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By Dr. Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP 0 Comments Athletes, Chiropractic Care, El Paso TX, Sporting , , , , , , , , , , , , , , , ,

Bunions Management: Relief and Care Strategies

What is the most effective method for managing the initial symptoms of bunions?

Bunions

A bunion, which is also known as hallux valgus, is a bony bump that is frequently excruciating and located on the side of the big toe. A misalignment of the big toe is the most prevalent cause of bunions. Redness, edema, tenderness, and thickened skin around the big toe joint are early indications of bunions. Although it is impossible to halt the progression of a bunion, it is possible to alleviate its symptoms as it progresses. Pain management strategies and various treatment options are among the early indications of bunions. (MedlinePlus, 2024)

Visual Signs of Early Symptoms

Bunions initially develop slowly and do not cause significant discomfort right away. When a bunion first begins to form, you can notice the following symptoms around your metatarsophalangeal (MTP) joint, which joins the base of your big toe to the remainder of your foot. (American Academy of Orthopaedic Surgeons, 2022)

  • Erythema
  • Edema Hyperpigmentation
  • Hyperkeratotic skin
  • A bony protrusion exists
  • Prominence where the hallux deviates towards the second digit or even beneath it
  • Calluses and corns

Initial Somatic Indicators

Although bunions may not be immediately apparent, they can still cause discomfort in the early stages. The following are some of the initial physical indicators of a developing bunion: (MedlinePlus, 2024)

  • Pain in the foot and big toe
  • This discomfort is especially evident during ambulation or when donning constrictive, pointed footwear.
  • Decreased movement of the big toe
  • Tenderness
  • Inflammation
  • Swelling
  • Stiffness
  • Heat

Stages

Bunions are typically progressive, meaning they tend to deteriorate over time. Failure to implement preventive measures for your bunions may result in consequences. Subsequent symptoms often accompany advanced-stage bunions. (American Academy of Orthopaedic Surgeons, 2022)

  • Persistent, intense pain in and around the metatarsophalangeal joint and the lateral and plantar aspects of the foot
  • Bursitis results in the formation of a fluid-filled cyst near the base of the big toe.
  • Hallux adducting and maybe overlapping the second toe
  • Excessive osseous proliferation along the lateral aspect of the hallux
  • Inability to accommodate your standard footwear
  • Impediment in ambulation
  • Hammertoe abnormalities occur when the second, third, or fourth toes exhibit an upward bend at the middle joint, like a hammer or claw.
  • Hallux rigidus, a kind of arthritis affecting the big toe

Halt the Advancement

Once bunions have begun to form, they will become irreversible. Nevertheless, some methods exist to prevent their exacerbation or the onset of additional issues. These encompass (American Academy of Orthopaedic Surgeons, 2022)

  • Refraining from wearing improperly fitting footwear and elevated heels
  • Utilizing orthopedic footwear and/or broad, comfy, soft-soled, and low-heeled shoes
  • Inserting spacers between the toes to avert friction and irritation
  • Applying over-the-counter (OTC) pads composed of felt, silicone, or foam to the bunion
  • Extending your calf muscles to enhance joint alignment

Analgesic Administration

Ice packs and non-steroidal anti-inflammatory medicines (NSAIDs), such as Advil or Motrin (ibuprofen), may alleviate bunion discomfort. Research indicates that Botox injections into the forefoot muscles may offer analgesic benefits. (Hurn, S. E., et al., 2022)

Non-invasive Therapy in Initial Phases

If your bunions continue to deteriorate despite using the aforementioned self-care measures, you may need to seek intervention from a podiatrist or another healthcare professional. A healthcare professional may advise

Foot orthoses, commonly referred to as orthotics

  • Orthoses, also known as foot orthoses, are specially designed implants that alleviate bunion-associated pain and prevent chafing.

Splints

Physical Therapy

  • A physical therapist can assist you by offering exercises to enhance the alignment of your feet and joints. They may further administer manual treatment to alleviate pain. (Hurn, S. E., et al., 2022)

Podiatrist

A podiatrist is a medical doctor (M.D.) specializing in the treatment of health issues affecting the foot, ankles, and lower legs. Request a referral to a podiatrist from your healthcare physician if you seek assistance in managing your bunion problems. (American Podiatric Medical Association, 2025)

Chiropractic Perspective

Chiropractors focus on biomechanical alignment and musculoskeletal health, viewing bunions as part of a broader kinetic chain dysfunction. Their approach emphasizes manual therapies and functional restoration.

  1. Biomechanical Assessment:
    • Evaluate foot, ankle, knee, hip, and spinal alignment to identify compensatory patterns contributing to bunion formation (e.g., overpronation, pelvic misalignment).
    • Assess gait and foot mechanics to identify areas of abnormal stress on the big toe joint.
  2. Chiropractic Interventions:
    • Adjustments: Perform gentle manipulations to the foot and ankle (e.g., metatarsal or tarsal adjustments) to improve joint mobility and reduce stress on the bunion. Spinal or pelvic adjustments may address upstream biomechanical issues.
    • Soft Tissue Therapy: Utilize techniques such as myofascial release or instrument-assisted soft tissue mobilization to reduce tension in the foot’s muscles and fascia, thereby improving circulation and flexibility.
    • Taping: Apply kinesiology tape to support the big toe and reduce strain during movement.
  3. Corrective Exercises:
    • Prescribe exercises to strengthen intrinsic foot muscles and improve toe alignment, such as:
      • Toe spreading: Actively spread toes apart to strengthen the abductor hallucis.
      • Arch strengthening: Perform short foot exercises to support the medial longitudinal arch.
      • Calf stretches: Address tight Achilles tendons that contribute to foot strain.
    • Recommend balance and proprioception exercises (e.g., standing on one leg) to improve overall foot stability.
  4. Orthotic and Footwear Guidance:
    • Fit patients with custom orthotics to correct overpronation or supination, which can exacerbate bunions.
    • Advise on minimalist or wide-toe-box shoes to promote natural foot mechanics, aligning with chiropractic principles of functional movement.
  5. Holistic Approach:
    • Address lifestyle factors, such as posture and ergonomics, that affect lower extremity alignment.
    • Educate on anti-inflammatory diets (e.g., rich in omega-3 fatty acids, low in processed sugars) to help reduce joint inflammation.

Nurse Practitioner Perspective

NPs focus on holistic patient care, symptom management, and coordinating multidisciplinary treatment. Their approach to bunions focuses on pain relief, slowing the progression, and providing patient education.

  1. Assessment and Diagnosis:
    • Conduct a thorough history and physical exam to evaluate bunion severity, pain level, and contributing factors (e.g., footwear, family history, arthritis).
    • Order imaging (X-rays) if needed to assess joint alignment and rule out complications like osteoarthritis or bone spurs.
    • Screen for systemic conditions (e.g., rheumatoid arthritis, gout) that may worsen bunions.
  2. Conservative Management:
    • Footwear Education: Recommend wide-toe-box shoes with low heels to reduce pressure on the bunion. Avoid high heels and narrow shoes.
    • Orthotics: Prescribe custom or over-the-counter orthotic inserts to support the arch, redistribute pressure, and correct foot mechanics.
    • Padding and Splinting: Suggest bunion pads or spacers to cushion the area and reduce friction. Night splints may help align the toe, though evidence for their effectiveness is mixed.
    • Pain Relief: Advise over-the-counter NSAIDs (e.g., ibuprofen) for pain and inflammation, ensuring proper dosing and monitoring for side effects. For severe cases, refer to a specialist for corticosteroid injections.
    • Physical Therapy: Refer to a physical therapist for exercises to strengthen foot muscles, improve flexibility, and enhance gait. Examples include toe stretches, towel curls, and marble pickups.
  3. Patient Education:
    • Educate on weight management to reduce stress on the feet.
    • Discuss lifestyle changes, such as avoiding prolonged standing or high-impact activities that worsen symptoms.
    • Highlight the progressive nature of bunions and the importance of early intervention.
  4. Referral and Coordination:
    • Refer to a podiatrist or orthopedic surgeon if conservative measures fail or if the bunion causes significant pain, deformity, or functional impairment.
    • Collaborate with chiropractors, physical therapists, or other specialists for a comprehensive care plan.

