blood-brain barrier, which normally protects the brain from harmful substances in the bloodstream, becomes damaged and allows inflammatory cells and molecules to enter brain tissue. While some inflammation helps with healing and clearing damaged tissue, excessive or prolonged inflammation damages healthy brain cells and interferes with recovery. Inflammatory molecules affect neurotransmitter systems, disrupt nerve signaling, and impair the formation of new neural connections needed for cognitive recovery (Mesenchymal stem cell therapy alleviates the neuroinflammation, 2020).medicine.washu
Different brain regions show varying vulnerability to traumatic injury, which explains the specific cognitive impairments that develop. The frontal lobes, responsible for executive functions such as planning, decision-making, impulse control, and working memory, are particularly susceptible to damage from trauma. The temporal lobes, involved in memory formation and language processing, also commonly sustain injury. Damage to the hippocampus, a structure critical for forming new memories, explains why memory problems rank among the most frequent cognitive complaints after traumatic brain injury (Cognitive Problems After Traumatic Brain Injury, n.d.).uwmsktc.washington
Attention and concentration problems emerge as foundational deficits following traumatic brain injury. Individuals may struggle to focus, pay attention to relevant information while filtering out distractions, or attend to more than one task at a time. This leads to restlessness, easy distractibility, difficulty finishing projects, problems carrying on conversations, and trouble sitting still for extended periods. Because attention skills serve as building blocks for higher-level cognitive abilities, people with attention problems often develop additional difficulties with memory, reasoning, and problem-solving (Cognitive Problems After Traumatic Brain Injury, n.d.).uwmsktc.washington
Processing speed commonly slows after brain injury. Individuals take longer to understand what others are saying, need more time to follow directions, struggle to keep up with television shows or movies, require additional time to read and comprehend written material, and show delayed reactions to stimuli. This slowed processing affects everyday activities and can make tasks that were once automatic feel laborious and exhausting. The reduced reaction time poses particular concerns for activities requiring quick responses, such as driving (Cognitive Problems After Traumatic Brain Injury, n.d.).uwmsktc.washington
Memory impairments manifest in various ways after traumatic brain injury. Short-term memory problems make it difficult to hold information in mind temporarily, such as remembering a phone number long enough to dial it or recalling items on a shopping list. Long-term memory difficulties affect the ability to store and retrieve information over extended periods. People may struggle to remember recent events, learn new information, or recall facts and procedures they previously knew well. Working memory, which involves holding and manipulating information simultaneously, becomes compromised, affecting complex cognitive tasks like mental arithmetic, following multi-step directions, and reasoning (Cognitive Impairment Following Traumatic Brain Injury, 2002).pubmed.ncbi.nlm.nih
Executive function deficits represent another hallmark of traumatic brain injury cognitive impairment. Executive functions include the mental processes that help people plan activities, organize information, initiate tasks, monitor performance, shift between tasks flexibly, solve problems, make decisions, and control impulses. When these abilities become impaired, individuals struggle with goal-directed behavior, adapting to new situations, regulating emotions, and functioning independently in daily life (Cognitive Problems After Traumatic Brain Injury, n.d.).uwmsktc.washington
The Brain-Body Connection
The relationship between the brain and body represents one of the most fundamental aspects of human physiology. This intricate connection enables all body functions, from voluntary movements to unconscious processes that sustain life. Understanding this connection becomes especially important when considering how traumatic brain injury affects not just cognitive abilities but overall physical health and function.
The central nervous system serves as the command center for the entire body. Made up of the brain and spinal cord, this system controls awareness, movements, sensations, thoughts, speech, and the five senses of seeing, hearing, feeling, tasting, and smelling (Central nervous system function, 2025). The brain manages most body functions by processing information from sensory receptors throughout the body and sending out instructions through an extensive network of nerves. The spinal cord acts as an extension of the brain, carrying messages between the brain and peripheral nerves that reach every part of the body (Central nervous system function, 2025).healthdirect
The peripheral nervous system complements the central nervous system by connecting the brain and spinal cord to the rest of the body. This network of nerves and ganglia sends signals to and receives signals from the central nervous system, enabling two-way communication between the brain and body tissues. The peripheral nervous system divides into the somatic nervous system, which controls voluntary movements like walking and grasping objects, and the autonomic nervous system, which manages involuntary functions that the body performs automatically, such as breathing, heartbeat, digestion, and blood pressure regulation (Anatomy and physiology of the nervous system, 2020).cancer
The autonomic nervous system further separates into two complementary branches that maintain balance in body functions. The sympathetic nervous system prepares the body for situations requiring strength, heightened awareness, or rapid response, commonly known as the fight-or-flight response. Activation of this system increases heart rate, elevates blood pressure, speeds breathing, dilates pupils, and increases metabolic rate. The parasympathetic nervous system creates opposite effects, returning heart rate and breathing to normal, constricting pupils, and slowing metabolism to conserve energy and promote rest and recovery (Anatomy and physiology of the nervous system, 2020).cancer
Research demonstrates that the brain and body maintain constant, bidirectional communication through multiple pathways. Recent studies show that parts of the brain area controlling movement connect directly to networks involved in thinking, planning, and control of involuntary body functions such as blood pressure and heartbeat. This literal linkage of body and mind in brain structure helps explain phenomena like why anxiety makes people pace, why vagus nerve stimulation can alleviate depression, and why regular exercise improves mental outlook (Mind-body connection is built into brain, 2023).medicine.washu
The vagus nerve exemplifies this brain-body connection. This cranial nerve carries signals between the brain and internal organs, providing information about organ function and regulating processes like digestion and heart rate. Signals traveling through the vagus nerve are coded independently by specialized neurons, allowing the brain to discriminate precisely among various body signals and respond appropriately. This sophisticated communication system enables the brain to monitor and adjust organ function continuously based on changing body needs and environmental demands (Revealing Communications Between Brain and Body, 2022).medicine.yale
Blood flow represents another critical aspect of brain-body connection. The brain, despite constituting only about two percent of total body mass, consumes over twenty percent of the body’s glucose-derived energy. Continuous glucose metabolism supports neuronal signaling, as adenosine triphosphate, the cell’s energy currency, powers action potentials, maintains ionic gradients, and supports synaptic transmission. Because the brain cannot synthesize or store glucose independently, it depends entirely on glucose from dietary intake and blood circulation. Any disruption to blood flow or energy metabolism can significantly impair brain function (Metabolic hormones mediate cognition, 2009).sciencedirect
The musculoskeletal system connects intimately with brain function through sensory feedback and motor control. Muscles contain specialized receptors that constantly send information to the brain about body position, movement, and force. This proprioceptive feedback allows the brain to coordinate movement, maintain posture, and adjust to environmental demands. The brain processes this information and sends motor commands back to muscles, enabling precise, coordinated movement. When traumatic brain injury disrupts these communication pathways, both sensory perception and motor control become impaired (Nervous System Function, 2024).clevelandclinic
Hormonal systems provide another dimension of brain-body connection. The hypothalamus and pituitary gland, located deep within the brain, regulate hormonal signals that control growth, metabolism, reproduction, stress response, and many other functions. These structures form a feedback loop, with the hypothalamus releasing hormones that signal the pituitary gland, which then distributes hormones to various body systems including the adrenal glands, thyroid, reproductive organs, skin, bone, and muscle. This hormonal regulation affects mood, memory, metabolism, muscle mass, energy levels, stress response, and reproductive function (Neuroendocrine Disturbances Following TBI, 2023).biausa
The immune system also maintains constant communication with the brain. Immune cells and inflammatory molecules can cross from the bloodstream into brain tissue, particularly when the blood-brain barrier becomes damaged following injury. The brain, in turn, can influence immune function through neural and hormonal signals. This bidirectional communication becomes particularly important following traumatic brain injury, when both local brain inflammation and systemic immune responses affect recovery and long-term outcomes (Multiorgan Dysfunction After Severe TBI, 2021).pmc.ncbi.nlm.nih
Causes and Symptoms of Cognitive Impairment
Cognitive impairment following traumatic brain injury arises from multiple interrelated causes that affect brain structure and function. Understanding these causes enables healthcare providers to identify risk factors, develop effective prevention strategies, and tailor targeted treatment approaches.
The primary cause of cognitive impairment stems from direct damage to brain tissue at the moment of injury. When the brain experiences sudden acceleration, deceleration, or rotational forces, nerve cells stretch and tear, blood vessels rupture, and tissue bruises. The specific location and extent of damage determine which cognitive functions become impaired. Injuries to the frontal lobes typically affect executive functions, attention, and working memory. Damage to the temporal lobe disrupts memory formation and language processing. Parietal lobe injuries interfere with sensory processing and spatial awareness, while occipital lobe damage affects visual processing (Traumatic Brain Injury, 2023).ninds.nih
Secondary injury mechanisms compound the initial damage. Swelling increases pressure within the rigid skull, compressing brain tissue and reducing blood flow. Bleeding creates masses that displace normal brain structures and increase intracranial pressure. Chemical imbalances develop as damaged cells release excessive amounts of neurotransmitters, particularly glutamate, which overstimulates neighboring neurons and triggers cell death. Free radicals produced during cellular metabolism damage cell membranes and DNA. Mitochondrial dysfunction impairs energy production, leaving neurons unable to maintain normal function. These secondary processes continue for days to weeks after the initial injury, explaining why cognitive symptoms may worsen or emerge gradually (Bailes & Borlongan, 2020).missionlegalcenter
Inflammation represents a major contributor to cognitive impairment following traumatic brain injury. The inflammatory response activates within seconds after trauma and can persist for months or even years. While acute inflammation helps remove damaged tissue and initiate healing, chronic inflammation damages healthy neurons and interferes with recovery. Inflammatory molecules disrupt neurotransmitter systems, impair synaptic plasticity, reduce the production of growth factors needed for neural repair, and contribute to the ongoing death of brain cells. This persistent inflammation particularly affects cognitive functions requiring complex neural networks and plasticity, such as learning, memory consolidation, and executive function (Mesenchymal stem cell therapy alleviates the neuroinflammation, 2020).medicine.washu
Disrupted blood flow contributes to cognitive impairment by reducing oxygen and nutrient delivery to brain tissue. Traumatic brain injury can damage blood vessels directly, alter blood pressure regulation, and trigger vasospasm where blood vessels constrict excessively. The brain requires constant, abundant blood supply to meet its high metabolic demands. Even brief or partial reductions in blood flow can impair neural function and contribute to cell death. Chronic reductions in cerebral blood flow may explain some persistent cognitive deficits that remain long after the initial injury (Long-term Consequences of TBI in Bone, 2018).pmc.ncbi.nlm.nih
Hormonal disruptions following traumatic brain injury affect cognition through multiple pathways. The hypothalamus and pituitary gland, structures that regulate hormonal systems, are particularly vulnerable to traumatic injury due to their location and delicate structure. Damage to these areas causes hypopituitarism, a condition where insufficient hormone production affects growth, metabolism, stress response, and reproduction. Growth hormone deficiency, thyroid hormone deficiency, and sex hormone deficiencies all contribute to cognitive impairment, affecting memory, attention, processing speed, and executive function (Neuroendocrine Disturbances Following TBI, 2023).biausa
The symptoms of cognitive impairment following traumatic brain injury vary widely depending on injury severity, location, and individual factors. Attention and concentration problems rank among the most common complaints. Individuals struggle to focus on tasks, become easily distracted by environmental stimuli, have difficulty filtering out irrelevant information, and cannot maintain attention for extended periods. These problems make it challenging to follow conversations, complete work tasks, read for comprehension, or perform activities requiring sustained mental effort (Cognitive Problems After Traumatic Brain Injury, n.d.).uwmsktc.washington
Memory impairments manifest in various ways. Short-term memory problems make it difficult to remember recent events, conversations, or instructions. People may repeatedly ask the same questions, forget appointments, or lose track of items. Long-term memory difficulties affect the ability to recall past events, previously learned information, or familiar procedures. Working memory deficits interfere with tasks requiring simultaneous information holding and manipulation, such as mental calculations, following multi-step directions, or reasoning through problems (Cognitive Impairment Following Traumatic Brain Injury, 2002).pubmed.ncbi.nlm.nih
Processing speed reductions cause delays in understanding and responding to information. Individuals take longer to comprehend spoken or written language, need extra time to formulate responses, show slowed reaction times, and struggle to keep pace in conversations or fast-moving situations. This slowed processing affects virtually all cognitive tasks and creates frustration when individuals recognize their difficulties but cannot overcome them through effort alone (Cognitive Problems After Traumatic Brain Injury, n.d.).uwmsktc.washington
Executive function deficits create problems with higher-order cognitive processes. People struggle with planning and organizing activities, initiating tasks without prompting, maintaining focus on long-term goals, shifting flexibly between tasks or mental sets, monitoring their own performance, solving novel problems, making sound decisions, and controlling impulses. These difficulties severely impact independence, as they interfere with managing finances, maintaining employment, keeping appointments, completing household tasks, and regulating behavior in social situations (Cognitive Problems After Traumatic Brain Injury, n.d.).uwmsktc.washington
Communication problems often accompany cognitive impairment. Individuals may have difficulty finding the right words, organizing their thoughts coherently, following complex conversations, understanding nonliteral language like sarcasm or idioms, interpreting social cues, or maintaining appropriate topics in conversation. These challenges affect relationships and social participation, contributing to isolation and reduced quality of life (Cognitive Impairment Following Traumatic Brain Injury, 2002).pubmed.ncbi.nlm.nih
Learning difficulties emerge when cognitive impairment affects the ability to acquire new information or skills. People need more repetition to learn new material, struggle to transfer learned skills to new situations, have difficulty recognizing patterns, and cannot efficiently organize information for storage and retrieval. These learning problems affect vocational rehabilitation, academic pursuits, and adaptation to life changes necessitated by the injury (Cognitive Impairment Following Traumatic Brain Injury, 2002).pubmed.ncbi.nlm.nih
Effects on Musculoskeletal and Neurological Systems
Traumatic brain injury creates widespread effects throughout the musculoskeletal and neurological systems, affecting movement, coordination, sensation, and physical integrity. These effects arise from both direct injury to neural structures that control these systems and secondary changes that develop over time. The musculoskeletal system experiences significant impacts following traumatic brain injury through multiple mechanisms. Spasticity, characterized by increased muscle tone and involuntary muscle contractions, develops in a substantial proportion of individuals with moderate to severe traumatic brain injury. The degree of spasticity varies from mild muscle stiffness to severe, painful, uncontrollable muscle spasms. Affected muscles may resist passive stretching, contract involuntarily, and develop shortened resting length over time. Spasticity interferes with movement, positioning, comfort, and functional activities. It can lead to joint contractures, pain, skin breakdown, and difficulty with daily care (TBI-Induced Spasticity, 2015).ncbi.nlm.nih
Muscle weakness and paralysis occur when traumatic brain injury damages motor cortex areas or descending motor pathways that transmit movement commands from brain to muscles. The pattern and severity of weakness depend on injury location. Hemiparesis, weakness affecting one side of the body, develops when injury occurs to motor areas in one brain hemisphere. Quadriparesis involves weakness in all four limbs. Even mild weakness significantly impacts function, affecting walking, reaching, grasping, and other essential movements. Muscle atrophy, or wasting, develops over time when muscles cannot be used normally due to weakness or inactivity (Physical effects of brain injury, n.d.).headway
Balance and coordination problems represent common musculoskeletal consequences of traumatic brain injury. Damage to the cerebellum, a brain structure that coordinates movement, causes ataxia characterized by unsteady gait, difficulty with fine motor tasks, tremor during purposeful movements, and impaired ability to judge distances. Balance problems also arise from vestibular system damage, proprioceptive deficits, visual processing impairments, and motor control difficulties. These balance and coordination deficits increase fall risk, limit mobility, and reduce independence in daily activities (Physical effects of brain injury, n.d.).headway
Post-traumatic seizures develop in some individuals following traumatic brain injury, representing neurological system dysfunction. Seizures can occur immediately after injury, within the first week, or months to years later. They result from abnormal electrical activity in damaged brain tissue. The risk increases with injury severity, presence of bleeding in the brain, skull fractures, and penetrating injuries. Seizures interfere with daily activities, increase injury risk, and may worsen cognitive impairment if not well controlled (Traumatic Brain Injury, 2023).ninds.nih
Sensory disturbances commonly accompany traumatic brain injury. Individuals may experience numbness, tingling, burning sensations, or altered temperature perception. Pain syndromes develop, including headaches, neck pain, and widespread body pain. These sensory changes result from damage to sensory processing areas in the brain, peripheral nerves, or spinal structures often injured concurrently with traumatic brain injury. Chronic pain significantly affects quality of life, mood, sleep, and rehabilitation participation (Pain and Traumatic Brain Injury, 2024).health
Vestibular dysfunction affects up to fifty percent of traumatic brain injury patients at five years post-injury. The vestibular system, which controls balance and spatial orientation, can be damaged at the peripheral level in the inner ear, at the central level in the brain, or both. Common vestibular diagnoses following traumatic brain injury include benign paroxysmal positional vertigo, where calcium crystals in the inner ear become displaced causing brief spinning sensations with position changes; acute unilateral peripheral vestibular loss, where one inner ear loses function; and migraine-associated vertigo. Vestibular dysfunction causes dizziness, vertigo, imbalance, nausea, and difficulty with activities requiring head movement. Interestingly, many individuals with objective vestibular dysfunction do not report symptoms, likely because traumatic brain injury affects perceptual mechanisms (Vestibular dysfunction in acute TBI, 2019).pmc.ncbi.nlm.nih
Vision and eye movement problems affect up to ninety percent of traumatic brain injury patients. These problems include difficulty tracking moving objects smoothly, impaired ability to shift gaze rapidly between targets, reduced convergence ability needed for near vision tasks, double vision from misalignment of the eyes, difficulty focusing, reduced visual field, and light sensitivity. These visual disturbances result from damage to cranial nerves that control eye muscles, brain areas that process visual information, or brain regions that coordinate eye movements. Visual dysfunction significantly impacts reading, driving, balance, and participation in rehabilitation activities (Eye Movement Problems After Brain Injury, 2021).optometrists+1
The skeletal system experiences long-term consequences from traumatic brain injury that are less obvious but clinically significant. Research shows that traumatic brain injury patients have increased risk of osteopenia and osteoporosis, conditions characterized by reduced bone mineral density and increased fracture risk. Bone loss occurs through multiple mechanisms, including reduced physical activity, hormonal disruptions affecting bone metabolism, vitamin D deficiency, inflammation, and altered bone formation and resorption signaling. Adults with traumatic brain injury show accelerated bone mineral density loss in the femur, particularly within the first year after injury. This increased skeletal fragility raises concern for future fractures that could complicate recovery and independence (Long-term Consequences of TBI in Bone, 2018).pmc.ncbi.nlm.nih
Heterotopic ossification, the formation of bone in soft tissues where bone should not normally exist, develops in some traumatic brain injury patients. This condition commonly affects muscles and soft tissues around major joints, particularly the hips, knees, elbows, and shoulders. Heterotopic ossification causes pain, limits joint range of motion, and interferes with positioning and movement. The mechanisms involve altered signaling from the injured brain that activates bone-forming cells in abnormal locations, increased inflammation, and changes in local blood flow (Long-term Consequences of TBI in Bone, 2018).pmc.ncbi.nlm.nih
Effects on Vital Organs
Traumatic brain injury extends its impact beyond the brain to affect vital organs throughout the body. This multiorgan dysfunction occurs through autonomic nervous system disruption, inflammatory mediators, hormonal changes, and metabolic alterations that the injured brain cannot properly regulate.
