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Category: Sleep Hygiene

ChiroMedBlogSleep Hygiene

Sleep Hygiene ChiroMed. Healthy sleep is important for physical and mental health, improving productivity and overall quality of life. Dr. Alex Jimenez describes sleep hygiene as a variety of habits that are often necessary to achieve a proper quality of sleep to rise with full daytime alertness. Everyone, from children to older adults, can benefit from better sleep, and sleep hygiene is key to achieving that goal. Sleep is essential for physical health and well-being because it is important in the body’s natural healing and repairing functions. Therefore, the most important sleeping measure is to maintain regular sleeping patterns. Research has demonstrated that forming good habits is a central part of health. The ideal sleep environment is cool, quiet, and dark. Research has also shown that uncomfortable room temperature, light, and noises can interrupt continuous sleep. Sleep hygiene specialists recommend selecting a comfortable mattress, pillows, and bedding and moving or hiding a visible clock. This prevents the sleeper from focusing on time passing while trying to fall asleep. Heavy meals before bed, caffeine or alcohol before bed, and even improper sleeping postures accompanied by pain and discomfort can be frequent poor sleep hygiene practices that can interfere with the sleep quality of many individuals. Crafting sustainable and beneficial routines makes healthy behaviors feel almost automatic, creating an ongoing process of positive reinforcement that can lead to higher-quality sleep and better overall health.

Why Your Neck Feels Worse at the End of the Week

Why Your Neck Feels Worse at the End of the Week

Abstract: Neck stiffness that grows from Monday through Friday is often less about one bad moment and more about accumulated workload. Long hours at a screen, repetitive lifting, driving, stress, interrupted sleep, and too little recovery can gradually exceed what the neck and shoulder muscles comfortably tolerate. This guide explains why symptoms can build across the week, how to recognize common patterns, and how movement, chiropractic care, rehabilitation, sleep, and practical recovery habits can help interrupt the cycle while keeping patients in control of their care.

Why Your Neck Feels Worse at the End of the Week

Monday morning may feel manageable. By Wednesday, you are rubbing the base of your neck during meetings. By Friday afternoon, turning your head in traffic feels stiff, your shoulders are elevated, and carrying groceries or picking up a child sounds exhausting.

For many tech workers, data-center employees, Amazon associates, and working parents, that pattern makes sense. The neck does not experience work one task at a time. It experiences the total load of the week.

A software employee may sit for hours, commute home, look down at a phone, help with homework, and sleep poorly. A warehouse associate may scan, lift, reach, drive, and repeat those tasks for several days. A data-center technician may alternate between laptop work, cable management, ladders, crouching, and overhead tasks. None of these exposures automatically causes injury, but repeated demands with limited recovery can leave muscles and joints increasingly sensitive.

Think of Your Neck Like a Weekly Work Budget

Your neck, upper back, and shoulders have a certain capacity for sitting, lifting, reaching, concentrating, and stabilizing the head. That capacity changes from day to day.

When demand repeatedly exceeds recovery, symptoms may accumulate. A useful way to picture it is a weekly budget. Every long meeting, lifting session, stressful commute, poor night of sleep, and evening spent looking down at a screen makes a withdrawal. Movement, sleep, exercise, position changes, and recovery make deposits.

By Friday, the account may simply be running low.

Research on office workers with chronic neck pain suggests that strengthening the neck, shoulder, and shoulder-blade muscles can reduce pain and disability, although the certainty of evidence is limited (Jones et al., 2024).

Why Friday Can Feel Different From Monday

Several small factors can stack together.

  • Prolonged sitting: Staying in one position reduces movement variety. Even a reasonable workstation can become uncomfortable when the same tissues are loaded for hours.
  • Repetitive lifting or reaching: Warehouse, delivery, technical, and home tasks can repeatedly challenge the neck and shoulder complex.
  • Driving: Commuting adds another block of relatively fixed posture, especially when traffic increases stress and muscle tension.
  • Mental stress: Concentration and deadline pressure can change breathing, muscle tone, and how strongly the nervous system interprets discomfort.
  • Poor sleep: Sleep problems and chronic musculoskeletal pain can reinforce each other. A 2024 systematic review found that sleep problems were associated with a higher risk of chronic musculoskeletal pain over time (Runge et al., 2024).
  • Less recovery: By late week, you may skip exercise, go to bed later, and fatigue can make healthy routines harder to maintain.

The result is often not a dramatic injury. It can be a gradual loss of comfortable motion, endurance, and tolerance.

The Answer Is Usually More Movement, Not Perfect Posture

Posture matters, but chasing a rigid “correct” position can become another source of stress. A better goal is variety.

During the workday, try simple resets:

  • Stand up briefly between tasks or calls.
  • Walk for a few minutes when possible.
  • Change screen height or chair position during long work blocks.
  • Let the shoulders relax instead of holding them lifted.
  • Alternate hands when carrying light objects.
  • Break large lifting jobs into smaller bouts when the job allows.
  • Use your lunch or break period for a short walk instead of another hour of sitting.

For workers with recurring symptoms, strengthening may be especially important. A systematic review of workplace interventions found low-quality evidence that neck strengthening and tailored workstation changes may reduce neck pain symptoms in office workers (Frutiger & Borotkanics, 2021). The practical lesson is that comfort often improves when the body becomes more capable, not when life becomes completely free of physical demand.

Where Chiropractic Care Fits

Chiropractic care should begin with examination, not assumptions. Neck pain can come from joints, muscles, tendons, irritated nerves, headaches, previous injuries, or conditions that are not primarily musculoskeletal.

A clinician may assess neck motion, shoulder mechanics, posture tolerance, strength, reflexes, sensation, grip, and the movements that reproduce symptoms. If the pattern appears mechanical and no red flags are present, care may include manual therapy, chiropractic adjustments or mobilization, soft-tissue work, therapeutic exercise, and progressive rehabilitation.

Current evidence supports a combined approach rather than relying on a single treatment. An umbrella review found strong support for manual therapy combined with exercise for nonspecific neck pain, while also noting that study quality varies across the literature (Reynolds et al., 2025). Another systematic review similarly found that manual therapy plus exercise can improve pain and disability compared with several control approaches, although certainty ranges from low to moderate for many outcomes (Wilhelm et al., 2023).

That combination reflects beneficence: care is organized around what helps the patient function safely. It also supports non-maleficence by emphasizing conservative, non-invasive options when clinically appropriate before more aggressive interventions are considered.

Rehabilitation Helps Build a Bigger Reserve

Feeling looser after treatment is useful, but lasting improvement often requires greater physical capacity.

Rehabilitation may target:

  • deep neck flexor endurance,
  • shoulder-blade control,
  • upper-back mobility,
  • rotator-cuff strength,
  • lifting mechanics,
  • grip and carrying tolerance,
  • thoracic movement,
  • and gradual return to work-specific demands.

A programmer who becomes stiff after six hours of screen work needs a different plan than an associate who repeatedly lifts boxes or a technician who spends time overhead.

Progress also matters. Exercises that are too easy may not build capacity, while exercises that are too aggressive may flare symptoms. A measured progression helps the body adapt without turning rehabilitation into another source of overload.

Recovery Habits Can Change the End of Your Week

Start with the habits most likely to restore capacity.

Aim for a consistent sleep window, especially on work nights. Eat regular meals and stay hydrated enough to support normal energy and concentration. Add brief movement breaks instead of waiting until pain forces you to stop. Keep some strength training in the week, even if sessions are short. After physically demanding shifts, choose recovery that includes gentle activity rather than spending the entire evening completely still.

Working parents may need even simpler strategies. A ten-minute walk after dinner, two short strength sessions, changing positions while helping with homework, and going to bed thirty minutes earlier can be more realistic than an ambitious plan that disappears by Tuesday.

When Neck Pain Needs More Than Self-Care

Most end-of-week stiffness is not an emergency, but some symptoms deserve prompt evaluation. Seek medical attention for neck pain after significant trauma, new or progressive weakness, loss of coordination, severe headache unlike your usual pattern, fever with neck stiffness, unexplained weight loss, chest pain, difficulty breathing, or new bowel or bladder changes.

Persistent numbness, tingling, pain traveling into the arm, or steadily worsening symptoms also deserve examination.

A Multidisciplinary Plan Keeps You in Charge

At ChiroMed, integrated care aims to avoid forcing every patient into the same pathway. Dr. Alex Jimenez, DC, APRN, FNP-BC, CFMP, IFMCP, can combine chiropractic assessment and rehabilitation with advanced medical evaluation when the clinical picture calls for it. Dr. Maria Guadalupe Cardenas, MD, Board Certified in Internal Medicine, provides medical direction and oversight for patients whose symptoms may involve broader health concerns.

That coordination matters when neck discomfort is accompanied by unusual fatigue, inflammatory symptoms, neurological changes, medication concerns, sleep problems, or other issues that may require medical testing or referral. It also protects patient autonomy. You should understand what clinicians think is happening, what options are available, the benefits and risks, and what you can do between visits.

The Friday flare is often a message, not a verdict. Your body may be telling you that five days of work are currently demanding more than your recovery system can comfortably replace. By adding movement, building strength, improving sleep, adjusting repeated exposures, and using chiropractic and medical care when appropriate, you can work toward finishing the week with more motion, more energy, and less time thinking about your neck.

References

Frutiger, M., & Borotkanics, R. (2021). Systematic review and meta-analysis suggest strength training and workplace modifications may reduce neck pain in office workers. Pain Practice, 21(1), 100–131.

Jones, L. B., Jadhakhan, F., & Falla, D. (2024). The influence of exercise on pain, disability and quality of life in office workers with chronic neck pain: A systematic review and meta-analysis. Applied Ergonomics, 117, 104216.

Reynolds, B., McDevitt, A., Kelly, J., Mintken, P., & Clewley, D. (2025). Manual physical therapy for neck disorders: An umbrella review. Journal of Manual & Manipulative Therapy, 33(1), 18–35.

Runge, N., Ahmed, I., Saueressig, T., Perea, J., Labie, C., Mairesse, O., Nijs, J., Malfliet, A., Verschueren, S., Van Assche, D., de Vlam, K., Van Waeyenberg, T., Van Haute, J., & De Baets, L. (2024). The bidirectional relationship between sleep problems and chronic musculoskeletal pain: A systematic review with meta-analysis. Pain, 165(11), 2455–2467.

Wilhelm, M., Cleland, J., Carroll, A., Marinch, M., Imhoff, M., Severini, N., & Donaldson, M. (2023). The combined effects of manual therapy and exercise on pain and related disability for individuals with nonspecific neck pain: A systematic review with meta-analysis. Journal of Manual & Manipulative Therapy, 31(6), 393–407.

The Weekend Recovery Trap: Why Tech and Shift-Work Parents Spend Their Days Off Exhausted

The Weekend Recovery Trap: Why Tech and Shift-Work Parents Spend Their Days Off Exhausted

Abstract: Tech parents and shift workers may spend weekends recovering instead of enjoying time with family. Sleep debt, rotating schedules, pain, inconsistent meals, limited movement, caffeine, and medical conditions can all contribute. This article explains the weekend “crash,” practical recovery strategies, and when integrated chiropractic and medical evaluation may uncover treatable causes.

The Weekend Recovery Trap: Why Tech and Shift-Work Parents Spend Their Days Off Exhausted

Friday night arrives. The laptop closes, the warehouse shift ends, or the data-center handoff is complete. A parent imagines breakfast with the kids, errands, a game at the park, and dinner together.

They sleep late, wake stiff, need coffee, and spend much of the day recovering. By Sunday evening, they may feel better—just in time for another demanding week. For tech workers, Amazon associates, data-center employees, and rotating-shift parents, days off can become repair days instead of family days.

Why the Crash Shows Up on Days Off

During the workweek, alarms, caffeine, deadlines, responsibility, and momentum can keep a person moving even when recovery is incomplete. When those demands stop, accumulated tiredness becomes harder to ignore.

Nonstandard schedules and extended hours can shorten or disrupt sleep and contribute to work-related fatigue. Fatigue can affect attention, reaction time, memory, and judgment (National Institute for Occupational Safety and Health [NIOSH], 2026). It can also reduce the energy available for family responsibilities.

A parent may “make it through” the week while borrowing energy from the weekend.

Sleep Debt Is Real, but Weekends Are Not a Reset Button

Adults generally need about seven to eight hours of sleep nightly, although needs vary. Repeated short sleep creates sleep debt. Sleeping longer on days off may help temporarily, but it does not completely replace consistent nighttime sleep (National Heart, Lung, and Blood Institute [NHLBI], 2022).