Both NPs and chiropractors emphasize:

  • Early Intervention: Addressing bunions early can prevent the worsening of deformity.
  • Footwear Modification: Wearing wide, supportive shoes is critical to reducing pressure.
  • Exercise and Mobility: Strengthening and stretching exercises improve foot function.
  • Pain Management: Non-invasive methods, such as padding, icing, or non-steroidal anti-inflammatory drugs (NSAIDs), are the first-line approach.
  • Referral for Surgery: If conservative measures prove ineffective, a specialist may be consulted for surgical options, such as bunionectomy, although this is typically considered a last resort.

Limitations and Considerations

  • Evidence Gaps: While orthotics and exercises are widely recommended, studies on their efficacy for bunions are limited. Splints may not correct severe deformities.
  • Individual Variation: Treatment must be tailored to the patient’s bunion severity, lifestyle, and comorbidities.
  • Surgical Indications: Severe pain, joint damage, or inability to walk may necessitate surgical consultation, which neither NPs nor chiropractors are qualified to perform.

Injury Medical Chiropractic and Functional Medicine Clinic

Dr. Jimenez, a nurse practitioner, integrates medical expertise with chiropractic care to address a wide range of conditions. The clinic provides individualized care programs that incorporate functional medicine, acupuncture, electroacupuncture, and sports medicine. The clinic addresses chronic pain syndromes and injuries by prioritizing strength, agility, and flexibility. Comprehensive care programs, combined with in-person and virtual health coaching, ensure personalized treatment and wellness outcomes for patients of all ages and abilities.

Enhance Your Performance with Functional Foot Orthotics

References

MedlinePlus (2024). Bunions. U.S. Department of Health and Human Services.

American Academy of Orthopaedic Surgeons. (2022). “Bunions.” OrthoInfo. from https://orthoinfo.aaos.org/en/diseases–conditions/bunions/.

Hurn, S. E., Matthews, B. G., Munteanu, S. E., & Menz, H. B. (2022). Effectiveness of Nonsurgical Interventions for Hallux Valgus: A Systematic Review and Meta-Analysis. Arthritis care & research, 74(10), 1676–1688. https://doi.org/10.1002/acr.24603

Aebischer, A. S., & Duff, S. (2020). Bunions: A review of management. Australian Journal of General Practice, 49(11), 720–723. https://doi.org/10.31128/AJGP-07-20-5541

American Podiatric Medical Association. (2025). “What is a podiatrist?” Advancing foot and ankle medicine and surgery. from https://www.apma.org/patients-and-the-public/what-is-a-podiatrist/.

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

Chiropractic Care After a Car Crash and Support Options

What are the benefits of having both a chiropractor and a nurse practitioner help with spine health after a car accident?

Benefits of a Nurse Practitioner and a Chiropractic Specialist in Motor Vehicle Collision

Motor vehicle collisions (MVCs) are a leading source of spinal injuries such as whiplash, ruptured discs, and soft tissue injury, all of which can cause severe pain and limit movement. These injuries typically demand a multimodal therapeutic strategy for short-term and long-term recovery. As advanced practice registered nurses, nurse practitioners provide medical examinations, write prescriptions, and manage overall health, whereas chiropractors specialize in musculoskeletal care, such as spine adjustments and manual therapies. The partnership of these clinicians strives to create a complete, patient-centered plan for post-MVC spine health. (Kent, R., et al., 2023)

A chiropractic and nurse practitioner team can provide comprehensive spinal health treatment to individuals recovering from car accident injuries. This treatment will concentrate on improving mobility and managing pain.

  1. A chiropractic and nurse practitioner team can offer a comprehensive approach to spinal health after a car accident by addressing pain, improving mobility, and facilitating faster recovery.
  2. Chiropractors focus on spinal alignment and joint mobility.
  3. Nurse practitioners provide broader medical oversight and patient education.
  4. The team approach can lead to more effective and personalized care for individuals recovering from car accident injuries. (Riva, J. J., et al., 2010)

Key advantages of this collaborative strategy include:

A chiropractor and nurse practitioner (NP) therapy team can offer comprehensive care for spine health following a motor vehicle collision (MVC) by combining their expertise to address immediate and long-term requirements.

Comprehensive and Interdisciplinary Care

  • Working together, chiropractors and NPs can help with structural and systemic issues, leading to better results, especially for MVC-related spine injuries, notably chronic neck pain and headaches. (Riva, J. J., et al., 2010)

Customized Therapeutic Strategies

  • Chiropractors and nurse practitioners develop individualized treatment regimens for patients that focus on their specific injuries and general health, including any pre-existing diseases and prescription requirements. This method improves results by adjusting treatment to the patient’s particular situation.

Managing pain without relying too much on drugs

  • Chiropractic care uses non-invasive methods to ease pain, which may lead to less use of opioids. NPs can prescribe short-term pain relief and monitor side effects, ensuring safe use and reducing dependency risks. This mix of natural pain treatment and medical supervision lowers the risk of reliance and side effects. (Prater, C., Tepe, M., & Battaglia, P. 2020)

Faster healing and rehabilitation

  • As demonstrated in the treatment of motor vehicle accidents, chiropractic adjustments can help joints work better and ease muscular spasms. NPs can send patients to physical therapy and monitor their progress. This coordinated treatment speeds up healing and lowers the chance of long-term back discomfort. This coordinated care speeds healing and reduces the risk of long-term problems like chronic back pain.

Insurance and Legal Assistance

  • After an MVC, chiropractors and doctors must carefully record injuries and treatments for insurance claims or legal actions to ensure that patients receive fair reimbursement and coverage for their care.

Rationale for Efficacy Post-MVC

A team of nurse practitioners and chiropractors provides a patient-centered approach to spine health following motor vehicle collisions (MVCs). This team integrates NP’s medical management with chiropractic expertise to improve patient outcomes, reduce chronic risks, and enhance recovery. This method is especially beneficial for spine injuries that are complex and related to motor vehicle accidents (MVCs), as it guarantees both immediate relief and long-term health.

Injury Medical Chiropractic and Functional Medicine Clinic

Dr. Jimenez, a nurse practitioner, integrates chiropractic care with medical expertise to address various conditions. The clinic provides customized care programs integrating functional medicine, acupuncture, electro-acupuncture, and sports medicine. The clinic addresses chronic pain syndromes and injuries by prioritizing agility, flexibility, and strength. Comprehensive care plans and in-person and virtual health coaching guarantee individual wellness outcomes and treatment plans for patients of all ages and abilities.

