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By admin 0 Comments Exercises, Sleep Hygiene , , , , , , , , , , , , , , , , , ,

Exercising Before Bed: Impact on Your Sleep Cycle

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

Exercising Before Bed

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

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

Advantages

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

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

Disadvantages

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

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

Recommended Types of Exercise

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

Restorative Yoga

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

Tai Chi

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

Slow Walking

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

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

Exercises to Avoid

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

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

Working Out In The Evening

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

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

How Long After Working Out to Go To Sleep?

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

Injury Medical Chiropractic & Functional Medicine Clinic

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.

Optimizing Your Wellness

References

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

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

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

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

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

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

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

By admin 0 Comments Chiropractic Care, Physio, Therapy , , , , , , , , , , , , , , , , ,

Lidocaine Patch for Pain Relief: An Overview

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

Lidocaine Patch

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

The Patch

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

  • Aspercreme
  • Lidocare
  • Salonpas

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

Other Lidocaine Forms

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

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

Effectiveness

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

How to Use Safely

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

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

How to use (MedlinePlus, 2025)

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

How Quickly Does It Work?

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

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

Side Effects

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

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

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

Serious Allergic Reaction

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

Methemoglobinemia

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

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

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

Injury Medical Chiropractic & Functional Medicine Clinic

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.

Sciatica Causes and Treatments

References

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

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

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

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

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

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

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

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

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

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

By admin 0 Comments Advanced Practice Registered Nurses (APRN) , , , , , , , , , , ,

A Clinical Approach To Identity Formation and Its Benefits

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

Introduction

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

Understanding Identity Formation

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

Erikson’s Stages and Role Confusion

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

The Four Identity Statuses

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

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

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

Understanding The Effects Of Personal Injury- Video

The Role of Identity Formation in Health and Medicine

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

1. Religious Identity

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

2. Political Identity

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

3. Vocational Identity

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

4. Ethnic and Racial Identity

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

5. Gender Identity

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

Self-Concept and Chronic Disease Management

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

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

Strategies for Supporting Identity Formation in Healthcare

1. Patient-Centered Communication

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

2. Holistic Treatment Planning

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

3. Behavioral and Cognitive Interventions

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

4. Interdisciplinary Collaboration

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

Conclusion

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

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

Injury Medical & Functional Medicine Clinic

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

References

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

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

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

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

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

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

Disclaimer

By admin 0 Comments Acupuncture, Chiropractic Care, Therapy , , , , , , , , , , , , , , , , ,

What to Wear to Physical Therapy and Why It Matters

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

What To Wear To Physical Therapy?

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

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

Physical Therapy

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

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

Upper Body Neck, Shoulders, Arms, Back

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

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

Lower Body, Hips, Legs, Knees

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

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

Feet and Ankles

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

Other Considerations

Avoid

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

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

Injury Medical Chiropractic & Functional Medicine Clinic

If you are unsure if what you plan to wear is appropriate, call the office and ask. If you’re leaving work and need to change, make sure your therapist’s office has a place for you to do that. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.

Unlocking Pain Relief: How We Assess Motion To Alleviate Pain

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Apple Cider Vinegar for Health and Wellness

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

Apple Cider Vinegar

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

Daily Consumption

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

Digestion

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

Weight Management

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

Blood Sugar Regulation

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

Antimicrobial

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

Heart Health

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

Skin Benefits

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

Safe Limit

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

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

Safely Diluting

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

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

Risks and Side Effects

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

Insulin

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

Antidiabetic Meds

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

Diuretic Meds

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

Digoxin Heart Medication

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

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

  • Upset stomach
  • Esophagus irritation 
  • Tooth enamel erosion

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

Injury Medical Chiropractic & Functional Medicine Clinic

Always contact a healthcare provider before starting a new supplement to ensure it is safe for the individual and their health. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.

Healthy Diet and Chiropractic

References

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

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

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

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

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Cobb Angle: From Measurement to Treatment Decisions

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

Cobb Angle

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

X-Ray and Interpretation

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

Visualizing the Angle

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

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

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

10 Degrees Cobb Angle 

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

Less Than 25 Degrees Cobb Angle

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

Between 25 and 40 Degrees Cobb Angle

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

Scoliosis in Adults

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

40 Degrees or More Cobb Angle

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

Variations

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

Injury Medical Chiropractic & Functional Medicine Clinic

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.