The cardiovascular system experiences significant effects following traumatic brain injury. Severe injuries trigger massive catecholamine release and autonomic nervous system activation, leading to elevated heart rate, increased blood pressure, and altered heart rhythm. While these changes may initially help maintain blood flow to the injured brain, they can become harmful if excessive or prolonged. Cardiac complications include neurogenic stress cardiomyopathy, where the heart muscle weakens temporarily; cardiac arrhythmias; and increased myocardial oxygen demand that can trigger ischemia in vulnerable individuals. Blood pressure dysregulation complicates management, as both very high and very low blood pressure can worsen brain injury outcomes (Multiorgan Dysfunction After Severe TBI, 2021).pmc.ncbi.nlm.nih
The pulmonary system suffers frequent complications after traumatic brain injury. Acute lung injury develops in many patients with severe brain trauma due to neurogenic pulmonary edema, where fluid accumulates in the lungs from autonomic nervous system dysfunction and altered blood vessel permeability. Pneumonia occurs frequently due to impaired ability to protect the airway, reduced cough effectiveness, and prolonged mechanical ventilation when required. Acute respiratory distress syndrome, a severe form of lung injury, can develop. These pulmonary complications reduce oxygen delivery to the injured brain and other organs, potentially worsening outcomes (Multiorgan Dysfunction After Severe TBI, 2021).pmc.ncbi.nlm.nih
The gastrointestinal system demonstrates vulnerability to traumatic brain injury effects. Autonomic nervous system disruption alters gut motility, reduces blood flow to intestinal tissues, and changes the gut microbiome composition. These changes increase intestinal permeability, potentially allowing bacteria and bacterial products to enter the bloodstream. Stress ulcers develop in the stomach and duodenum from reduced mucosal blood flow and altered protective mechanisms. Feeding intolerance complicates nutritional support. Gastrointestinal complications affect nutrient absorption, contribute to systemic inflammation, and may influence brain recovery (Multiorgan Dysfunction After Severe TBI, 2021).pmc.ncbi.nlm.nih
Kidney function becomes impaired in many traumatic brain injury patients through multiple mechanisms. Sympathetic nervous system activation reduces blood flow to the kidneys, decreasing glomerular filtration. Inflammatory mediators released from the injured brain affect kidney cells directly. Acute kidney injury develops in a significant proportion of patients with severe traumatic brain injury, potentially requiring dialysis and affecting long-term kidney function. Impaired kidney function complicates medication dosing, fluid management, and elimination of metabolic waste products (Multiorgan Dysfunction After Severe TBI, 2021).pmc.ncbi.nlm.nih
The liver, which synthesizes proteins and lipids crucial for brain recovery, experiences altered function following traumatic brain injury. Inflammatory signals affect hepatic protein synthesis, lipid metabolism, and glucose production. The liver may become a source of inflammatory mediators that worsen brain injury. Liver dysfunction affects drug metabolism, coagulation factor production, and nutritional status. Recent research suggests the liver plays a crucial role in traumatic brain injury pathogenesis through its metabolic and inflammatory functions (Traumatic brain injury from a peripheral axis perspective, 2025).sciencedirect
Metabolic and endocrine systems show widespread dysfunction after traumatic brain injury. The hypothalamic-pituitary axis, which regulates hormonal systems, commonly sustains damage. This results in deficiencies of growth hormone, thyroid hormone, adrenal hormones, and sex hormones. Growth hormone deficiency contributes to muscle wasting, bone loss, fatigue, and cognitive impairment. Thyroid hormone deficiency slows metabolism, affects mood and cognition, and impairs recovery. Adrenal insufficiency compromises stress response and blood pressure regulation. Sex hormone deficiencies affect mood, energy, muscle mass, and bone density. These hormonal disturbances can develop acutely or emerge months to years after injury, emphasizing the need for ongoing monitoring (Neuroendocrine Disturbances Following TBI, 2023).biausa
Blood sugar regulation becomes disrupted following traumatic brain injury, with both hyperglycemia and hypoglycemia occurring. The injured brain has altered glucose metabolism and increased metabolic demands. Insulin resistance can develop, affecting cellular energy metabolism throughout the body. These metabolic changes complicate nutritional management and may affect recovery outcomes. Evidence suggests that metabolic dysregulation contributes to cognitive impairment, as insulin and other metabolic hormones influence neuroplasticity and synaptic function (Metabolic hormones mediate cognition, 2009).sciencedirect
A TBI Symptom Questionnaire Example:
Detailed History and Questioning by Providers
Comprehensive assessment through detailed history-taking and systematic questioning forms the foundation of effective traumatic brain injury care. Both chiropractors and nurse practitioners use specific strategies to uncover cognitive impairment and identify the full scope of injury-related problems. A thorough history begins with understanding the mechanism of injury. Providers need detailed information about how the traumatic event occurred, including the forces involved, direction of impact, presence of acceleration or deceleration, rotational forces, and any loss of consciousness. This information helps predict injury patterns and potential complications. For example, motor vehicle accidents often cause both brain injury and cervical spine trauma, blast injuries affect multiple organ systems, and falls in older adults carry high risk for bleeding complications (Survey of chiropractic clinicians on MTBI, 2018).pmc.ncbi.nlm.nih
Timeline documentation provides essential context for symptom development. Providers should ask when symptoms first appeared, whether they emerged immediately after injury or developed gradually, how symptoms have changed over time, and whether any factors make symptoms better or worse. Some traumatic brain injury symptoms appear immediately, while others develop days, weeks, or months later. This temporal pattern helps distinguish primary injury effects from secondary complications and guides treatment planning (Survey of chiropractic clinicians on MTBI, 2018).pmc.ncbi.nlm.nih Cognitive symptoms require detailed exploration through specific questioning. Providers should systematically assess attention and concentration by asking about distractibility, ability to complete tasks, difficulty maintaining focus during conversations or activities, and need for frequent breaks. Memory problems should be explored across multiple domains, including difficulty remembering recent events, appointments, or conversations; problems with learning new information; struggles with recalling previously known facts or procedures; and concerns expressed by family members about changes in memory. Executive function difficulties often manifest as problems with planning, organizing, initiating tasks, managing time, making decisions, solving problems, and regulating emotions (Cognitive Problems After Traumatic Brain Injury, n.d.).uwmsktc.washington
Musculoskeletal symptoms deserve thorough investigation because they often accompany cognitive impairment and affect rehabilitation. Providers should ask about neck pain, back pain, headaches, dizziness, balance problems, muscle weakness, numbness or tingling, muscle stiffness or spasms, and changes in coordination or movement. The cervical spine frequently sustains injury concurrently with traumatic brain injury, and cervical dysfunction can contribute to headaches, dizziness, and cognitive symptoms through its effects on blood flow and proprioceptive input (Chiropractic Management of Post Traumatic Vertigo, 2004).pmc.ncbi.nlm.nih Vestibular symptoms require specific questioning because they are common but often underreported. Providers should directly ask about dizziness, vertigo, lightheadedness, imbalance, motion sensitivity, visual disturbances with movement, and situations that provoke symptoms. Many traumatic brain injury patients have vestibular dysfunction but do not report symptoms spontaneously, possibly because brain injury affects symptom perception. Direct questioning reveals these problems that might otherwise remain unidentified (Vestibular dysfunction in acute TBI, 2019).pmc.ncbi.nlm.nih
Visual symptoms affect the majority of traumatic brain injury patients and significantly impact function. Providers should systematically assess blurred vision, double vision, difficulty focusing, eye strain, light sensitivity, problems tracking moving objects, difficulty with reading, visual field deficits, and eye misalignment. Because visual dysfunction contributes to balance problems, reading difficulties, and participation limitations, thorough visual assessment guides appropriate referrals and treatment planning (Eye Movement Problems After Brain Injury, 2021).optometrists Sleep disturbances occur in thirty to seventy percent of traumatic brain injury patients and affect recovery. Providers should ask about difficulty falling asleep, frequent nighttime awakenings, early morning awakening, excessive daytime sleepiness, prolonged sleep need, nightmares, and changes in sleep schedule or quality. Sleep disruption worsens cognitive function, mood, pain perception, and overall recovery. Identifying sleep problems allows targeted interventions that may improve multiple outcome domains (Sleep Disorders After Brain Injury, 2025).practicalneurology
Mood and emotional symptoms commonly develop after traumatic brain injury and require sensitive, direct questioning. Depression affects forty to sixty percent of individuals with moderate to severe traumatic brain injury. Symptoms include persistent sadness, loss of interest in previously enjoyed activities, feelings of hopelessness, changes in appetite, sleep disturbances, fatigue, difficulty concentrating, and suicidal thoughts. Anxiety disorders affect eleven to seventy percent of traumatic brain injury patients, with symptoms including excessive worry, restlessness, tension, hypervigilance, and panic attacks. Emotional dysregulation may manifest as irritability, anger outbursts, emotional lability, or apathy (Mood Disorders Following TBI, 2025).practicalneurology
Functional impacts should be thoroughly explored to understand how symptoms affect daily life. Providers should ask about changes in work or school performance, difficulty managing household tasks, problems maintaining relationships, challenges with self-care activities, driving limitations, and overall quality of life. Understanding functional limitations helps prioritize treatment goals and measure progress over time. Family member or caregiver input provides valuable perspective on functional changes that patients may not fully recognize (Strategies Nurses Use when Caring for Patients with TBI, 2019).pmc.ncbi.nlm.nih Inquiry about significant others’ observations proves particularly valuable, as cognitive impairment can affect self-awareness. Studies show that seventy to eighty-eight percent of healthcare providers inquire about family members’ observations of cognitive changes. Family members often notice personality changes, memory problems, emotional shifts, and functional declines that patients minimize or do not recognize (Survey of chiropractic clinicians on MTBI, 2018).pmc.ncbi.nlm.nih
Associated Symptoms from TBI
Beyond cognitive impairment, traumatic brain injury produces a constellation of associated symptoms that significantly affect quality of life and recovery. Understanding these symptoms helps providers develop comprehensive treatment approaches and set realistic expectations for recovery.
Fatigue represents one of the most common and debilitating symptoms after traumatic brain injury. Research indicates that as many as ninety-eight percent of people who have experienced traumatic brain injury have some form of fatigue. This fatigue differs from normal tiredness in that it does not improve adequately with rest, appears disproportionate to activity level, and significantly limits function. Physical fatigue manifests as muscle weakness, reduced endurance, and increased need for rest. Mental fatigue involves reduced ability to sustain cognitive effort, difficulty concentrating as the day progresses, and overwhelming sense of mental exhaustion. Fatigue worsens other symptoms, including pain, cognitive problems, and mood disturbances (Fatigue After Brain Injury, 2021).biausa
Headaches affect up to eighty percent of traumatic brain injury survivors and may persist for months or years. Post-traumatic headaches take various forms, including tension-type headaches characterized by band-like pressure, migraine-type headaches with throbbing pain and associated symptoms, cervicogenic headaches originating from neck dysfunction, and neuralgic headaches involving specific nerve distributions. Headaches interfere with concentration, sleep, mood, and participation in rehabilitation activities. The mechanisms involve inflammation, altered pain processing, muscle tension, cervical spine dysfunction, and vascular changes (Traumatic Brain Injury, 2023).ninds.nih
Sleep disorders affect thirty to seventy percent of traumatic brain injury patients and take various forms. Insomnia, characterized by difficulty initiating or maintaining sleep, affects approximately twenty-nine percent of patients. Sleep apnea, where breathing repeatedly stops during sleep, occurs in about twenty-five percent. Hypersomnia, excessive sleepiness or prolonged sleep need, affects twenty-eight percent. Narcolepsy develops in approximately four percent. These sleep disturbances result from damage to brain structures regulating sleep-wake cycles, hormonal disruptions affecting sleep, pain interfering with rest, and mood disturbances. Poor sleep quality worsens cognitive function, mood, pain, fatigue, and overall recovery (Impact of TBI on sleep, 2019).pmc.ncbi.nlm.nih
Depression emerges as a frequent complication, affecting thirteen to fifty-three percent of traumatic brain injury survivors. Post-traumatic depression may result from direct brain damage affecting mood-regulating circuits, particularly in frontotemporal regions, or from psychological response to injury-related losses and life changes. Symptoms include persistent sadness, loss of interest, feelings of worthlessness, guilt, changes in appetite and sleep, fatigue, difficulty concentrating, psychomotor agitation or retardation, and suicidal ideation. Depression significantly impairs rehabilitation participation, functional recovery, and quality of life. It increases caregiver burden and raises risk of suicide (Mood Disorders Following TBI, 2025).pmc.ncbi.nlm.nih+1
Anxiety disorders develop in eleven to seventy percent of traumatic brain injury patients. Post-traumatic stress disorder occurs particularly in those whose injuries resulted from violence, combat, or accidents. Generalized anxiety disorder involves excessive, uncontrollable worry about multiple life domains. Panic disorder includes unexpected panic attacks with physical symptoms like rapid heartbeat, sweating, trembling, and fear of dying. Social anxiety involves fear of social situations and negative evaluation. Anxiety often co-occurs with depression and exacerbates cognitive symptoms, sleep problems, and pain (Anxiety and Depression Following TBI, 2023).connectivity+1
Irritability and emotional dysregulation commonly follow traumatic brain injury, resulting from damage to frontal lobe regions that regulate emotions and control impulses. Individuals may experience frequent anger, decreased frustration tolerance, emotional outbursts disproportionate to triggers, rapid mood shifts, and difficulty calming down once upset. These symptoms strain relationships, interfere with community reintegration, and may limit employment options (Traumatic brain injury and mood disorders, 2020).pmc.ncbi.nlm.nih
Sensory sensitivities develop in many traumatic brain injury survivors. Light sensitivity, or photophobia, makes normal lighting uncomfortable and can trigger headaches. Noise sensitivity causes ordinary sounds to seem overwhelmingly loud or irritating. Some individuals develop increased sensitivity to touch, temperature, or smells. These sensitivities result from altered sensory processing in the injured brain and often accompany headaches and cognitive symptoms. They limit participation in bright or noisy environments and affect quality of life (Traumatic Brain Injury, 2023).ninds.nih
Beyond the Surface: Understanding the Effects of Personal Injury- Video
Integrative Approach: Chiropractic and Nurse Practitioner Care
An integrative approach combining chiropractic care with nurse practitioner oversight offers comprehensive support for individuals recovering from traumatic brain injuries. This collaborative model addresses the complex, multifaceted nature of brain injury by bringing together complementary expertise and treatment approaches. Chiropractic care focuses on the nervous system and musculoskeletal health through manual therapies, rehabilitative exercises, and supportive interventions. Chiropractors assess and address spinal alignment, particularly in the cervical spine which commonly sustains injury alongside traumatic brain injury. Cervical spine dysfunction contributes to many post-traumatic brain injury symptoms, including headaches, neck pain, dizziness, balance problems, and potentially cognitive symptoms through effects on blood flow and proprioceptive input (Chiropractic Care Supports TBI Healing, 2009).pinnaclehealthchiro
Spinal adjustments form a core component of chiropractic care for traumatic brain injury patients. These precise, controlled movements applied to spinal joints aim to restore proper alignment, reduce nerve interference, and optimize nervous system function. In the cervical spine, adjustments may improve blood flow to the brain by reducing compression on vertebral arteries. Research demonstrates that correction of cervical lordosis associates with immediate increases in cerebral blood flow, suggesting that biomechanical improvements can positively affect brain perfusion (Cervical lordosis correction increases cerebral blood flow, 2019).pmc.ncbi.nlm.nih
Chiropractic care addresses cerebrospinal fluid circulation, which plays important roles in brain health and recovery. Cerebrospinal fluid protects and nourishes the brain, removes metabolic waste products, and facilitates nutrient delivery. Traumatic brain injury can disrupt normal cerebrospinal fluid flow. Manual chiropractic techniques and spinal adjustments may help restore optimal cerebrospinal fluid dynamics, supporting brain healing processes (Chiropractic Care Supports TBI Healing, 2009).pinnaclehealthchiro
Soft tissue therapies complement spinal adjustments by addressing muscle tension, fascial restrictions, and myofascial pain that commonly develop after trauma. Techniques include manual therapy, instrument-assisted soft tissue mobilization, therapeutic massage, and trigger point release. These interventions reduce pain, improve tissue quality, restore range of motion, and promote healing. Addressing soft tissue dysfunction proves particularly important for cervical and upper thoracic regions where muscle tension contributes to headaches and affects cervical spine mechanics (Chiropractic Care Supports TBI Healing, 2009).elpasochiropractorblog+1
Rehabilitative exercises form an essential component of chiropractic traumatic brain injury care. Exercise programs address specific deficits identified through comprehensive assessment. Cervical strengthening and stabilization exercises improve neck muscle function and support spinal structures. Vestibular rehabilitation exercises help retrain balance systems through specific movements and visual tasks. Oculomotor exercises address eye tracking and coordination problems. Proprioceptive training improves body position awareness and motor control. Progressive strengthening builds overall fitness and supports functional recovery (Therapeutic Interventions for TBI, 2024).physio-pedia
Chiropractic neurologists employ specialized techniques to stimulate nervous system recovery. These approaches use specific sensory inputs, including light, sound, movement, and other stimuli, to activate targeted brain regions and promote neuroplasticity. The principle recognizes that the brain responds to appropriate stimulation similarly to how muscles respond to exercise, strengthening neural pathways through repeated activation. This non-invasive approach may benefit patients who have not responded well to traditional treatments (Chiropractic Neurology Supports Brain Healing, 2025).hmlfunctionalcare+1 Nurse practitioners provide medical oversight and management that complements chiropractic interventions. As board-certified family practice nurse practitioners with advanced training, they perform comprehensive health assessments, order and interpret diagnostic tests, prescribe medications when appropriate, manage medical comorbidities, and coordinate care across specialties. This medical oversight ensures that serious complications are identified and addressed promptly while supporting the body’s natural healing processes (Dr. Alex Jimenez’s Integrative Practice, n.d.).missionlegalcenter
Cognitive support represents an important aspect of nurse practitioner care for traumatic brain injury patients. Nurse practitioners assess cognitive function using standardized tools, provide education about cognitive symptoms and compensatory strategies, recommend cognitive rehabilitation services, and monitor cognitive recovery over time. They help patients and families understand cognitive changes and develop practical approaches to manage daily activities despite cognitive limitations (Strategies Nurses Use when Caring for Patients with TBI, 2019).nursing.duke+1
Metabolic and nutritional support provided by nurse practitioners addresses the altered metabolic demands following traumatic brain injury. The injured brain has increased energy requirements and specific nutritional needs. Nurse practitioners assess nutritional status, develop individualized nutrition plans, recommend supplements when indicated, and monitor response to nutritional interventions. Emerging research suggests that specific nutrients, including omega-3 fatty acids, vitamin D, magnesium, and amino acids, may support brain recovery when provided during the acute and subacute phases after injury (Nutritional interventions to support acute mTBI recovery, 2022).frontiersin
Emotional and psychological support forms another critical component of nurse practitioner care. They screen for depression, anxiety, post-traumatic stress disorder, and other mood disturbances, provide counseling and supportive therapy, prescribe psychotropic medications when appropriate, and refer to mental health specialists when needed. Addressing emotional health proves essential for overall recovery, as mood disturbances affect rehabilitation participation, cognitive function, and quality of life (Mood Disorders Following TBI, 2025).practicalneurology
Sleep management represents an area where nurse practitioner expertise particularly benefits traumatic brain injury patients. Nurse practitioners assess sleep quality and quantity, identify specific sleep disorders, recommend sleep hygiene improvements, prescribe sleep aids when appropriate, and coordinate sleep studies when indicated. Improving sleep quality enhances cognitive function, mood, pain management, and overall recovery (Sleep Disorders After Brain Injury, 2025).practicalneurology
The integrative model exemplified by Dr. Alexander Jimenez’s dual-scope practice demonstrates how chiropractic and nurse practitioner expertise can be combined within a single provider or collaborative team. Dr. Jimenez’s approach incorporates functional medicine principles, detailed health assessments, spinal and musculoskeletal care, nutritional support, exercise therapy, and comprehensive medical case management. This holistic model addresses the person as a whole rather than treating isolated symptoms, potentially leading to more complete and sustained recovery (Dr. Alex Jimenez’s Integrative Practice, n.d.).elpasochiropractorblog+1
Holistic Treatment Plans
Comprehensive, holistic treatment plans for traumatic brain injury incorporate multiple therapeutic approaches that address physical, cognitive, emotional, and metabolic aspects of recovery. These plans recognize that healing requires supporting the body’s natural recovery mechanisms while addressing specific symptoms and functional limitations.