Personal Injury Rehabilitation

References

Kent, R., Cormier, J., McMurry, T. L., Johan Ivarsson, B., Funk, J., Hartka, T., & Sochor, M. (2023). Spinal injury rates and specific causation in motor vehicle collisions. Accident; analysis and prevention, 186, 107047. https://doi.org/10.1016/j.aap.2023.107047

Riva, J. J., Muller, G. D., Hornich, A. A., Mior, S. A., Gupta, A., & Burnie, S. J. (2010). Chiropractors and collaborative care: An overview illustrated with a case report. The Journal of the Canadian Chiropractic Association, 54(3), 147–154.

Prater, C., Tepe, M., & Battaglia, P. (2020). Integrating a Multidisciplinary Pain Team and Chiropractic Care in a Community Health Center: An Observational Study of Managing Chronic Spinal Pain. Journal of primary care & community health, 11, 2150132720953680. https://doi.org/10.1177/2150132720953680

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

Exercise and Dementia: Key to Cognitive Health

To what extent can regular exercise contribute to the overall health of elderly individuals and reduce the likelihood of developing dementia?

Exercise and Dementia: Improving Brain Function

Dementia Prevention and Exercise

Dementia is a term that refers to various diseases that impede memory and cognition, and it is presently the seventh most common cause of death worldwide. (World Health Organization, 2025) Approximately 10 million new cases of dementia are diagnosed annually on a global scale. (Yoon J.H. et al., 2023) A study investigating the correlation between insulin and exercise in the brain discovered that consistent physical activity may enhance brain function and reduce the likelihood of developing dementia. Researchers have discovered that factors such as.

Exercise and stretching are necessary. Muscle rigidity impairs insulin’s ability to work in those who don’t exercise. The body enhances insulin sensitivity by contracting and releasing those muscles in response to movement. Dementia prevention efforts might benefit from identifying mechanisms that lower insulin resistance.

Physical Activity and Reduced Risk

After observing 21 older individuals with prediabetes for two weeks, the researchers discovered that physical activity assists the brain in regulating insulin, directly improving cognitive function. Under supervision, they completed twelve exercise sessions that ranged from moderate to high intensity. (Malin S. K. et al., 2025)

  • The findings show a notable rise in the number of extracellular vesicles produced from the brain that contain insulin-related proteins.
  • These micro-messengers ensure that neurons can communicate with one another and play an essential part in maintaining the brain.
  • AKT (also known as protein kinase B or PKB) comprises three specific protein kinases that are important for many body functions, such as keeping cells alive, helping them grow, managing metabolism, and controlling the cell cycle.
  • The protein is considered a significant factor in insulin signaling and has ramifications for neuronal cell growth and health.
  • Inadequate insulin response may contribute to dementia. Hence, it is noteworthy that exercise could mitigate this by potentially enhancing insulin signaling.

Although further investigation is necessary, these results underscore that physical activity may be an accessible, cost-effective method to promote long-term cognitive health. In the subsequent phase of the investigation, researchers will employ an insulin spray and MRIs to gain further insight into insulin’s impact on brain activity. They will analyze cerebral blood circulation before and during the administration of the insulin spray to elucidate its effects.

Insulin, Exercise, and Brain Health

Insulin is a hormone synthesized by the pancreas that regulates blood glucose levels. Nonetheless, insulin’s significance in cerebral health is equally crucial. The brain’s abundance of insulin receptors facilitates neuronal communication, enhances synaptic connections upon insulin binding, and promotes memory and learning. (Gray, S. M., Meijer, R. I., & Barrett, E. J. 2014)

Impaired insulin signaling, as observed in situations such as type 2 diabetes, renders the brain more susceptible to cognitive deterioration. (Yoon J.H. et al., 2023) Research indicates that insulin resistance plays a role in the accumulation of amyloid-beta plaques and tau tangles, which are fundamental features of Alzheimer’s disease. (Hong, S., Han, K., & Park, C. Y. 2021) Enhancing insulin sensitivity may mitigate or avert these cerebral alterations. Aerobic exercise positively influences total brain health. Prior research has demonstrated that physical activity improves or sustains adult cognitive function and memory. (Rosenberg A. et al., 2020) Other ways to increase brain health include

  • Staying socially engaged
  • Challenging the mind
  • Getting plenty of sleep
  • Managing Stress
  • Healthy diet
  • Staying physically active
  • Diabetes management
  • Blood pressure management

The future of dementia prevention will likely entail a synthesis of lifestyle modifications, including physical activity and pharmacological treatments, to achieve the most significant impact. Consistent physical activity may substantially diminish the likelihood of dementia in adults with prediabetes or diabetes and support normal cognitive function.

Clinic for Chiropractic Care and Functional Medicine

Family Practice Nurse Practitioner Dr. Jimenez integrates sophisticated medical proficiency with chiropractic treatment to manage diverse illnesses. Our clinic combines Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine to develop tailored care plans that enhance natural healing, mobility, and sustained wellness. By emphasizing flexibility, agility, and strength, we enable patients to flourish, irrespective of age or health obstacles. At El Paso’s Chiropractic Rehabilitation Clinic & Integrated Medicine Center, we dedicate ourselves to treating individuals recovering from injuries and chronic pain disorders. We enhance your capabilities through flexibility, mobility, and agility programs customized for various age demographics and disabilities. We employ in-person and virtual health coaching and comprehensive care plans to guarantee tailored care and optimal wellness outcomes for each patient.

Is Motion Key to Healing?

References

World Health Organization. (2025). “Dementia.” World Health Organization. from https://www.who.int/news-room/fact sheets/detail/dementia#:~:text=Alzheimer%20disease%20is%20the%20most,60%E2%80%9370%25%20of%20cases.

Yoon, J. H., Hwang, J., Son, S. U., Choi, J., You, S. W., Park, H., Cha, S. Y., & Maeng, S. (2023). How Can Insulin Resistance Cause Alzheimer’s Disease?. International Journal of Molecular Sciences, 24(4), 3506. https://doi.org/10.3390/ijms24043506

Malin, S. K., Battillo, D. J., Beeri, M. S., Mustapic, M., Delgado-Peraza, F., & Kapogiannis, D. (2025). Two weeks of exercise alters neuronal extracellular vesicle insulin signaling proteins and pro-BDNF in older adults with prediabetes. Aging cell, 24(1), e14369. https://doi.org/10.1111/acel.14369

Gray, S. M., Meijer, R. I., & Barrett, E. J. (2014). Insulin regulates brain function, but how does it get there?. Diabetes, 63(12), 3992–3997. https://doi.org/10.2337/db14-0340

Hong, S., Han, K., & Park, C. Y. (2021). The insulin resistance by triglyceride glucose index and risk for dementia: population-based study. Alzheimer’s research & therapy, 13(1), 9. https://doi.org/10.1186/s13195-020-00758-4

Rosenberg, A., Mangialasche, F., Ngandu, T., Solomon, A., & Kivipelto, M. (2020). Multidomain Interventions to Prevent Cognitive Impairment, Alzheimer’s Disease, and Dementia: From FINGER to World-Wide FINGERS. The Journal of Prevention of Alzheimer’s disease, 7(1), 29–36. https://doi.org/10.14283/jpad.2019.41

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

Sauerkraut and Its Incredible Health Benefits

Can incorporating sauerkraut into one’s diet help promote healthy gut bacteria?