Academic Low Back Pain: Impact and Chiropractic Solutions

References

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

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

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

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

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

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Finger Pulley Anatomy: Understanding Your Fingers’ Structure

Finger pulley injuries are unique digital injuries distinct from sprains or dislocations. They occur specifically in rock climbers and occasionally in baseball pitchers. What are the symptoms, diagnoses, and treatments available?

Finger Pulley Injury

A finger pulley injury, common in activities like climbing, involves damage to the fibrous bands (pulleys) that hold tendons against bones. This causes pain, swelling, and potentially bowstringing of the tendons.

  • Finger pulleys are structures that hold tendons against the bones of the fingers.
  • Injury symptoms include pain, swelling, and a popping sound heard at the time of the injury.
  • Finger pulley injuries, or ruptures of the digital pulley, are seen almost exclusively in rock climbers. (Miro P. H. et al., 2021)

This activity stresses the digits when maneuvering along uneven surfaces while supporting the entire body’s weight. The injuries result from the mechanics of the finger tendons and joints and the position the fingers hold while rock climbing. Rock climbing has grown in popularity. The only other sport in which this injury has been described is baseball, in pitchers. The forces acting on the finger are very different in these activities, but both place high stress on the finger pulleys.

Digital Pulleys

Everyone has structures in their fingers called digital pulleys. These pulleys hold the tendons against the bones of the fingers. Each finger has eight pulleys, but only two are considered critical to prevent the finger tendons’ bowstringing (when one pulley gives out or ruptures). This can result in various injury outcomes, from a simple strain of the pulley to ruptures of multiple pulleys in a single digit. Pain, stiffness, and an inability to fully flex the finger can occur. (Carruthers K. H., Skie M., & Jain M. 2016) In severe situations, when the tendons are bowstringing, the tendon may lift away from the finger when making a fist.

Symptoms

Pain and Tenderness

  • Localized pain and tenderness at the finger’s base, particularly when gripping or bending. Pain on the palm side of finger and tenderness with pressure

Swelling

  • Swelling and bruising around the affected finger joint, especially on the palm side.

Popping Sound

Stiffness and Difficulty Bending

  • Stiffness and pain when bending the fingers or difficulty gripping. Difficulty forming a fist

Bowstringing

  • Visible displacement of the tendon from its normal position, causing a bulge at the finger’s base.

Most commonly, the middle or index digit is the injured finger. The two critical pulleys in the finger are designated the A2 and A4. (Carruthers K. H., Skie M., & Jain M. 2016) Individuals may see swelling, redness, and inflammation at the base of the finger (A2) and/or in the space between the two finger joints closest to the tip of the finger (A4). In rock climbers, either or both of those pulleys may be injured. In baseball pitchers, the injury is typically isolated to the A4 pulley.

Causes

  • Overuse and Repetitive Strain: Frequent or intense gripping or crimping, common in rock climbing and other activities, can cause pulley injuries.
  • Dynamic or Sudden Movements: Desperate or dynamic moves or poor technique can lead to injury.
  • Excessive Force: Pulleys can rupture when the force exerted on them is too great.
  • Mechanism of injury: The A2 pulley is the most commonly injured, followed by the A4 pulley.

Diagnosis

Emergency treatment is generally unnecessary. However, it is important to have suspected digital pulley injuries examined by a specialist within several days to a week after the injury. The most important aspect of an evaluation is determining whether the injury has caused the bowstringing of the tendons. Imaging tests may be performed to help with the diagnosis and plan treatment. An ultrasound is recommended as the initial imaging technique. (Miro P. H. et al., 2021)

If an ultrasound is inconclusive, an MRI may be advised. Sometimes, an MRI is performed with the finger held straight and then bent to see if the tendons are bowstringing. An X-ray can also help exclude other causes of finger pain, including sprains and fractures.

Treatment

Conservative Care

  • Immobilization, physical therapy, and pulley-protective measures, such as splints or taped fingers, are often used.

Surgery

  • Surgery may be necessary for severe grade IV injuries where conservative care fails.
  • Only in situations where there are multiple pulley ruptures or if there is delayed treatment should surgery be necessary.

Rehabilitation

  • Focuses on regaining flexibility, strength, and grip function through exercises and physical therapy.