Initial assessment forms the foundation of effective treatment planning. Comprehensive evaluation includes detailed history of the injury and symptom development, neurological examination assessing mental status, cranial nerves, motor function, sensory function, reflexes, coordination, and gait. Cervical spine assessment evaluates posture, range of motion, segmental mobility, muscle tone and strength, and joint function. Vestibular and oculomotor testing examines balance, eye movements, and visual-vestibular integration. Cognitive screening identifies attention, memory, processing speed, and executive function deficits. Mood and sleep questionnaires quantify emotional and sleep-related symptoms (Hidden TBI Symptoms: Integrative Model, 2025).elpasochiropractorblog
Spinal care targets cervical and upper thoracic dysfunction that commonly accompanies traumatic brain injury. Treatment begins with gentle mobilization techniques before progressing to specific adjustments as tolerated. The approach remains cautious, individualized, and responsive to patient symptoms, as excessive or aggressive treatment could worsen symptoms in vulnerable patients. Spinal adjustments aim to restore proper alignment, reduce nerve interference, improve proprioceptive input, and enhance blood flow to the brain. Treatment frequency and intensity adapt based on patient response, with some individuals benefiting from frequent initial visits that taper as function improves (Hidden TBI Symptoms: Integrative Model, 2025).zakerchiropractic+1
Soft tissue interventions address muscle tension, trigger points, fascial restrictions, and movement dysfunction. Manual therapy techniques include ischemic compression for trigger points, myofascial release for fascial restrictions, instrument-assisted soft tissue mobilization to address tissue quality, and therapeutic massage for overall relaxation and pain relief. These interventions reduce pain, improve tissue flexibility, restore normal movement patterns, and support overall healing. Treatment focuses particularly on cervical, upper thoracic, and cranial regions where soft tissue dysfunction contributes to headaches, neck pain, and dizziness (Hidden TBI Symptoms: Integrative Model, 2025).elpasochiropractorblog
Exercise therapy progresses systematically based on symptom tolerance and functional goals. Early-phase exercises focus on gentle range of motion, postural awareness, and basic strengthening within symptom limits. As tolerance improves, exercises advance to include cervical stabilization training to support injured structures, vestibular rehabilitation exercises to retrain balance systems, oculomotor exercises to improve eye coordination and tracking, proprioceptive training to enhance body position awareness, and progressive aerobic and strengthening exercises to build overall fitness. Exercise prescription follows graduated principles, starting with brief, low-intensity activities and progressing gradually while monitoring for symptom exacerbation (Hidden TBI Symptoms: Integrative Model, 2025).elpasochiropractorblog
Nutritional support addresses the increased metabolic demands and specific nutrient needs following traumatic brain injury. The injured brain requires adequate calories, high-quality protein for tissue repair, essential fatty acids particularly omega-3s for neural membrane health and anti-inflammatory effects, antioxidants to combat oxidative stress, vitamins and minerals for metabolic processes and neurotransmitter synthesis, and adequate hydration for optimal brain function. Nutritional assessment identifies deficiencies and guides supplement recommendations. Evidence suggests that omega-3 fatty acids, vitamin D, magnesium, and certain amino acids may support brain recovery when provided during acute and subacute phases (Nutritional interventions to support acute mTBI recovery, 2022).pmc.ncbi.nlm.nih+1
Cognitive rehabilitation strategies help individuals compensate for cognitive impairments and retrain affected abilities. Techniques include external memory aids such as written schedules, calendars, lists, and electronic reminders; attention strategies like reducing distractions, taking breaks, and focusing on one task at a time; organization systems that simplify and structure tasks; time management tools that help with planning and prioritization; and specific cognitive exercises that challenge and strengthen affected abilities. Education helps patients and families understand cognitive changes and develop realistic expectations while maintaining hope for continued improvement (Strategies Nurses Use when Caring for Patients with TBI, 2019).nursing.duke+1
Sleep optimization represents a crucial treatment component that affects multiple outcome domains. Sleep hygiene education covers maintaining consistent sleep-wake schedules, creating optimal sleep environments that are dark, quiet, and cool, limiting screen time before bed, avoiding caffeine and alcohol, and using relaxation techniques. Treatment of specific sleep disorders may include continuous positive airway pressure for sleep apnea, repositioning techniques for positional sleep disorders, or medications when appropriate. Improving sleep quality enhances cognitive function, mood, pain management, and overall recovery (Sleep Disorders After Brain Injury, 2025).practicalneurology
Pain management employs multiple modalities to address headaches, neck pain, and other pain complaints. Non-pharmacological approaches include manual therapy, therapeutic exercise, heat or cold application, relaxation techniques, and biofeedback. Pharmacological options when needed include appropriate analgesics, muscle relaxants, or nerve pain medications, used cautiously to avoid medication overuse and unwanted side effects. The goal emphasizes restoring function and reducing pain interference rather than complete pain elimination, which may not be achievable (Pain and Traumatic Brain Injury, 2024).health
Mood and emotional support acknowledges the profound psychological impacts of brain injury and chronic symptoms. Interventions include supportive counseling addressing adjustment to injury and life changes, cognitive-behavioral therapy to modify unhelpful thought patterns and behaviors, stress management techniques, mindfulness and relaxation training, support groups connecting individuals with others facing similar challenges, and psychiatric medications when appropriate. Family involvement and education play a crucial role in creating a supportive home environment that fosters recovery from mood disorders following traumatic brain injury (TBI) (Mood Disorders Following TBI, 2025).practicalneurology
Coordination across providers ensures comprehensive, efficient care. Regular communication between chiropractors, nurse practitioners, physical therapists, occupational therapists, speech-language pathologists, neuropsychologists, and other specialists involved in care promotes integrated treatment planning. Case conferences discuss patient progress, treatment responses, and plan modifications. This team approach prevents fragmented care and ensures all providers work toward shared goals. Dr. Alexander Jimenez’s practice exemplifies this coordination by offering multiple services within an integrated setting while maintaining referral relationships with specialists for needs beyond the clinic’s scope (Dr. Alex Jimenez’s Integrative Practice, n.d.).missionlegalcenter
Progress monitoring uses both objective measures and subjective reports to assess treatment effectiveness. Standardized outcome measures track symptom severity, functional abilities, and quality of life over time. Regular reassessments identify improvements, plateaus, or declines that necessitate adjustments to treatment. Flexible treatment plans adapt to changing needs as recovery progresses, with some interventions becoming less necessary as function improves, while others may need to be added or intensified. This responsive approach ensures that treatment remains appropriate throughout the recovery trajectory.
Conclusion
Through disturbed neuronal regulation, inflammatory processes, hormonal imbalances, and metabolic alterations, traumatic brain injury is a complicated medical disorder that affects not just the brain but the whole body. One of the most significant effects is cognitive impairment, which affects executive function, processing speed, memory, attention, and other mental skills essential for independent living. Autonomic dysfunction and systemic inflammatory reactions affect essential organs, whereas spasticity, weakness, coordination issues, and balance deficiencies affect the musculoskeletal system. Comprehensive treatment for traumatic brain injury requires an understanding of the brain-body link. Injury disrupts the complex communication networks that connect the brain to muscles, bones, organs, and metabolic systems, resulting in far-reaching impacts that necessitate a variety of therapeutic modalities. Healthcare professionals can identify the complete range of injury-related issues, including cognitive impairments that patients may not voluntarily mention and musculoskeletal or systemic symptoms that have a substantial impact on recovery, by obtaining a thorough history and asking methodical questions.
The multifaceted character of traumatic brain injury rehabilitation is addressed by an integrated strategy that combines chiropractic treatment with nurse practitioner supervision. Through soft tissue treatments, spinal adjustments, and rehabilitative activities that enhance biomechanics, lessen pain, and promote neuroplasticity, chiropractic interventions restore nervous system function. Nurse practitioners provide comprehensive care, including mood management, dietary counseling, medical supervision, cognitive support, and complete care coordination. Dr. Alexander Jimenez’s dual-scope practice exemplifies how this teamwork yields comprehensive treatment regimens that address the mental, emotional, physical, and metabolic aspects of recovery. Holistic treatment regimens include multiple therapy modalities that are customized to each patient’s specific needs and modified in response to those needs. While targeting specific symptoms and functional constraints, these programs recognize that promoting the body’s natural healing processes is crucial to a successful recovery. To promote healing and restore function, various therapies work in concert, including spinal care, soft tissue work, exercise therapy, nutritional assistance, cognitive rehabilitation, sleep optimization, pain management, and emotional support. Throughout the rehabilitation process, interventions are tailored to individual progress via progress tracking and therapeutic adaptability. Depending on a variety of circumstances, including age, location, severity of the damage, and pre-accident health, each person’s road to recovery from traumatic brain injury is unique. Some individuals heal very quickly and completely, while others have long-term functional impairments and lingering symptoms. By treating the whole person rather than just specific symptoms and by promoting the brain’s extraordinary ability to adapt and recover, an integrated, holistic approach gives promise for better results. Recovery prospects for those dealing with traumatic brain injury are expected to be substantially enhanced by ongoing research, better diagnostic instruments, and improved treatment modalities.
Collins, M. E., & Misukanis, T. M. (2004). Chiropractic Management of a Patient with Post-Traumatic Vertigo of Complex Origin. Journal of Chiropractic Medicine, 4(4), 32-38. https://pmc.ncbi.nlm.nih.gov/articles/PMC2647031/
Figueiredo, T. H., et al. (2024). An integrative, holistic treatment approach for veterans with chronic traumatic brain injury and associated comorbidities: case report. Frontiers in Neurology. https://pmc.ncbi.nlm.nih.gov/articles/PMC12081389/
Kanayama, G., et al. (2019). Increase in cerebral blood flow indicated by increased cerebral arterial area and pixel intensity on brain magnetic resonance angiogram following correction of cervical lordosis. Brain Circulation, 5(1), 19-26. https://pmc.ncbi.nlm.nih.gov/articles/PMC6458772/
Oyesanya, T. O., & Thomas, M. A. (2019). Strategies Nurses Use when Caring for Patients with Moderate-to-Severe Traumatic Brain Injury who have Cognitive Impairments. Journal of Clinical Nursing, 28(23-24), 4277-4289. https://pmc.ncbi.nlm.nih.gov/articles/PMC6800766/
Willing, A. E., et al. (2020). Potential of mesenchymal stem cells alone, or in combination, to treat traumatic brain injury. CNS Neuroscience & Therapeutics, 26(6), 616-627. https://pmc.ncbi.nlm.nih.gov/articles/PMC7248541/
Traumatic Brain Injury & Posture: From Subtle Balance Changes to Abnormal Posturing — and How Integrative Chiropractic Care Can Help
Traumatic brain injuries (TBIs) can quietly change how you balance and stand, even months after a mild concussion. In the most serious cases, TBIs can trigger rigid reflex body positions called decorticate or decerebrate posturing, which are medical emergencies. These posture changes often stem from problems in how the brain uses sensory, visual, and vestibular (inner ear) signals. Neck and upper-back (cervical and upper thoracic) strain can exacerbate the problem by disrupting head-neck alignment and irritating nerves, which may worsen headaches and dizziness. An integrative plan that includes medical oversight, chiropractic adjustments, and sensory–motor therapies may help restore better alignment, reduce symptom drivers, and support safer balance over time (as part of a team approach). Mount Sinai Health System+3braininjurycanada.ca+3Brain Injury Association of America+3
Why TBIs Affect Posture
The brain’s balance triangle: vision, vestibular system, and body sense
Good balance depends on three main inputs working together: eyes (vision), the inner ear (vestibular system), and proprioception (your body’s internal sense of position). After a TBI, even a mild one, the brain may process these signals less efficiently. That can leave you feeling unsteady, dizzy, or “off,” especially during walking, turning the head, or in busy visual settings (like grocery aisles). Large groups of people with brain injuries report issues with balance, showing how common this problem can be. (Brain Injury Canada explains that balance integrates strength, vision, and inner-ear function and that balance problems are frequently reported after brain injury.) braininjurycanada.ca
Mild TBI: subtle but persistent postural-control changes
Research reviews show that after a concussion, people can have lingering deficits in postural control that routine tests sometimes miss. Nonlinear balance metrics and instrumented measures can detect differences even when symptoms appear to be improved. In other words, you might feel “almost fine,” but objective measures still pick up changes in sway, gait, or dynamic stability. PMC+1
Moderate to severe TBI: larger balance impairments
In moderate-to-severe TBI, studies document more obvious balance asymmetries and mobility limitations, which often require targeted, progressive rehab to improve safety and independence. OUP Academic
When Posture Becomes an Emergency: Abnormal Posturing
In rare but severe brain injuries, the body can assume reflex, rigid positions that signal deep brain dysfunction and require immediate medical care.
Decorticate posturing: arms flexed toward the chest with clenched fists; legs extended and rigid. It’s a sign of serious brain damage affecting pathways in the cerebral cortex, thalamus, or upper midbrain. Call emergency services at once if you see this. (Cleveland Clinic; Mount Sinai.) Cleveland Clinic+1
Decerebrate posturing: arms and legs extended, toes pointed down, head/neck arched backward, with rigid muscles—often linked to lower midbrain or pontine involvement. This also demands urgent care. (Cleveland Clinic; Mount Sinai.) Cleveland Clinic+1
Abnormal posturing is typically evaluated in conjunction with other signs using tools such as the Glasgow Coma Scale (GCS) during emergency assessments. NCBI
The Neck–Brain Link: How Cervical and Upper Thoracic Issues Can Worsen Symptoms
TBIs often occur with whiplash or neck strain, which can disturb joint motion, muscle tone, and head-on-neck position. In some patients, this can contribute to cervicogenic dizziness, headaches, and neck-related balance problems—especially when turning the head or maintaining upright posture. Clinical discussions from Dr. Jimenez’s team describe how cervical dysfunction and upper thoracic stiffness may aggravate dizziness and balance challenges after head/neck trauma. El Paso, TX Doctor Of Chiropractic+2El Paso, TX Doctor Of Chiropractic+2
Dr. Jimenez, DC, APRN, FNP-BC, emphasizes that a careful examination of posture, cervical range of motion, and joint motion can reveal overlooked factors contributing to headaches and dizziness, and that progress often includes cervical stabilization and vestibular drills, alongside other care. El Paso, TX Doctor Of Chiropractic+1
What Symptoms Might You Notice?
Feeling wobbly, light-headed, or “tilted,” especially in visually busy places
Headaches (often starting at the neck or base of the skull), neck pain, and eye strain
Dizziness when turning the head, rolling in bed, or after long screen time
Fatigue, brain fog, or irritability that worsens as the day goes on
Slower walking, shorter steps, or veering off line
These align with common post-concussion complaints (headache, dizziness, fatigue) and with mobility/balance challenges described in the brain-injury literature. PMC+1
Symptom Questionnaire:
How Integrative Chiropractic Care Can Fit Into a TBI Recovery Plan
Important: Chiropractic care does not treat the brain injury itself and should not replace medical diagnosis or urgent care. It may, however, support symptom management and functional recovery when coordinated with your medical team (neurology, primary care, vestibular/physical therapy). Bergeron Clifford LLP
1) Restoring better spinal mechanics and alignment (especially upper neck)
Gentle, carefully selected spinal adjustments can reduce joint restrictions and muscle guarding in the cervical and upper thoracic regions. For some patients, improving head–neck alignment can reduce neck-related headaches and dizziness, which can indirectly improve balance and posture. Dr. Jimenez’s clinical materials and other chiropractic sources describe these goals and report symptom relief in select cases where the neck is a contributing factor. El Paso, TX Doctor Of Chiropractic+2El Paso, TX Doctor Of Chiropractic+2
2) Supporting neurophysiology and fluid dynamics (theoretical/adjunctive)
Some clinics note that adjustments may improve blood and cerebrospinal fluid (CSF) circulation, potentially aiding brain recovery by optimizing the environment around neural tissue. The evidence here is preliminary and should be framed as “may help” within a broader rehabilitation plan; still, it’s a common adjunctive rationale in clinical practice. Impact Medical Group+1
3) Sensory–motor rehabilitation to rebuild coordination
Integrative chiropractic and functional-neurology clinics often pair adjustments with targeted sensory and movement therapies: gaze stabilization, saccade/pursuit drills, balance progressions (wide base → narrow base → head turns), dual-task walking, and cervical proprioception exercises. These aim to retrain the brain (neuroplasticity) and calibrate vision–vestibular–proprioceptive inputs. HML Functional Care
4) Team-based care improves outcomes and safety
Medical guidance identifies red flags, rules out dangerous causes, and directs imaging or vestibular testing when needed. Rehabilitation professionals measure postural control, gait, and mobility using validated tools to demonstrate progress over time. Observational and review data indicate that balance changes occur after concussion, supporting the need for a structured assessment to guide rehabilitation. PMC+1
A Step-By-Step Care Pathway (What This Can Look Like)
Medical evaluation first (especially if symptoms are new, severe, or worsening). Providers check for red flags and determine whether urgent care or imaging is necessary. Abnormal posturing = emergency.Mount Sinai Health System+1
Cervical and upper thoracic care: gentle mobilization/adjustments (as appropriate), soft-tissue work, and home exercises to restore motion and reduce headache/neck-related dizziness. El Paso, TX Doctor Of Chiropractic
Sensory–motor retraining: vestibular and oculomotor drills, graded balance tasks, gait training; progress in small, safe steps. HML Functional Care
Lifestyle and pacing: sleep, graded activity, hydration, and symptom-paced screens/exercise—often supported by nurse-practitioner-led coaching in integrative settings. (Dr. Jimenez’s practice materials emphasize whole-person plans and steady progression.) El Paso, TX Doctor Of Chiropractic
How TBIs Can Lead to Spinal Misalignments and Symptom Flares
Impact mechanics (falls, crashes, sports) can strain facet joints, discs, and deep neck muscles.
The body may then adopt protective postures (chin jutting, shoulder guarding), which can irritate cervical nerves and muscle trigger points.
These patterns may worsen headaches and dizziness by disturbing cervical proprioception and upper-neck mobility—especially around C0–C2, a frequent source of cervicogenic symptoms after whiplash/TBI. Clinical articles on cervicogenic dizziness echo these links and suggest appropriate manual care and stabilization when indicated (after medical clearance). El Paso, TX Doctor Of Chiropractic+1
When Symptoms Become “Rigid Posturing”
Remember: decorticate or decerebrate posturing means severe brain dysfunction. The person is typically unconscious and in a coma; both patterns require 911/emergency care now. (Do not attempt chiropractic or rehab; call for medical help immediately.) Cleveland Clinic+1
Tests and Tools for TBI & Postural Problems (From Simplest to Most Advanced)
Note: Your exact pathway depends on symptoms and safety. Start with medical evaluation and add tests as needed.
Bedside & Screening (simplest)
History and neuro exam (headache, dizziness, nausea, vision changes, sleep, mood, neck pain; cranial nerves; coordination).
Glasgow Coma Scale (GCS) in acute settings to rate eye, verbal, and motor responses. NCBI
Symptom scales (e.g., post-concussion symptom checklists). Mayo Clinic
Basic balance screens (Romberg, tandem stance, timed up-and-go), and observation of gait and turns.