Sauerkraut

Sauerkraut, a fermented cabbage food, is a great source of probiotics and fiber, both of which can contribute to gut health. It’s a living food containing various microbial strains and can help improve digestion, reduce inflammation, and improve overall gut health. (Shahbazi R. et al., 2021)

Fermented foods like sauerkraut have live cultures that promote the growth of beneficial probiotics, bacteria that provide powerful health benefits. Probiotics also help make foods more digestible, increasing the gut’s ability to absorb the vitamins and minerals they contain. A study found that fermented cabbage may help protect intestinal cells from inflammatory damage more than raw cabbage. (Wei L., & Marco M. L., 2025)

Homemade sauerkraut likely contains more live cultures than store-bought since processing may destroy some of the healthy bacteria. (National Institutes of Health Office of Dietary Supplements, 2023) Depending on which supplement is chosen, sauerkraut may have a greater diversity of probiotic strains. This is because an oral supplement has a known quantity and strain of probiotics. Individuals who want to add probiotics to their diet for potential gut health benefits should take a food-first approach, which is generally recommended over oral supplements. (National Institutes of Health, 2025)

Look at the Benefits

Probiotics

  • Sauerkraut contains lactic acid bacteria, which are beneficial bacteria that can help support the immune system and reduce inflammation. (Healthline, 2023)

Fiber

  • Sauerkraut is a robust source of fiber, which aids in digestion and can help you feel full longer.

Digestion

Anti-inflammatory

Gut Microbiome

  • Sauerkraut can help diversify and improve the composition of the gut microbiome, leading to various health benefits. (Healthline, 2023)

IBS symptoms

How to incorporate sauerkraut into one’s diet

Check the Ingredients

Option for unpasteurized

  • Look for sauerkraut that is labeled raw or naturally fermented to ensure it contains live probiotics.

Try to Eat Regularly

  • Aim to include sauerkraut in your diet a few times a week to reap the benefits. (Healthline, 2023)

Pair with Other Gut-Healthy Foods

  • Sauerkraut can be eaten alone or paired with other fermented foods, such as yogurt, kimchi, or chard, to promote gut health.

What to consider

Cabbage Allergy

  • Individuals who have a cabbage allergy or histamine intolerance should avoid sauerkraut.

Sodium

MAOI Medications

  • Consult with a doctor before adding sauerkraut to your diet if you are taking monoamine oxidase inhibitors (MAOIs).

Start small and learn how you like to eat sauerkraut, which can be as a condiment, side dish, or sandwich ingredient.

Injury Medical Chiropractic and Functional Medicine Clinic

As a Family Practice Nurse Practitioner, Dr. Jimenez combines advanced medical expertise with chiropractic care to address various conditions. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop highly effective treatment plans through an integrated approach for each patient and restore health and function to the body through nutrition and wellness, functional medicine, acupuncture, electroacupuncture, and integrated medicine protocols. We focus on what works for you to relieve pain, restore function, prevent injury, and mitigate issues through adjustments that help the body realign itself. The clinic can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.

Body In Balance: Chiropractic, Fitness, and Nutrition

References

Shahbazi, R., Sharifzad, F., Bagheri, R., Alsadi, N., Yasavoli-Sharahi, H., & Matar, C. (2021). Anti-Inflammatory and Immunomodulatory Properties of Fermented Plant Foods. Nutrients, 13(5), 1516. https://doi.org/10.3390/nu13051516

Healthline. (2023). 8 Surprising Benefits of Sauerkraut (Plus How to Make It). https://www.healthline.com/nutrition/benefits-of-sauerkraut#nutrients

Medical News Today. (2023). What are the benefits of eating sauerkraut? https://www.medicalnewstoday.com/articles/health-benefits-of-sauerkraut

Wei, L., & Marco, M. L. (2025). The fermented cabbage metabolome and its protection against cytokine-induced intestinal barrier disruption of Caco-2 monolayers. Applied and environmental microbiology, e0223424. Advance online publication. https://doi.org/10.1128/aem.02234-24

National Institutes of Health Office of Dietary Supplements. (2023). Probiotics. Retrieved from https://ods.od.nih.gov/factsheets/Probiotics-Consumer/

National Institutes of Health. (2025). Probiotics. Retrieved from https://ods.od.nih.gov/factsheets/Probiotics-HealthProfessional/

U.S. Department of Agriculture. (2018). Sauerkraut, canned, solids and liquids. Retrieved from https://fdc.nal.usda.gov/food-details/169279/nutrients

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

Muscles Retighten: Why Ongoing Care Is Essential

Why do the muscles retighten days or weeks later for individuals who have received massage or chiropractic adjustments?

Muscles Retighten

Muscles can retighten again days or weeks after chiropractic treatment and/or a massage. A few factors may cause this.

  • Muscle memory: The body’s natural tendency to return to its previous state of tension.
  • This includes all the unhealthy postures/positioning 
  • Delayed inflammatory response.
  • The body’s natural healing process
  • How muscles respond to manipulation
  • The need for ongoing maintenance of muscle health

After a massage, muscles can experience a temporary increase in soreness or tightness as the body heals from any minor damage or inflammation caused by the massage. Additionally, if the underlying issue causing muscle tightness is not addressed, the muscles may revert to their original state over time. (Cleveland Clinic, 2024)

Causes

Causes for muscles to retighten.

Underlying Issues

  • If the root cause of the muscle tightness is not addressed, such as unhealthy posture, injuries, repetitive motions, or muscle imbalances, it can lead to further complications.
  • In that case, the muscles may return to their original state after a few days or weeks.

Delayed Onset Muscle Soreness (DOMS)

  • For example, muscles feel sore after intense exercise, and individuals can also experience DOMS after a massage, especially if they are particularly tight or if it’s been a while since their last massage. (Healthline, 2020)

Delayed Inflammatory Response

  • Massage can sometimes cause microscopic tears or inflammation in muscle tissue, which triggers the body’s natural healing process.
  • This response can cause soreness and temporary tightness, as the body repairs the damaged tissue even after the initial massage. (Essential Chiropractic, 2025)

Muscle Memory

  • The body tends to revert to habitual patterns of muscle tension, especially if the underlying cause of the tightness isn’t addressed.
  • Muscles can retain how they were manipulated during the massage and may revert to their original tightness if they haven’t been consistently relaxed.

Muscle Guarding

  • The individual and body can subconsciously tense muscles to avoid pain or soreness, even after the massage. 
  • This muscle guarding can counteract the benefits of the massage and lead to a renewed cycle of tension. (Bhimani R. H., & Soomar D. 2019)

Muscle Health Maintenance

  • Regular Maintenance
  • Muscles need consistent care to maintain their optimal state of health and function.
  • Regular massages and other lifestyle changes, such as stretching and strengthening exercises, can help maintain muscle flexibility and reduce the likelihood of muscle tightness returning.

Individual Variation

  • Factors like the type of massage received, the frequency of massages, and individual body responses can all influence how long a massage’s benefits last. (Cleveland Clinic, 2024)

Massage Treatment

Muscles can retighten after a massage due to the body’s response to the pressure and manipulation during the treatment. This can include individual sensitivity to massage, the type of massage, and hydration levels, which can also play a role.

Type of Massage

  • Deep tissue massage, which focuses on specific muscle groups and applies deeper pressure, may cause more soreness than other types of massage.
  • Some individuals may be more sensitive to massage and experience soreness, even with a gentle massage. (Cleveland Clinic, 2024)

Muscle Fiber Manipulation

  • Deep tissue massage can break down spasms or microtears in muscle fibers, leading to soreness.
  • This is similar to the microscopic tears that occur during exercise, which are necessary for muscle repair and growth.

Dehydration

  • Individuals who are not adequately hydrated may experience increased soreness after a massage. (Cleveland Clinic, 2024)

Lactic Acid Buildup

  • During an intense massage, particularly deep tissue, lactic acid can build up in the muscles, leading to soreness and tightness. 
  • (Healthline, 2020)

Muscle Tensions

  • If the muscles were particularly tense or knotted before the massage, the manipulation could lead to soreness as the knots get worked out.