If the tendons do not bowstring, treatment usually protects the injured finger until swelling and pain subside. If there is bowstringing of the tendons, more careful management of the injury is needed. Individuals who suspect a pulley injury rest or splint the finger and use nonsteroidal anti-inflammatory drugs as necessary for pain until they can get a medical evaluation. (Carruthers K. H., Skie M., & Jain M. 2016) Physical therapy is recommended for most injuries, along with immobilization, the H-tape method, and a protective pulley splint. (Miro P. H. et al., 2021) Specialized splints and therapy techniques can allow the pulleys to heal properly.

Returning to activity varies significantly with the severity of the injury. With mild pulley strains, full activity can be resumed as soon as swelling and pain have subsided. Treatment for full ruptures being treated non-surgically is typically between one and three months. For individuals requiring surgical reconstruction of a pulley injury, restrictions may apply up to a year after the surgery.

Injury Medical Chiropractic & Functional Medicine Clinic

To prevent complications, a healthcare provider should evaluate pulley injuries as soon as possible. Treatment most often consists of physical therapy, but surgery may be necessary. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.

Sports Injury Treatments

References

Miro, P. H., vanSonnenberg, E., Sabb, D. M., & Schöffl, V. (2021). Finger Flexor Pulley Injuries in Rock Climbers. Wilderness & environmental medicine, 32(2), 247–258. https://doi.org/10.1016/j.wem.2021.01.011

Carruthers, K. H., Skie, M., & Jain, M. (2016). Jam Injuries of the Finger: Diagnosis and Management of Injuries to the Interphalangeal Joints Across Multiple Sports and Levels of Experience. Sports Health, 8(5), 469–478. https://doi.org/10.1177/1941738116658643

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Moringa Uses in Everyday Health Routines

Curious about moringa? Explore its incredible health benefits and why you should consider adding it to your diet.

Introduction

As a seasoned nurse practitioner with two decades of experience in physical and functional medicine, I have encountered countless patients struggling with joint inflammation. Many describe persistent joint pain that flares up after simple daily activities, tenderness in their extremities, or morning stiffness that gradually improves throughout the day. Chronic joint inflammation, often associated with conditions like arthritis, can significantly impact one’s quality of life. While conventional treatments such as NSAIDs and corticosteroids can provide relief, they also come with potential side effects. This has led many individuals to explore natural remedies, one of the most powerful being moringa oleifera.

Moringa: A Nutritional and Medicinal Powerhouse

Moringa, commonly referred to as the “Miracle Tree,” is native to parts of Africa and Asia and has been used for centuries in traditional medicine. This nutrient-dense plant is packed with essential vitamins, minerals, antioxidants, and bioactive compounds that promote overall health and well-being. The nutritional composition of 100 grams of dried moringa leaves includes:

  • Protein – 9 grams
  • Vitamin C – 51.7 mg
  • Vitamin A – 378 mcg
  • Calcium – 185 mg
  • Potassium – 337 mg
  • Iron – 4 mg
  • Magnesium – 147 mg
  • Fiber – 2 grams

One of moringa’s most notable attributes is its anti-inflammatory effects, which can alleviate joint pain and stiffness associated with arthritis and other musculoskeletal conditions.

Understanding Inflammation and Joint Pain

Inflammation is the body’s natural response to injury, infection, or chronic conditions like osteoarthritis and rheumatoid arthritis. It can be classified as acute or chronic:

  • Acute inflammation occurs as a temporary protective response, causing redness, swelling, and warmth in the affected area.
  • Chronic inflammation is prolonged and can contribute to progressive tissue damage, joint stiffness, and pain.

For individuals dealing with chronic joint pain, controlling inflammation is crucial to maintaining mobility and preventing long-term complications.

How Moringa Reduces Inflammation

Moringa contains a unique combination of antioxidants, anti-inflammatory compounds, and immune-boosting nutrients that work synergistically to combat inflammation. Here’s how it helps:

1. Rich in Antioxidants

Moringa is loaded with powerful antioxidants such as quercetin, kaempferol, and chlorogenic acid, which neutralize free radicals and inhibit inflammatory enzymes. Studies show that these antioxidants help reduce oxidative stress, a major contributor to joint inflammation.