If weekday wake-up time is 5:30 a.m. but weekend wake-up time drifts toward 10:00 a.m., the body clock receives a different signal. NHLBI recommends keeping weekday and weekend schedules close because large shifts can disturb the sleep-wake rhythm.

For rotating-shift workers, perfect consistency may be impossible. The goal is reducing avoidable swings.

A Practical Sleep Strategy

  • Protect a realistic sleep window on work nights.
  • Keep wake times as consistent as the schedule allows.
  • Use caffeine strategically, not continuously.
  • Avoid caffeine close to planned sleep.
  • Make daytime sleep after night shifts dark, quiet, and cool.
  • Ask family members to protect essential sleep after long or overnight shifts.

Sleep is not wasted family time. It helps make engaged family time possible. Even small improvements can create more usable family energy.

Meal Timing and Caffeine Can Keep the Cycle Going

Busy parents often eat when they can. Breakfast disappears, lunch happens at a workstation, and dinner gets pushed late by overtime, commuting, or children’s activities.

Irregular meals don’t automatically cause fatigue, but energy management gets harder when they combine with poor sleep, dehydration, or long stretches without food.

Caffeine can become a bridge. An afternoon energy drink may help finish a ticket queue, warehouse assignment, server repair, or commute. But caffeine used too late can interfere with the next sleep period and help create tomorrow’s need for more caffeine.

Ask: “What job is caffeine doing for me, and what happens to my sleep afterward?”

Pain Can Drain Energy Even When You Keep Working

A parent with neck tension, low-back pain, headaches, shoulder discomfort, or aching feet may spend the day guarding movement. They shift positions, brace, avoid lifting, sleep awkwardly, and use extra mental effort to stay productive.

Chiropractic care can be appropriate when examination identifies a musculoskeletal problem. For low-back pain, spinal manipulation is one of several nondrug approaches that may produce small improvements in pain and function for some patients (National Center for Complementary and Integrative Health [NCCIH], 2022). Care should fit the diagnosis, risks, preferences, and other appropriate treatments.

The goal at ChiroMed is not to “adjust away” fatigue. It is to reduce mechanical strain that may be consuming energy while medical contributors are evaluated when needed.

Movement Helps Recovery Without Becoming Another Job

Long sitting during programming, monitoring, dispatch, security work, or commuting can stiffen the spine, shoulders, hips, and calves. Warehouse work creates another pattern: hours of physical loading followed by near-complete inactivity on days off.

Recovery can include gentle movement without becoming another performance demand. Try a short family walk, easy mobility after waking, light outdoor activity, or several five-minute movement breaks.

If activity causes pain, dizziness, unusual breathlessness, or profound worsening afterward, adjust the activity and have the pattern evaluated instead of pushing through.

Persistent Fatigue Deserves a Medical Differential

If weekends repeatedly disappear into exhaustion despite adequate opportunity for sleep, fatigue deserves clinical attention.

Evaluation starts with history, examination, sleep patterns, medication review, nutrition, mental health, work schedule, and associated symptoms. Testing should follow the individual findings rather than a one-size-fits-all panel. Depending on the history, clinicians may consider anemia or iron problems, thyroid disease, glucose regulation, kidney or liver issues, vitamin deficiencies, sleep apnea, medication effects, infection, cardiopulmonary conditions, or other causes (Latimer et al., 2023).

Clues worth discussing include:

  • Loud snoring, gasping, or witnessed breathing pauses.
  • Enough sleep hours without feeling refreshed.
  • New exercise intolerance or unusual shortness of breath.
  • Heavy menstrual bleeding or another possible source of iron loss.
  • Unexplained weight change, temperature intolerance, or palpitations.
  • Fatigue after starting a new medication or changing your dose.
  • Persistent low mood, anxiety, weakness, numbness, fainting, or chest pain.

These clues do not diagnose the cause. They help guide the next step.

What About Hormones or BHRT?

Hormones can matter, but fatigue alone does not prove a hormone deficiency.

When clinical history and appropriate findings point to a defined endocrine problem or menopausal indication, hormone therapy may be discussed through shared decision-making. Bioidentical hormone replacement therapy should not be treated as an energy treatment. Professional guidance emphasizes accurate diagnosis, individualized risk assessment, and monitoring. Compounded bioidentical products should not be assumed safer or more effective than FDA-approved options (American College of Obstetricians and Gynecologists [ACOG], 2023).

Patients should understand the reason for treatment, alternatives, expected benefits, uncertainties, and risks before deciding.

Integrated Care Should Give the Weekend Back

ChiroMed’s integrated model allows us to examine fatigue from more than one direction.

Dr. Alex Jimenez, DC, APRN, FNP-BC, CFMP, IFMCP, bridges chiropractic structural care, mechanical rehabilitation, functional medicine nutrition, and advanced medical diagnostics. Alongside Dr. Maria Guadalupe Cardenas, MD, Board Certified in Internal Medicine with over 40 years of experience, care can coordinate musculoskeletal findings with medical evaluation, laboratory testing, medication review, metabolic risk assessment, and sleep concerns when clinically appropriate.

This supports beneficence by addressing identified contributors. It supports non-maleficence by favoring appropriate conservative, non-invasive options when suitable and avoiding unnecessary procedures or medication dependence. It supports autonomy by giving patients understandable choices while coordinating with their existing healthcare team.

A Family-Centered Recovery Plan

For one week, track sleep timing, caffeine timing, pain, and end-of-day energy. Then make one small change rather than rebuilding your entire routine.

That change might be an earlier caffeine cutoff, a protected bedtime, a ten-minute walk with the kids, a more consistent meal, or an evaluation for pain that interrupts sleep.

If the pattern continues, bring the record to a clinician. Specific information is more useful than simply saying, “I am tired all the time.”

The goal isn’t to squeeze more productivity from an exhausted body. It is having enough energy after work to cook dinner, attend a game, help with homework, take a walk, laugh with your family, and still feel like yourself.

References

American College of Obstetricians and Gynecologists. (2023). Compounded bioidentical menopausal hormone therapy. Clinical Consensus No. 6.

Latimer, K. M., Gunther, A., & Kopec, M. (2023). Fatigue in adults: Evaluation and management. American Family Physician, 108(1), 58–69.

National Center for Complementary and Integrative Health. (2022). Spinal manipulation: What you need to know. U.S. Department of Health and Human Services.

National Heart, Lung, and Blood Institute. (2022). Sleep deprivation and deficiency: How much sleep is enough?. National Institutes of Health.

National Institute for Occupational Safety and Health. (2026). Fatigue and work. Centers for Disease Control and Prevention.

Your Bed Is the Second Workstation: Sleep and Neck Strain

Your Bed Is the Second Workstation: Sleep and Neck Strain

Abstract: A tech day can follow you into bed. Pillow height, sleep position, shoulder pressure, and daytime tension may shape morning comfort. This guide explains practical sleep adjustments, when neurological symptoms deserve evaluation, and how coordinated care can support recovery without prescribing one “perfect” sleep position.

Your Bed Is the Second Workstation: Sleep and Neck Strain

You close the laptop, answer one last family message, brush your teeth, and finally get into bed. Work is over. Your neck, however, may still be carrying the day.

Tech workers can spend hours looking downward, reaching toward a mouse, or barely moving. Bedtime adds hours in a smaller range of positions. A pillow that feels too high, an arm tucked under the head, or pressure on one shoulder may make an irritated area harder to settle.

The goal is not to sleep like a mannequin. It is to wake with enough comfort and energy for work, school drop-off, exercise, dinner, and family life.

The Workday Does Not End at the Desk

Imagine a software engineer finishing a deadline with tight shoulders and a stiff neck. At bedtime, that person curls onto one side, reaches overhead, and uses a pillow that pushes the head upward. By morning, the neck feels stuck and the shoulder aches.

That does not mean the pillow “caused” everything. Daytime loading, stress, sleep quality, previous injuries, and anatomy can contribute. Research shows that sleep problems and chronic musculoskeletal pain can interact in both directions: poor sleep may raise the risk of persistent pain, while pain can disturb sleep (Runge et al., 2024).

This is why ChiroMed looks at the twenty-four-hour pattern instead of blaming one posture.

Pillow Height: Support Without Forcing the Neck

A pillow has a simple job: support the head and neck comfortably while you rest. The right height depends on body size, shoulder width, mattress firmness, and sleep position.

When side sleeping, a pillow needs enough height to fill the space between head and mattress. Too little support can let the head drop; too much can push it away. Back sleepers often need less height because the shoulders create less space.

Research suggests that pillow shape and height can influence cervical alignment and waking symptoms, although no single design works for everyone (Pang et al., 2021).

Instead of shopping by marketing claims, ask: Do you wake feeling supported, or more twisted and sore?

Side, Back, or Stomach: There Is No Universal Winner

People often ask for the “best” sleeping position. Bodies are more complicated than that.

Side sleeping may comfort the neck but irritate a sensitive shoulder. Back sleeping may reduce shoulder pressure but be unsuitable with some breathing problems. Stomach sleeping requires sustained head rotation, which can aggravate an already stiff neck.

Research has not established that one common sleep position automatically causes shoulder pain. A worker study found a more complicated relationship than expected and noted that people with pain may change how they sleep in response to symptoms (Holdaway et al., 2018).

Comfort, breathing, symptoms, and freedom to change position matter more than chasing a universal rule.

Your Shoulder and Arm Need a Place to Go

For tech workers, arm position matters. Typing, mousing, texting, and carrying children can leave shoulders and forearms tired before bedtime.

Try these adjustments for several nights and notice what changes:

  • If you sleep on your side, avoid trapping the lower arm under your head.
  • Hug a pillow if it helps the upper shoulder relax instead of rolling forward.
  • If a painful shoulder is underneath, try the opposite side or partial back position.
  • Keep the wrist and elbow relaxed instead of tightly folded.
  • Adjust pillow height gradually rather than making a dramatic change overnight.
  • Track stiffness, headache, tingling, soreness, and how quickly symptoms fade after moving.

These are experiments, not commandments. Your response provides useful information.

Morning Stiffness Versus Neurological Symptoms

A mildly stiff neck that loosens after a warm shower, walking, or normal morning movement is different from progressive neurological symptoms.

Hand tingling can come from several locations. A cervical nerve root may be irritated, but nerves can also be compressed around the elbow or wrist. Cervical radiculopathy can include arm pain, numbness, pins-and-needles sensations, reflex changes, or weakness (Childress & Becker, 2016).

Evaluation matters when symptoms persist, worsen, or are accompanied by weakness, loss of hand coordination, significant trauma, fever, unexplained weight loss, new balance problems, or bowel or bladder changes. Don’t treat progressive neurological deficits as a pillow problem.

A careful history and examination can help determine whether symptoms appear mechanical, neurological, sleep-related, medical, or mixed.

Why Headaches Can Join the Morning Picture

Some tech workers wake with pressure at the skull base or a headache. Neck stiffness, muscle tension, jaw clenching, poor sleep, dehydration, migraine, medication effects, and other conditions can overlap.

That is why a morning headache should not automatically be labeled “tech neck.” Chiropractic assessment can examine cervical motion, muscular tension, joint mechanics, and symptom response to movement. When history suggests another contributor, medical evaluation can broaden the investigation.

Integrated care works best when the explanation fits the person rather than forcing every symptom into one category.

A Better Evening Transition for Tech-Working Parents

The most useful sleep strategy may begin before your head touches the pillow.

After work, give your body a transition. Stand, walk, let your arms swing, and gently change neck and shoulder positions. If family life allows, put the phone down instead of carrying work into bed.

Keep a second pillow nearby for small adjustments to arm support, shoulder pressure, or head height. If one position becomes uncomfortable, move. Healthy sleep does not require staying perfectly still.

Pay attention to whether you are waking more restored. Better mornings can mean more patience, steadier concentration, and confidence returning to exercise.

Coordinated Care When Home Adjustments Are Not Enough

At ChiroMed, integrative care helps patients make safe choices. Chiropractic evaluation can identify mechanical findings that may respond to appropriate manual care, rehabilitation, mobility work, or ergonomic changes. Non-invasive care may reduce reliance on unnecessary heavier interventions.

When symptoms suggest a broader issue, MD/NP evaluation can consider sleep disorders, medication effects, metabolic concerns, inflammatory conditions, or other medical contributors. This helps prevent every complaint from being forced into a musculoskeletal explanation.

Dr. Alex Jimenez, DC, APRN, FNP-BC, CFMP, IFMCP, bridges chiropractic structural care, rehabilitation, medical diagnostics, and functional medicine. Dr. Maria Guadalupe Cardenas, MD, a board-certified Internal Medicine physician with more than 40 years of experience, provides medical direction and oversight for complex medical and metabolic concerns. Their collaborative model supports coordinated care while respecting the patient’s existing medical team and treatment decisions.