Injury Medical Chiropractic and Functional Medicine Clinic

As a Family Practice Nurse Practitioner, Dr. Jimenez combines advanced medical expertise with chiropractic care to address various conditions. Our clinic integrates Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine to create customized care plans that promote natural healing, mobility, and long-term wellness. By focusing on flexibility, agility, and strength, we empower patients to thrive, regardless of age or health challenges. At El Paso’s Chiropractic Rehabilitation Clinic & Integrated Medicine Center, we passionately focus on treating patients after injuries and chronic pain syndromes. We focus on improving your ability through flexibility, mobility, and agility programs tailored for all age groups and disabilities. We use in-person and virtual health coaching and comprehensive care plans to ensure every patient’s personalized care and wellness outcomes.

Secrets of Optimal Wellness

References

Cleveland Clinic. (2024). How to Relieve Muscle Soreness After a Massage. https://health.clevelandclinic.org/why-does-my-body-feel-worse-after-a-massage

Healthline. (2020). How to Relieve Sore Muscles After a Massage. https://www.healthline.com/health/sore-after-massage#causes-of-soreness

Essential Chiropractic and Physiotherapy. (2025). Muscle Ache After Massage: Common Causes and Relief. https://essentialchiropractic.co.uk/muscle-ache-after-massage-common-causes-and-relief/#:~:text=Post%2Dmassage%20soreness%20is%20a,hours%20as%20the%20muscles%20recover.

Bhimani, R. H., & Soomar, D. (2019). Understanding Symptoms of Muscle Tightness, Weakness, and Rigidity From a Nursing Perspective. Rehabilitation Nursing: The Official Journal of the Association of Rehabilitation Nurses, 44(5), 271–281. https://doi.org/10.1097/rnj.0000000000000151

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

Pace Running: How to Work with Pacers

Can pace running help runners concentrate on other things, like breathing, form, or mental toughness?

Pace Running

Running is a sport many participate in and doesn’t require any equipment—only quality running shoes. Running in races comes with various physical and mental challenges. Some runners enjoy running in races and marathons but want to perfect their abilities and techniques, become more consistent, finish in a certain time, or pass a personal record. This is where pace running or working with a pace runner can help achieve those goals.

What is a Pace Runner?

A pace runner, or pacer, is an experienced runner who can run at a set pace for a long time. The pacer sets the speed so the runner can focus on running. Pacers run in races or marathons to help set the pace for a runner or runners. There are different reasons why professional and amateur runners work with a pace runner. Professional runners often use pace runners to work on techniques and help reach new levels in their running, while amateur runners can work on improving their overall running abilities. There are three typical types of pacers.

Race Pacer

  • Pacers wear or carry signs to make it easier for the runners and can often run split times.
  • A split time is the time it takes to run a certain distance.
  • Typically, these pacers will run at an even pace.
  • Many marathons will have pace groups that run at a specific speed or pace throughout the race.
  • The pace groups will have runners running a set time so other runners can key off these runners.
  • There are typically set paces for a 3-hour marathon time up to a 6-hour marathon time.
  • Runners can use pacers to help them reach their goals without relying on technology, such as a smartwatch or GPS, to determine if they maintain the correct speed throughout the race.

Distance Pacer

  • Professional and non-professional runners who run long distances or ultramarathons may also use a pace runner to set a specific tempo.
  • Ultramarathons are any race with a distance longer than the standard marathon of 26.2 miles.
  • Because some ultramarathons can be as long as 50 to 100 miles, runners who choose to have a pacer often have several pacers at different sections to motivate them and help set the rhythm.

Record Pacer or Rabbit

  • A record pacer, also known as a rabbit, is a pacer who helps a professional runner set a new record.
  • A rabbit often leads the race for a predetermined distance at a predetermined pace.
  • Some races have multiple pacers at various distances.

How Are Pacers Used?

There are different reasons for having a pacer, but they are based on the runner’s goals.

  • A runner being paced runs directly behind a pacer or pacers.
  • A pacer can run any pace requested, but typically, the pace groups run at an even pace or with a slight negative split.
  • A negative split is when a runner runs the race’s second half faster than the first half.

How Do They Help?

  • A pacer can be helpful because it takes more energy to lead a race than to sit back and follow another runner.
  • The pacer is responsible for timing and establishing the tempo so runners only have to focus on running.
  • A pacer does more work setting the pace, which allows the runner being paced to relax and not stress about hitting the pace.

A study focused on elite athletes who used pacers. It found that running together at a realistic speed helped optimize and achieve finishing time goals. (Casado A. et al., 2021) However, not all elite events allow pacers to participate. Some championship events, like the Olympics and NCAA Championships, do not allow pacer runners.

Benefits

Benefits of running with a pacer.

Prevent Running Too Fast

  • When a race begins, runners can take off and start too fast.
  • Starting too quickly can negatively impact the runners, like losing energy and stamina.
  • A pacer can help start the race with a steady pace, keeping them from going out too fast or expending too much energy.

Maintain an Even Pace

  • Maintaining an even pace can be difficult throughout a long race or a marathon.
  • Having a pacer can relieve some stress and pressure.
  • A pacer can keep the runners on an even pace or negative splits versus going out too fast and losing energy.

Focus on the Race

  • Pacers help the runners stay focused on the race without worrying about how they are running or maintaining the right speed.
  • A pacer can help keep runners relaxed.

Motivating

  • Pacers can help motivate runners.
  • The pace runners may encourage individuals along the way and help them stay motivated to keep working toward their goal, especially when the hard parts come.

Disadvantages

Running with a pacer can sometimes be more stressful than beneficial, especially for amateur runners. A pacer or pace group can be helpful, but it also can create more stress for some amateur runners.

  • Sometimes, individuals realize the pacer is running too quickly for what they can handle.
  • Anxiety can present as not being able to keep up.
  • Other times, runners underestimate their abilities and run more slowly than their bodies can handle.
  • However, runners don’t have to stay with a pace group just because they started with them.
  • Individuals can run ahead.
  • Or if the group is too fast, the runner can slow down and join the slower-paced group behind them.
  • The key is to listen to your body and do what feels right.

Becoming a Pacer

An experienced runner who wants to be a pacer for a race can contact a running organization about becoming a pace runner.

  • Individuals need to be able to have consistent racing times.
  • Be able to run at a set speed for a long duration.
  • Most pacers will contact the race organization to apply for a certain pace.
  • Some pacers enjoy the thrill of running in a race and helping other runners meet their goals.
  • The runner’s goals and the type of event also influence who the pacer is.

Injury Medical Chiropractic & Functional Medicine Clinic

Individuals can talk to local running experts or a running coach. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. We can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.

The Difference of Using Custom Foot Orthotics

References

Casado, A., Hanley, B., Jiménez-Reyes, P., & Renfree, A. (2021). Pacing profiles and tactical behaviors of elite runners. Journal of Sport and Health Science, 10(5), 537–549. https://doi.org/10.1016/j.jshs.2020.06.011

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

Center of Gravity Explained: A Comprehensive Guide

What is the body’s center of gravity to understand and maintain a healthy posture and balance?

Center of Gravity

The human center of gravity, or COG, also known as the center of mass, with the two terms being interchangeable, is where the body’s weight appears to be concentrated. It’s a point in space where the entire body’s mass can be concentrated. When standing upright, the COG is generally located behind the navel and in front of the sacrum, around the level of the second vertebra. (Le Huec, J. 2011) The center of gravity is related to posture, including issues such as swayback, the design of posture exercise programs, and much more.