2. Contains Natural Anti-Inflammatory Compounds

Moringa’s isothiocyanates have been shown to have strong anti-inflammatory properties, helping to regulate inflammatory gene expression and reduce the production of pro-inflammatory cytokines. This is particularly beneficial for individuals with autoimmune-related joint diseases such as rheumatoid arthritis.

3. Supports Immune Function

Since chronic inflammation is closely linked to immune dysfunction, moringa’s immune-boosting properties play a crucial role in modulating inflammatory responses. Rich in vitamin A, vitamin C, and beta-carotene, moringa strengthens the immune system, promoting a balanced inflammatory response and reducing excessive immune activation.

Unlocking The Secrets Of Inflammation-Video

Moringa for Joint Pain & Arthritis

For individuals experiencing arthritis-related joint pain, moringa may serve as a natural alternative to conventional pain relievers. Here are some key benefits:

1. Reduces Joint Swelling and Stiffness

Moringa’s anti-inflammatory properties help reduce joint swelling and stiffness, making it easier to move without discomfort. Research suggests that moringa extracts can lower pro-inflammatory cytokines, helping to restore joint function.

2. Prevents Cartilage Breakdown

The high antioxidant content in moringa helps protect against cartilage degradation, a major cause of joint pain in conditions such as osteoarthritis. By reducing oxidative stress and inflammation, moringa supports joint integrity and prevents further deterioration.

3. Improves Joint Mobility and Flexibility

Many individuals who incorporate moringa into their diet report enhanced joint mobility and flexibility, allowing them to maintain an active lifestyle.

How to Incorporate Moringa Into Your Daily Routine

Adding moringa to your diet is a simple and effective way to harness its health benefits. Here are several ways to consume it:

1. Moringa Powder

  • Mix 1-2 teaspoons of moringa powder into smoothies, soups, or teas for a nutrient-rich boost.

2. Moringa Capsules

  • Ideal for busy individuals, moringa capsules provide a convenient way to incorporate this superfood into your daily routine.

3. Moringa Tea

  • Steeping moringa leaves in hot water for 3-5 minutes creates a soothing, anti-inflammatory herbal tea.

4. Moringa Oil (Ben Oil)

  • Applying moringa oil directly to affected joints can provide additional topical pain relief and reduce inflammation.

Scientific Evidence Supporting Moringa’s Anti-Inflammatory Benefits

Several studies have validated the anti-inflammatory and joint-protective properties of moringa:

  • A 2023 study published in the Journal of Inflammation Research found that moringa extracts significantly reduced pro-inflammatory cytokines in individuals with arthritis.
  • Research from the International Journal of Molecular Sciences highlights moringa’s ability to modulate inflammatory gene expression, reducing chronic inflammation at the molecular level.
  • A 2022 study in the Phytotherapy Research Journal showed that moringa supplementation improved joint mobility and reduced pain in osteoarthritis patients over a 12-week period.

Final Thoughts

Moringa is a powerful, natural remedy for joint inflammation and pain relief. Its anti-inflammatory, antioxidant, and immune-modulating properties make it an excellent alternative to conventional treatments for arthritis and other inflammatory joint conditions. Incorporating moringa into a balanced diet and healthy lifestyle can enhance joint mobility, reduce pain, and improve overall well-being.

For those seeking a holistic approach to joint health, moringa stands out as a safe, effective, and research-backednatural supplement. Whether consumed as a powder, tea, capsule, or oil, moringa can be a game-changer in managing joint inflammation and supporting long-term musculoskeletal health.

Injury Medical & Functional Medicine Clinic

We associate with certified medical providers who understand the importance of the various effects of incorporating moringa to reduce the inflammatory effects that are causing joint pain. When asking important questions to our associated medical providers, we advise patients to implement small changes to their daily routine, like incorporating anti-inflammatory foods into their diets to reduce the effects of joint inflammation and restore mobility. Dr. Alex Jimenez, D.C., utilizes this information as an academic service. Disclaimer.