Wake Up for More Than Work

Your bed should not feel like an overnight extension of your workstation. Small changes in pillow height, shoulder support, arm position, and evening movement may improve comfort, but persistent symptoms deserve evaluation rather than endless pillow shopping.

The best sleep position is the one that helps you rest safely and comfortably while fitting your health needs. The goal is simple: wake with enough comfort and energy for work and family.

If neck stiffness, shoulder pain, headaches, or hand tingling keep returning, ChiroMed can evaluate the pattern, explain options, and build a coordinated plan that supports recovery while keeping you in control.

References

Childress, M. A., & Becker, B. A. (2016). Nonoperative management of cervical radiculopathy. American Family Physician, 93(9), 746–754.

Holdaway, L. A., Hegmann, K. T., Thiese, M. S., & Kapellusch, J. (2018). Is sleep position associated with glenohumeral shoulder pain and rotator cuff tendinopathy: A cross-sectional study. BMC Musculoskeletal Disorders, 19, 408.

Pang, J. C. Y., Tsang, S. M. H., & Fu, A. C. L. (2021). The effects of pillow designs on neck pain, waking symptoms, neck disability, sleep quality, and spinal alignment in adults: A systematic review and meta-analysis. Clinical Biomechanics, 85, 105353.

Runge, N., Ahmed, I., Saueressig, T., Perea, J., Labie, C., Mairesse, O., Nijs, J., Malfliet, A., Verschueren, S., Van Assche, D., de Vlam, K., Van Waeyenberg, T., Van Haute, J., & De Baets, L. (2024). The bidirectional relationship between sleep problems and chronic musculoskeletal pain: A systematic review with meta-analysis. Pain, 165(11), 2455–2467.

When Screen Work Tightens the Jaw and Steals Sleep

When Screen Work Tightens the Jaw and Steals Sleep

Abstract: Focused screen work can tighten the jaw, stiffen the neck, and fragment sleep. This article explains how concentration, stress, forward-head posture, and unconscious clenching overlap for hybrid employees, software engineers, analysts, and tech parents. It maps the jaw, neck, shoulders, and rest without treating every headache as a mechanical problem. A chiropractic assessment can address related neck mechanics, while an MD or NP evaluation considers sleep, medications, and other medical causes. The aim is calmer mornings, easier eating, and more family comfort.

When Screen Work Tightens the Jaw and Steals Sleep

The laptop is still open on the kitchen table. Dinner is half-finished. A child is asking a question, and you realize your teeth have been pressed together for twenty minutes. Your temples feel tight. You call it “just stress,” then wake at 2 a.m. with a sore jaw from grinding at night.

That scene is familiar in El Paso homes where adults work hybrid schedules, write code, analyze data, or parent between meetings. The jaw is not separate from the neck or the night. It is part of a family story about concentration, recovery, and who you want to be when the screen closes.

Why Focused Screen Work Recruits the Jaw

The temporomandibular joints sit just in front of the ears and let you chew, talk, yawn, and rest the lower jaw. Temporomandibular disorders, often called TMDs, can involve those joints, the chewing muscles, or both. They are common and rarely caused by one factor (Yao et al., 2023).

Awake clenching is different from sleep grinding. Many people brace the jaw when they concentrate. That habit is awake bruxism. At night, jaw-muscle activity can occur during brief sleep arousals. That is sleep bruxism. Bruxism is not a pain diagnosis by itself. It becomes a problem when it overloads muscles, irritates joints, wears teeth, or fragments rest (Voß et al., 2024; Mayo Clinic, 2024).

Hybrid workers and software engineers often sit in one posture for hours: eyes on a monitor, shoulders rounded, head drifting forward, teeth touching. Laptop and phone use have been linked with higher TMD severity, forward-head posture, and clenching (Abdul, 2025). Work tension and neck pain also cluster with jaw symptoms in computer jobs (Pihut et al., 2022).

None of that means every facial ache is “tech neck.” Sinus disease, dental infection, migraine, medication effects, and sleep-disordered breathing can look similar. Careful evaluation protects you from treating the wrong problem.

The Hidden Loop: Jaw, Neck, Shoulders, and Sleep

The jaw and the cervical spine share muscles, fascia, and nerve pathways. When the head sits forward of the shoulders, chewing muscles and deep neck muscles often work harder to hold the face up. Adults with neck pain show higher rates of TMD and reduced jaw mobility, though that evidence remains limited (Bizzarri et al., 2026).

Jaw bracing can also recruit neck muscles. That is why a tight masseter can feel like an earache, a temple headache, or a stiff upper back. Research does not prove that posture alone causes TMD in every person. It does show a two-way relationship worth examining when eating or sleeping becomes harder (Bizzarri et al., 2026; Voß et al., 2024).

Sleep sits in the middle of the loop.

  • Insomnia and difficulty getting up have been linked with higher TMD risk in genetic studies (Xu & Zhou, 2024).
  • Short sleep may raise the chance of TMD-related pain (Xu et al., 2024).
  • Sleep bruxism often travels with snoring, sleep apnea, anxiety, reflux, caffeine, and some antidepressant or stimulant medicines (Mayo Clinic, 2024).
  • Poor sleep makes pain feel louder the next day, which makes clenching more likely the next night.

For tech parents, the loop is social as well as physical. Evening emails, homework help, and late scrolling keep the nervous system on alert. Breakfast becomes a negotiation with a sore face.

What You May Notice at Home

Symptoms vary. Many people clench quietly for years. Others notice a change after a project sprint, a new medicine, or a stretch of poor sleep.

Common clues include:

  • Morning jaw stiffness, tooth sensitivity, or a partner who hears grinding
  • Clicking, catching, or limited opening when you yawn or take a large bite
  • Temple, cheek, or ear-area aching that rises with long meetings
  • Neck tightness, shoulder hiking, and a heavy-headed feeling
  • Headaches that cluster with screen time, but not every headache

Red flags need a different door. Sudden inability to open or close the jaw, fever, facial swelling, neurologic change, or a severe new headache needs prompt medical attention. Autonomy starts with knowing when home care is not enough.

How Integrative Assessment Separates Overlap From Coincidence

At Injury Medical Clinic PA in El Paso, families do not have to choose between “it is all in the neck” and “it is all in the mind.” Dr. Alex Jimenez, DC, APRN, FNP-BC, CFMP, IFMCP, is a Doctor of Chiropractic and board-certified Family Practice Nurse Practitioner. He holds Texas Advanced Practice Nursing License #1191402 with full Prescriptive Authority #59628 (NPI 1205907805). Dr. Maria Guadalupe Cardenas, MD, Board Certified in Internal Medicine, serves as Medical Director and Collaborative Physician (Texas Medical License #J2933; NPI 1164426748). Together, they look at structure and systems.

Chiropractic evaluation of associated neck mechanics

A chiropractic visit for jaw-related tension is not a promise to “fix TMJ” with one adjustment. It examines how the head sits on the neck, how the upper back and shoulders move, and how those patterns affect chewing and sleep position.

Assessment may include posture and workstation habits, cervical and thoracic motion, jaw range and joint sounds, chewing-muscle sensitivity, and nighttime pillow setup.

Cervical manual therapy and neck exercise have shown short-term benefit for pain and muscle sensitivity in muscle-related TMD (Bednarczyk et al., 2024). A large analysis of chronic TMD pain found that coping-focused therapies, jaw mobilization, trigger-point work, postural exercise, and supervised stretching were among the better-supported options compared with placebo (Yao et al., 2023). That supports gentle, reversible care first. Non-maleficence here means slowing the rush toward surgery or heavy medication when safer options may help.

When indicated under medical collaboration, drug-free tools such as MLS laser therapy can calm local irritation without adding another prescription to a crowded nightstand.

MD and NP evaluation of sleep, medicines, and medical causes

Not every clenched jaw is a spinal problem. Dr. Cardenas provides internal-medicine oversight for metabolic panels, sleep-related risk, and medication review. Dr. Jimenez, as an APRN with prescriptive authority, can coordinate the same medical lens.

A medical pass may ask whether you snore or wake unrefreshed, whether clenching started after an SSRI, SNRI, stimulant, or other new medicine, and whether reflux, anxiety, or dental wear is part of the picture.

Beneficence means the structural plan and the medical plan serve the same person. If sleep apnea is likely, the next step may be a sleep evaluation, not another stretch. If a medicine is a plausible trigger, you discuss it with your existing prescriber. Integrative care coordinates with your dentist and medical team so you don’t have to assemble the story alone.

What Families Usually Want: Sleep, Meals, and Presence

The destination is not a perfect joint. It is a quieter face at dinner and a body that can rest.

Helpful household changes often include:

  • Keep the teeth slightly apart and the tongue resting on the palate during deep work
  • Raise screens so the gaze is level and unround the shoulders
  • Unclench and roll the shoulders every 20 to 30 minutes
  • Cut late caffeine and give the last hour to dim light
  • Choose a sleep position that does not crank the neck
  • Soften tough foods during a flare, so meals stay social

These are tools, not tests you fail. Autonomy means you decide which changes fit your household.

A Coordinated Next Step in El Paso

If jaw tightness is stealing sleep or making family meals tense, you do not have to wait for a crisis. A visit can start with listening, a mechanical exam, and a medical screen.

Dr. Jimenez and Dr. Cardenas work so that chiropractic alignment, rehabilitation, and medical review travel together. The aim is root-cause clarity, fewer avoidable procedures, and a plan you can steer. Better sleep, easier eating, and more comfortable time after the laptop closes: that is the measure of success.

Meta Description: Screen work can clench the jaw, stiffen the neck, and steal sleep. Integrative care helps El Paso families rest and eat easier.

References

Abdul, N. S. (2025). A systematic review on the impact of smartphone usage on temporomandibular disorders. Cureus, 17(10), e95683.

Bednarczyk, A., et al. (2024). The effectiveness of cervical rehabilitation interventions for pain in adults with myogenic temporomandibular disorders: A systematic review and meta-analysis. Journal of Oral Rehabilitation.

Bizzarri, P., Giusti, A., Pernici, M., Bulzacca, P., Asquini, G., Maselli, F., Mourad, F., Balli, E., Pisacane, G., Bagnoli, C., Manzari, A., Pompi, M., & Scafoglieri, A. (2026). Temporomandibular disorders and orofacial outcomes in subjects with neck pain and/or cervicogenic headache: A systematic review with meta-analysis. Journal of Clinical Medicine, 15(1), 266.

Mayo Clinic. (2024). Teeth grinding (bruxism).

Pihut, M., Orczykowska, M., & Gala, A. (2022). Risk factors for the development of temporomandibular disorders related to the work environment. Folia Medica Cracoviensia, 62(3), 43–49.

Voß, L. C., Basedau, H., Svensson, P., & May, A. (2024). Bruxism, temporomandibular disorders, and headache: A narrative review of correlations and causalities. Pain, 165(11), 2409–2418.

Xu, C., Ren, X., Lin, P., et al. (2024). Exploring the causal effects of sleep characteristics on TMD-related pain: A two-sample Mendelian randomization study. Clinical Oral Investigations, 28, 384.

Xu, L., & Zhou, H. (2024). Causal associations between sleep traits and temporomandibular disorders: A bidirectional Mendelian randomization analysis. Frontiers in Genetics, 15, 1429190.

Yao, L., Sadeghirad, B., Li, M., et al. (2023). Management of chronic pain secondary to temporomandibular disorders: A systematic review and network meta-analysis of randomised trials. BMJ, 383, e076226.

Tech Parents: Neck Tension, Headaches, and Fatigue

Tech Parents: Neck Tension, Headaches, and Fatigue

Abstract

For tech parents, the workday can end while the body stays “online.” Hours of coding, tickets, dashboards, video calls, and family multitasking may leave the neck tight, the jaw clenched, the head aching, and sleep less restorative. This article explains how mechanical strain, movement habits, sleep quality, nutrition, and metabolic health can overlap. It also shows how ChiroMed’s integrated chiropractic and medical approach can help parents protect something more meaningful than a pain score: the energy to be present with their families.

Tech Parents: Neck Tension, Headaches, and Fatigue

The laptop closes at 5:30, but your shoulders are still near your ears at dinner. You answer one more message while helping with homework. Later, you notice a dull headache, rub the base of your skull, and promise yourself you will stretch after the kids are asleep. Then bedtime arrives, your mind is still running, and tomorrow begins before you feel restored.