  • Gravity is a downward pull or force the Earth exerts on the body, creating weight. (NASA, 2013)
  • The center of gravity (COG) is where a body’s weight is equally balanced in all directions. (Physiopedia, 2025)
  • When the COG is defined, it is done from the reference of a static, standing position.
  • Because the body is in motion when we change positions, the COG is located in a new position with each new position.
  • The center of gravity is the point around which all the parts balance, which may be inside or outside the body.
  • Even slight changes in position can change where the COG is. (Physiopedia, 2025)

Key aspects of the COG

Location

  • When standing upright, the COG is typically found at the second vertebral level, behind the navel and in front of the sacrum. (Le Huec, J. 2011)

Shifting COG

  • The COG can shift depending on body position, posture, and movements like bending forward or backward. (Physiopedia, 2025)

Balance Impact 

  • The relationship between the COG and the base of support (the area of the body in contact with the ground) is fundamental to maintaining balance.

Variations

  • There can be variations in the COG location based on factors like gender (men tend to have a slightly higher COG), body shape, and even conditions like obesity or chronic low back pain. (Physiopedia, 2025)

Biomechanics

  • Understanding the COG is crucial in biomechanics and movement analysis, as it’s an index of total body motion and how the body responds to external forces.

The Human Center

The center of gravity is the point at which the body’s mass is equally balanced. This point changes depending on one’s position:

  • Arms up/down
  • Leaning
  • Turning

With strength and flexibility training, the human body can change its center of gravity, as gymnasts and dancers do.

  • When standing, the center of gravity is normally located behind the navel and in front of the sacrum bone (made up of five vertebrae fused vertically) at about the second vertebra level. (Hasegawa K. et al., 2022)
  • Because the body has moving parts, its overall shape changes every time it moves. Carrying something like a suitcase or grocery bag or wearing a backpack adds weight to some areas but not others, changing the center of gravity as it does.
  • The center of gravity is a continually changing point inside or outside the body that represents where the weight or mass of the rest of the body is equally balanced in every direction.
  • This point can and does change based on what is being carried and how it is carried, as well as body position and movements.

Chronic Lower Back Pain

  • A study in the Journal of Back and Musculoskeletal Rehabilitation found that individuals with chronic lower back pain tend to have their center of gravity located excessively towards the back. (Kim D. H., Park J. K., & Jeong M. K. 2014)
  • In the study, the individuals had decreased low back strength upon extension and a reduced normal low back curve.
  • The researchers found that those with chronic lower back pain whose center of gravity was too far back may need physical therapy to retrain the body to overcome strength and balance challenges to re-establish and maintain a healthy posture.

Injury Medical Chiropractic and Functional Medicine Clinic

As a Family Practice Nurse Practitioner, Dr. Jimenez combines advanced medical expertise with chiropractic care to address various conditions. Our clinic integrates Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine to create customized care plans that promote natural healing, mobility, and long-term wellness. By focusing on flexibility, agility, and strength, we empower patients to thrive, regardless of age or health challenges. At El Paso’s Chiropractic Rehabilitation Clinic & Integrated Medicine Center, we passionately focus on treating patients after injuries and chronic pain syndromes. We focus on improving your ability through flexibility, mobility, and agility programs tailored for all age groups and disabilities. We use in-person and virtual health coaching and comprehensive care plans to ensure every patient’s personalized care and wellness outcomes.

Enhance Your Lifestyle Today with Chiropractic Care

References

Le Huec, J. C., Saddiki, R., Franke, J., Rigal, J., & Aunoble, S. (2011). Equilibrium of the human body and the gravity line: the basics. European spine journal: official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 20 Suppl 5(Suppl 5), 558–563. https://doi.org/10.1007/s00586-011-1939-7

NASA. Jet Propulsion Laboratory, California Institute of Technology. (2013). What is gravity? Retrieved from https://gracefo.jpl.nasa.gov/news/5/what-is-gravity/

Physiopedia. (2025). Centre of gravity. https://www.physio-pedia.com/Centre_of_Gravity

Hasegawa, K., Amabile, C., Nesme, M., & Dubousset, J. (2022). Gravity center estimation for evaluation of standing whole body compensation using virtual barycentremetry based on biplanar slot-scanning stereoradiography – validation by simultaneous force plate measurement. BMC musculoskeletal disorders, 23(1), 22. https://doi.org/10.1186/s12891-021-04948-5

Kim, D. H., Park, J. K., & Jeong, M. K. (2014). Influences of posterior-located center of gravity on lumbar extension strength, balance, and lumbar lordosis in chronic low back pain. Journal of Back and Musculoskeletal Rehabilitation, 27(2), 231–237. https://doi.org/10.3233/BMR-130442

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

Cornstarch: How to Replace Flour in Recipes

How can cornstarch be used instead of flour in recipes for individuals on a gluten-free diet who are looking for a flour alternative due to celiac disease or non-celiac gluten sensitivity?

flour table

Cornstarch Substitute

Flour is often used as a thickener or a coating in recipes. Pure cornstarch (made from corn) is a gluten-free flour substitute (Rai S., Kaur A., & Chopra C.S., 2018). However, some brands are not considered gluten-free.

Substitute for Flour

It’s easy to substitute cornstarch for flour when the recipe calls for a thickener, such as in gravies, sauces, pies, or coatings for fried foods. If flour is unavailable or individuals want to try a gluten-free alternative, cornstarch has a similar effect in these cooking applications.

However, individuals should be aware that it cannot be used as a substitute for flour in baked goods.

As a Thickener

Cornstarch can be a thickener in sauces, gravy, and pie fillings. (Bob’s Red Mill, 2020)

  • There is no taste of cornstarch.
  • However, foods will be more translucent.
  • This is because it is pure starch, while flour contains some protein.
  1. Cornstarch is not a 1:1 substitute for flour.
  2. Individuals should generally use one tablespoon for each 1 1/2 to 2 cups of flour for sauce/gravy for medium thickness. (The Denver Post, 2016)

When using cornstarch as a thickener:

  • Bring the mixture to a full boil for 1 minute, which allows the granules to swell to their maximum.
  • Reduce the heat as it thickens.
  • Overcooking can cause mixtures to thin when cooled.
  • Cook over medium-low to medium heat, as high heat can cause lumping.
  • Stir gently
  • Stirring vigorously can break down the mixture.
  • If more ingredients are needed, remove the pot from the heat and stir them quickly and gently.
  • Avoid freezing sauces or gravies since they won’t freeze well. (Cook’s Info, 2008)

How To Use

  • Use half as much cornstarch as you would flour.
  • For example, if the recipe calls for two tablespoons of flour, use one tablespoon of cornstarch.
  • If the recipe calls for 1/4 cup of flour, use 1/8 cup of cornstarch.
  • This is true for other starches, including arrowroot, potato, and tapioca. (Taste of Home, 2023)
  • Adding the cornstarch directly will cause it to clump and form lumps in the sauce that will be difficult to dissolve.
  • To avoid this, mix the cornstarch with cold water (1 tablespoon of cornstarch to 1 tablespoon of cold water) until it is dissolved.
  • Then pour the water/starch mixture/slurry into the mix.
  • Keep stirring as the mixture thickens. (Bon Appetit, 2020)

Cornstarch is not as effective as flour when thickening acidic sauces. It doesn’t work well with tomato, vinegar, or lemon juice sauces. It is also less effective than flour when thickening sauces made with fat, including butter or egg yolks. (The BC Cook Articulation Committee, 2015)

If the mixture contains too little liquid, the starch granules cannot absorb. This is also the case when there is more sugar than liquid, in which case, more liquid is needed to firm up the mixture.