References

Arora, S., & Arora, S. (2021). Nutritional significance and therapeutic potential of Moringa oleifera: The wonder plant. J Food Biochem, 45(10), e13933. https://doi.org/10.1111/jfbc.13933

Bibi, N., Rahman, N., Ali, M. Q., Ahmad, N., & Sarwar, F. (2024). Nutritional value and therapeutic potential of Moringa oleifera: a short overview of current research. Nat Prod Res, 38(23), 4261-4279. https://doi.org/10.1080/14786419.2023.2284862

Chis, A., Noubissi, P. A., Pop, O. L., Muresan, C. I., Fokam Tagne, M. A., Kamgang, R., Fodor, A., Sitar-Taut, A. V., Cozma, A., Orasan, O. H., Heghes, S. C., Vulturar, R., & Suharoschi, R. (2023). Bioactive Compounds in Moringa oleifera: Mechanisms of Action, Focus on Their Anti-Inflammatory Properties. Plants (Basel), 13(1). https://doi.org/10.3390/plants13010020

Cuellar-Nunez, M. L., Gonzalez de Mejia, E., & Loarca-Pina, G. (2021). Moringa oleifera leaves alleviated inflammation through downregulation of IL-2, IL-6, and TNF-alpha in a colitis-associated colorectal cancer model. Food Res Int, 144, 110318. https://doi.org/10.1016/j.foodres.2021.110318

Gessl, I., Popescu, M., Schimpl, V., Supp, G., Deimel, T., Durechova, M., Hucke, M., Loiskandl, M., Studenic, P., Zauner, M., Smolen, J. S., Aletaha, D., & Mandl, P. (2021). Role of joint damage, malalignment and inflammation in articular tenderness in rheumatoid arthritis, psoriatic arthritis and osteoarthritis. Ann Rheum Dis, 80(7), 884-890. https://doi.org/10.1136/annrheumdis-2020-218744

Sailaja, B. S., Hassan, S., Cohen, E., Tmenova, I., Farias-Pereira, R., Verzi, M. P., & Raskin, I. (2022). Moringa isothiocyanate-1 inhibits LPS-induced inflammation in mouse myoblasts and skeletal muscle. PLOS ONE, 17(12), e0279370. https://doi.org/10.1371/journal.pone.0279370

Vergara-Jimenez, M., Almatrafi, M. M., & Fernandez, M. L. (2017). Bioactive Components in Moringa Oleifera Leaves Protect against Chronic Disease. Antioxidants (Basel), 6(4). https://doi.org/10.3390/antiox6040091

Xiao, X., Wang, J., Meng, C., Liang, W., Wang, T., Zhou, B., Wang, Y., Luo, X., Gao, L., & Zhang, L. (2020). Moringa oleifera Lam and its Therapeutic Effects in Immune Disorders. Front Pharmacol, 11, 566783. https://doi.org/10.3389/fphar.2020.566783

Disclaimer

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Abdominal Self Massage Techniques for Constipation

For individuals struggling with constipation, a common digestive issue, could performing abdominal self-massage help bring relief?

Abdominal Self Massage

Constipation refers to having a bowel movement fewer than three times per week. In addition to stress, certain lifestyle issues can lead to constipation, including not getting enough fiber, exercise, and proper hydration. Many also experience constipation while traveling. Abdominal self-massage involves gently massaging the stomach with your hands, either in a circular motion or with strokes, to improve digestion, relieve constipation, and reduce bloating. Performing self-massage on and around the abdomen can help ease constipation in several ways, such as stimulating the muscles, producing bowel movements, and soothing chronic stress. (Sinclair M. 2011)

Massage and Constipation

Abdominal massage can provide several benefits, including:

Stimulates and Improves Digestion

  • Massage stimulates the muscles and nerves that control digestion, promoting bowel movements and reducing constipation.

Reduces Bloating

  • Massaging the abdomen may help to reduce bloating and gas by gently moving fluids and gases through the digestive system.
  • In addition, it can help soften stool, speed up the movement of stool through the gut, and reduce the need to use laxatives. (University of Michigan Medicine, 2021)

Relieves Constipation

  • Abdominal massage can help with constipation by encouraging bowel movements.

Reduces Pain and Discomfort

  • Some find that abdominal massage helps to reduce pain and discomfort related to digestive issues.
  • Massage can help relax tense abdominal muscles and reduce pain associated with conditions like irritable bowel syndrome (IBS).

Improved lymphatic drainage

  • Massage helps move lymphatic fluid, which carries waste products and toxins away from the abdominal area.