For hybrid and remote software engineers, help-desk employees, and data analysts, this pattern can feel normal. Don’t automatically blame it on “bad posture,” and don’t treat it as one problem with one cause. Neck tension, headaches, fatigue, jaw clenching, and poor sleep can reinforce one another. A family-centered plan asks a better question: what is draining your physical reserve, and how can care help you get more of your evening back?

Why Screen Work Can Feel Heavier Than It Looks

Computer work is physically quiet but not physically neutral. A parent may sit for hours with the eyes fixed forward, elbows anchored near a keyboard, and the head held in a narrow range. Research in office workers has linked neck pain with muscular tension and low task variation, while exercise programs can improve pain and disability in workers with chronic neck pain (Jun et al., 2017; Jones et al., 2024).

No single “perfect” posture works all day. The bigger issue is staying in one position too long. When the workday has little movement variety, the neck and shoulder muscles repeatedly perform low-level holding work. Add deadline pressure or a makeshift workstation, and the body may stay braced after the meeting ends.

Jaw clenching can join the same loop. Temporomandibular disorders and neck symptoms often overlap, although the relationship is complex and does not prove that one always causes the other (Bizzarri et al., 2026).

Headaches Need the Right Label Before the Right Plan

Not every end-of-day headache is a cervicogenic headache. Migraine, tension-type headache, dehydration, medication effects, vision strain, sleep loss, blood pressure concerns, and other causes may produce head pain. Repeated or changing headaches therefore deserve an appropriate history and examination.

When a headache is truly cervicogenic, neck structures contribute to the symptoms. Evidence suggests that manual therapy and exercise can reduce headache intensity or frequency for some patients, but the certainty of evidence ranges from low to moderate and results vary by technique and time frame (Núñez-Cabaleiro & Leirós-Rodríguez, 2022; Martins et al., 2026).

At ChiroMed, structural chiropractic care is appropriate when examination findings support a mechanical component. The goal is not to assume every headache is spinal. It is to improve motion, reduce mechanical irritation, and pair hands-on care with active rehabilitation when appropriate.

The Fatigue Question: Is the Neck the Whole Story?

A parent can have genuine neck strain and still have another reason for feeling exhausted. Fatigue is a broad symptom. Primary-care evaluation may consider sleep quantity and quality, nutrition, medication effects, mood, anemia, thyroid disease, diabetes, sleep apnea, kidney or liver concerns, vitamin deficiencies, and other possibilities based on history and examination (Latimer et al., 2023).

Structural care and medical evaluation answer different questions. A chiropractic assessment asks how joints, muscles, movement patterns, and daily loading may contribute. Medical evaluation asks whether poor recovery reflects a sleep, nutritional, metabolic, medication-related, or systemic issue. Neither replaces the other.

Adults generally need at least seven hours of sleep, and U.S. data show that short sleep remains common. In 2024, 30.5% of U.S. adults reported sleeping less than seven hours in a 24-hour period (Ng et al., 2026). For tech parents, the challenge is protecting sleep when work, childcare, chores, and late-night screens compete for the same hours.

A Family-Energy Reset Starts With Small Decisions

The most useful plan is one a parent can repeat during a real workweek. Focus on changes that create movement variety and protect recovery:

  • Change position regularly. Stand for a call, walk during a voice meeting, or perform a brief movement break between focused work blocks.
  • Bring the screen closer to eye level and keep frequently used devices within easy reach so the neck and shoulders do less sustained holding.
  • Notice jaw tension. Let the teeth separate at rest, soften the tongue and face, and seek dental or medical evaluation if jaw pain, locking, or significant grinding persists.
  • Protect a work shutdown ritual. Close work applications, leave the workstation, and take a short walk or transition activity before family time.
  • Build a consistent sleep window. Reduce late caffeine, dim evening light, and keep the bedroom cool, dark, and quiet when possible.
  • Eat and hydrate consistently enough to support the day. Skipping meals, living on caffeine, or relying on highly restrictive diets can worsen the sense of running on empty.

These steps support autonomy because the parent remains the decision-maker. The clinician’s role is to explain findings and help the patient choose a plan that fits work, family responsibilities, preferences, and existing medical care.

How ChiroMed Coordinates Structural and Medical Care

Dr. Alex Jimenez, DC, APRN, FNP-BC, CFMP, IFMCP, is both a Doctor of Chiropractic and a board-certified Family Practice Nurse Practitioner/Advanced Practice Registered Nurse. He holds Texas Advanced Practice Nursing License #1191402, Prescriptive Authority #59628, and NPI #1205907805. His clinical work bridges structural chiropractic care, mechanical rehabilitation, functional medicine nutrition, diagnostics, and medically appropriate interventions. Current ChiroMed materials also identify his Texas APRN license and NPI.

Dr. Maria Guadalupe Cardenas, MD, is board-certified in Internal Medicine with more than 40 years of experience. She holds Texas Medical License #J2933 and NPI #1164426748. As Medical Director, Clinical Director, and collaborative physician at Injury Medical Clinic PA in El Paso, she oversees metabolic comorbidities, laboratory interpretation, risk stratification, and internal medicine coordination.

For a tech parent, that collaboration may pair a mechanical examination and rehabilitation plan with appropriate review of sleep, nutrition, metabolic health, medications, or laboratory needs. Beneficence means choosing care for the patient’s good, not adding services simply because they are available. Non-maleficence means starting with conservative, non-invasive strategies when appropriate and escalating only when clinical findings justify it.

Advanced options such as IV infusion, peptide, orthobiologic, injection, or hormone therapies are not routine answers for ordinary screen-related neck tension. They belong only in selected cases with clear indications, informed consent, appropriate medical oversight, and a rationale tied to the patient’s diagnosis.

Know When a Headache or Neck Problem Needs Prompt Evaluation

Seek urgent medical care for a sudden severe headache, new weakness or numbness, trouble speaking, fainting, fever with marked neck stiffness, new confusion, major trauma, chest pain, or other rapidly worsening neurologic symptoms. New headaches that are persistent, progressively changing, or accompanied by concerning systemic symptoms also warrant medical evaluation.

This is another part of patient autonomy: knowing when self-care is reasonable and when escalation is the safest choice.

The Real Goal Is More Life After Work

Pain relief matters. Better neck motion matters. Sleeping more soundly matters. But for a parent, the most valuable outcome may be having enough energy to cook dinner without feeling depleted, play with a child without counting the minutes until bedtime, or sit with a partner without carrying the entire workday in the shoulders.

ChiroMed’s integrated approach aims to protect that family reserve. Structural chiropractic care can address mechanical strain when appropriate, while MD/NP evaluation helps identify broader contributors that hands-on care cannot diagnose or correct on its own. The plan can also coordinate with existing physicians, specialists, dentists, or therapists when needed.

If work keeps following you home through neck tension, headaches, fatigue, or poor sleep, consider a multidisciplinary evaluation. Bring your symptom timeline, medication list, sleep concerns, workstation habits, and questions. The goal is not to hand control of your health to a clinic. It is to give you clearer information, safer choices, and a coordinated path toward feeling more available for the people waiting on the other side of your laptop.

References

Bizzarri, P., Giusti, A., Pernici, M., Bulzacca, P., Asquini, G., Maselli, F., Mourad, F., Balli, E., Pisacane, G., Bagnoli, C., Manzari, A., Pompi, M., & Scafoglieri, A. (2026). Temporomandibular disorders and orofacial outcomes in subjects with neck pain and/or cervicogenic headache: A systematic review with meta-analysis. Journal of Clinical Medicine, 15(1), 266.

Jones, L. B., Jadhakhan, F., & Falla, D. (2024). The influence of exercise on pain, disability and quality of life in office workers with chronic neck pain: A systematic review and meta-analysis. Applied Ergonomics, 117, 104216.

Jun, D., Michaleff, Z., Johnston, V., & O’Leary, S. (2017). Physical risk factors for developing non-specific neck pain in office workers: A systematic review and meta-analysis. International Archives of Occupational and Environmental Health, 90(5), 373–410.

Latimer, K. M., Gunther, A., & Kopec, M. (2023). Fatigue in adults: Evaluation and management. American Family Physician, 108(1), 58–69.

Martins, L., Collet, P., Lafrance, S., & Demont, A. (2026). Efficacy of nonsurgical interventions for the management of adults with cervicogenic headache: A systematic review and meta-analyses. Annals of Physical and Rehabilitation Medicine, 69(4), 102070.

Ng, A. E., Black, L. I., & Adjaye-Gbewonyo, D. (2026). Short sleep duration and sleep difficulties among adults: United States, 2024. NCHS Data Brief, No. 559. National Center for Health Statistics.

Núñez-Cabaleiro, P., & Leirós-Rodríguez, R. (2022). Effectiveness of manual therapy in the treatment of cervicogenic headache: A systematic review. Headache, 62(3), 271–283.

Multigenerational Physical Resilience for Amazon Warehouse Families

Multigenerational Physical Resilience for Amazon Warehouse Families

Abstract: Amazon fulfillment work can demand repeated lifting, packing, bending, walking, and long hours on concrete while family responsibilities continue after the shift. This article explains how movement care, sleep-aware habits, family practice nursing diagnostics, and coordinated medical oversight can support multigenerational physical resilience. The goal is to protect mobility, energy, recovery, and family participation over time.

Multigenerational Physical Resilience for Amazon Warehouse Families

For many Amazon fulfillment center associates, the workday does not end when the badge scans out. A parent may leave a shift filled with lifting, packing, reaching, walking, and standing on concrete, then head home to dinner, homework, errands, and family responsibilities.

That is why resilience matters. Resilience is not ignoring pain or pushing through exhaustion. It is the ability to recover, move well, sleep deeply, and keep enough physical capacity for both work and the people who depend on you.

Why Warehouse Work Can Follow You Home

Fulfillment work can place repeated mechanical demands on the back, hips, shoulders, knees, wrists, and feet. Research on occupational mechanical exposures continues to link certain work demands to low-back and lower-body musculoskeletal disorders, although risk varies by exposure and condition (Jahn et al., 2026).

A typical shift may include:

  • Reaching into low bins or overhead locations
  • Repeated lifting, carrying, and twisting
  • Packing with the hands and wrists for long periods
  • Standing or walking on hard flooring
  • Working at a fast, repetitive pace
  • Recovering between shifts with limited sleep

Hundreds or thousands of repetitions can add up. Muscles fatigue, movement patterns change, and joints may become irritated. A worker may notice morning stiffness, soreness after the commute, or less patience for playing with the kids because every bend feels harder.

The Family Cost of “Just Toughing It Out”

Parents often minimize their symptoms because others need them. Yet poorly managed pain can influence sleep, mood, activity, and participation at home.

Work schedules also matter. NIOSH notes that work can affect health through physical exposures, sleep, eating patterns, social connection, and time available outside work (NIOSH, 2024a). Shift work and long hours can contribute to fatigue and make healthy routines harder to maintain (NIOSH, 2024b).

That creates a common cycle:

  1. The shift creates physical fatigue.
  2. Pain makes sleep harder.
  3. Poor sleep reduces recovery.
  4. The next shift begins with less reserve.
  5. Family time becomes recovery time instead of connection time.

Structural Care: Helping the Body Move With Less Strain

Chiropractic care can be one part of a broader plan when appropriate for the patient’s diagnosis and goals. The World Health Organization recommends person-centered care for chronic primary low-back pain and includes education, structured exercise, and spinal manipulative therapy among options that may be used as part of care (World Health Organization [WHO], 2023).

For a warehouse associate, structural care may focus on:

  • Joint mobility and movement restrictions
  • Hip and thoracic mobility
  • Trunk endurance and lifting mechanics
  • Workstation or packing-position habits
  • Gradual rehabilitation after strain
  • Home movements that support recovery

The aim is practical: bend more comfortably, tolerate work more safely, sleep with less mechanical irritation, and preserve enough mobility to stay active with family.

A systematic review and meta-analysis found that workplace interventions for workers with low-back pain improve pain, disability, and quality-of-life measures (Russo et al., 2021).

Metabolic Care: Looking Beyond the Spine

A worker can have mechanical pain and still need a broader medical picture. Fatigue, poor sleep, blood-sugar swings, medication effects, dehydration, nutrition problems, or other health conditions may influence recovery.

Dr. Alex Jimenez, DC, APRN, FNP-BC, CFMP, IFMCP, brings both chiropractic and advanced-practice nursing perspectives to this process. He is a Doctor of Chiropractic and board-certified Family Nurse Practitioner/Advanced Practice Registered Nurse, with Texas Advanced Practice Nursing License #1191402, Prescriptive Authority #59628, and NPI #1205907805.