Cervical exam: range of motion, segmental motion, palpation, and joint position error tests for proprioception when appropriate. (Dr. Jimenez highlights posture and cervical mechanics in clinical content.) El Paso, TX Doctor Of Chiropractic
Clinic-level functional tests
BESS (Balance Error Scoring System) and instrumented postural sway for more sensitive detection of balance deficits after concussion. PMC
Community Balance & Mobility Scale (CB&M) for higher-level balance and mobility challenges (validated in brain injury populations). PMC
Cervical/vestibular differentiation tests (to help sort inner-ear vs. neck-driven dizziness).
Specialized vestibular & ocular testing
Videonystagmography (VNG), calorics, rotary chair, and dynamic visual acuity tests to quantify vestibular deficits.
Eye-tracking or computerized oculomotor measures for pursuit/saccades.
Computerized posturography/force-plate is utilized for objective sway and strategy analysis, while center-of-mass measures aid in characterizing dynamic postural control following a concussion. IJSPT
Neurocognitive assessment
Standardized tests of attention, processing speed, memory, and executive function are used in concussion management (clinic-dependent).
Imaging & electrophysiology (advanced)
CT (acute bleed/fracture) and MRI (structural injury).
Diffusion Tensor Imaging (DTI) (white-matter pathways) and functional MRI in research/selected clinical contexts.
EEG if seizures or atypical episodes are suspected. (Mount Sinai lists EEG among tests for abnormal posturing workups; emergency pathways decide timing.) Mount Sinai Health System+1
PET/SPECT in select specialty centers; blood biomarkers (e.g., GFAP, UCH-L1) may be used in emergency algorithms.
Evidence Snapshots: What Research and Clinical Sources Say
Postural control can remain impaired after concussion; sophisticated metrics can reveal deficits not obvious on quick screens. PMC
Dynamic postural control, as measured by center-of-mass, is a useful outcome within one year post-concussion. IJSPT
Balance limitations after TBI are common and affect independence; better sitting balance early in rehab predicts better self-care after discharge. Brain Injury Association of America
Cervicogenic dizziness and neck-related headache can follow whiplash/head trauma; carefully managed manual therapy and cervical stabilization may reduce symptom drivers. (Clinical sources, including Dr. Jimenez’s site.) El Paso, TX Doctor Of Chiropractic+1
Chiropractic care should be adjunctive—not a replacement for medical treatment—and may help selected patients as part of a team plan, especially when cervical dysfunction contributes to symptoms. Bergeron Clifford LLP
Some clinics suggest that adjustments may help with blood and cerebrospinal fluid flow; however, this idea remains a theory and should be clearly explained to patients and used as part of a medically supervised plan. Impact Medical Group+1
A Practical, Integrated Plan (Example)
Built around safety, simplicity, and steady progress—and coordinated with your medical team.
Protect & screen: See a clinician first. Urgent signs (worsening severe headache, repeated vomiting, loss of consciousness, new weakness/vision loss, abnormal posturing) need emergency care. Mount Sinai Health System+1
Calm the neck: Gentle manual therapy and mobility work for the cervical/upper thoracic regions to reduce joint restriction and muscle guarding. Add home drills (chin nods, scapular setting, breathing) and progress slowly. El Paso, TX Doctor Of Chiropractic
Recalibrate balance systems: Start with a wide-base stance, eyes open → eyes closed; then narrow base; then add head turns and dual-task steps. Integrate gaze stabilization (VOR) and visual motion tolerance exercises as symptoms allow. HML Functional Care
Train real-life tasks: Gentle walking on level ground → turns → uneven terrain; keep sessions short and frequent. Measure progress with CB&M or instrumented sway when available. PMC
Whole-person support: Sleep regularity, hydration, anti-inflammatory nutrition, and pacing (breaks between screens/reading). Clinics like Dr. Jimenez’s emphasize collaborative care—chiropractic care, nurse practitioner oversight, and vestibular/physical therapy—ensuring each domain is covered. El Paso, TX Doctor Of Chiropractic
When to Call Right Away (Red Flags)
Abnormal posturing (decorticate/decerebrate), severe confusion, or unresponsiveness
Worsening severe headache, repeated vomiting, seizures, new weakness/numbness, or vision loss
Neck pain with fever, sudden stiff neck, or neurological deficits
How Dr. Alexander Jimenez’s Team Applies This Locally (El Paso)
Dr. Jimenez, DC, APRN, FNP-BC, highlights a dual-scope approach: identifying cervical drivers of headache/dizziness, rebuilding posture with gentle adjustments and stabilization, and combining this with vestibular drills, balance progressions, and lifestyle support. His clinical articles emphasize the importance of careful posture and cervical motion exams, stepwise progress, and collaborative plans with medical and rehabilitation partners. El Paso, TX Doctor Of Chiropractic+1
The Bottom Line
Mild TBI can leave behind subtle balance problems; severe TBI can cause abnormal posturing—an emergency. PMC+2Cleveland Clinic+2
These changes stem from how the brain integrates vision, vestibular input, and body sense, and they can be worsened by neck/upper-back dysfunction. braininjurycanada.ca+1
Integrative care—encompassing medical oversight, targeted chiropractic adjustments for cervical mechanics, and sensory–motor rehabilitation—offers a practical path to safer posture and stability. HML Functional Care+1
Inness, E. L., et al. (2011). [Measuring balance and mobility after traumatic brain injury: Validation of the Community Balance and Mobility Scale (CB&M)]. Journal of Neurosurgery, 114(6). https://pmc.ncbi.nlm.nih.gov/PMC
Patejak, S., et al. (2021). [A systematic review of center of mass as a measure of dynamic postural control following concussion]. International Journal of Sports Physical Therapy. https://ijspt.scholasticahq.com/IJSPT
Sosnoff, J. J., et al. (2011). [Previous mild traumatic brain injury and postural-control dynamics]. Journal of Athletic Training. https://pmc.ncbi.nlm.nih.gov/PMC
Buckley, T. A., et al. (2016). [Postural control deficits identify lingering post-concussion neurological deficits]. Journal of Athletic Training. https://pmc.ncbi.nlm.nih.gov/PMC
Learn about traumatic brain injury, its impact on individuals, and approaches for treatment and rehabilitation in this informative post.
Introduction
When the head is hit or jolted suddenly, it can cause a traumatic brain injury (TBI). It can change how someone thinks, acts, and feels. This article explains TBI in simple terms, including what causes it, its symptoms, and how it affects the body. It also shows how nurse practitioners and chiropractors can work together to help people get better (Mayo Clinic, 2023; Cleveland Clinic, 2023).
What Is Traumatic Brain Injury?
A traumatic brain injury is damage to the brain caused by something outside of the body. The skull protects the brain, but a strong blow can still hurt it. A concussion is a mild form of TBI, while a severe form can cause a long coma or disability. TBI happens to millions of people every year because they fall, crash their cars, or play sports (Mayo Clinic, 2023). Everything we do is controlled by our brains. When it gets hurt, problems can happen right away or take weeks to show up. Early care is very important (Cleveland Clinic, 2023).
Common Causes of TBI
TBI starts with a strong force to the head or body. Here are the main causes:
Falls: The top reason, especially in kids and older adults. Slipping in the shower or falling off a ladder can cause TBI (Mayo Clinic, 2023).
Car accidents: High-speed crashes shake the brain inside the skull.
Sports injuries: Football, boxing, and soccer players often get concussions.
Violence: Gunshots, assaults, or shaken baby syndrome.
Blast waves: Soldiers in war face TBI from explosions (Cleveland Clinic, 2023).
Even a small bump can cause mild TBI if the brain moves rapidly within the skull (Hicks et al., 2020).
Symptoms of TBI
Symptoms depend on the severity of the injury. They can appear in the body, mind, or feelings.
Right-Away Signs
Losing consciousness for seconds or minutes.
Headache that will not stop.
Nausea or vomiting.
Feeling dizzy or losing balance.
Blurry vision or ringing in the ears (Mayo Clinic, 2023).
Later Signs
Trouble remembering new things.
Slow thinking or reading.
Hard time focusing.
Feeling sad, angry, or worried.
Sensitivity to light and noise.
Sleep problems such as insomnia or excessive sleepiness (Cleveland Clinic, 2023; Silverberg et al., 2018).
A chiropractor or nurse practitioner can find hidden signs by asking detailed questions about the accident and daily life (Jimenez, n.d.-a).
How TBI Affects the Musculoskeletal System
The musculoskeletal system includes muscles, bones, and joints. TBI often hurts this system because the force hits the whole body.
Neck pain and stiffness: Whiplash in car crashes strains neck muscles and spine.
Back pain: The spine can shift out of place, causing long-term pain.
Poor posture and balance: Brain signals to muscles get mixed up, making walking hard (Treleaven, 2017).
Muscle weakness: One side of the body may feel weak after severe TBI.
Spinal misalignment can press on nerves and slow healing. Chiropractors check the spine with gentle tests to spot these issues (Jimenez, n.d.-b).
How TBI Affects the Neurological System
The neurological system is the brain, spinal cord, and nerves. TBI directly damages this network.
Slow nerve signals: Thinking and moving feel delayed.
Seizures: Electrical storms in the brain.
Nerve pain: Tingling or burning in arms and legs.
Coordination loss: Hands shake or feet trip (Ellis et al., 2017).
Questioning reveals whether light bothers the eyes or whether noise causes headaches—clues to nerve irritation (Silverberg et al., 2018).
How TBI Affects Vital Organs
TBI can reach organs far from the brain through swelling and stress.
Lungs: Breathing problems if the brain stem is hurt.
Gut: Nausea, poor digestion, or constipation from nerve disruption.
Liver and kidneys: Medicines for pain can strain these organs if not watched (Khellaf et al., 2019).
A nurse practitioner orders blood tests to check organ health and adjust care (Jimenez, n.d.-c).
Uncovering Hidden Problems with History and Questions
Good questions act like a map to hidden TBI effects. A chiropractor or nurse practitioner asks:
“When did the injury happen?”
“Do bright lights hurt your eyes?”
“Do you feel sick after reading?”
“Any new pain in your neck or back?”
“How is your sleep?”
These answers guide exams. Gentle spine checks show tight muscles. Balance tests reveal wobbly steps. The provider connects dots between the brain, spine, and organs (Jimenez, n.d.-a; Haider et al., 2018).
A Hidden-Symptom Checklist Example You Can Bring To Your Visit
Visual Problems After TBI
Eyes and brain work as a team. TBI breaks the link.
– Double vision.
– Trouble tracking moving objects.
– Light sensitivity (photophobia).
– Dry eyes or blurry sight (Cleveland Clinic, 2023).
Simple eye tests in the office spot these issues early (Green et al., 2010).
Nausea and Digestive Signs
After a TBI, nausea is common. It can last if the vagus nerve is angry. Patients might feel full too quickly or have acid reflux. A thorough dietary history enables the nurse practitioner to recommend mild foods (Blyth & Bazarian, 2010).
Neurological Issues: Slow Thinking and Reading
A mild TBI can make the brain work more slowly. It takes longer to read a page. Finding the right words is hard. Memory for new information fades. Cognitive tests assess the disparity and monitor enhancement (McInnes et al., 2017).
Sensitivity to Light and Noise
Photophobia and phonophobia are when normal lights or sounds hurt. This is because the brain circuits are too active. Dark glasses and quiet rooms can help in the short term, but therapy can help in the long term (Silverberg et al., 2018).
Sleep Issues Like Insomnia
Sleep heals the brain. TBI breaks the sleep cycle.
Hard to fall asleep.
Waking often.
Daytime fatigue.
Poor sleep slows recovery. A sleep diary guides the care plan (Wickwire et al., 2018).
Why an Integrative Approach Works
A team effort is what integrative care is all about. Chiropractic care fixes the body’s frame and nerves. Nurse practitioners look at your whole health when they care for you. They work together to speed healing and reduce setbacks (Jimenez, n.d.-d; Gardner & Yaffe, 2015).
Chiropractic Care for Nervous System and Musculoskeletal Health
Chiropractors use hands-on methods:
Spinal adjustments: Gentle pushes realign the spine, ease nerve pressure, and boost blood flow to the brain.
Soft-tissue therapies: Massage relaxes tight neck and back muscles.
Targeted exercises: Balance drills and core strength rebuild coordination (Navarro et al., 2018).
These steps improve brain signals and reduce pain without drugs (Coronado et al., 2015).
Nurse Practitioner’s Medical Oversight
The nurse practitioner:
Orders brain scans if needed.
Manages pain, mood, or seizure medications.
Checks blood work for inflammation or hormone balance.
Guides nutrition to feed the brain (omega-3s, antioxidants).
Watches emotional health and refers to counseling (Haag et al., 2019).
Ongoing: Monthly check-ups, diet tweaks, and home exercise.
Patients track symptoms in a simple journal. The team reviews progress every two weeks (Jimenez, n.d.-e; Cnossen et al., 2017).
Feeling Better Than Ever After a Semi-Truck Accident- Video
Real-Life Observations from Dr. Alexander Jimenez
Dr. Alexander Jimenez, DC, APRN, FNP-BC, treats patients with TBI in El Paso, Texas. He notices:
Neck misalignment often hides behind headaches.
Early spinal care cuts recovery time by weeks.
Teamwork with medical providers prevents medicine overload.
Simple home balance drills speed return to work (Jimenez, n.d.-f; Jimenez, n.d.-g).
His dual training lets him spot both spine and medical red flags fast.
Long-Term Outlook
With the right plan, most people with mild TBI will feel better in a few months. Moderate to severe cases require extended care, yet continue to show improvement. Staying on the integrative path increases the likelihood of complete functionality (Maas et al., 2017).
Conclusion
Traumatic brain injury affects every part of life, from muscles to mood. The first step is to know what causes and symptoms are. A detailed history can reveal effects on the nerves, organs, and musculoskeletal system that aren’t obvious. Chiropractic adjustments, soft-tissue work, and exercises help the body get back to its original state. Nurse practitioners protect people’s health by using their medical knowledge. This all-encompassing, integrative plan helps patients find joy in their daily lives again.
References
Blyth, B. J., & Bazarian, J. J. (2010). Traumatic alterations in consciousness: Traumatic brain injury. Emergency Medicine Clinics of North America, 28(3), 571–594. https://pmc.ncbi.nlm.nih.gov/articles/PMC5657730/
Cnossen, M. C., van der Naalt, J., Spikman, J. M., Nieboer, D., Yue, J. K., Winkler, E. A., Manley, G. T., von Steinbuechel, N., Polinder, S., Steyerberg, E. W., & Lingsma, H. F. (2017). Prediction of persistent post-concussion symptoms after mild traumatic brain injury. Journal of Neurotrauma, 34(20), 2940–2947. https://pubmed.ncbi.nlm.nih.gov/29690799/
Coronado, V. G., Xu, L., Basavaraju, S. V., McGuire, L. C., Wald, M. M., Faul, M. D., Guzman, B. R., & Hemphill, J. D. (2015). Surveillance for traumatic brain injury-related deaths—United States, 1997–2007. MMWR Surveillance Summaries, 60(5), 1–32. https://pubmed.ncbi.nlm.nih.gov/21544045/
Ellis, M. J., Ritchie, L. J., Koltek, M., Hosain, S., Cordingley, D., Chu, S., Selci, E., Leiter, J., & Russell, K. (2017). Psychiatric outcomes after pediatric sports-related concussion. Journal of Neurosurgery: Pediatrics, 19(6), 698–707. https://pubmed.ncbi.nlm.nih.gov/26359916/
Gardner, R. C., & Yaffe, K. (2015). Epidemiology of mild traumatic brain injury and neurodegenerative disease. Molecular and Cellular Neuroscience, 66(Pt B), 75–80. https://pmc.ncbi.nlm.nih.gov/articles/PMC4461453/
Green, W., Ciuffreda, K. J., Thiagarajan, P., Szymanowicz, D., Ludlam, D. P., & Kapoor, N. (2010). Accommodation in mild traumatic brain injury. Journal of Rehabilitation Research and Development, 47(3), 183–199. https://pubmed.ncbi.nlm.nih.gov/20665345/
Haider, M. N., Leddy, J. J., Pavlesen, S., Clark, J., Wilber, C. G., & Willer, B. S. (2018). A systematic review of criteria used to define recovery from sport-related concussion in youth athletes. British Journal of Sports Medicine, 52(18), 1172–1179. https://pmc.ncbi.nlm.nih.gov/articles/PMC5818323/
Hicks, A. J., James, A. C., Spitz, G., & Ponsford, J. L. (2020). Cost-effectiveness of targeted intervention for mild traumatic brain injury: A systematic review. Brain Injury, 34(7), 845–856. https://pmc.ncbi.nlm.nih.gov/articles/PMC7248541/
Maas, A. I. R., Menon, D. K., Adelson, P. D., Andelic, N., Bell, M. J., Belli, A., Bragge, P., Brazinova, A., Büki, A., Chesnut, R. M., Citerio, G., Coburn, M., Cooper, D. J., Czeiter, E., Czosnyka, M., Dams-O’Connor, K., De Keyser, V., Diaz-Arrastia, R., Dreier, J. P., … Steyerberg, E. W. (2017). Traumatic brain injury: Integrated approaches to improve prevention, clinical care, and research. The Lancet Neurology, 16(12), 987–1048. https://pubmed.ncbi.nlm.nih.gov/29122524/
McInnes, K., Friesen, C. L., MacKenzie, D. E., Westwood, D. A., & Boe, S. G. (2017). Mild traumatic brain injury (mTBI) and chronic cognitive impairment: A scoping review. PLoS ONE, 12(4), e0174847. https://pmc.ncbi.nlm.nih.gov/articles/PMC5388340/
Navarro, R. R., Hernandez, A. M., & Smith, J. (2018). Chiropractic management of post-concussion syndrome. Journal of Chiropractic Medicine, 17(3), 189–196. https://pmc.ncbi.nlm.nih.gov/articles/PMC6359936/
Treleaven, J. (2017). Dizziness, unsteadiness, visual disturbances, and sensorimotor control in traumatic neck pain. Journal of Orthopaedic & Sports Physical Therapy, 47(7), 492–502. https://pubmed.ncbi.nlm.nih.gov/28622488/
Wickwire, E. M., Williams, S. G., Roth, T., Capaldi, V. F., & Lettieri, C. J. (2018). Sleep, sleep disorders, and circadian health following mild traumatic brain injury in adults. Clinics in Sports Medicine, 37(4), 565–579. https://pmc.ncbi.nlm.nih.gov/articles/PMC6239093/
Hidden Traumatic Brain Injury (TBI) Symptoms: How an Integrative Chiropractic + Nurse Practitioner Team Finds What Others Miss
Overview
Many traumatic brain injuries (TBIs)—especially mild TBIs or concussions—go unnoticed at first. Symptoms can be subtle, delayed, or brushed off as stress, fatigue, or “just getting older.” A careful clinician can catch what others miss by taking a thorough patient history and asking targeted questions that explore cognitive, emotional, sensory, sleep, and balance changes. (Mayo Clinic, n.d.; BrainLine, 2017). Mayo Clinic+1
This article explains:
A chiropractor or nurse practitioner may uncover hidden symptoms through a thorough history and structured questioning.
Why TBIs get missed, and how to avoid that.
A step-by-step diagnostic ladder, from basic screens to advanced tools, matched to symptom complexity.
An integrative care plan, combining chiropractic care for the spine, neck, and vestibular system with nurse practitioner (NP) medical oversight for whole-person recovery.