Research

Although massage isn’t a standard treatment for constipation, some research shows it may help restore regularity. A report reviewed several clinical trials focusing on abdominal massage and its use as a treatment for chronic constipation. The results showed that abdominal massage may provide relief by promoting peristalsis, a series of muscle contractions that help move food through the digestive tract.  The report also found that massage may help lessen colonic transit time, which is when digested food passes through the colon or last segment of the digestive tract. The report determined that abdominal massage can help alleviate constipation-related pain and discomfort. (Sinclair M. 2011)

In clinical trials, individuals with constipation reported improved quality of life after abdominal self-massage. However, some research suggests that using abdominal massage for constipation relief will not decrease the use of laxatives, the most commonly used treatment. (Lämås K. et al., 2009)

How to Massage

Various massage techniques may help relieve constipation and promote bowel movements. These are typically performed while lying down.

  • One technique involves placing the palm on the abdomen and making small, circular, clockwise motions around your belly button.
  • Individuals can also widen these circles so that the massage covers their entire abdomen.
  • Another technique begins by placing your hand below your breastbone, then gliding that hand down the length of your abdomen in one smooth stroke.
  • Repeat the movement with the other hand and continue this cycle for a few minutes.
  • When practicing self-massage, use light and gentle pressure, then gradually increase the pressure.
  • If you experience pain or tenderness, lighten up and return to a comfortable pressure level.

Try performing massage twice daily, aiming for a 20-minute session. Incorporating deep breathing into each session may also help. Before trying a massage or any home remedy, it is recommended to discuss it with a healthcare provider to see if it’s appropriate and safe. Pregnant women, for example, should avoid any massage on their abdomen. Constipation can sometimes signal an underlying condition that requires medical treatment, such as an underactive thyroid. Other symptoms like abdominal pain may be present, but sometimes constipation may be the only symptom.

Other Remedies

Self-massage alone is unlikely to treat chronic constipation; the goal should be to improve overall digestion to keep the organs functioning properly. To maintain regularity, it’s essential to drink plenty of water daily, eat enough fiber-rich foods, and engage in physical activity. Other alternative treatments include therapies like:

  • Acupressure
  • Biofeedback
  • Probiotics

Before trying self-massage, consult a medical caregiver to ensure it is safe and correct for the individual. Abdominal massage may not help with painful bloating caused by disease, infection, or other reasons.

Injury Medical Chiropractic & Functional Medicine Clinic

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.

Massage Therapy Rehabilitation

References

Sinclair M. (2011). The use of abdominal massage to treat chronic constipation. Journal of bodywork and movement therapies, 15(4), 436–445. https://doi.org/10.1016/j.jbmt.2010.07.007

University of Michigan Medicine. (2021). Self-abdominal massage. https://www.med.umich.edu/1libr/MBCP/AbdominalSelfmassage.pdf

Lämås, K., Lindholm, L., Stenlund, H., Engström, B., & Jacobsson, C. (2009). Effects of abdominal massage in management of constipation–a randomized controlled trial. International journal of nursing studies, 46(6), 759–767. https://doi.org/10.1016/j.ijnurstu.2009.01.007

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Complex Regional Pain Syndrome: A Patient’s Guide

Individuals dealing with chronic pain following a minor injury, surgery, or trauma could be experiencing complex regional pain syndrome. What are the symptoms, diagnosis, and treatments available?

Complex Regional Pain Syndrome

Reflex sympathetic dystrophy syndrome (RSDS), more commonly known as complex regional pain syndrome (CRPS), is a chronic pain condition where a person experiences severe, persistent pain in a limb, usually following an injury, that is significantly more profound than from the initial trauma. It is considered a neuroinflammatory disorder in which the body’s response to injury is dysregulated. The condition is characterized by severe burning pain, often in an arm or leg, that can occur following a minor injury, surgery, or trauma. It is associated with abnormal changes in skin temperature, swelling, and sensitivity to touch, usually affecting the affected area’s nerves, skin, muscles, blood vessels, and bones. Other names it is known by include:

  • Causalgia
  • Shoulder-Hand Syndrome
  • Sudeck’s Atrophy

Causes

CRPS is a chronic pain condition believed to result from dysfunction in the central or peripheral nervous systems (National Institute of Neurological Disorders and Stroke, 2017). It involves irritation and abnormal excitation of nervous tissue, leading to abnormal impulses along nerves that affect blood vessels and skin. Animal studies indicate that norepinephrine, a catecholamine released from sympathetic nerves, acquires the ability to activate pain pathways after tissue or nerve injury, resulting in CRPS. Another theory is that CRPS, which follows an injury, is caused by triggering an immune response and continuous inflammation symptoms (swelling, redness, warmth). (Goh E. L., Chidambaram S., & Ma, D. 2017) It is believed to have multiple causes producing similar symptoms.