His clinical scope bridges structural chiropractic care, mechanical rehabilitation, functional medicine nutrition, advanced diagnostics, and, when clinically indicated, procedures such as PRP, PRF/PFP, MFAT, image-guided spinal injections, and bioidentical hormone replacement therapy. These options require evaluation, diagnosis, discussion of alternatives, and appropriate medical oversight.

Medical Oversight for the Whole Family Picture

Dr. Maria Guadalupe Cardenas, MD, is board-certified in Internal Medicine with more than 40 years of experience. She holds Texas Medical License #J2933 and NPI #1164426748 and serves as Medical Director, Clinical Director, and Collaborative Physician alongside Dr. Jimenez at Injury Medical Clinic PA in El Paso.

Her role includes medical direction for complex metabolic conditions, laboratory interpretation, risk stratification, and internal medicine coordination. That matters when musculoskeletal complaints overlap with blood pressure, abnormal lipids, liver enzymes, metabolic disease, medication use, or other concerns.

For a working parent, coordinated care can mean fewer disconnected conversations. The back, sleep, energy, medications, laboratory findings, and rehabilitation plan can be considered together.

Three Ethical Principles Behind Family-Centered Care

Beneficence: Care Should Help the Patient’s Real Life

The goal is not a perfect X-ray or temporary soreness reduction. Meaningful outcomes are personal: lifting a child with confidence, sleeping better, finishing a shift with less pain, walking comfortably, or having energy for family time.

Non-Maleficence: Start With Appropriate, Lower-Risk Options

Doing no harm means matching treatment intensity to the condition. Many musculoskeletal problems can begin with education, movement, rehabilitation, and conservative approaches when clinically appropriate. Consider more invasive procedures or medications based on diagnosis, risk, benefit, and medical necessity rather than using them automatically.

Autonomy: The Patient Remains the Decision-Maker

Every worker deserves understandable information about findings, options, benefits, limits, and alternatives. Integrated care should also work with the patient’s existing physicians and specialists. Coordination should strengthen informed choice, not replace it.

A Simple Resilience Routine for Warehouse Parents

Small habits can support recovery when time is limited:

  • Change positions during breaks when possible.
  • Use the hips and legs instead of repeatedly folding through the lower back.
  • Keep frequently handled loads close to the body.
  • Hydrate consistently across the shift.
  • Protect a regular sleep window as much as your schedule allows.
  • Use brief mobility work after the commute instead of collapsing into one position.
  • Seek evaluation when pain keeps returning, spreads into an arm or leg, causes weakness or numbness, follows significant trauma, or interferes with sleep and normal function.

These habits are not a substitute for diagnosis. They create better conditions for recovery.

Resilience Is a Family Health Investment

A strong family does not require a parent to be invulnerable. It benefits from adults who notice warning signs early, understand their options, and model health habits for children and older relatives.

For Amazon fulfillment associates, physical resilience means more than surviving repetitive work. It means protecting the ability to earn, move, rest, parent, and participate in life outside the warehouse.

ChiroMed’s integrated approach combines chiropractic structural care, rehabilitation, family practice nursing diagnostics, and internal medicine oversight so treatment can address mechanics and broader health factors that influence recovery. Families deserve sustainable health support.

If work-related pain, poor sleep, persistent fatigue, or declining mobility is affecting family life, consider a coordinated evaluation. Dr. Alex Jimenez and Dr. Maria Guadalupe Cardenas can help identify appropriate next steps, explain available options, and work with your existing medical team so you remain informed and in control of your care.

References

Jahn, A., Kjærgaard, C., Evanoff, B., Nielsen, F. K., Descatha, A., Andersen, J. H., & Dalbøge, A. (2026). The association between occupational mechanical exposures and low-back and lower-body musculoskeletal disorders: An overview of systematic reviews. Annals of Work Exposures and Health, 70(5), wxag045.

National Institute for Occupational Safety and Health. (2024a). Primary care and the working patient—Occupational health principles in practice. Centers for Disease Control and Prevention.

National Institute for Occupational Safety and Health. (2024b). NIOSH training for nurses on shift work and long work hours. Centers for Disease Control and Prevention.

Russo, F., Papalia, G. F., Vadalà, G., Fontana, L., Iavicoli, S., Papalia, R., & Denaro, V. (2021). The effects of workplace interventions on low back pain in workers: A systematic review and meta-analysis. International Journal of Environmental Research and Public Health, 18(23), 12614.

World Health Organization. (2023). WHO guideline for non-surgical management of chronic primary low back pain in adults in primary and community care settings.

Chiropractic & Regenerative Care for El Paso Workers

Chiropractic & Regenerative Care for El Paso Workers

Abstract: El Paso tech professionals and warehouse associates face different job demands, yet both can develop neck, back, shoulder, hip, or joint problems that disrupt work and family life. This article explains how integrated chiropractic, medical, rehabilitation, and carefully selected regenerative care can support movement and recovery while keeping safety, informed choice, and coordinated care at the center.

Chiropractic & Regenerative Care for El Paso Workers

A heating pad may calm tight muscles after a long shift. But temporary warmth does not answer the bigger question: why does the same pain keep returning?

That question matters whether you spend your workday behind monitors or moving products through a warehouse. One worker may sit for hours. Another may walk miles, bend into low bins, lift boxes, twist, push, pull, and repeat the same motions hundreds of times. The loads differ, but both bodies can become irritated when movement is too limited, repetitive, or demanding.

For household providers, the goal is not simply to get through another shift. It is to keep working, sleeping, helping at home, and aging with strength and independence.

Two Jobs, Two Stress Patterns

Tech desk workers: too little movement

Computer work often creates a low-motion problem. A 2025 review linked office-worker low-back symptoms with factors such as longer sitting, static sitting behavior, poor posture, and fewer breaks, although individual studies were not completely consistent (Alaca et al., 2025). Exercise, especially strengthening, can improve pain and disability in office workers with chronic neck pain (Jones et al., 2024).

Common pressure points include:

  • Forward-head positioning during screen work.
  • Rounded shoulders and stiff hips.
  • Reduced trunk and upper-back endurance.
  • Wrist and forearm irritation from keyboard and mouse repetition.
  • Too little movement variety across workdays.

Warehouse associates: repeated loading

Warehouse work creates almost the opposite problem. OSHA identifies lifting, lowering, bending, overhead reaching, pushing, pulling, awkward postures, and repeated tasks as important ergonomic risk factors for musculoskeletal disorders (Occupational Safety and Health Administration [OSHA], n.d.).

That can mean:

  • Repeated low-bin bending.
  • Lifting from floor or pallet height.
  • Reaching above shoulder level.
  • Twisting while carrying or scanning.
  • Repetitive gripping and wrist loading.
  • Long hours on hard floors with limited recovery.

The answer for either worker is rarely “sit perfectly” or “lift perfectly” all day. Human bodies need capacity, recovery, movement variety, and workloads they can tolerate.

Chiropractic Care as Part of the Plan

Chiropractic care is most useful when it is not treated as a stand-alone miracle. Structural examination and manual care can be paired with exercise, rehabilitation, medical evaluation, and patient education.

For chronic primary low-back pain, the World Health Organization recommends person-centered care that may include education, exercise, some physical therapies such as spinal manipulative therapy, and other coordinated options rather than relying on a single treatment (World Health Organization [WHO], 2023).

At ChiroMed, practical goals may include:

  • Improve painful or restricted movement.
  • Restore joint motion when clinically appropriate.
  • Build trunk, hip, shoulder, and neck endurance.
  • Teach safer lifting and workstation habits.
  • Increase tolerance for work and home demands.
  • Reassess when symptoms do not follow an expected recovery pattern.

The benefit is not simply “better alignment.” The larger target is better function: standing from a chair with less stiffness, completing a shift with less irritation, sleeping more comfortably, or lifting a child with greater confidence.

Where Regenerative Medicine May Fit

Regenerative medicine is a broad term, so careful language matters. Not every injection marketed as “regenerative” has the same evidence, regulatory status, or safety profile. The FDA warns consumers about unapproved products promoted for orthopedic pain and other conditions (U.S. Food and Drug Administration [FDA], 2021).

Platelet-rich plasma, or PRP, is prepared from a patient’s blood and concentrates platelets that contain signaling molecules involved in healing. Evidence varies by condition. For knee osteoarthritis, a review of randomized trials found that PRP may improve pain and function for some patients, while protocols and outcomes remain inconsistent (Pelluri et al., 2025).

Candidacy matters. A worker with an irritated tendon, early joint degeneration, or stubborn soft-tissue problem may need a different plan than someone with nerve compression, fracture, inflammatory disease, or simple muscular fatigue. An injection should not replace diagnosis or the rehabilitation needed to change forces that keep aggravating tissue.

The ChiroMed Integrated Care Model

ChiroMed brings structural care and medical oversight into one conversation. Dr. Alex Jimenez, DC, APRN, FNP-BC, CFMP, IFMCP, is a Doctor of Chiropractic and board-certified Family Practice Nurse Practitioner. He holds Texas Advanced Practice Nursing License #1191402, Prescriptive Authority #59628, and NPI #1205907805. His scope bridges chiropractic structural care, mechanical rehabilitation, functional medicine diagnostics, nutrition, and, when clinically and legally appropriate, advanced therapies including PRP, PRF/PFP, MFAT, image-guided epidural spinal injections, and BHRT.

Dr. Maria Guadalupe Cardenas, MD, is board-certified in Internal Medicine, has more than 40 years of experience, and holds Texas Medical License #J2933 and NPI #1164426748. She serves as Medical Director, Clinical Director, and collaborative physician, overseeing complex medical risks, advanced laboratory interpretation, and treatment coordination.

This teamwork matters because recovery may also depend on sleep, blood sugar regulation, nutrition, medication use, inflammation, age, and other health factors.

Protect the Breadwinner, Support the Family

When one person’s income depends on staying physically capable, pain affects the household. Missing overtime, avoiding family activities, losing sleep, or fearing normal movement can create stress beyond the injured body part.

An integrated plan should ask, “What does this person need to keep doing safely?”

For a tech worker, that may mean:

  • Tolerating computer sessions with movement breaks.
  • Reducing neck and shoulder fatigue.
  • Rebuilding upper-back and trunk endurance.
  • Improving recovery after mentally demanding days.

For a warehouse associate, it may mean:

  • Bending and lifting with better hip and trunk control.
  • Improving leg and core endurance.
  • Recovering between repetitive shifts.
  • Returning to higher loads gradually.

These are practical outcomes families can feel.

Beneficence and Non-Maleficence: Start With the Safest Reasonable Path

Good care should serve the patient’s welfare, not the procedure. Begin with reasonable lower-risk options, measure response, and escalate only when the clinical picture supports it.

Non-invasive care may include education, activity modification, therapeutic exercise, chiropractic manipulation or mobilization, soft-tissue care, and progressive rehabilitation. When symptoms are severe, persistent, or linked to a specific tissue problem, medical evaluation may identify additional options.

The goal is not to promise that every patient can avoid medication or surgery. It is to use lower-risk strategies when appropriate while recognizing that medication, injections, or surgical consultation may sometimes be needed.

Autonomy: You Stay in Charge

Integrated care should expand choices. Before any procedure, patients deserve clear answers:

  • What is the working diagnosis?
  • What alternatives exist?
  • What are the likely benefits and risks?
  • What evidence supports this treatment for my condition?
  • How will we measure whether it is working?

ChiroMed can also coordinate with a patient’s existing physician, specialist, therapist, or other clinician. A connected plan helps reduce duplicated care and keeps important information from living in separate silos.

When a Heating Pad Is Not Enough

Home care is reasonable for many mild aches. Persistent or worsening symptoms deserve evaluation, especially when pain repeatedly limits work, sleep, or family activity.

Seek prompt medical attention for new or progressive weakness, loss of bowel or bladder control, numbness in the groin or saddle region, major trauma, fever with severe back pain, unexplained weight loss, chest pain, or other concerning symptoms.

For less urgent problems, the signal may be simpler: pain keeps returning, sleep suffers, your normal workload shrinks, or temporary relief never improves capacity.

Move From Relief to Resilience

El Paso’s tech workers and warehouse associates may live at opposite ends of the movement spectrum, but both need the same basic outcome: a body that can handle real life.

The most useful plan does more than quiet symptoms. It identifies the stress pattern, rules out important medical concerns, restores movement, rebuilds capacity, and considers advanced therapies only when they fit the diagnosis and patient goals.

At ChiroMed, chiropractic care, rehabilitation, advanced practice nursing, and internal medicine oversight can work as one coordinated team. If pain is shrinking your work capacity or family time, schedule an integrated evaluation to identify the problem, review conservative and advanced options, and build a plan around safe function, informed choice, and the life you work hard to provide.