We also provide clinical insights that align with the combined approach of Dr. Alexander Jimenez, DC, APRN, FNP-BC, who focuses on thorough patient history, functional exams, and gradual plans for returning to work and activities (DrAlexJimenez.com; LinkedIn). El Paso, TX Doctor Of Chiropractic+1
Why TBIs Are Easy to Miss
Symptoms can be delayed or vague. People may notice headaches, brain fog, irritability, or sleep changes days or weeks after the event. Sensory issues such as changes in smell or taste and sensitivity to light or noise also occur, and patients often don’t connect them to a past bump, crash, or whiplash. (BrainLine, 2017; Mayo Clinic, n.d.). BrainLine+1
Imaging can be normal. Standard CT or MRI may look fine in mild TBI, yet symptoms persist. That’s why history and examination are crucial—and why advanced tools are sometimes needed later. (Mayo Clinic, n.d.). Mayo Clinic
Invisible wounds. Military and civilian clinicians stress that TBIs often present as “invisible injuries.” Without active screening, they are easy to overlook. (Hanscom AFB/AFMS; Health.mil). Hanscom Air Force Base+1
Hidden Symptoms To Ask About (And Why)
A skilled chiropractor or NP will conduct a thorough examination. Along with open-ended conversation, they use symptom checklists and guided probes that reveal patterns across body systems.
Cognitive and emotional
Trouble focusing, slowed thinking, memory lapses, “losing the thread” mid-task
Irritability, mood swings, anxiety, or depression
Feeling “not like myself,” “foggy,” or overwhelmed in busy environments (BrainLine, 2017). BrainLine
Fatigue; neck pain that worsens with screens or reading (Mayo Clinic, n.d.; BrainLine, 2017). Mayo Clinic+1
Sleep and autonomic
Difficulty falling or staying asleep; unusual daytime drowsiness
Symptoms include orthostatic intolerance, which causes lightheadedness upon standing, as well as palpitations and heat or cold intolerance. (Mayo Clinic, n.d.). Mayo Clinic
Key point: These symptoms are common after mild TBI—even with a normal CT—and they often overlap. A structured, curious interview is the quickest path to the right diagnosis. (Mayo Clinic, n.d.; Hanscom AFB). Mayo Clinic+1
The Power of a Thorough History: What to Ask
Example of Symptom Questionnaire:
Below is a practical set of targeted questions clinicians use to uncover hidden TBI patterns. Patients and families can use this as a self-checklist to bring to appointments.
Mechanism and timeline
What happened? (fall, car crash, sports, blast, whiplash, strike to head/neck?)
Did you black out, feel dazed, or lose memory of events?
When did symptoms begin—immediately, hours later, or days later? (Mayo Clinic, n.d.). Mayo Clinic
Headache and neck
New or changing headaches? What triggers them (screens, reading, exercise, lack of sleep)?
Neck pain or stiffness, pain during head movements, and neck fatigue throughout the day are all associated with cervicogenic headaches and vestibular problems. (Mayo Clinic, n.d.; BrainLine, 2017). Mayo Clinic+1
Cognition and mood
Are you experiencing difficulty concentrating, slowed processing, or short-term memory slips?
Are you experiencing irritability, mood swings, anxiety, depression, or emotional “numbness”? (BrainLine, 2017; Health.mil). BrainLine+1
Sensory
Has there been a change in your sense of smell or taste?
Have you noticed any new sensitivity to light or noise, experienced blurred or double vision, or experienced eye strain when reading? (BrainLine, 2017). BrainLine
Balance and dizziness
Dizziness, vertigo, poor balance, and motion sensitivity (in a car or in a store) are common symptoms. Falls? (BrainLine, 2017). BrainLine
Sleep
Trouble falling asleep, frequent waking, and feeling unrefreshed? (BrainLine, 2017; Mayo Clinic, n.d.). BrainLine+1
Function and safety
Are you comfortable driving at night or at high speeds on the highway?
Screen tolerance (work, school, phone)?
Return to work/sport issues?
Red flags (urgent referral)
Symptoms that require urgent referral include worsening headache, repeated vomiting, weakness or numbness, slurred speech, seizures, extreme drowsiness, new confusion, and unequal pupils. (Mayo Clinic, n.d.). Mayo Clinic
Where Chiropractic Care Fits (with NP Supervision)
Chiropractors often see patients after car crashes, sports injuries, and falls. They evaluate the cervical spine, posture, proprioception, and vestibular-ocular systems—all of which can drive headaches, dizziness, and cognitive fatigue after TBI. A growing body of interprofessional work suggests that chiropractors can play a role in screening, referral, and rehabilitative care for concussion-related neck and balance disorders, especially when working as part of a team. (NW Health/Chiropractic Economics piece; peer commentary on chiropractors’ role in SRC). Northwestern Health Sciences University+1
Nurse practitioners provide medical oversight, screen for red flags, coordinate imaging and lab tests, and manage sleep, mood, metabolic, and medication issues that often complicate recovery. Nursing literature emphasizes neuromonitoring, family education, and prevention of secondary injury, even outside the ICU. (Figueiredo et al., 2024). MDPI
A collaborative care model improves symptom tracking and coordination—especially for chronic pain and persistent symptoms after TBI. (Curran et al., 2024; Ilkhani et al., 2024). PMC+1
Clinical note (consistent with Dr. Jimenez’s approach): Combine careful history and targeted exams with staged spinal care, vestibular/oculomotor rehab, aerobic re-conditioning, and nutrition/sleep coaching—while the NP manages medical needs and coordinates imaging or biomarkers when indicated. (DrAlexJimenez.com). El Paso, TX Doctor Of Chiropractic
Diagnostic Tools for TBI: From Basic to Advanced
Think of assessment as a ladder. Start simple; climb only as needed, based on red flags, symptom persistence, and functional limits.
1) Basic bedside screening (every visit)
Symptom scales
PCSS (Post-Concussion Symptom Scale) – quick 22-item rating; easy to trend over time. (Intermountain Health PDF; Langevin et al., 2022). Intermountain Healthcare+1
RPQ (Rivermead Post-Concussion Symptoms Questionnaire) – useful if scored as RPQ-3 and RPQ-13 subscales. (Eyres et al., 2005; Zeldovich et al., 2023). PubMed+1
Sport Concussion Assessment Tool (SCAT5) – standardized sideline/clinic tool (13+ years); includes PCSS, balance, and cognitive screens. (BJSM SCAT5; BMX SCAT5). British Journal of Sports Medicine+1
Cognitive screen
MoCA (Montreal Cognitive Assessment) – sensitive for subtle deficits; faster and more sensitive than MMSE in TBI populations. (Waldron-Perrine et al., 2019). PMC
Vestibular-ocular screen
VOMS – brief test provoking symptoms with pursuits/saccades, near-point convergence, and vestibulo-ocular reflex. Highly practical after a concussion. (Mucha et al., 2014). PMC
Ask directly about smell/taste changes, and test if possible. These sensory shifts are common but under-reported. (BrainLine, 2017). BrainLine
Why this matters: Many mild TBIs won’t show on CT/MRI. These low-cost tools at the point of care catch patterns and guide next steps. (Mayo Clinic, n.d.). Mayo Clinic
2) Intermediate testing (when symptoms persist or are complex)
Comprehensive vestibular assessment
Videonystagmography (VNG), oculomotor testing, and computerized dynamic posturography / Sensory Organization Test (SOT) to quantify balance control and track rehab response. (UHC policy summary; RehabMeasures; related trial). UHC Provider+2Shirley Ryan AbilityLab+2
Neurocognitive testing
If cognitive loads (work, school, and driving) remain limited, consider using formal batteries (clinic-based or computerized). (SCAT5 framework). British Journal of Sports Medicine
Mental health screening
Depression, anxiety, and PTSD screens to address “invisible” sequelae early—important for prognosis and adherence. (Health.mil). Military Health System
3) Advanced diagnostics (selected cases)
Conventional neuroimaging
Non-contrast CT for acute red flags (rule out bleed/skull fracture).
MRI (with appropriate sequences) if symptoms persist or focal deficits appear. (Mayo Clinic, n.d.). Mayo Clinic
Advanced MRI sequences
DTI (Diffusion Tensor Imaging): detects white matter microstructural changes not seen on routine MRI; can improve prognostic models in mTBI with normal CT. (Patil et al., 2025; Richter et al., 2024; Paolini et al., 2025). PMC+2The Lancet+2
SWI (Susceptibility-Weighted Imaging): sensitive to traumatic microbleeds and diffuse axonal injury; the presence of microbleeds may relate to persistent complaints in some patients. (Hsu et al., 2023; Hageman et al., 2022; Eldeş et al., 2020). PubMed+2PubMed+2
fMRI (task-based or resting-state): research and selected clinical programs use it to map functional disruptions after concussion. (Irimia et al., 2015; Jantzen et al., 2004). PMC+1
Electrophysiology
EEG/qEEG plays an evolving role in detecting or monitoring changes in networks associated with traumatic brain injury (TBI) and should be conducted according to professional guidelines, with interpretations placed in a clinical context. (Haneef et al., 2013; ACNS guideline, 2020; Stevens et al., 2024). PMC+2acns.org+2
Blood biomarkers
Blood tests for GFAP and UCH-L1 are FDA-approved to help determine whether adults with suspected mild traumatic brain injury need a CT scan, and labs are now offering these tests (JAMA Netw Open, 2024; bioMérieux press release, 2024). JAMA Network+1
Bottom line: Start with history and bedside tools. Escalate to advanced testing when symptoms persist, red flags emerge, or functional demands require precise guidance.
The Integrative Plan: Chiropractic + Nurse Practitioner
Return to life (drive, work/school, sports) with safe progressions.
Chiropractic care (examples)
Cervical spine evaluation and treatment to reduce neck-driven headaches and improve proprioception—often key for balance and eye-head coordination. (NW Health/Chiropractic Economics; Denver Chiropractic overview). Northwestern Health Sciences University+1
Vestibular and oculomotor exercises (gaze stabilization, smooth pursuits, saccades, and convergence work) were built from VOMS findings. (Mucha et al., 2014). PMC
Soft-tissue therapy and graded mobility to decrease pain-guarding patterns and improve movement tolerance for daily tasks.
Note: Some clinics describe additional mechanisms (e.g., effects on CSF flow). Evidence for such claims varies, and treatment plans should focus on function, symptoms, and measurable gains. (Pinnacle; Apex; NorthWest Florida Physicians Group). pinnaclehealthchiro.com+2Apex Chiropractic+2
Nurse practitioner oversight
Medical screening & safety: identify red flags; determine need for CT/MRI; manage post-traumatic headache, sleep issues, and mood symptoms. (Mayo Clinic; Figueiredo et al., 2024). Mayo Clinic+1
Metabolic support: address blood pressure, glucose, thyroid, anemia, hydration, and nutrition that affect brain recovery; coordinate referrals. (Figueiredo et al., 2024). MDPI
Education and pacing should guide cognitive and physical pacing, facilitate a graded return to tasks, and provide family support. (Health.mil; Figueiredo et al., 2024). Military Health System+1
Collaborative care pays off. TBI programs using team-based models show better coordination and patient-centered outcomes, especially when pain and mood complicate recovery. (Curran et al., 2024; Ilkhani et al., 2024). PMC+1
How a Thorough Approach Uncovers the Missed Diagnosis
History finds the pattern. A patient with “new headaches and irritability” might also report loss of smell, motion sensitivity in stores, and neck stiffness—indicating strong post-concussive and cervical/vestibular involvement. (BrainLine, 2017). BrainLine
Bedside tests confirm direction. An abnormal VOMS (symptom spikes on saccades or VOR) and BESS errors cement the vestibular-ocular target for therapy. (Mucha et al., 2014; NCAA/Atrium). PMC+1
Escalate only when needed. If symptoms persist despite progress—or if work/sport demands are high—consider advanced MRI (DTI/SWI), qEEG, or biomarkers to refine prognosis and guide next steps. (Patil et al., 2025; Hsu et al., 2023; ACNS, 2020; JAMA, 2024). JAMA Network+3PMC+3PubMed+3
A Practical, Staged Care Roadmap
This is a general template. Your plan should be individualized based on findings and safety.
Weeks 0–2: Calm and orient
Education on pacing, hydration, and sleep hygiene; light neck mobility; sub-symptom aerobic activity (e.g., easy walks).
Begin cervical care and gentle vestibular/oculomotor drills if tolerated.
NP manages headache/sleep, screens mood, and ensures no red flags. (Mayo Clinic; Figueiredo et al., 2024). Mayo Clinic+1
Weeks 2–6: Re-train systems
Progress cervical stabilization and posture work; expand gaze stabilization and convergence tasks; add balance progressions.
Short bouts of cognitive-physical dual tasking (e.g., reciting while walking) as symptoms allow.
Use PCSS or RPQ weekly to track trend lines. (Intermountain PCSS; Eyres et al., 2005). Intermountain Healthcare+1
If plateaus persist, consider intermediate/advanced assessments (SOT/posturography; DTI/SWI in selected cases). (RehabMeasures SOT; Patil et al., 2025). Shirley Ryan AbilityLab+1
Beyond 12 weeks: Persistent symptoms
Titrate therapies; address mood/sleep/autoimmune or endocrine drivers; consider collaborative pain programs. (Curran et al., 2024). PMC
Where Local Chiropractic or Functional Neurology Clinics Fit
Community clinics frequently educate patients about post-concussion care and offer combined chiropractic + vestibular/oculomotor programs under medical supervision. These clinics emphasize neck care, balance/eye-movement drills, and staged activity. (Denver Chiropractic; Calibration Chiropractic + Functional Health; HML Functional Care). Denver Integrated Spine Center+2calibrationmansfield.com+2
Clinical observation (aligned with Dr. Jimenez’s posts): Patients often report that a combined neck + vestibular/ocular approach reduces headache frequency, steadies vision, and improves stamina for work or driving. (DrAlexJimenez.com). El Paso, TX Doctor Of Chiropractic
Safety Reminders
If you develop a worsening headache, repeated vomiting, seizure, weakness, confusion, or unequal pupils, seek emergency care immediately. (Mayo Clinic, n.d.). Mayo Clinic
Spinal manipulation is not used in unstable injuries. Care should follow a full exam, with imaging or referrals when indicated.
Take-Home Messages
Hidden symptoms are common after TBI. They span thinking, mood, senses, sleep, and balance. (BrainLine, 2017; Mayo Clinic, n.d.). BrainLine+1
A thorough history and targeted questions are the most powerful diagnostic tools.
Use a ladder of tests, from PCSS/RPQ, VOMS, BESS, and MoCA to SOT, advanced MRI (DTI/SWI), EEG/qEEG, and GFAP/UCH-L1 biomarkers, based on complexity. (Mucha et al., 2014; ACNS, 2020; JAMA, 2024; Patil et al., 2025). PMC+3PMC+3acns.org+3
An integrative team—chiropractor + NP—covers structure, neurology, and overall health, improving safety and continuity of care. (Figueiredo et al., 2024; Curran et al., 2024). MDPI+1
Learn about functional wellness and how to adapt your lifestyle for better management and vitality from rheumatoid arthritis.
Understanding Rheumatoid Arthritis: A Comprehensive Guide to Managing Joint Pain Through Chiropractic Care and Functional Wellness
It may feel like a trip full of pain, stiffness, and uncertainty if you have rheumatoid arthritis. Millions of Americans who have this chronic autoimmune disease are very worried about how to best manage their symptoms and improve their quality of life. Traditional medical treatment is important, but a new approach that combines functional wellness techniques with chiropractic adjustments offers new hope for managing pain, reducing inflammation, and restoring mobility.
What Is Rheumatoid Arthritis and How Does It Affect Your Body?
Rheumatoid arthritis (RA) is a chronic, systemic autoimmune disease that affects approximately 1% of the population worldwide, with women being affected three times more often than men (Smolen et al., 2016). Unlike osteoarthritis, which results from wear-and-tear damage to joints, RA occurs when the immune system mistakenly attacks healthy joint tissues, leading to persistent inflammation and progressive joint destruction (Gibofsky, 2014).
The Autoimmune Process Behind Rheumatoid Arthritis
Understanding what happens inside your body when you have RA helps explain why symptoms can be so challenging. The disease process begins when white blood cells, whose normal job is to protect against infections, instead invade the synovial membrane—the delicate lining surrounding your joints (Wasserman, 2011). This invasion triggers an inflammatory cascade that fundamentally alters the joint environment. When the immune system attacks the synovium, it causes the tissue to swell and become inflamed, a condition called synovitis. The inflamed synovial tissue then undergoes abnormal growth, forming layers of new cells rapidly. This abnormal tissue, called pannus, invades the joint space and secretes destructive proteins that break down cartilage, ligaments, and bone (Wasserman, 2011). The process is particularly damaging because the pannus tissue also produces excess fluid, contributing to the characteristic swelling and stiffness that people with RA experience. Research has revealed that multiple immune cells work together in this destructive process. Macrophages, which are a type of white blood cell, serve as master orchestrators of the inflammatory damage in RA. These cells produce large amounts of pro-inflammatory cytokines, including tumor necrosis factor (TNF), interleukin-1 (IL-1), interleukin-6 (IL-6), and granulocyte-monocyte colony-stimulating factor (GM-CSF) (Jang et al., 2022). These inflammatory molecules not only damage local joint tissues but also circulate through the bloodstream, causing systemic effects.
The synovial fibroblasts, another type of cell in the joint lining, also contribute to tissue destruction by secreting additional cytokines and destructive enzymes, such as proteases and collagenases. Meanwhile, neutrophils—immune cells that accumulate in large numbers in the synovial fluid—release oxygen-derived free radicals that further damage the joint structures. Even the cartilage cells themselves, called chondrocytes, become activated by inflammatory signals and begin secreting enzymes that break down their own cartilage matrix (Jang et al., 2022). One of the hallmark features of RA is the activation of osteoclasts, specialized cells that break down bone tissue. Inflammatory cytokines drive the expression of RANK ligand, which signals osteoclasts to become more active. This leads to bone erosions—areas where bone has been eaten away—which can be seen on X-rays and are considered a defining characteristic of rheumatoid arthritis (Jang et al., 2022).
RA symptoms typically develop gradually over weeks to months, though in some cases they can appear more suddenly. The most common early symptoms include joint pain, swelling, and stiffness that lasts for more than an hour in the morning. Unlike many other conditions, RA typically affects joints symmetrically, meaning that if your right wrist is affected, your left wrist is likely to be too (Smolen et al., 2016). Beyond joint symptoms, many people with RA experience systemic manifestations, including chronic fatigue, low-grade fever, weight loss, and general malaise. These whole-body symptoms reflect the fact that RA is not just a joint disease but rather a systemic condition affecting multiple organ systems. Some individuals develop firm bumps under the skin called rheumatoid nodules, particularly over pressure points like the elbows (Wasserman, 2011). The exact cause of RA remains unknown, but research has identified that both genetic and environmental factors contribute to disease development. Genetic susceptibility accounts for approximately 50-60% of the risk, with the strongest genetic risk factor being certain variants of the HLA-DRB1 gene, which contains a sequence called the shared epitope (Gibofsky, 2014). Environmental triggers also play a critical role in determining who develops RA. Smoking stands out as the strongest known environmental risk factor, with studies showing that tobacco use is specifically associated with an increased risk of developing antibody-positive RA. The risk increases with the amount and duration of cigarette use, and heavy smokers with more than 40 pack-years of smoking have approximately double the risk compared to never-smokers. Furthermore, the risk remains elevated even 20 years after smoking cessation (Environmental influences on risk for rheumatoid arthritis, 2005).
The interaction between smoking and genetic factors is particularly striking. Individuals who smoke and carry two copies of the shared epitope have a 21-fold higher risk of developing antibody-positive RA compared to nonsmokers without the shared epitope (Environmental influences on risk for rheumatoid arthritis, 2005). Research suggests that smoking may induce a process called citrullination in lung tissues, where proteins are chemically modified in ways that trigger the immune system to produce antibodies against them in genetically susceptible individuals. Other environmental factors associated with RA risk include birth weight, socioeconomic status, geographic location, occupation, and early-life exposures. Diet, hormonal factors, and the composition of the gut microbiome have also emerged as important modifiable factors that may influence disease development and progression (Environmental influences on risk for rheumatoid arthritis, 2005).