Triggers

There can be numerous triggers, including:

Symptoms

CRPS usually affects one of the extremities (arm, leg, hand, or foot). The primary symptom is intense, continuous pain. (National Institute of Neurological Disorders and Stroke, 2017) Other symptoms can include

  • Burning pain
  • Swelling
  • Increased skin sensitivity
  • Extreme sensitivity to touch, often causing significant disability in the affected limb.
  • Stiffness and swelling in affected joints
  • Skin color changes – blotchy, purple, pale, red.
  • Skin temperature changes – warmer or cooler than the opposing extremity.
  • Skin texture changes – shiny, thin, sweaty.
  • Changes in nail and hair growth patterns.
  • Pain can spread, for example, from the finger to the entire arm and the opposite extremity or from the left to the right arm.
  • Emotional stress can cause symptoms to worsen.

Some experts suggest three stages during which progressive changes occur in the affected area’s skin, muscles, joints, ligaments, and bones (Harvard Health Publishing, 2023). However, further research is needed.

Stages

Stage One

  • Lasts 1 to 3 months
  • Severe, burning pain
  • Muscle spasm
  • Joint stiffness
  • Rapid hair growth
  • Skin color and temperature changes (Stanford Medicine, 2025)

Stage Two

  • Lasts from 3 to 6 months
  • Pain becomes more intense
  • Swelling
  • Decreased hair growth
  • Nails are cracked, brittle, grooved, spotty
  • Softened bones
  • Stiff joints
  • Weak muscle tone

Stage Three

  • Pain is continuous
  • Muscle atrophy
  • Severely limited mobility
  • Irreversible changes to skin and bone
  • Contractions of muscles and tendons – limbs may be twisted

Diagnosis

  • A patient’s clinical history – signs and symptoms are the major factor in diagnosis.
  • The diagnosis is difficult because many symptoms overlap with other conditions. (Goh E. L., Chidambaram S., & Ma, D. 2017)
  • There is no specific blood test or other diagnostic tests.
  • X-rays may show osteoporosis, and nuclear bone scans may show characteristic uptake patterns that help diagnose.

Treatments

Treatment focuses on relieving painful symptoms and can include: (Goh E. L., Chidambaram S., & Ma, D. 2017)

  • Physical therapy and exercise
  • Psychotherapy to alleviate stress, anxiety, and depression
  • Sympathetic nerve blocks
  • Surgery
  • Spinal cord stimulation
  • Intrathecal drug pumps

Medications

These can include:

  • Topical analgesics
  • Anti-seizure drugs
  • Antidepressants
  • Corticosteroids
  • Opioids

It is estimated that there are 50,000 new cases every year in the United States. (Tajerian M., & Clark J. D. 2016)

Injury Medical Chiropractic & Functional Medicine Clinic

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.

The Root Causes of Pain

References

National Institute of Neurological Disorders and Stroke. (2017). Complex regional pain syndrome fact sheet. Retrieved from https://www.ninds.nih.gov/sites/default/files/migrate-documents/CRPS_FactSheet-E_508C.pdf

Goh, E. L., Chidambaram, S., & Ma, D. (2017). Complex regional pain syndrome: a recent update. Burns & Trauma, 5, 2. https://doi.org/10.1186/s41038-016-0066-4

Bruehl S. (2015). Complex regional pain syndrome. BMJ (Clinical research ed.), 351, h2730. https://doi.org/10.1136/bmj.h2730

Harvard Health Publishing. (2023). Complex Regional Pain Syndrome (CRPS). https://www.health.harvard.edu/a_to_z/complex-regional-pain-syndrome-crps-a-to-z

Stanford Medicine. (2025). Complex Regional Pain Syndrome (CRPS). https://med.stanford.edu/pain/about/chronic-pain/crps.html

Tajerian, M., & Clark, J. D. (2016). New Concepts in Complex Regional Pain Syndrome. Hand Clinics, 32(1), 41–49. https://doi.org/10.1016/j.hcl.2015.08.003