References

Alaca, N., Acar, A. Ö., & Öztürk, S. (2025). Low back pain and sitting time, posture and behavior in office workers: A scoping review. Journal of Back and Musculoskeletal Rehabilitation, 38(5), 919–943.

Jones, L. B., Jadhakhan, F., & Falla, D. (2024). The influence of exercise on pain, disability and quality of life in office workers with chronic neck pain: A systematic review and meta-analysis. Applied Ergonomics, 117, 104216.

Occupational Safety and Health Administration. (n.d.). Warehousing: Hazards and solutions. U.S. Department of Labor.

Pelluri, R., Sridevi, B., Guntupalli, C., Gurram, P. C., Nagasubramanian, V. R., Punnem, U. S., Kanukula, R., Ponnusankar, S., Nagendra, V. H., & Mateti, U. V. (2025). Effect of platelet-rich plasma versus placebo or corticosteroid for knee osteoarthritis: A systematic review and meta-analysis of randomized controlled trials. Journal of Clinical Orthopaedics and Trauma, 62, 102870.

U.S. Food and Drug Administration. (2021). Important patient and consumer information about regenerative medicine therapies.

World Health Organization. (2023). WHO guideline for non-surgical management of chronic primary low back pain in adults in primary and community care settings.

Data Center Shift Workers: Back, Sleep & Energy Tips

Data Center Shift Workers: Back, Sleep & Energy Tips

A data center never truly sleeps. Servers keep running, alerts arrive at odd hours, and overnight teams keep essential systems online while most families sleep. For employees working those shifts, the challenge isn’t just productivity. It is coming home with enough comfort, patience, energy, and presence for the people who depend on you.

At ChiroMed, that family role matters. Providing for a household also means protecting your ability to move well, sleep deeply, think clearly, and stay engaged at home. Shift work can make those goals harder, but a thoughtful plan can help protect your health and family time.

Data Center Shift Workers: Back, Sleep & Energy Tips

Why 24/7 Work Can Follow You Home

Night and rotating shifts can disrupt the body’s normal sleep-wake rhythm. When sleep is shortened or irregular, fatigue may affect attention, reaction time, mood, and judgment. Research links shift work with disrupted sleep and higher metabolic risk, although individual risk varies with schedule, health history, activity, diet, and other factors (Khosravipour et al., 2021; National Institute for Occupational Safety and Health [NIOSH], 2026).

For data center employees, the physical side also matters. A shift may include console work, standing, device use, reaching into racks, carrying equipment, or crouching. A systematic review of IT professionals identified prolonged sitting, awkward posture, insufficient sleep, job demands, and overexertion among musculoskeletal risk factors (Prasetya et al., 2024).

Small stressors can stack up. A stiff neck follows ticket work. Tight hips can make the low back feel guarded. Fatigue makes balanced meals less convenient, while daytime sleep competes with the household schedule.

Protecting Your Back During the Shift

Your body benefits from variety. When possible, alternate sitting, standing, walking, and task positions. Keep frequently used screens near eye level. Bring work toward you instead of repeatedly reaching with rounded shoulders. When lifting equipment, keep the load close, use your hips and legs, and avoid twisting while carrying.

Short active breaks may help. Evidence suggests breaks involving postural change can reduce discomfort for some workers without necessarily reducing productivity (Waongenngarm et al., 2018). One person may benefit from a brief walk and chest-opening movement, while another needs hip mobility, trunk activation, or a change in workstation height.

Persistent pain deserves more than repeated stretching. New weakness, numbness, loss of coordination, severe pain after trauma, bowel or bladder changes, fever, unexplained weight loss, or progressive neurological symptoms should be medically evaluated promptly.

Sleep Is Part of the Family Budget

Shift workers often treat sleep as the flexible part of the schedule. Work is fixed. School drop-off is fixed. Bills, appointments, meals, and family responsibilities feel fixed. Sleep gets whatever time remains. Over time, that trade can become expensive.

Adequate sleep supports attention, recovery, and safety, yet night work can shorten or disrupt sleep (NIOSH, 2026). Daytime rest is often difficult because light, noise, messages, errands, and family routines signal that it is time to be awake.

Treat your sleep window like a protected appointment. Use blackout curtains or an eye mask, reduce noise, silence nonessential notifications, and keep the room cool. After a night shift, a predictable wind-down routine can separate work from rest. If caffeine helps, stop it far enough before sleep that it does not interfere with settling down.

Make the plan visible to your family. A shared calendar can show sleep, work, and priorities. Protecting sleep is not withdrawing from family life. It protects the energy you bring back.

Meals, Energy, and Metabolic Health

Overnight schedules can disrupt meal timing as easily as sleep. When healthy food is unavailable at 2:00 a.m., vending machines, energy drinks, or drive-through meals become easy defaults. Shift work has been associated with a modestly higher risk of metabolic syndrome, but association does not mean every shift worker will develop metabolic disease (Khosravipour et al., 2021).

Reduce decisions by packing food before the shift: protein, vegetables or fruit, a high-fiber carbohydrate, and water. Hydrate steadily rather than catching up at the end of the night. If you have diabetes, high blood pressure, abnormal cholesterol, gastrointestinal symptoms, or major weight changes, discuss meal timing with a clinician.

Integrated Care Looks at Structure and Physiology Together

A sore back and exhausted mornings may share the same demanding schedule, but they are not the same problem. Integrated care can evaluate both.

A chiropractic evaluation can assess spinal and extremity motion, posture, movement patterns, muscular imbalance, and mechanical contributors to neck or back symptoms. Spinal manipulation is one nonpharmacologic option included in major low-back-pain guidelines for appropriately selected patients, alongside exercise and other conservative care (Qaseem et al., 2017). Treatment should match your diagnosis, preferences, risks, and response.

Medical and nurse-practitioner evaluation can look at sleep quality, blood pressure, medications, fatigue patterns, nutrition, cardiometabolic history, and other symptoms. When clinically appropriate, laboratory testing may assess glucose control, lipids, liver enzymes, or other concerns. The goal is not to order tests; it is to choose information that may change care.

At ChiroMed, Dr. Alex Jimenez, DC, APRN, FNP-BC, CFMP, IFMCP, bridges physical medicine with functional diagnostics through chiropractic structural alignment, mechanical rehabilitation, metabolic assessment, and personalized functional medicine nutrition. He holds Texas Chiropractic License #TX5807, New Mexico Chiropractic License #NM-DC2182, Texas Advanced Practice Nursing License #1191402 with Prescriptive Authority #59628, and NPI #1205907805.

Dr. Maria G. Cardenas, MD, Board Certified in Internal Medicine, serves as Medical Director and Clinical Director, providing oversight for complex metabolic comorbidities, advanced laboratory panels, risk stratification, and internal medicine treatment coordination. She holds Texas Medical License #J2933 and NPI #1164426748.

Your Health Plan Should Fit Your Family

Beneficence means care should serve your well-being, not force you into a generic protocol. For a shift-working parent or family provider, improvement may mean less pain during rounds, safer lifting, steadier energy, better sleep after nights, or enough reserve to enjoy breakfast with your children instead of arriving home uncomfortable and depleted.

Autonomy matters just as much. You deserve to understand what is being assessed, why a treatment or test is suggested, what alternatives exist, and what you can do at home. Your schedule, family obligations, goals, culture, budget, and preferences should shape the plan.

Ask yourself: What symptom most interferes with work? What health issue follows you home? Which part of your schedule makes recovery hardest? What change would help your family feel the difference?

A Stronger Shift Can Support a Stronger Home

You may not control the 24/7 demands of the data center, but you can protect your body and family life. Movement habits, sleep, planned meals, hydration, and individualized care can reduce avoidable strain and reveal problems that deserve attention.

If neck or back tension, fatigue, poor sleep, or metabolic concerns are affecting work or family time, ChiroMed can evaluate both structural and medical factors. A collaborative DC-MD/NP approach can help you understand your options and choose a plan supporting safe movement, informed decisions, sustainable energy, and the people you provide for.

References

Khosravipour, M., Khanlari, P., Khazaie, S., Khosravipour, H., & Khazaie, H. (2021). A systematic review and meta-analysis of the association between shift work and metabolic syndrome: The roles of sleep, gender, and type of shift work. Sleep Medicine Reviews, 57, 101427. doi:10.1016/j.smrv.2021.101427

Prasetya, T. A. E., Al Mamun, A., Rahmania, A., Ahmed, M., Uddin, A. S. M. S., Nilamsari, N., & Wardani, R. W. K. (2024). Prevalence and associated risk factors of musculoskeletal disorders among information technology professionals: A systematic review. Narra J, 4(3), e1100. doi:10.52225/narra.v4i3.1100

Qaseem, A., Wilt, T. J., McLean, R. M., & Forciea, M. A. (2017). Noninvasive treatments for acute, subacute, and chronic low back pain: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 166(7), 514–530. doi:10.7326/M16-2367

Waongenngarm, P., Areerak, K., & Janwantanakul, P. (2018). The effects of breaks on low back pain, discomfort, and work productivity in office workers: A systematic review of randomized and non-randomized controlled trials. Applied Ergonomics, 68, 230–239. doi:10.1016/j.apergo.2017.12.003

National Institute for Occupational Safety and Health. (2026). Fatigue and work. Centers for Disease Control and Prevention.

Testosterone and Androgen Physiology in Women: A Guide to Subcutaneous Injections

Testosterone and Androgen Physiology in Women: A Guide to Subcutaneous Injections

Abstract: Testosterone is a normal hormone in women, not a male-only chemical. The ovaries, adrenal glands, and many local tissues all help make and use it. Levels fall slowly with age rather than dropping all at once at menopause. A single lab number rarely proves deficiency. The strongest research support for testosterone therapy in women is for distressing low sexual desire after menopause, after other causes are checked. Subcutaneous injections can give steadier levels in some studied groups, but evidence in women is thinner and remains off-label. At ChiroMed – Integrated Medicine in El Paso, Texas, this physiology sits inside a coordinated model of chiropractic care, nurse practitioner services, rehabilitation, nutrition, and medical oversight.

Testosterone and Androgen Physiology in Women: A Guide to Subcutaneous Injections

Testosterone belongs in women’s health

Many people still hear “testosterone” and think only of men. That idea is incomplete. Women keep lower amounts than men—often about 10 to 20 times less—yet those amounts still matter (Cleveland Clinic, n.d.; Davis & Wahlin-Jacobsen, 2015). For much of adult life, a woman’s circulating testosterone is higher than her circulating estradiol (Davis & Wahlin-Jacobsen, 2015).

Testosterone works in two ways:

  • Directly, on androgen receptors in muscle, bone, brain, fat, skin, and sexual tissues
  • Indirectly, when local enzymes turn it into estradiol or into the stronger androgen dihydrotestosterone (DHT)

These pathways help explain effects on sexual function, tissue upkeep, and metabolism even when blood levels look low (Davis & Wahlin-Jacobsen, 2015; Labrie et al., 2017). That is why ChiroMed treats androgen questions as part of whole-person care, not as a stand-alone “male hormone” add-on.

Testosterone_Androgen_Physiology_Whitepaper_MedivantDownload

Where women’s androgens come from

Women do not rely on one gland. Production is shared.

  • The ovaries release some testosterone and larger amounts of precursors.
  • The adrenal glands release DHEA and DHEA-sulfate (DHEAS), a large precursor pool.
  • Peripheral tissues—fat, skin, muscle, and other organs—convert those precursors into the small amounts of hormone they need.

This last step is called intracrinology. Many tissues make the hormone they need on site and then break it down before much of it returns to the blood (Labrie et al., 2017). A blood testosterone result is only the visible tip of a larger local system.

Tissue enzymes can convert DHEA to testosterone, make DHT, or turn testosterone into estradiol. The same precursor can become an androgen in one tissue and an estrogen in another. Local enzymes, not just the lab, decide the outcome (Labrie et al., 2017; Schiffer et al., 2018).

A long slope, not a sudden cliff

Estradiol falls sharply at menopause. Androgens do not. DHEA and DHEAS begin falling from about the third decade of life and may be down by roughly 60% by menopause (Davis & Wahlin-Jacobsen, 2015). A woman in her forties is already below her own earlier peak.

Midlife data measured by mass spectrometry found median testosterone falling from about 0.56 nmol/L in the early forties to about 0.42 nmol/L in the late fifties, with a low point near ages 58–59. In women of similar age, testosterone did not differ by menopausal stage. Natural menopause itself is not a stand-alone reason to give testosterone (Wang et al., 2025).