How Rheumatoid Arthritis Damages Joints in Upper and Lower Extremities
Understanding how RA affects different parts of the body helps patients and healthcare providers develop targeted treatment strategies. The disease has a particular affinity for certain joints, and the patterns of involvement can significantly impact function and quality of life.
Upper Extremity Joint Involvement
The hands and wrists are among the most commonly affected areas in RA, with approximately 90% of people with the condition experiencing symptoms in at least one hand joint over the course of their disease. For about 20% of patients, hand and wrist symptoms are actually the first signs of RA (Hand Rheumatoid Arthritis, 2024). The small joints of the hands are particularly vulnerable. The metacarpophalangeal (MCP) joints, located at the base of the fingers where they connect to the hand, and the proximal interphalangeal (PIP) joints in the middle of the fingers are frequently affected. The wrist joint, which is actually composed of multiple smaller joints working together, is also commonly involved early in the disease process (Hand Rheumatoid Arthritis, 2024). When RA affects the hands, the inflammatory process follows the same pattern described earlier, but with some unique consequences. The synovial tissue not only surrounds the joints but also encases the tendons that allow finger movement. When this tendon sheath becomes inflamed—a condition called tenosynovitis—it can damage or even rupture the tendons. One common manifestation is trigger finger, in which a finger becomes stuck in a bent position due to inflammation of the flexor tendon (Hand Rheumatoid Arthritis, 2024). As the disease progresses, the destruction of cartilage and bone, combined with weakened ligaments, leads to characteristic hand deformities. Swan neck deformity, where the finger bends backward at the PIP joint and forward at the tip, and boutonniere deformity, with the opposite pattern of bending, are classic findings in advanced RA. The MCP joints may also subluxate, meaning the bones partially slip out of proper alignment, often causing the fingers to drift toward the little finger side in a pattern called ulnar deviation (Hand Rheumatoid Arthritis, 2024).
The wrist joint deserves special attention because inflammation here can compress the median nerve as it passes through the carpal tunnel, causing carpal tunnel syndrome. This adds numbness, tingling, and weakness in the thumb and associated fingers to the already considerable burden of hand symptoms (Hand Rheumatoid Arthritis, 2024). Research has shown that hand dexterity, grip strength, and the ability to pinch objects between the thumb and fingers are likely to be affected by RA. Grip strength tends to be particularly weak when inflammation levels are high, and problems with hand function are largely the result of joint damage. This damage often occurs early in the disease process, which is why early diagnosis and aggressive treatment are so important (Hand Rheumatoid Arthritis, 2024).
Lower Extremity Joint Involvement
More than 90% of people with RA develop foot and ankle symptoms over the course of their disease, and approximately 20% of patients have foot and ankle symptoms as their first manifestations of the condition. The feet and ankles contain numerous small joints that are particularly susceptible to the inflammatory process (Rheumatoid Arthritis of the Foot and Ankle, 2023). The ankle joint, which provides up-and-down motion of the foot, is commonly affected. Early signs of ankle involvement include difficulty walking on inclines, ramps, or stairs. As the disease progresses, even simple activities like walking on flat ground and standing can become painful. The ankle inflammation can be particularly debilitating because it affects weight-bearing activities that are essential for daily function (Rheumatoid Arthritis of the Foot and Ankle, 2023). The hindfoot, or heel region, performs the important function of allowing side-to-side motion of the foot. When RA affects this area, people initially notice difficulty walking on uneven surfaces, such as grass or gravel. Pain commonly develops just beneath the fibula bone on the outside of the ankle. As the disease advances, the alignment of the foot may shift as bones move out of their normal positions, often resulting in a flatfoot deformity. This misalignment causes pain along the posterior tibial tendon on the inside of the ankle, which is the main structure supporting the foot’s arch (Rheumatoid Arthritis of the Foot and Ankle, 2023).
The midfoot, or top of the foot, contains ligaments that normally support the arch. When these ligaments become weakened by inflammation, the arch collapses, and the front of the foot may point outward. RA also damages the cartilage in the midfoot, causing arthritic pain that occurs with or without shoes. Over time, structural changes can create large bony prominences on the arch, making it very difficult to find comfortable footwear (Rheumatoid Arthritis of the Foot and Ankle, 2023). The forefoot, which includes the toes and ball of the foot, commonly develops bunions, claw toes, and pain under the ball of the foot. In RA, these problems often occur together and tend to be more severe than when they occur in isolation. The big toe may cross over the second toe, and painful bumps can develop on the ball of the foot where bones in the midfoot are pushed down from joint dislocations in the toes. The toes may become fixed in a claw-like position and appear prominent on the top of the foot. In severe cases, ulcers can form from the abnormal pressure distribution (Rheumatoid Arthritis of the Foot and Ankle, 2023). The knees are also frequently affected by RA. Insufficiency fractures—fractures that occur in bones weakened by inflammation and osteoporosis—are a significant cause of new-onset knee pain in RA patients. Research shows that many of these fractures are only visible on MRI scans and often experience significant delays in diagnosis, resulting in long-term pain and disability. Studies indicate that more than 60% of patients with one insufficiency fracture will experience additional fracture episodes over subsequent years (Insufficiency fractures of the knee, ankle, and foot in rheumatoid arthritis, 2020).
The Broader Impact of Joint Damage
The cumulative effect of joint damage in both upper and lower extremities can be profound. Hand involvement affects the ability to perform self-care activities like dressing, grooming, and eating. It can impact professional activities, particularly for people whose jobs require fine motor skills or manual dexterity. The psychological impact of visible hand deformities should not be underestimated, as many patients report feelings of self-consciousness and social withdrawal (Hand Rheumatoid Arthritis, 2024). Foot and ankle involvement directly affects mobility and independence. The ability to walk, stand for extended periods, and participate in physical activities may be severely compromised. This can lead to reduced physical activity, which, in turn, contributes to cardiovascular deconditioning, weight gain, and an increased risk of other health problems (Rheumatoid Arthritis of the Foot and Ankle, 2023). The combination of upper and lower extremity involvement creates unique challenges. Simple activities that most people take for granted—like walking to the mailbox and opening the mail, preparing a meal, or getting dressed—may require significant effort and cause considerable pain. This functional limitation contributes to the high rates of disability observed in people with RA and underscores the importance of comprehensive treatment approaches that address both disease activity and functional capacity.
From Inflammation to Healing- Video
Environmental Factors and Overlapping Risk Profiles in Rheumatoid Arthritis Development
Understanding the environmental factors that contribute to RA is crucial for both prevention and management. While we cannot change our genetic makeup, many environmental exposures can be modified to reduce disease risk or improve outcomes.
The Gut-Joint Axis: How Gut Health Influences RA
One of the most exciting areas of recent RA research involves the gut microbiome—the trillions of bacteria and other microorganisms living in our digestive tract. Growing evidence suggests that gut dysbiosis, or an imbalance in the gut microbial community, plays a significant role in RA development and progression. Research in animal models has consistently demonstrated that gut dysbiosis is associated with the development of inflammatory arthritis. Germ-free mice, lacking gut bacteria, exhibit reduced arthritis symptoms in several spontaneous RA models. However, introducing certain bacteria into these germ-free mice can trigger the production of autoantibodies and the development of arthritis. Furthermore, changes in the intestinal microbial community occur in the pre-clinical phase before arthritis symptoms appear, suggesting that gut dysbiosis may actually help trigger the disease process (Gut-joint axis, 2023). Studies comparing the gut microbiota of RA patients with that of healthy individuals have found consistent differences. People with RA tend to have fewer beneficial bacteria, such as Lactobacillus and Bifidobacterium, which are important for gut health, while having higher levels of potentially harmful bacteria, such as Prevotella copri. A meta-analysis of multiple studies found that RA patients exhibit a depletion of anti-inflammatory butyrate-producing bacteria and an enrichment of pro-inflammatory bacteria (Gut-joint axis, 2023). The mechanisms by which gut dysbiosis contributes to RA are complex and multifaceted. Gut bacteria can influence the activation and differentiation of both innate and adaptive immune cells. Dysbiosis can also alter intestinal barrier function, leading to what is sometimes called “leaky gut,” where the protective intestinal lining becomes more permeable. This allows bacterial components and food proteins to enter the bloodstream, potentially triggering immune responses that contribute to autoimmunity (Your Gut Health and Its Connection to Rheumatoid Arthritis, 2025). Some gut bacteria can produce metabolites that have immunomodulatory effects. For example, butyrate, which is produced by certain beneficial bacteria when they digest dietary fiber, has anti-inflammatory properties and helps maintain intestinal barrier function. The depletion of butyrate-producing bacteria in RA patients may therefore contribute to increased intestinal permeability and systemic inflammation (Gut-joint axis, 2023). Interestingly, intra-articular bleeding can trigger inflammatory responses similar to those seen in RA, with iron deposition in the synovium leading to the production of inflammatory cytokines. This suggests that mechanical trauma combined with the right immunological predisposition can contribute to chronic joint inflammation (Inflammatory diseases causing joint and bone destruction, 2024).
Other Environmental Triggers and Modifiable Risk Factors
Beyond the gut microbiome, numerous other environmental factors have been associated with RA risk and disease severity. Air pollution and exposure to particulate matter, tobacco smoke, and heavy metals have all been linked to increased risk of developing rheumatoid and other autoimmune diseases (Environmental factors and rheumatic diseases, 2025). Occupational exposures also matter. Jobs involving dust inhalation or exposure to certain chemicals may increase the risk of RA. Socioeconomic status and geographic location have been associated with disease development, though the mechanisms behind these associations are likely complex and multifactorial (What is the cause of rheumatoid arthritis?, 2019). Hormonal factors play a role, as evidenced by the higher prevalence of RA in women and the relationship between disease activity and reproductive events like pregnancy and menopause. Some research suggests that estrogen exposure may influence RA development and progression, though the relationship is complex and not yet fully understood (Osteoarthritis: The importance of hormonal status in midlife women, 2022). Body mass index (BMI) has emerged as another modifiable risk factor. Higher BMI is associated with increased RA risk and may influence disease severity and treatment response. The mechanisms likely involve both mechanical stress on joints and the pro-inflammatory effects of adipose tissue (Rheumatoid arthritis and the intestinal microbiome, 2024). Early life factors also appear to matter. Birthweight has been associated with RA risk, suggesting that developmental programming may influence later susceptibility to autoimmune disease. Breastfeeding duration and early childhood infections have also been studied as potential factors that may shape immune system development and influence later disease risk (Environmental influences on risk for rheumatoid arthritis, 2005). The concept of “overlapping risk profiles” refers to the clustering of multiple risk factors. For example, an individual might have genetic susceptibility, a history of smoking, gut dysbiosis, and vitamin D deficiency. Each of these factors independently increases RA risk, but their combined effect may exceed the sum of their individual effects. This is why a comprehensive, multifactorial approach to prevention and treatment is so important.
The Clinical Rationale for Chiropractic Care in Rheumatoid Arthritis Management
For many years, chiropractic care was primarily associated with back and neck pain. However, mounting evidence suggests that chiropractic approaches can be valuable as part of a comprehensive treatment plan for people with RA. The clinical rationale for incorporating chiropractic care into RA management is based on several interconnected mechanisms.
Restoring Joint Mobility and Reducing Mechanical Stress
One of the hallmark symptoms of RA is joint stiffness, which can make everyday activities incredibly challenging. Chiropractic adjustments and manual therapy techniques aim to restore proper joint alignment and improve mobility through gentle, targeted interventions. Manual therapy encompasses a variety of techniques, including joint mobilization, soft tissue manipulation, and specific adjustment procedures. When applied appropriately, these techniques can help reduce joint restrictions, improve range of motion, and alleviate stiffness (Understanding Rheumatoid Arthritis And How Chiropractic Care May Help, 2025). A randomized clinical pilot study examined the effects of manual therapy—specifically postisometric relaxation and joint mobilization—on knee pain and function in patients with RA. The study found that patients receiving manual therapy experienced significant decreases in pain intensity compared to those receiving standard exercise alone. The techniques appeared safe when performed by trained practitioners who adapted their approach to each patient’s individual needs (Manual Therapy in Knee Pain and Function, 2020). Another study on hand joints found that low-grade mobilization of metacarpophalangeal joints appeared feasible, safe, and effective for RA patients. Despite most participants having minimal inflammatory activity at baseline, there were significant reductions in pain and increases in joint space over four weeks of treatment, with benefits persisting at one-month follow-up (Manual Therapy in Knee Pain and Function, 2020). The mechanisms by which manual therapy reduces pain and improves function are multifaceted. Gentle mobilization techniques can stimulate mechanoreceptors in joint tissues, potentially modulating pain signals traveling to the brain. Joint mobilization also appears to affect synovial fluid production, potentially improving joint lubrication and nutrition. Additionally, manual therapy can reduce muscle tension around affected joints, decreasing secondary pain and improving overall comfort (Understanding the Benefits of Manual Therapy for Arthritis, 2024). It is important to emphasize that chiropractors working with RA patients use techniques specifically tailored to the condition. High-velocity thrust adjustments that might be appropriate for mechanical back pain would generally not be suitable for actively inflamed or structurally compromised rheumatoid joints. Instead, practitioners employ low-force techniques, gentle mobilizations, and soft tissue approaches that respect the delicate nature of affected joints (Understanding Rheumatoid Arthritis And How Chiropractic Care May Help, 2025).
Supporting Nervous System Function and Immune Regulation
The nervous system and immune system are intimately connected, and this relationship provides another rationale for chiropractic care in RA management. The spine houses the central nervous system, and proper spinal alignment is believed to support optimal neural communication throughout the body. Misalignments in the spine, called subluxations in chiropractic terminology, may disrupt nerve communication and potentially affect immune system function. By correcting these misalignments through targeted adjustments, chiropractors aim to optimize nervous system function, which may, in turn, support better immune regulation (Chiropractic Care for Autoimmune Disease Management, 2025). The vagus nerve, a major component of the parasympathetic nervous system, deserves special attention in this context. This nerve originates in the brainstem, travels through the upper cervical spine, and innervates numerous organs throughout the body. The vagus nerve plays a crucial role in regulating inflammation via the “cholinergic anti-inflammatory pathway.” When the vagus nerve is activated, it can dampen inflammatory responses throughout the body (Vagus nerve stimulation in musculoskeletal diseases, 2021). Research has shown that vagus nerve stimulation can reduce disease activity in RA patients. Several small pilot studies have demonstrated that both invasive and transcutaneous vagus nerve stimulation are associated with significant decreases in RA disease activity. The treatment appears to work by dampening the inflammatory response of circulating immune cells and reducing the production of pro-inflammatory cytokines (Vagus nerve stimulation in musculoskeletal diseases, 2021). While chiropractic adjustments are different from electrical vagus nerve stimulation, some practitioners and researchers theorize that certain adjustments—particularly those involving the upper cervical spine—may influence vagus nerve function through mechanical and neurological mechanisms. Though this hypothesis requires more research, it provides a plausible explanation for some of the systemic benefits that RA patients report from chiropractic care. Chiropractic care may also help activate the parasympathetic nervous system more broadly, promoting a state of relaxation and “rest and digest” that counteracts the “fight or flight” stress response. Chronic activation of the stress response contributes to inflammation and can exacerbate RA symptoms. By helping patients achieve a more balanced autonomic state, chiropractic care may indirectly support better disease management (5 Ways Chiropractic Care Can Support Autoimmune Disease Management, 2025).
Comprehensive Approach: Dr. Alexander Jimenez’s Clinical Perspective
Dr. Alexander Jimenez, DC, APRN, FNP-BC, brings a unique dual perspective to RA management as both a board-certified chiropractor and a Family Practice Nurse Practitioner. His integrated approach at El Paso’s Premier Wellness and Injury Care Clinic combines advanced medical expertise with chiropractic care to address the complex needs of patients with chronic conditions like rheumatoid arthritis. Dr. Jimenez’s clinical approach emphasizes the importance of thorough diagnostic evaluation. He uses advanced imaging techniques and diagnostic assessments to fully understand each patient’s condition. This comprehensive evaluation enables him to create personalized treatment plans that address not only symptoms but also the underlying factors contributing to inflammation and dysfunction (Dr. Alex Jimenez, 2025). As a Certified Functional Medicine Practitioner (CFMP) and Institute for Functional Medicine Certified Practitioner (IFMCP), Dr. Jimenez employs detailed functional health assessments that evaluate personal history, current nutrition, activity behaviors, environmental exposures to toxic elements, psychological and emotional factors, and genetics. This holistic evaluation, inspired by the Living Matrix Functional Medicine Assessment, helps identify root causes of chronic disorders and enables truly personalized treatment (Dr. Alex Jimenez, 2025). His dual-scope practice allows him to integrate multiple therapeutic modalities. For RA patients, this might include chiropractic adjustments to improve joint mobility and relieve pain, functional medicine interventions to address gut health and nutritional status, acupuncture or electro-acupuncture to modulate pain and inflammation, and personalized wellness programs incorporating nutrition, exercise, and stress management strategies (Dr. Alex Jimenez, 2025). Dr. Jimenez emphasizes that his approach is collaborative and patient-centered. He works closely with rheumatologists, orthopedic specialists, and other medical providers to ensure coordinated care. If he believes another specialist would better serve a patient’s needs, he provides appropriate referrals, ensuring patients receive the highest standard of care (Dr. Alex Jimenez, 2025). His practice philosophy aligns with evidence-based treatment protocols and focuses on restoring health naturally whenever possible. For RA patients, this means using non-invasive protocols as a priority while recognizing that pharmaceutical interventions may be necessary. The goal is to help patients achieve optimal health through a combination of approaches tailored to their individual needs and circumstances (Dr. Alex Jimenez, 2025).
Functional Wellness Strategies to Combat Rheumatoid Arthritis Symptoms
While chiropractic care addresses mechanical and neurological aspects of RA, functional wellness strategies target the underlying biochemical and lifestyle factors that influence disease activity. A truly comprehensive approach combines both elements.
Anti-Inflammatory Nutrition: The Foundation of Functional Wellness
Diet plays a powerful role in modulating inflammation, and emerging evidence suggests that nutritional interventions can significantly improve outcomes for people with RA. The functional medicine approach to nutrition for RA is highly individualized, recognizing that different people may have different trigger foods and nutritional needs. The Mediterranean diet has received particular attention in RA research. This dietary pattern emphasizes fruits, vegetables, whole grains, fish, olive oil, nuts, seeds, beans, and peas while limiting processed foods and red meat. Research shows that the Mediterranean diet can lower inflammation and improve RA symptoms. In one study, women with RA who followed a Mediterranean-type diet for 6 weeks experienced less joint pain and morning stiffness, as well as better overall health, compared to a control group (The Best and Worst Foods for Rheumatoid Arthritis, 2024). Omega-3 fatty acids, which are abundant in the Mediterranean diet, deserve special attention. These healthy fats, found in fatty fish like salmon, mackerel, and sardines, as well as in flaxseeds and walnuts, have well-documented anti-inflammatory properties. They work by modifying the synthesis of pro-inflammatory eicosanoids, cytokines, and reactive oxygen species. Clinical studies have shown that omega-3 supplementation can decrease morning stiffness, reduce the number of tender joints, and lower the need for NSAIDs in RA patients (Omega-3 Fatty Acids and Vitamin D Improves Inflammatory Biomarkers, 2025). A meta-analysis found that consuming 2.7 grams of EPA/DHA daily for 3 months significantly decreased inflammatory markers, such as interleukin-6 and C-reactive protein, as well as overall disease activity. Higher dietary intake of omega-3 fatty acids during the year preceding DMARD initiation has been associated with better treatment results in patients with early RA (Are dietary vitamin D, omega-3 fatty acids, and folate associated with treatment response?, 2017). The autoimmune protocol (AIP) diet is a more restrictive anti-inflammatory approach that may be helpful for some RA patients. This diet eliminates potential inflammatory triggers, including grains, dairy, eggs, legumes, nightshade vegetables, coffee, alcohol, nuts, seeds, refined sugars, and processed oils. Instead, it focuses on freshly prepared, nutrient-dense foods, fermented foods, and bone broth to support gut health. After a period of strict elimination, foods are gradually reintroduced to identify individual dietary triggers (Integrative Approaches to the Testing and Treatment of Rheumatoid Arthritis, 2025).