Fried Dishes

Individuals can use cornstarch instead of flour to coat fried chicken, fish, or other fried dishes. It creates a crisper coating that better withstands sauces and absorbs less frying oil, resulting in a lower-fat meal. Tips for frying:

  • Try a 50/50 blend of cornstarch and gluten-free flour for a coating closer to wheat flour. (Bon Appetit, 2016)
  • Ensure there is a light, even cornstarch coating on the food.
  • Heavier coatings can get gummy.

Injury Medical Chiropractic and Functional Medicine Clinic

When cooking gluten-free, individuals may be able to continue to enjoy some of their favorite sauces by learning how to use cornstarch and other gluten-free thickeners instead of flour. As a Family Practice Nurse Practitioner, Dr. Jimenez combines advanced medical expertise with chiropractic care to address various conditions. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop highly effective treatment plans through an integrated approach for each patient and restore health and function to the body through nutrition and wellness, functional medicine, acupuncture, electroacupuncture, and integrated medicine protocols. We focus on what works for you to relieve pain, restore function, prevent injury, and mitigate issues through adjustments that help the body realign itself. The clinic can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.

From Consultation to Transformation: Assessing Patients in a Chiropractic Setting

References

Rai, S., Kaur, A., & Chopra, C. S. (2018). Gluten-Free Products for Celiac-Susceptible People. Frontiers in Nutrition, 5, 116. https://doi.org/10.3389/fnut.2018.00116

Bob’s Red Mill. (2020). Baking with cornstarch: Everything you need to know. https://www.bobsredmill.com/articles/baking-with-cornstarch-everything-you-need-to-know

Denver Post. (2016). Cornstarch a good way to thicken gravy lightly. https://www.denverpost.com/2010/11/20/cornstarch-a-good-way-to-thicken-gravy-lightly/

Cook’s Info. (2008). Thickeners. https://www.cooksinfo.com/thickeners/

Taste of Home. (2023). Cornstarch vs. flour vs. arrowroot – when should you use which thickener? https://www.tasteofhome.com/article/best-thickener/

Bon Appetit. (2020). Cornstarch is a powerful tool that must be used responsibly. https://www.bonappetit.com/story/the-power-of-almighty-cornstarch

The BC Cook Articulation Committee. (2015). Understanding Ingredients for the Canadian Baker
Types of thickening agents. https://opentextbc.ca/ingredients/chapter/types-of-thickening-agents/

Bon Appetit. (2016). 4 brilliant ways to cook with cornstarch. https://www.bonappetit.com/story/cornstarch-uses-sauce-crispy-meat

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

Paraspinal Muscle Tension: Understanding the Impacts

Can a paraspinal muscle spasm in the lower back create a chain reaction leading to hamstring spasms and potential sciatic nerve entrapment?

Paraspinal Muscle Spasm Chain Reaction

A paraspinal muscle spasm in the lower back can cause a cascade of events, including: (Cedars-Sinai, 2025)

  • Spasms in other lower back muscles
  • Hamstring spasms
  • Potential entrapment of the sciatic nerve

Leading to symptoms similar to sciatica: 

  • Pain
  • Sore, achy muscles
  • Weak muscles
  • Numbness
  • Tingling along the back of the leg

Possible Mechanisms

Triggering Muscle Spasms in the Lower Back

  • Paraspinal muscles are located along the spine and help to stabilize and support the lower back.
  • When these muscles spasm, they can become tense and painful, causing a chain reaction.
  • This tension can radiate down and affect other muscles in the lower back. (Noonan A. M., & Brown S. H. M., 2021)

Can Affect Lower Back Muscles and Cause Hamstring Spasms

  • Lower back muscles, including those like the quadratus lumborum, can be affected by paraspinal spasms. (Hospital for Special Surgery, 2024)
  • The spasms can cause these muscles to tighten or spasm, potentially pulling on the hamstring muscles.
  • This can lead to hamstring spasms and tightness, further contributing to pain and potential nerve irritation.

Entrapment of the Sciatic Nerve

  • Piriformis syndrome is a common condition where the piriformis muscle (located in the buttock) spasms and compresses the sciatic nerve. (Cedars-Sinai, 2025)
  • The sciatic nerve runs from the lower back down the back of the thigh and into the leg, making it vulnerable to compression by surrounding muscles.
  • If the paraspinal and hamstring spasms create enough tension on the piriformis muscle or surrounding tissues, it can lead to sciatic nerve entrapment. (Hospital for Special Surgery, 2024)

How acupuncture helps relieve sciatica

Acupuncture can help relieve sciatica pain by stimulating specific points on the body, which can trigger the release of endorphins, reduce inflammation, improve blood flow, and relax tight muscles that could be compressing the sciatic nerve. By modulating the nervous system and promoting the body’s natural healing processes, acupuncture can help alleviate pain and improve overall function. (Qin, Z. et al., 2015)

Releases endorphins

  • Acupuncture stimulates the nervous system, triggering the release of endorphins, the body’s natural painkillers.

Reduces inflammation

  • Acupuncture can help reduce inflammation in the area surrounding the sciatic nerve, which can contribute to pain and nerve irritation. (Natural Care Chiropractic, 2022)

Improves circulation

  • By increasing blood flow to the affected area, acupuncture can help deliver nutrients and oxygen to the sciatic nerve and surrounding tissues, promoting faster healing.

Relaxes tight muscles

  • Sciatica pain can be exacerbated by tight muscles compressing the nerve. Acupuncture can help relax these muscles, reducing pressure on the sciatic nerve and alleviating pain.

Regulates the nervous system

  • Acupuncture can help regulate the nervous system, positively impacting pain perception and overall well-being. (Qin, Z. et al., 2015)

Promotes regeneration

  • Some evidence suggests that acupuncture can promote sciatic nerve regeneration, potentially leading to long-term pain relief. (Natural Care Chiropractic, 2022)

Needling Types

Distal needling

  • Acupuncture can also involve using points that are further away from the site of pain, which can also help to reduce pain and inflammation. 

Local needling

  • Points are also selected on or near the sciatic nerve’s path, which can help directly address the source of pain and inflammation. (Qin, Z. et al., 2015)

Holistic approach

  • Acupuncture is often viewed as a holistic approach to pain management, addressing the symptoms of sciatica and the underlying causes and imbalances in the body.

Injury Medical Chiropractic and Functional Medicine Clinic

As a Family Practice Nurse Practitioner, Dr. Jimenez combines advanced medical expertise with chiropractic care to address various conditions. Our clinic integrates Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine to create customized care plans that promote natural healing, mobility, and long-term wellness. By focusing on flexibility, agility, and strength, we empower patients to thrive, regardless of age or health challenges. At El Paso’s Chiropractic Rehabilitation Clinic & Integrated Medicine Center, we passionately focus on treating patients after injuries and chronic pain syndromes. We focus on improving your ability through flexibility, mobility, and agility programs tailored for all age groups and disabilities. We use in-person and virtual health coaching and comprehensive care plans to ensure every patient’s personalized care and wellness outcomes.