Two exceptions matter in clinic:

  • Surgical menopause (both ovaries removed) cuts the ovarian share at once
  • Premature ovarian insufficiency creates an earlier deficit than the usual age-related slope (Davison et al., 2005; Soman et al., 2019)

The postmenopausal ovary is not silent. Its stroma can keep making some testosterone for years after estradiol output collapses (Davis & Wahlin-Jacobsen, 2015).

Why one lab number rarely settles the question

Measuring female testosterone is hard. Routine immunoassays were built for the much higher male range. Liquid chromatography–tandem mass spectrometry (LC-MS/MS) is more reliable. Most circulating testosterone is bound to sex hormone-binding globulin (SHBG), so free hormone can change when SHBG changes even if total testosterone stays the same (Rosner & Vesper, 2010).

What moves SHBG—and the free fraction:

  • Oral estrogen and high thyroid hormone tend to raise SHBG and lower free testosterone
  • Obesity and insulin resistance tend to lower SHBG and raise free testosterone
  • Androgen excess, including polycystic ovary syndrome (also discussed as polyendocrine metabolic ovarian syndrome, or PMOS), also lowers SHBG (Luo et al., 2024; Teede et al., 2023)

Low SHBG is also a metabolic clue and has been linked to higher type 2 diabetes risk in women (Ding et al., 2009). That is one reason nutrition counseling and metabolic review belong in the same visit as a hormone panel.

Major guidelines do not diagnose androgen deficiency from a single value. A level can serve as a baseline and a safety check. It should not be the sole basis for diagnosis (Davis et al., 2019; Parish et al., 2021).

What the evidence supports—and what it does not

The clearest evidence is in sexual function. Higher endogenous testosterone tracks modestly with better desire (Maseroli & Vignozzi, 2022). In randomized trials, testosterone improved desire, arousal, orgasm, pleasure, and satisfaction and reduced sexual distress in postmenopausal women with low desire (Islam et al., 2019).

Androgen receptors are found in bone, muscle, fat, vessels, and the brain. That map is real. It is not the same as proven benefit. Trials supporting sexual-function gains have not firmly shown better body composition, bone, mood, or cognition to the same standard (Davis, 2025; Islam et al., 2019). Some tissue effects may also come from local conversion to estradiol.

Too much androgen is the other problem: acne, unwanted hair, cycle changes, and higher cardiometabolic risk in PMOS/PCOS (Teede et al., 2023). Risk can appear at both ends of the female range (Luo et al., 2024). The target is a physiologic band, not “more is better.”

International groups have not endorsed a broad “female androgen deficiency syndrome,” because no blood cutoff cleanly separates symptomatic women from normal variation (Davis et al., 2019; Wierman et al., 2014). The one consensus indication is hypoactive sexual desire disorder (HSDD) in postmenopausal women—low desire that causes distress—after relationship, mood, medicine, and genitourinary issues are addressed (Parish et al., 2021).

There is still no FDA-approved testosterone product for women in the United States. Prescribing remains off-label. Long-term heart and breast data in women are limited (Islam et al., 2019; Panay et al., 2024).

What subcutaneous testosterone injections are

A subcutaneous (SubQ) injection places testosterone into the fatty layer under the skin, usually in the abdomen or thigh, with a short, thin needle. An intramuscular (IM) injection goes deeper into muscle.

In men and in some gender-affirming care settings, weekly SubQ testosterone esters can reach therapeutic levels with smaller peaks and troughs, less pain, and easier self-use than some IM schedules (Figueiredo et al., 2022). That data should not be copied wholesale onto women.

  • Women need much smaller doses
  • Female physiologic ranges are far lower
  • Randomized evidence in women is mainly transdermal, not SubQ (Davis et al., 2019)
  • Guidelines do not establish a subcutaneous route for women and do not endorse compounded products as first-line (Parish et al., 2021)

If a clinician considers low-dose SubQ testosterone cypionate in oil, it is an individualized, off-label choice. The goal is to keep exposure within the premenopausal physiologic range, monitor for acne, hair changes, voice changes, or metabolic shifts, and document informed consent (Davis et al., 2019). For a clinic-focused companion on injection practicality and strength, see ChiroMed’s SubQ Testosterone for Women: Strength and Balance.

If this route is used at all:

  • Start low and titrate to symptoms plus labs, not to a male-range number
  • Use the same assay method over time, ideally LC-MS/MS
  • Recheck total testosterone, SHBG, and clinical signs after any dose or route change
  • Do not treat menopause itself as an automatic indication (Wang et al., 2025)

Some practices have compounded prefilled low-dose syringes. They are not FDA-approved for women. They are a delivery tool, not proof that therapy is indicated.

How chiropractic care fits this physiology

Hormones do not exist outside the musculoskeletal system. Androgen receptors sit on muscle and bone. Women with midlife androgen decline often describe fatigue, slower recovery, joint stiffness, and lower exercise capacity alongside sexual and mood changes (Davis, 2025). Chiropractic care does not replace hormone evaluation. It treats the mechanical side of the same person: spinal motion, posture, muscle balance, post-injury inflammation, and graded return to activity.

In clinical observation, Dr. Alexander Jimenez, DC, APRN, FNP-BC, CFMP, IFMCP, ATN, CCST, Clinical Director at ChiroMed, describes testosterone as one part of a wider plan, not a stand-alone energy shot. He notes that women have androgen receptors across muscle, bone, and brain; that levels often fall by the mid-forties compared with the mid-twenties; and that low-dose, monitored strategies may support libido, energy, and musculoskeletal integrity in selected patients when labs, symptoms, and safety checks line up (Jimenez, 2026a, 2026c). He also stresses that SubQ use in women is not the same as male testosterone replacement and should not be sold as routine wellness care (Jimenez, 2026b). Related clinical framing is available in ChiroMed’s insights on androgen hormone optimization and bioidentical HRT overview.

At ChiroMed, that review sits next to hands-on and supportive care:

  • Spinal and extremity adjustments to restore joint motion
  • Rehabilitation after auto injuries, work strain, or chronic back and neck pain
  • Nutrition and functional review of sleep, gut, thyroid, iron, and metabolic drivers that also change SHBG and energy
  • Nurse practitioner evaluation for coordinated medical and musculoskeletal planning
  • Acupuncture and naturopathic medicine when those tools fit the plan

Hormone support, when used, helps tissue biology. Chiropractic and rehab help the person move, load, and recover.

Medical direction in the ChiroMed model

Off-label hormone decisions need medical oversight. At ChiroMed – Integrated Medicine, 11860 Vista Del Sol Dr, Suite 105, El Paso, TX 79936, Dr. Maria Guadalupe Cardenas, MD, board-certified in internal medicine (NPI #1164426749, Texas MD License #J2933), serves as Medical Director, Clinical Director, and Collaborative Physician. She brings more than 40 years of internist experience to screening, comorbidity review, and safety.

This MD–DC–NP model is the clinic’s working structure:

  • Dr. Cardenas provides internal-medicine direction and collaborative oversight
  • Dr. Jimenez provides chiropractic care, functional-medicine framing, and dual-licensed nurse practitioner evaluation
  • Together they connect hormone questions to spinal care, rehabilitation, injury recovery, and follow-up rather than treating a lab value alone

ChiroMed describes its approach as bringing multiple healthcare disciplines together to create individualized, patient-centered treatment plans. That structure matters here. No approved female product exists, measurement is imperfect, and the proven indication is narrow. A team that can say “monitor and keep the dose physiologic” or “not indicated; treat sleep, pain, mood, and pelvic symptoms first” is safer than a single-hormone sales pitch.

Putting the pieces together

A careful visit at ChiroMed starts with the story—desire, distress, energy, sleep, pain, injuries, medicines, and surgery—then an exam and labs used as a baseline, not a verdict. Other causes come first: relationship strain, depression, pain, vaginal dryness, thyroid disease, and medication effects. For many women, that means no testosterone. For some postmenopausal women with HSDD, a carefully dosed, monitored plan may be discussed. If SubQ is chosen, it stays small, measured, and reversible, while chiropractic care and rehab rebuild the capacity to move and recover.

Testosterone is a normal female hormone made in more than one place and used inside many tissues. It declines on a long slope. Blood tests tell only part of the story. The honest evidence base is strongest for distressed low sexual desire after menopause, not for menopause itself. Subcutaneous injections can offer steady delivery in other groups, but in women they remain an individualized, off-label option that must stay within a physiologic range.

That is the ChiroMed frame: medical direction for safety, chiropractic and rehabilitation for movement and injury recovery, and nutrition and functional review for the rest of the hormone picture. Two licenses, one patient, and a plan that treats physiology as a foundation rather than a marketing claim.

To discuss whether this topic applies to your care, contact ChiroMed – Integrated Medicine at +1 (915) 412-6680 or visit chiromed.com. Clinical insights from Dr. Jimenez are also collected at dralexjimenez.com and LinkedIn.

“Navigating hormone health can feel overwhelming, but you don’t have to guess your way to recovery. Note any questions this guide raised about female physiology, and let’s review them at your next visit to ensure your treatment path is safe, monitored, and structurally supportive.”

References

Cleveland Clinic. (n.d.). What are androgens?

Davis, S. R. (2025). Not just sex: Other roles for testosterone in women. Climacteric, 28(4), 373–376.

Davis, S. R., Baber, R., Panay, N., Bitzer, J., Perez, S. C., Islam, R. M., Kaunitz, A. M., Kingsberg, S. A., Lambrinoudaki, I., Liu, J., Parish, S. J., Pinkerton, J., Rymer, J., Simon, J. A., Vignozzi, L., & Wierman, M. E. (2019). Global consensus position statement on the use of testosterone therapy for women. The Journal of Clinical Endocrinology & Metabolism, 104(10), 4660–4666.

Davis, S. R., & Wahlin-Jacobsen, S. (2015). Testosterone in women—the clinical significance. The Lancet Diabetes & Endocrinology, 3(12), 980–992.

Davison, S. L., Bell, R., Donath, S., Montalto, J. G., & Davis, S. R. (2005). Androgen levels in adult females: Changes with age, menopause, and oophorectomy. The Journal of Clinical Endocrinology & Metabolism, 90(7), 3847–3853.

Ding, E. L., Song, Y., Manson, J. E., Hunter, D. J., Lee, C. C., Rifai, N., Buring, J. E., Gaziano, J. M., & Liu, S. (2009). Sex hormone-binding globulin and risk of type 2 diabetes in women and men. The New England Journal of Medicine, 361(12), 1152–1163.

Figueiredo, M. G., Rodrigues, V. P., & Sande-Lee, S. (2022). Testosterone therapy with subcutaneous injections: A safe, practical, and reasonable option. Journal of the Endocrine Society.

Islam, R. M., Bell, R. J., Green, S., Page, M. J., & Davis, S. R. (2019). Safety and efficacy of testosterone for women: A systematic review and meta-analysis of randomised controlled trial data. The Lancet Diabetes & Endocrinology, 7(10), 754–766.

Jimenez, A. (2026a). Hormone optimization explained for women’s health. Dr. Alex Jimenez.

Jimenez, A. (2026b). Subcutaneous testosterone for hormone balance therapy guide. Dr. Alex Jimenez.

Jimenez, A. (2026c). Integrative hormone therapy and chiropractic care insights. Dr. Alex Jimenez.

Labrie, F., Martel, C., Bélanger, A., & Pelletier, G. (2017). Androgens in women are essentially made from DHEA in each peripheral tissue according to intracrinology. The Journal of Steroid Biochemistry and Molecular Biology, 168, 9–18.

Luo, X., Wang, Y., Wang, L., Shen, Y., & Ren, M. (2024). Association between female androgen levels, metabolic syndrome, and cardiovascular disease: An NHANES analysis (2013–2016). International Journal of Women’s Health, 16, 2087–2101.

Maseroli, E., & Vignozzi, L. (2022). Are endogenous androgens linked to female sexual function? A systematic review and meta-analysis. The Journal of Sexual Medicine, 19(4), 553–568.

News-Medical. (n.d.). The role of testosterone in women’s health.

Panay, N., Ang, S. B., Cheshire, R., Goldstein, S. R., Maki, P., & Nappi, R. E. (2024). Menopause and MHT in 2024: Addressing the key controversies—An International Menopause Society white paper. Climacteric, 27(5), 441–457.

Parish, S. J., Simon, J. A., Davis, S. R., Giraldi, A., Goldstein, I., Goldstein, S. W., Kim, N. N., Kingsberg, S. A., Morgentaler, A., Nappi, R. E., Park, K., Stuenkel, C. A., Traish, A. M., & Vignozzi, L. (2021). International Society for the Study of Women’s Sexual Health clinical practice guideline for the use of systemic testosterone for hypoactive sexual desire disorder in women. The Journal of Sexual Medicine, 18(5), 849–867.