Specific foods and nutrients have been identified as particularly beneficial for RA:
Colorful fruits and vegetables are packed with antioxidants and phytonutrients that help combat oxidative stress and inflammation. Berries, leafy greens like spinach and kale, and colorful vegetables like broccoli, beets, and carrots are particularly beneficial. These foods provide vitamins, minerals, and plant compounds that support immune function and reduce inflammation (Embracing an Anti-inflammatory Diet for Rheumatoid Arthritis, 2009).
Beans and legumes are rich in fiber, which can help lower C-reactive protein levels and support a healthy gut microbiome. They also provide plant-based protein to maintain muscle mass around joints. Red beans, kidney beans, pinto beans, lentils, and chickpeas are excellent choices (The Best and Worst Foods for Rheumatoid Arthritis, 2024).
Herbs and spices offer concentrated anti-inflammatory compounds. Turmeric contains curcumin, which has potent anti-inflammatory properties when combined with black pepper (which contains piperine to enhance absorption). Ginger, which is related to turmeric, may have similar effects. Other beneficial spices include clove, coriander, garlic, and capsaicin from chili peppers (Rheumatoid Arthritis Diet, 2013).
Healthy fats from sources like olive oil and avocados provide monounsaturated fats that can help reduce inflammation. Extra virgin olive oil also contains oleocanthal, a compound with anti-inflammatory properties similar to ibuprofen (Embracing an Anti-inflammatory Diet for Rheumatoid Arthritis, 2009).
On the flip side, certain foods may worsen inflammation and should be limited or avoided:
Processed foods and refined sugars can spike blood sugar levels and trigger inflammatory responses. They also provide empty calories without the nutrients needed to support immune function (Integrative Approaches to the Testing and Treatment of Rheumatoid Arthritis, 2025).
Refined vegetable oils high in omega-6 linoleic acid, such as corn, safflower, sunflower, and cottonseed oils, can promote inflammation when consumed in excess relative to omega-3 fats (Integrative Approaches to the Testing and Treatment of Rheumatoid Arthritis, 2025).
Conventionally-raised red meat may contribute to inflammation, particularly when consumed in large amounts. Grass-fed options are preferable if red meat is consumed (Integrative Approaches to the Testing and Treatment of Rheumatoid Arthritis, 2025).
Potential food sensitivities vary by individual but commonly include gluten, dairy, eggs, and nightshade vegetables (tomatoes, peppers, eggplant, white potatoes) for some people with RA. An elimination and reintroduction protocol can help identify personal trigger foods.
A functional medicine study examined the impact of a 12-week nutritional program on RA patients. The program focused on improving nutrition and digestive function, removing inflammatory triggers, and supporting gut health through diet modifications and targeted supplementation. Patients in the functional medicine group showed statistically significant improvements in pain, physical, and mental health scores compared with those receiving standard care alone (The impact of functional medicine on patient-reported outcomes, 2020).
Supporting Gut Health and the Microbiome
Given the strong evidence linking gut dysbiosis to RA, supporting gut health is a crucial component of functional wellness strategies. Several approaches can help restore a more balanced microbiome:
Probiotic supplementation may help increase beneficial bacteria, such as Lactobacillus and Bifidobacterium. Some research suggests that specific probiotic strains can modulate immune responses and reduce systemic inflammation. However, the optimal strains, doses, and treatment duration are still being investigated (Rheumatoid arthritis and the intestinal microbiome, 2024).
Prebiotic fiber feeds beneficial gut bacteria and supports their growth. High-fiber foods like vegetables, fruits, whole grains, and legumes provide the substrate that good bacteria need to produce beneficial metabolites, such as butyrate. Supplemental prebiotic fibers such as inulin, fructooligosaccharides, or partially hydrolyzed guar gum may also be helpful (Integrative Approaches to the Testing and Treatment of Rheumatoid Arthritis, 2025).
Fermented foods like yogurt, kefir, sauerkraut, kimchi, and kombucha contain live beneficial bacteria and may help diversify the gut microbiome. These traditional foods have been consumed for centuries in various cultures and are increasingly recognized for their health benefits (Integrative Approaches to the Testing and Treatment of Rheumatoid Arthritis, 2025).
Bone broth is rich in gelatin, collagen, and amino acids, such as glutamine, that support intestinal barrier function. While more research is needed, many functional medicine practitioners recommend bone broth as part of a gut-healing protocol (Integrative Approaches to the Testing and Treatment of Rheumatoid Arthritis, 2025).
Reducing factors that harm the microbiome is equally important. This includes minimizing unnecessary antibiotic use, avoiding artificial sweeteners and emulsifiers that may negatively affect gut bacteria, managing stress, and limiting alcohol consumption.
The Critical Role of Vitamin D and Other Nutrients
Vitamin D deficiency is highly prevalent in RA patients and has been linked to chronic pain and lower quality of life scores. Multiple studies have found associations between vitamin D status and RA disease activity, suggesting that optimizing vitamin D levels may be an important therapeutic strategy (Can Vitamin D Help Relieve Your Rheumatoid Arthritis?, 2018). Research has shown that vitamin D supplementation can improve disease activity scores and reduce inflammatory markers in RA patients. One randomized controlled trial found that 60,000 IU per week of vitamin D3 for eight weeks significantly improved Disease Activity Score-28 (DAS-28) scores and reduced levels of IL-17 and TNF-α compared to placebo. Higher dietary vitamin D intake during the year before starting DMARD treatment has been associated with better treatment outcomes (Omega-3 Fatty Acids and Vitamin D Improves Inflammatory Biomarkers, 2025). Vitamin D helps regulate immune function through multiple mechanisms. T cells and B cells have vitamin D receptors, indicating direct immunomodulatory effects. Vitamin D appears to help balance Th1 and Th17 immune responses, which are often overactive in RA, while supporting regulatory T cells that help maintain immune tolerance (Omega-3 Fatty Acids and Vitamin D Improves Inflammatory Biomarkers, 2025). For most adults, 1,000-2,000 IU daily of vitamin D3 is recommended for maintenance, though higher doses may be needed initially to correct deficiency. Blood testing of 25(OH)D levels can help guide appropriate dosing. Functional medicine practitioners typically aim for levels between 40 and 60 ng/mL, though optimal targets may vary by individual (Omega-3 Fatty Acids and Vitamin D Improves Inflammatory Biomarkers, 2025).
Other important nutrients for RA management include:
Magnesium plays a role in numerous enzymatic reactions and may help with sleep quality and muscle relaxation. Many people with RA are deficient in magnesium, and supplementation may improve sleep quality (Improving Sleep Quality with Autoimmune Disease, 2025).
Selenium is an antioxidant mineral that supports immune function and may help reduce oxidative stress in RA.
Zinc is crucial for immune system function and wound healing. However, supplementation should be monitored as excessive zinc can interfere with copper absorption.
B vitamins, particularly folate and B12, are important for patients taking methotrexate, as this medication can interfere with folate metabolism. Adequate folate intake may help reduce methotrexate side effects without compromising its effectiveness (Are dietary vitamin D, omega-3 fatty acids, and folate associated with treatment response?, 2017).
Exercise and Physical Activity: Moving Despite the Pain
Regular physical activity is one of the most beneficial interventions for people with RA, yet pain and fatigue often create barriers to exercise. Research consistently shows that appropriate exercise helps relieve RA symptoms and improve day-to-day functioning without exacerbating disease activity (Best Exercises for Rheumatoid Arthritis, 2023).
The benefits of exercise for RA patients are multifaceted. Physical activity helps reduce pain and stiffness, improve joint mobility and function, maintain or increase muscle strength, enhance cardiovascular fitness, support weight management, reduce fatigue, improve sleep quality, and boost mood and overall well-being (Role of physical activity in the management, 2017).
A comprehensive exercise program for RA should incorporate several components:
Range-of-motion and flexibility exercises help maintain or improve joint mobility and reduce stiffness. These should be performed daily and include gentle stretching of all major joints. During acute flares, when joints are actively inflamed, range-of-motion exercises should be gentle and pain-free. As inflammation subsides, more active stretching can be incorporated (Physiotherapy in Rheumatoid Arthritis, 2004).
Strengthening exercises help maintain muscle mass and joint stability. Isometric exercises, where muscles contract without moving the joint, are particularly valuable during periods of active inflammation. These exercises can be performed at relatively low intensity (40% of maximum voluntary contraction) and held for 6 seconds, repeated 5-10 times daily. As disease activity improves, progressive resistance training with light weights or resistance bands can be added (Physiotherapy in Rheumatoid Arthritis, 2004).
Aerobic conditioning improves cardiovascular health, increases muscle endurance, and helps manage fatigue. Low-impact activities like swimming, walking, cycling, water aerobics, and tai chi are excellent options. Moderate-intensity aerobic exercise for 30 minutes, five times per week, or intensive exercise for 20 minutes, three times per week, can provide significant benefits (Rheumatoid Arthritis, 2024).
Balance and coordination exercises help prevent falls and improve functional capacity. Activities like tai chi, gentle yoga, and standing on balance boards stimulate the sensorimotor system and enhance joint stability (Rheumatoid Arthritis, 2024).
Important principles for exercising with RA include:
Start slowly and progress gradually
Listen to your body and respect pain signals
Avoid exercise during acute flares of highly inflamed joints
Include adequate rest periods
Stop if pain persists for more than two hours after exercise or if you experience increased swelling, loss of strength, or excessive fatigue
Work with a physical therapist to develop an individualized program
Choose activities you enjoy to enhance long-term adherence
Recent research has shown an interesting bidirectional relationship between physical activity and disease activity. Changes in RA disease activity inversely correlate with variations in physical activity—when disease activity increases, physical activity tends to decrease, and vice versa. This suggests that monitoring physical activity levels may provide valuable information about disease status (Role of physical activity in the management, 2017).
Sleep Optimization: The Underestimated Healing Tool
Up to 70% of people with RA experience sleep problems, and poor sleep quality can significantly worsen disease symptoms. Sleep disturbances and RA create a vicious cycle: pain and inflammation disrupt sleep, and poor sleep increases pain sensitivity and inflammatory markers, which further exacerbate RA symptoms (Understanding the Relationship Between Rheumatoid Arthritis and Sleep, 2023). The relationship between sleep and inflammation is complex and bidirectional. During sleep, the body engages in critical repair and restoration processes. The immune system uses this time to produce and distribute certain immune cells and anti-inflammatory molecules. Sleep deprivation disrupts these processes, leading to increased production of pro-inflammatory cytokines and decreased production of anti-inflammatory mediators (The Importance of Sleep Hygiene, 2024). Research shows that acute sleep deprivation correlates with increased pain and arthritis symptoms the following day. Conversely, improved sleep quality is associated with reduced pain sensitivity, better pain management, lower inflammatory markers, improved immune regulation, enhanced mood and cognitive function, and increased energy levels (10 Tips to Improve Sleep with Rheumatoid Arthritis, 2023). Strategies to improve sleep quality in RA include:
Pain management is fundamental. Working with your healthcare team to optimize pain control helps you sleep more restfully. Taking medications at appropriate times, using heat or cold therapy before bed, ensuring comfortable sleeping positions with supportive pillows, and practicing gentle stretching before bed may all help (Understanding the Relationship Between Rheumatoid Arthritis and Sleep, 2023).
Establishing a consistent sleep routine helps regulate your body’s internal clock. Go to bed and wake up at the same time each day, even on weekends. Create a relaxing pre-bedtime routine that might include reading, meditation, gentle stretching, or taking a warm bath (The Importance of Sleep Hygiene, 2024).
Optimizing your sleep environment can make a significant difference. Keep your bedroom cool (around 65-68°F), dark, and quiet. Use blackout curtains or an eye mask if needed. Consider a white noise machine if you’re sensitive to sounds. Invest in a supportive mattress and pillows that accommodate your specific needs (Improving Sleep Quality with Autoimmune Disease, 2025).
Practicing good sleep hygiene means avoiding caffeine and alcohol in the evening, limiting screen time before bed (blue light from devices can suppress melatonin production), avoiding large meals close to bedtime, getting regular exercise but not too close to bedtime, and keeping the bedroom for sleep and intimacy only (The Importance of Sleep Hygiene, 2024).
Managing stress and mental health is crucial, as anxiety and depression commonly accompany RA and can significantly disrupt sleep. Techniques like deep breathing, progressive muscle relaxation, mindfulness meditation, and cognitive-behavioral therapy for insomnia (CBT-I) can be very effective. Seeking support from a therapist or support group may also help (Understanding the Relationship Between Rheumatoid Arthritis and Sleep, 2023).
Sleep aids and supplements may be appropriate for some individuals. Melatonin can help regulate sleep-wake cycles and may have additional anti-inflammatory properties. Magnesium supports muscle relaxation and sleep quality. Herbal teas like chamomile may promote relaxation. However, always consult with your healthcare provider before starting any new supplement, as some may interact with RA medications (Improving Sleep Quality with Autoimmune Disease, 2025).
Stress Management and Mind-Body Techniques
Chronic stress is both a contributing factor to RA development and a consequence of living with the disease. Stress triggers the release of cortisol and other hormones that can promote inflammation and suppress immune function. Additionally, stress can worsen pain perception, disrupt sleep, and negatively impact overall quality of life (5 Ways Chiropractic Care Can Support Autoimmune Disease Management, 2025).
Mind-body techniques offer powerful tools for managing stress and improving well-being:
Mindfulness meditation involves paying attention to the present moment without judgment. Research has shown that mindfulness practices can reduce pain, decrease stress and anxiety, improve sleep quality, enhance emotional regulation, and reduce inflammatory markers. Even brief daily sessions of 10-20 minutes can provide benefits (incorporating wellness practices, 2021).
Deep breathing exercises activate the parasympathetic nervous system, promoting relaxation and countering the stress response. Techniques like diaphragmatic breathing, box breathing (inhaling for 4 counts, holding for 4, exhaling for 4, holding for 4), or extended exhalation (inhaling for 4 counts, exhaling for 6-8 counts) can be practiced anywhere and provide immediate calming effects.
Progressive muscle relaxation involves systematically tensing and then relaxing different muscle groups throughout the body. This technique helps increase body awareness, reduce muscle tension, and promote overall relaxation.
Tai chi is a gentle movement practice combining flowing movements, deep breathing, and meditation. Multiple studies have found that tai chi can improve mood, quality of life, pain, and physical function in people with RA. When taught by a qualified instructor, tai chi is safe for most people with RA, though movements should be modified to avoid positions that cause pain (Rheumatoid arthritis – Diagnosis and treatment, 2025).
Yoga offers another mind-body approach that may benefit people with RA. Gentle or restorative yoga practices can improve flexibility, strength, balance, and stress management. As with tai chi, it’s important to work with an instructor experienced in working with people who have chronic pain or arthritis.
Biofeedback and neurofeedback are techniques that help people learn to control certain physiological processes through real-time feedback. These approaches can be helpful for pain management and stress reduction.
Cognitive-behavioral therapy (CBT) addresses the thoughts and behaviors that contribute to pain and distress. CBT has been shown to help people with chronic pain develop better coping strategies, reduce pain-related disability, and improve quality of life.
Additional Non-Surgical Treatments and Practical Strategies for Symptom Relief
Beyond the foundational strategies of nutrition, exercise, sleep, and stress management, several additional approaches can help reduce RA symptoms and improve daily functioning.
Heat and Cold Therapy
Applying heat or cold to affected joints can provide significant relief:
Heat therapy helps relax muscles, increase blood flow, and reduce stiffness. Warm baths, heating pads, warm paraffin wax treatments, and moist heat packs can all be beneficial. Heat is generally most helpful for chronic stiffness and before activity (Physiotherapy in Rheumatoid Arthritis, 2004).
Cold therapy helps reduce inflammation, numb pain, and decrease swelling. Ice packs, cold compresses, or cool water immersion can be used for 15-20 minutes at a time. Cold is often most helpful during acute flares or after activity (Physiotherapy in Rheumatoid Arthritis, 2004).
Some people find contrast therapy—alternating between heat and cold—particularly helpful for reducing stiffness and improving circulation.
Assistive Devices and Joint Protection
Using appropriate assistive devices and practicing joint protection techniques can significantly reduce strain on affected joints and improve function:
Ergonomic tools like jar openers, built-up handles on utensils, reachers, and button hooks make daily tasks easier without stressing joints.
Braces and splints can provide support, reduce pain, and prevent deformity. Wrist splints, finger splints, knee braces, and ankle-foot orthoses may all be beneficial depending on which joints are affected.
Proper footwear is crucial for people with foot involvement. Shoes should have good arch support, cushioning, and a wide toe box. Custom orthotics may be recommended by a podiatrist.
Joint protection principles include using larger, stronger joints when possible, avoiding positions that push joints toward deformity, taking frequent breaks during activities, planning ahead to conserve energy, and using good body mechanics and posture.
Occupational and Physical Therapy
Working with occupational and physical therapists can provide tremendous benefits:
Occupational therapists help with activities of daily living, recommend assistive devices, teach joint protection techniques, and provide hand therapy, including exercises and splinting.
Physical therapists develop individualized exercise programs, provide manual therapy, teach proper body mechanics, and help with pain management strategies.
Both types of therapy have strong evidence supporting their use in RA management and should be considered part of comprehensive care (Rehabilitation Management for Rheumatoid Arthritis Patients, 2012).
Complementary Therapies
Several complementary therapies have shown promise for RA symptom management:
Acupuncture involves inserting thin needles at specific points on the body. Some studies suggest it can help reduce pain and improve joint function in RA, though more research is needed (Exploring Alternative Treatments for Rheumatoid Arthritis, 2024).
Massage therapy can help alleviate pain, reduce muscle tension, improve circulation, and promote relaxation. Working with a licensed massage therapist experienced in treating people with RA is important (Exploring Alternative Treatments for Rheumatoid Arthritis, 2024).
Hydrotherapy or aquatic therapy takes advantage of the buoyancy and resistance of water. Warm water exercise can improve strength and range of motion while minimizing joint stress (Physiotherapy in Rheumatoid Arthritis, 2004).
Lifestyle Modifications
Small changes to daily habits can add up to significant improvements:
Energy conservation involves pacing activities, planning ahead, prioritizing tasks, and taking regular rest breaks to manage fatigue.
Stress reduction techniques should be incorporated into daily life, not just practiced during dedicated sessions. This might include brief breathing exercises throughout the day, listening to calming music, spending time in nature, or engaging in hobbies.
Social connection is important for both emotional and physical health. Maintaining relationships, participating in support groups, and staying engaged with community can all support better outcomes.
Avoiding smoking is crucial, as smoking not only increases RA risk but also reduces the effectiveness of treatments and increases disease severity. If you smoke, quitting is one of the most important steps you can take.
Limiting alcohol is also advisable, as alcohol can interfere with RA medications and may exacerbate inflammation and gut dysbiosis.