Rosner, W., & Vesper, H. (2010). Toward excellence in testosterone testing: A consensus statement. The Journal of Clinical Endocrinology & Metabolism, 95(10), 4542–4548.

Schiffer, L., Arlt, W., & Storbeck, K. H. (2018). Intracrine androgen biosynthesis, metabolism and action revisited. Molecular and Cellular Endocrinology, 465, 4–26.

Soman, M., Huang, L. C., Cai, W. H., Xu, J. B., Chen, J. Y., He, R. K., Ruan, H. C., Xu, X. R., Qian, Z. D., & Zhu, X. M. (2019). Serum androgen profiles in women with premature ovarian insufficiency: A systematic review and meta-analysis. Menopause, 26(1), 78–93.

Teede, H. J., Tay, C. T., Laven, J. J. E., Dokras, A., Moran, L. J., Piltonen, T. T., Costello, M. F., Boivin, J., Redman, L. M., Boyle, J. A., Norman, R. J., Mousa, A., & Joham, A. E. (2023). Recommendations from the 2023 international evidence-based guideline for the assessment and management of polycystic ovary syndrome. The Journal of Clinical Endocrinology & Metabolism, 108(10), 2447–2469.

Wang, Y., Islam, R. M., Bond, M., & Davis, S. R. (2025). Testosterone and pre-androgens by age and menopausal stage at midlife: Findings from a cross-sectional study. eBioMedicine, 121, 105972.

Wierman, M. E., Arlt, W., Basson, R., Davis, S. R., Miller, K. K., Murad, M. H., Rosner, W., & Santoro, N. (2014). Androgen therapy in women: A reappraisal. An Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 99(10), 3489–3510.

Percutaneous Tenotomy for Chronic Tendinopathy

Percutaneous Tenotomy for Chronic Tendinopathy: An Integrative Approach

Abstract

Hello, I’m Dr. Alex Jimenez. Welcome to our educational corner, where we delve into the latest advancements in musculoskeletal health. My extensive background, holding titles like DC, APRN, FNP-BC, and multiple functional medicine certifications, allows me to bridge various disciplines to offer comprehensive, evidence-based care.

In this post, we will explore percutaneous tenotomy, a groundbreaking, minimally invasive procedure for treating chronic tendinopathies such as tennis elbow, plantar fasciitis, and Achilles tendinopathy. We will detail the two leading techniques, Tenex (ultrasonic emulsification) and TenJet (hydroresection), explain their physiological mechanisms, and show how they remove diseased tendon tissue while preserving healthy structures. This discussion is grounded in the latest evidence-based research from leading experts in the field.

Furthermore, I will explain how our unique multidisciplinary practice in El Paso, Texas, integrates these advanced procedures. At Injury Medical Clinic, I work alongside our Medical Director, Dr. Maria Guadalupe Cardenas, MD. With over 40 years of experience as a Board-Certified Internist, Dr. Cardenas provides essential medical oversight, ensuring a safe, effective, collaborative environment. Together, we combine functional medicine, rehabilitative science, and integrative chiropractic care to create a holistic treatment journey that resolves pain, restores optimal function, and prevents recurrence.

Join me as we explore the science behind percutaneous tenotomy and discover how this innovative treatment, combined with a patient-centered, integrative framework, is transforming outcomes for those with chronic tendon pain.

Percutaneous Tenotomy for Chronic Tendinopathy

Understanding the Challenge of Chronic Tendinopathy

As a clinician with decades of experience, I’ve seen countless patients struggle with tendinopathy, a condition often mislabeled as “tendinitis”. The key difference is that tendinitis implies active inflammation, whereas tendinopathy describes a degenerative state of the tendon. In tendinopathy, the tendon’s collagen fibers become disorganized, weakened, and filled with abnormal, painful tissue and sometimes microcalcifications. This is not an inflammatory problem but a structural failure of the tissue.

Conditions like lateral epicondylosis (tennis elbow), patellar tendinopathy (jumper’s knee), Achilles tendinopathy, and plantar fasciitis can be notoriously difficult to treat. Traditional conservative measures like rest, ice, and physical therapy are often effective for acute injuries but may fall short once the condition becomes chronic. In these cases, the degenerative tissue itself prevents healing, creating a cycle of pain and dysfunction. This is where modern, targeted interventions become essential.

Introducing Percutaneous Tenotomy: A Minimally Invasive Revolution

One of the most exciting advancements in musculoskeletal medicine is percutaneous tenotomy, an FDA-approved, ultrasound-guided procedure designed to debride, or remove, diseased tendon tissue. The term “percutaneous” simply means “through the skin,” highlighting its minimally invasive nature. This procedure represents a significant leap forward, offering a more definitive solution than conservative care but far less invasive than traditional open surgery.

The beauty of percutaneous tenotomy lies in its precision. Using real-time ultrasound imaging, we can guide a specialized instrument directly to the damaged tissue. This lets us selectively remove the degenerative, pain-generating portions of the tendon while leaving the surrounding healthy tissue intact. This precision is critical for promoting a robust healing response.

Two primary technologies dominate this field: Tenex and TenJet. Both are now accessible to appropriately trained primary care and specialty providers, allowing these procedures to be performed safely and effectively in the office.

The Tenex Health TX System: Ultrasonic Debridement

At our clinic, we utilize the Tenex Health TX system. This technology is a marvel of bioengineering, leveraging the principles of phacoemulsification—a technique famously used in modern cataract surgery.

  • How It Works: The Tenex system uses a handheld device connected to a console. The key component is an 18-gauge, double-lumen needle. When activated by a foot pedal, the needle tip vibrates at an ultrasonic frequency (around 20,000 Hz). This ultrasonic energy precisely emulsifies, or liquefies, the targeted degenerative tendon tissue.
  • The Double-Lumen Design: The Tenex probe’s ingenuity lies in its dual functionality. While the vibrating tip breaks down the pathologic tissue, a second, parallel lumen within the same needle simultaneously irrigates the area with saline and suctions the emulsified debris away. This “cut and remove” action is performed in a single, efficient step.
  • The Procedure: The procedure is performed under sterile conditions. After administering a local anesthetic, I use an ultrasound probe (covered in a sterile sheath) to visualize the damaged tendon. I insert the Tenex needle through the skin and guide it in real time to the area of tendinopathy. I then activate the device and methodically move the needle tip back and forth through the diseased tissue. The entire debridement process, or “cutting time,” is remarkably short, typically lasting between 30 and 90 seconds. The patient hears a humming sound but feels no pain due to the local anesthetic.

The TenJet System: A High-Velocity Saline Jet

The primary alternative to Tenex is the TenJet system. While the goal is the same—to remove diseased tendon tissue—the mechanism is different.

  • How It Works: TenJet uses a technology called hydroresection. Instead of ultrasonic energy, it employs a highly pressurized, high-velocity jet of sterile saline that shoots out from the tip of its specialized needle. This powerful fluid stream acts like a water knife, cutting and excising soft, degenerative tissue.
  • Simultaneous Aspiration: Like Tenex, the TenJet wand has a built-in suction feature that immediately removes resected tissue and excess saline, keeping the operative field clear and preventing pressure buildup.
  • Comparison: Both Tenex and TenJet are excellent tools. The choice between them often comes down to physician preference, training, and the specific characteristics of the tendon being treated. Both offer a significant advantage over traditional surgery by minimizing tissue trauma and accelerating recovery.

The Power of Integrative Care: Our Multidisciplinary Model

Performing an advanced procedure like percutaneous tenotomy is only one piece of the puzzle. True, lasting healing requires a comprehensive, integrative approach that addresses the patient as a whole. This is the core philosophy of our practice at Injury Medical Clinic.

My unique qualifications as a Doctor of Chiropractic (DC), an Advanced Practice Registered Nurse (APRN), a Family Nurse Practitioner (FNP-BC), and a certified Functional Medicine practitioner allow me to view health through multiple lenses. This is further strengthened by our collaborative structure with Dr. Maria Guadalupe Cardenas, MD, our esteemed Medical Director.

Dr. Cardenas is a Board-Certified Internist with an NPI of #1164426749 and Texas Medical License #J2933. With over four decades of clinical experience, she provides invaluable medical oversight for our practice. This multidisciplinary setup, where an MD and a DC work in tandem, ensures that our patients receive care that is both holistic and medically sound. We integrate the following services to create a powerful, synergistic treatment plan:

  1. Medical Oversight and Diagnosis (Dr. Cardenas): Dr. Cardenas’s internal medicine expertise is crucial for screening patients, managing comorbidities, and ensuring advanced procedures are medically appropriate. Her role guarantees the highest standards of patient safety.
  2. Functional Medicine Investigation (Dr. Jimenez): Why did the tendon fail in the first place? Functional medicine helps us answer this question. We investigate underlying factors like nutritional deficiencies (e.g., Vitamin C, zinc), systemic inflammation, metabolic dysfunction (like insulin resistance), and hormonal imbalances that can impair tissue repair. Addressing these root causes is essential for preventing recurrence.
  3. Integrative Chiropractic Care (Dr. Jimenez): A tendinopathy in the elbow or foot doesn’t exist in a vacuum. It is often linked to biomechanical dysfunction elsewhere in the body. As a chiropractor, I assess and correct kinetic chain imbalances. For example:
    • Tennis Elbow: This is often related to poor mechanics in the shoulder, scapula, and even the thoracic spine. Chiropractic adjustments and soft tissue mobilization can restore proper joint mobility and muscle firing patterns, reducing strain on the elbow.
    • Plantar Fasciitis: This is frequently linked to ankle immobility, tight calf muscles, or even pelvic misalignments that alter gait mechanics. Chiropractic care can address these upstream biomechanical faults. By correcting the body’s overall structure and movement patterns, we offload the healing tendon and create an environment where it is no longer subjected to repetitive microtrauma.
  4. Targeted Rehabilitation: Following a procedure like Tenex, the body needs the right signals to rebuild the tendon with strong, organized collagen. Our rehabilitation programs are designed to do just that. We progress patients from gentle range-of-motion exercises to eccentric loading exercises, which are scientifically proven to stimulate collagen synthesis and tendon remodeling (Alfredson et al., 1998). This phase is critical for translating the procedure’s structural fix into functional strength and resilience.

A Patient’s Journey at Our Clinic: From Pain to Performance

Let’s walk through a typical patient journey for someone with chronic tennis elbow:

  1. Initial Consultation & Diagnosis: The journey begins with a comprehensive evaluation. This includes a detailed history, physical exam, and diagnostic ultrasound to confirm tendinopathy and pinpoint the exact location of the diseased tissue.
  2. Collaborative Review: Dr. Cardenas and I review the case to confirm the diagnosis and ensure the patient is a good candidate for percutaneous tenotomy. We rule out any medical contraindications.
  3. Root Cause Analysis: We conduct a functional medicine workup, which may include blood tests to check inflammatory markers, nutrient levels, and metabolic health indicators.
  4. The Procedure: We perform the Tenex procedure in our office. The patient walks in and walks out, typically needing only a small adhesive bandage over the entry site.
  5. Post-Procedure Care: The initial phase focuses on rest and pain management, then quickly transitions to the active phase.
  6. Integrative Chiropractic & Rehabilitation: This is where the magic happens. The patient begins a structured program that includes:
    • Chiropractic adjustments to the spine, shoulder, and wrist to optimize biomechanics.
    • Soft tissue therapies like Active Release Technique (ART) or Graston to address scar tissue in surrounding muscles.
    • A progressive rehabilitation plan starting with gentle isometrics and progressing to the crucial eccentric strengthening exercises.
  7. Nutritional & Lifestyle Support: Based on the functional medicine findings, we provide targeted nutritional advice and supplements to support collagen production and reduce systemic inflammation.

By combining the precision of percutaneous tenotomy with the holistic framework of integrative chiropractic and functional medicine, we don’t just eliminate pain; we rebuild a more resilient, functional person. This is the future of musculoskeletal care—a future we are proud to offer our patients in El Paso today.

References

Alfredson, H., Pietilä, T., Jonsson, P., & Lorentzon, R. (1998). Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis. The American Journal of Sports Medicine, 26(3), 360–366. https://doi.org/10.1177/03635465980260030301

Seng, K., & Lee, K. (2020). Percutaneous ultrasonic tenotomy for tendinopathies. Journal of Functional Morphology and Kinesiology, 5(3), 54. https://doi.org/10.3390/jfmk5030054