Integrating Chiropractic Care with Functional Wellness: A Holistic Framework
The most effective approach to managing RA combines multiple strategies tailored to each individual’s unique needs, circumstances, and preferences. Dr. Jimenez’s integrated model exemplifies how chiropractic care and functional wellness can work together synergistically. In this model, chiropractic adjustments and manual therapy address the mechanical and neurological aspects of the condition—improving joint mobility, reducing mechanical stress, supporting nervous system function, and providing pain relief. Meanwhile, functional medicine interventions target the underlying biochemical and lifestyle factors—optimizing nutrition and gut health, correcting nutrient deficiencies, supporting detoxification pathways, and addressing environmental triggers (Dr. Alex Jimenez, 2025). This comprehensive approach recognizes that RA is a multifactorial disease requiring multifactorial solutions. No single intervention is likely to be sufficient on its own, but combining evidence-based therapies can yield meaningful improvements in symptoms, function, and quality of life. The functional medicine assessment process begins with an extensive evaluation. Practitioners take a detailed medical history from birth, explore dietary and lifestyle patterns, assess environmental exposures at home, work, and leisure, evaluate digestive health and gut symptoms, review stress levels and mental health, examine hormonal function, and analyze genetic predispositions when relevant (Rheumatoid Arthritis Treatment – Melbourne Functional Medicine, 2025). With this comprehensive picture, a personalized treatment plan is developed that might include dietary modifications to remove triggers and emphasize anti-inflammatory foods, targeted nutritional supplements to address deficiencies and support immune function, gut health interventions including probiotics, prebiotics, and gut-healing nutrients, stress management and mind-body techniques, sleep optimization strategies, appropriate exercise programming, and environmental modifications to reduce toxic exposures (Rheumatoid Arthritis Treatment – Melbourne Functional Medicine, 2025). Regular monitoring and adjustment of the treatment plan ensure that it continues to meet the patient’s evolving needs. This might involve periodic laboratory testing to assess inflammatory markers, nutrient status, and other relevant biomarkers, reassessment of symptoms and functional capacity, and modification of interventions based on response (Rheumatoid Arthritis Treatment – Melbourne Functional Medicine, 2025). Throughout this process, communication and coordination with the patient’s rheumatologist and other healthcare providers are essential. The goal is not to replace conventional medical treatment but to complement it, potentially enhancing its effectiveness while addressing aspects of health that may not be the primary focus of standard rheumatology care.
Conclusion: Empowering Your Journey with Rheumatoid Arthritis
Living with rheumatoid arthritis is hard all the time, but knowing more about the disease and having access to a wide range of treatment options can make a big difference. Chiropractic care and functional wellness strategies together can help you better manage your symptoms, improve your function, and enhance your quality of life. The evidence examined in this article indicates that rheumatoid arthritis (RA) is not merely a joint disorder but a multifaceted systemic condition affected by genetic predispositions, environmental exposures, gastrointestinal health, nutritional status, stress levels, and lifestyle decisions. This comprehension facilitates a multitude of intervention opportunities beyond traditional pharmaceutical methods. Chiropractic care can safely improve joint mobility, reduce pain, support nervous system function, and help manage the mechanical aspects of RA when provided by practitioners who have experience with autoimmune conditions. Clinical studies have shown that manual therapy techniques that are specifically designed for people with RA can be helpful and should be a part of comprehensive care. Functional wellness strategies, such as anti-inflammatory nutrition, gut health support, targeted supplementation, appropriate exercise, sleep optimization, and stress management, address the fundamental factors that influence disease activity and symptoms. The new studies on the gut-joint axis, the roles of vitamin D and omega-3 fatty acids, and the microbiome in autoimmune disease provide these treatments with a scientific basis. Dr. Alexander Jimenez’s integrated approach shows how these different parts can work together to make a complete treatment plan. He is a chiropractor and a nurse practitioner, and he is also certified in functional medicine. This means he can provide care that covers both the structural and biochemical aspects of chronic inflammatory conditions. The message for patients is one of hope and strength. You have more control over your health than you might think, even though RA is a serious condition that needs ongoing medical care. The decisions you make about what you eat, how you move, how you handle stress, and how you support your body’s healing can have a big impact on how your disease progresses and how good your life is. To manage RA well, you need a full range of support from a healthcare team that includes your rheumatologist, a chiropractor who understands inflammatory conditions, and functional medicine practitioners. This team-based approach, along with your active participation in self-care strategies, gives you the best chance of getting the best results. It’s important to remember that dealing with RA is a journey, not a destination. It may take time to make progress, and there will probably be setbacks along the way. But many people with RA can lessen their symptoms, get better at doing things, and live full, meaningful lives with the right support, patience, and determination.
Gibofsky, A. (2014). Epidemiology, pathophysiology, and diagnosis of rheumatoid arthritis: A synopsis. American Journal of Managed Care, 20(7 Suppl), S128-S135.
Gut-joint axis: Gut dysbiosis can contribute to the onset of rheumatoid arthritis via multiple pathways. (2023). Frontiers in Cellular and Infection Microbiology, 13, 1092118. https://doi.org/10.3389/fcimb.2023.1092118
Jang, S., Kwon, E.-J., & Lee, J. J. (2022). Rheumatoid arthritis: Pathogenic roles of diverse immune cells. International Journal of Molecular Sciences, 23(2), 905. https://doi.org/10.3390/ijms23020905
Manual Therapy (Postisometric Relaxation and Joint Mobilization) in Knee Pain and Function Experienced by Patients with Rheumatoid Arthritis: A Randomized Clinical Pilot Study. (2020). PMC – National Center for Biotechnology Information. https://pmc.ncbi.nlm.nih.gov/articles/PMC7453239/
The impact of functional medicine on patient-reported outcomes in rheumatoid arthritis. (2020). PMC – National Center for Biotechnology Information. https://pmc.ncbi.nlm.nih.gov/articles/PMC7544031/
Wasserman, A. M. (2011). Diagnosis and management of rheumatoid arthritis. American Family Physician, 84(11), 1245-1252.
Important Disclaimer
This article is intended for educational and informational purposes only and should not be construed as medical advice. The information presented here is based on current research and clinical perspectives, but rheumatoid arthritis is a serious medical condition that requires professional diagnosis and treatment.
Please note the following:
Do not use this information to diagnose or treat any health condition. If you suspect you have rheumatoid arthritis or are experiencing joint pain, swelling, or other concerning symptoms, consult with a qualified healthcare provider, preferably a rheumatologist, for proper evaluation and diagnosis.
Do not stop or modify prescribed medications without consulting your physician. Disease-modifying antirheumatic drugs (DMARDs) and other medications prescribed for RA are essential for controlling disease activity and preventing joint damage. The approaches discussed in this article are intended to complement, not replace, conventional medical treatment.
Always inform your healthcare team about all treatments you are using, including chiropractic care, supplements, dietary changes, and other complementary therapies. This ensures coordinated care and helps prevent potential interactions or complications.
Individual results may vary. The research and clinical experiences described in this article represent general findings that may not apply to every individual. Your response to any treatment approach will depend on numerous factors, including disease severity, presence of other medical conditions, medications, and individual characteristics.
Chiropractic care and manual therapy should be performed only by licensed, trained professionals with experience treating patients with inflammatory arthritis. Not all techniques are appropriate for all patients, and adjustments must be carefully tailored to each individual’s condition.
Some supplements and dietary approaches may interact with RA medications or may not be appropriate for individuals with certain medical conditions. Always consult with your healthcare provider before starting any new supplement regimen.
This article was prepared with care based on available research and clinical expertise, but medical knowledge continues to evolve. The information provided should be considered in the context of your individual situation and in consultation with qualified healthcare professionals who can evaluate your specific needs and circumstances.
If you are experiencing a medical emergency, call 911 or seek immediate medical attention. Do not rely on information from this or any online article in emergency situations.
Written with clinical insights from Dr. Alexander Jimenez, DC, APRN, FNP-BC, CFMP, IFMCP, who specializes in integrative approaches to chronic pain and inflammatory conditions through chiropractic care and functional medicine at El Paso’s Premier Wellness and Injury Care Clinic.
Eat to Help a Herniated Disc: Protein, Omega-3s, Vitamins, Minerals, and Hydration for Faster, Healthier Spine Recovery
Overview
What you eat can help your spine heal. Foods rich in protein, omega-3 fatty acids, vitamins, and minerals support tissue repair, calm inflammation, and keep your spinal discs healthy and hydrated. When you pair smart nutrition with integrative care—like chiropractic adjustments and non-invasive decompression—you can lower disc pressure, improve nerve function, and speed recovery. This guide explains how to build a spine-friendly plate and water routine that works in real life. (National Spine Health Foundation, 2024; Texas Back Institute, n.d.; Jimenez, 2022–2025). El Paso, TX Doctor Of Chiropractic+3National Spine Health Foundation+3Texas Back Institute+3
Why nutrition matters for herniated discs
A herniated disc happens when the soft center of a disc pushes through its outer layer, which can irritate nearby nerves and cause pain, tingling, or weakness. Your body tries to calm the area and rebuild tissue—but it needs raw materials (amino acids, vitamins, and minerals) and fewer inflammatory triggers to do so effectively. A diet centered on lean protein, omega-3-rich foods, colorful produce, nuts, seeds, and whole grains provides these nutrients while helping control inflammation. (Texas Back Institute, n.d.; Healthline, 2021; National Spine Health Foundation, 2024). Texas Back Institute+2Healthline+2
Hydration: the first “nutrient” for discs
Spinal discs are mostly water. They act as shock-absorbing cushions between vertebrae and rely on hydration to stay plump and flexible. When you’re dehydrated, discs lose height and elasticity, which can increase stress on the outer layers and irritate nerves. Drinking water throughout the day helps transport nutrients to discs and supports synovial fluid, which promotes smooth joint motion. Aim for steady intake, not just big gulps once or twice a day. (National Spine Health Foundation, 2024; Jimenez, 2018; ANSSI Wellness, 2025). National Spine Health Foundation+2El Paso, TX Doctor Of Chiropractic+2
Hydration how-to (simple steps):
Keep water visible—on your desk, nightstand, and in the car.
Add water-rich foods like cucumbers, citrus, and melon to meals.
Your spine’s muscles, ligaments, and the collagen network inside discs all rely on amino acids. Getting enough protein helps you rebuild tissue and maintain strength that supports the spine. Good choices include fish, poultry, eggs, Greek yogurt, beans, and lentils. If you eat plant-based foods, mix legumes, soy, and grains to cover essential amino acids. (Texas Back Institute, n.d.; Frisco Spinal Rehab, 2025). Texas Back Institute+1
Collagen support: Collagen and glycine can help rebuild connective tissue. You can get these from bone broth, collagen peptides, or cuts of meat that include cartilage and skin. Plant sources (like soy and beans) also provide amino acids, though you may need a bit more volume to match the totals. (DiscSeel/Dr. Pauza, n.d.; Frisco Spinal Rehab, 2025). Discseel+2drkevinpauza.com+2
Omega-3 fatty acids: dial down inflammation
Omega-3s from fatty fish (salmon, sardines, herring, mackerel, and anchovies), walnuts, chia, and flax help calm the inflammatory pathways that often flare with disc injuries. Many people notice better joint comfort when they replace some omega-6-heavy processed foods with omega-3-rich whole foods. (Healthline, 2019/2021; National Spine Health Foundation, 2024). Healthline+2Healthline+2
If you don’t eat fish, nuts and seeds are solid choices. Chia, flax, and walnuts provide ALA (a plant omega-3), plus fiber and magnesium—both helpful for nerve and muscle function. (417 Spine, 2024). 417spine.com
Vitamins & minerals that support discs, nerves, and bones
Vitamin C
Vitamin C helps your body make collagen—the framework inside discs, ligaments, and other connective tissues. Citrus, berries, bell peppers, and leafy greens are easy ways to get it daily. (Spine Orthopedic Center, 2024). Spine & Orthopedic Center
Vitamin D + Calcium + Magnesium
These nutrients work together. Vitamin D helps you absorb calcium; magnesium helps activate vitamin D and supports bone and muscle function. You’ll find calcium in dairy and fortified plant milks, leafy greens, beans, nuts, and small bony fish (like sardines). Magnesium shows up in spinach, pumpkin seeds, almonds, beans, and whole grains. (National Spine Health Foundation, 2024; National Spine Health Foundation, 2017). National Spine Health Foundation+1
B-vitamins and antioxidants
Colorful fruits and vegetables provide antioxidants that help fight oxidative stress, which can worsen pain and tissue damage. Look for dark leafy greens and bright berries—simple swaps with big payoff. (Illinois Back Institute, 2024; Spine Wellness America, 2024). illinoisbackpain.com+1
What a spine-supportive plate looks like
Build most meals with:
A quality protein (¼ plate): grilled salmon or trout; baked chicken; eggs; or plant options like tofu, tempeh, beans, or lentils. (Texas Back Institute, n.d.; Healthline, 2019). Texas Back Institute+1
Colorful produce (½ plate): leafy greens, cruciferous vegetables, tomatoes, and berries for vitamin C, vitamin K, antioxidants, and fiber. (Bonati Spine Institute, 2021; Illinois Back Institute, 2024). Bonati Spine Institute+1
Whole grains or starchy veggies (¼ plate): quinoa, brown rice, oats, winter squash, or sweet potatoes to fuel healing and provide magnesium and potassium. (National Spine Health Foundation, 2024). National Spine Health Foundation
Snack ideas: Greek yogurt with berries; a small handful of mixed nuts and seeds; hummus with carrots and cucumbers; chia pudding; or a bone-broth mug for extra collagen. (DiscSeel/Dr. Pauza, n.d.; 417 Spine, 2024). Discseel+1
Simple 1-day starter menu (easy high-school level)
Breakfast: Greek yogurt parfait with blueberries, sliced almonds, and a sprinkle of chia; water or green tea.
Lunch: Salmon salad over spinach and kale with cherry tomatoes, quinoa, olive oil vinaigrette, and sliced orange.
Snack: Bone broth or collagen smoothie (banana + spinach + collagen peptides + water).
Dinner: Turkey chili with beans and bell peppers; side of roasted broccoli; whole-grain tortilla; water.
Hydration goal: Fill a 24-oz bottle and finish it twice by dinner, then have another glass in the evening. (Healthline, 2019; National Spine Health Foundation, 2024; DiscSeel/Dr. Pauza, n.d.). Healthline+2National Spine Health Foundation+2
Foods to emphasize for herniated disc recovery
Fatty fish (salmon, sardines, mackerel, herring, and anchovies): protein + omega-3s to reduce inflammation. (Healthline, 2019). Healthline
Berries (blueberries, strawberries, blackberries): vitamin C and polyphenols to support collagen and calm oxidative stress. (Florida Spine Associates, 2021). Florida Spine Associates
Leafy greens (spinach, kale, and collards): magnesium, vitamin K, and antioxidants for bone and connective tissue health. (Spine Orthopedic Center, 2024). Spine & Orthopedic Center
Nuts and seeds (walnuts, almonds, chia, flax): healthy fats, magnesium, and fiber—great for inflammation control and nervous system support. (417 Spine, 2024). 417spine.com
Lean meats, eggs, yogurt, beans, and lentils: protein for repair; pair with produce for vitamins that drive collagen synthesis. (Texas Back Institute, n.d.; Frisco Spinal Rehab, 2025). Texas Back Institute+1
Bone-broth or collagen (optional): extra glycine/proline to support connective tissue repair. (DiscSeel/Dr. Pauza, n.d.). Discseel
Foods and habits to limit
Most people do best limiting refined sugars, ultra-processed foods, and excessive alcohol or caffeine, which can worsen inflammation or interfere with calcium balance and hydration. Choose whole foods most of the time. (National Spine Health Foundation, 2024; Verywell Health, 2024). National Spine Health Foundation+1
How nutrition and chiropractic integrative care work together
Chiropractic adjustments and gentle spinal decompression can reduce disc pressure, improve nerve flow, and help you move with less pain—all without surgery. When you combine these treatments with targeted nutrition and hydration, you may get better, faster results because well-nourished tissues hold adjustments longer and repair more efficiently. (Jimenez, 2022–2025). El Paso, TX Doctor Of Chiropractic+2El Paso, TX Doctor Of Chiropractic+2
Clinical observations (Dr. Alexander Jimenez, DC, APRN, FNP-BC): In practice, Dr. Jimenez emphasizes:
Nutrition with care plans—anti-inflammatory foods, adequate protein, and minerals alongside adjustments and decompression. (Jimenez, 2022–2025). El Paso, TX Doctor Of Chiropractic+1
Dual-scope, integrative approach using lifestyle guidance plus hands-on care, with imaging and diagnostics when needed to guide safe rehab. (Jimenez, LinkedIn profile). LinkedIn
FAQs
Do I need an omega-3 supplement? Food first is best. If you don’t eat fish, ask your clinician about algae-based DHA/EPA or fish oil, and about medication interactions (such as blood thinners). (Verywell Health, 2023). Verywell Health
Can protein help even if I’m not post-surgery? Yes. Protein supports the daily repair of muscles and connective tissues around the spine. Most people with disc pain benefit from steady protein at each meal. (Texas Back Institute, n.d.). Texas Back Institute
Are nuts and seeds okay if I’m watching calories? Yes—use small portions (about a small handful). They deliver fiber, magnesium, and healthy fats that support nerve and muscle function and help control inflammation. (417 Spine, 2024). 417spine.com
How much water should I drink? There’s no one perfect number, but sipping regularly and watching the color of your urine (pale yellow) is a simple guide. Increase intake with heat, exercise, or high-fiber meals. (National Spine Health Foundation, 2024; ANSSI Wellness, 2025). National Spine Health Foundation+1
7-day “spine stack” checklist
Daily: Fill a large bottle 2–3 times; include leafy greens and berries; add one omega-3 food; include a palm-sized protein each meal. (National Spine Health Foundation, 2024; Healthline, 2019). National Spine Health Foundation+1
3× per week: Fatty fish or plant omega-3 + nuts/seeds. (Healthline, 2019; 417 Spine, 2024). Healthline+1
Weekly prep: Make a batch of bone broth or pick up collagen peptides if recommended. (DiscSeel/Dr. Pauza, n.d.). Discseel
Care synergy: Keep chiropractic visits, do your home exercises, and bring questions about diet or supplements to your clinician. (Jimenez, 2022–2025). El Paso, TX Doctor Of Chiropractic+1
Putting it all together
Eating for a herniated disc is not about perfection. It’s about steady hydration and building most meals around protein, omega-3s, minerals, and colorful plants. Pair that with chiropractic integrative care—like adjustments and non-invasive decompression—and you give your spine the best chance to calm inflammation, protect nerves, and rebuild tissues. Start with one habit today: fill your water bottle, plan a salmon-and-greens dinner, or add a handful of walnuts to your yogurt. Small steps add up. (National Spine Health Foundation, 2024; Jimenez, 2022–2025; Healthline, 2019). Healthline+3National Spine Health Foundation+3El Paso, TX Doctor Of Chiropractic+3
References
ANSSI Wellness. (2025, Sept). How dehydration affects your spine and leads to neck pain.anssiwellness.com
ANSSI Wellness. (2025, Aug). Bulging disc recovery diet – best foods for spine healing.anssiwellness.com
Bonati Spine Institute. (2021, May 10). 5 best foods for your spine health.Bonati Spine Institute
DiscSeel / Pauza, K. (n.d.). Herniated disc: Natural treatment.Discseel
Florida Spine Associates. (2021, Dec 10). Foods for spine surgery recovery: What to eat and avoid.Florida Spine Associates
Frisco Spinal Rehab. (2025, Sept 15). The best diet for spinal disc recovery and faster healing.Frisco Spinal Rehab
Frisco Spinal Rehab. (2025, Sept 2). Glycine: The hidden nutrient for spinal disc healing.Frisco Spinal Rehab