Chiropractic and Integrative Healthcare

References

Cedars Sinai. (2025). Piriformis Syndrome. https://www.cedars-sinai.org/health-library/diseases-and-conditions/p/piriformis-syndrome.html#:~:text=Overview,can%20run%20through%20the%20muscle)

Noonan, A. M., & Brown, S. H. M. (2021). Paraspinal muscle pathophysiology associated with low back pain and spine degenerative disorders. JOR spine, 4(3), e1171. https://doi.org/10.1002/jsp2.1171

Hospital for Special Surgery. (2024). Sciatica. https://www.hss.edu/condition-list_sciatica.asp

Qin, Z., Liu, X., Wu, J., Zhai, Y., & Liu, Z. (2015). Effectiveness of Acupuncture for Treating Sciatica: A Systematic Review and Meta-Analysis. Evidence-based complementary and alternative medicine: eCAM, 2015, 425108. https://doi.org/10.1155/2015/425108

Natural Care Chiropractic, D. M. F. (2022). Acupuncture for Sciatica Pain Relief. https://www.naturalcarechiropractic.com/post/acupuncture-for-sciatica-pain-relief

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

Pseudoarthrosis After Spinal Fusion Surgery Explained

What is pseudoarthrosis of the cervical and lumbar spine?

Pseudoarthrosis of the cervical and lumbar spine

Individuals may need a spinal fusion to treat a fractured vertebra, scoliosis, or conditions like spinal stenosis, degenerative disc disease, and spondylolisthesis/slipped vertebrae. A spinal fusion reduces pain and stabilizes the spine by limiting movement between vertebrae. Pseudoarthrosis happens when the bones don’t heal after a fracture or bone surgery. When pseudoarthrosis affects the cervical or lumbar spine, it means that two vertebrae did not heal and grow together after spinal surgery to fuse them (spinal fusion). Reasons for a failed spinal fusion include:

  • Issues with the instruments used to stabilize the bone
  • Lack of bone growth
  • The number of vertebrae being fused.

The patient’s health and lifestyle play a role in failed fusions, which can include

  • Diabetes
  • Inflammatory health conditions increase the risk
  • Smoking
  • Long-term steroid use

In many cases, revision surgery is needed.

Surgery-Related

During a spinal fusion, surgeons insert a bone graft between two vertebrae and then apply spinal fixation hardware (instrumented spinal fusion) that includes:

  • Plates
  • Rods
  • Screws
  1. The bone graft promotes growth between the two bones.
  2. The hardware stabilizes the vertebrae and prevents movement while they fuse and grow together.
  3. The hardware goes inside, or internal fixation.
  4. Although rare, a severe spinal fracture or deformity may need external fixation.
  5. A rigid frame secured outside the body helps to stabilize the bones.

If the fusion fails, it could be caused by one or more of the following surgical issues:

Number of Vertebrae Being Fused

Hardware

  • The surgeon must carefully plan and use the right hardware.
  • The type of hardware used during a spinal fusion may influence bone healing.
  • The instruments can come loose or break, interfering with the fusion process.
  • Spinal osteoporosis, having thin, weak bones, can affect fixation.
  • Even with the optimal surgical preparedness, weak bones significantly increase the chance of the instruments loosening and pseudoarthrosis developing.

Bone Graft

  • The type of bone graft used may affect the fusion.
  • For example, in cervical/neck spinal fusions, an autograft, which uses a small piece of bone from the patient’s body, has a higher success rate. (Verla T. et al., 2021)
  • Other graft options include specialized steel cages that fit between vertebrae and contain bone growth factors.
  • The surgeon recommends the optimal bone graft for the type of surgery, the number of vertebrae involved, and risk factors.

Risk Factors

  • The patient’s overall health and lifestyle impact the results of spinal fusion. Smoking increases the risk. (Berman D. et al., 2017)
  • Nicotine restricts blood circulation, decreases bone density, reduces new bone formation, and delays bone healing. (Hernigou J., & Schuind F., 2019)

The risk of pseudoarthrosis increases if the individual has any of the following: (Scoliosis Research Society, 2023)

  • Previous pseudoarthrosis
  • Obesity
  • Chronic steroid use
  • Malnutrition
  • Inflammatory diseases

Inflammatory conditions that can lead to bone loss and non-optimal bone healing include: (Torres H. M. et al., 2023)

  • Diabetes (Jiao H, Xiao E, & Graves DT, 2015)
  • Inflammatory bowel disease
  • Psoriasis
  • Rheumatoid arthritis
  • Chronic obstructive pulmonary disease/COPD
  • Periodontitis
  • Systemic lupus erythematosus/SLE

Symptoms

  • The primary sign of pseudoarthrosis is pain in the same area as before the fusion surgery.
  • If the bones pinch a spinal nerve, one arm may experience pain, tingling, burning, or numbness.
  • Rarely does a pinched nerve affect both arms.
  • The pain may return shortly after the procedure.
  • The pain may develop gradually or not appear for many months.
  • However, it’s more likely to appear after several months when the individual returns to their usual activities.

Diagnosis

  • The healthcare provider will learn about symptoms and perform a physical exam to evaluate the back.
  • They’ll assess mobility and the type of movement that causes pain.
  • Then, they order diagnostic imaging to see the spine and identify the cause of pain.
  • Individuals may need a CT scan, MRI, and/or X-rays to evaluate the spinal structures and instrumentation fully.

Treatment

Treatment for pseudoarthrosis will likely start with:

  • Physical therapy
  • Pain management – especially in cases where it is important to rule out other sources of back or neck pain.
  • Medication
  • Injections
  • If symptoms don’t improve with conservative care or if there is severe pain, the healthcare provider may recommend revision surgery.
  • Revision surgery is another procedure to treat complications or correct issues that arise after the initial pseudoarthrosis surgery.

Injury Medical Chiropractic and Functional Medicine Clinic

As a Family Practice Nurse Practitioner, Dr. Jimenez combines advanced medical expertise with chiropractic care to address various conditions. Our clinic integrates Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine to create customized care plans that promote natural healing, mobility, and long-term wellness. By focusing on flexibility, agility, and strength, we empower patients to thrive, regardless of age or health challenges. At El Paso’s Chiropractic Rehabilitation Clinic & Integrated Medicine Center, we passionately focus on treating patients after injuries and chronic pain syndromes. We focus on improving your ability through flexibility, mobility, and agility programs tailored for all age groups and disabilities. We use in-person and virtual health coaching and comprehensive care plans to ensure every patient’s personalized care and wellness outcomes.

Enhancing Health Together

References

Boonsirikamchai, W., Wilartratsami, S., Ruangchainikom, M., Korwutthikulrangsri, E., Tongsai, S., & Luksanapruksa, P. (2024). Pseudarthrosis risk factors in lumbar fusion: a systematic review and meta-analysis. BMC musculoskeletal disorders, 25(1), 433. https://doi.org/10.1186/s12891-024-07531-w

Verla, T., Xu, D. S., Davis, M. J., Reece, E. M., Kelly, M., Nunez, M., Winocour, S. J., & Ropper, A. E. (2021). Failure in Cervical Spinal Fusion and Current Management Modalities. Seminars in plastic surgery, 35(1), 10–13. https://doi.org/10.1055/s-0041-1722853

Berman, D., Oren, J. H., Bendo, J., & Spivak, J. (2017). The Effect of Smoking on Spinal Fusion. International journal of spine surgery, 11(4), 29. https://doi.org/10.14444/4029

Hernigou, J., & Schuind, F. (2019). Tobacco and bone fractures: A review of the facts and issues that every orthopaedic surgeon should know. Bone & joint research, 8(6), 255–265. https://doi.org/10.1302/2046-3758.86.BJR-2018-0344.R1

Scoliosis Research Society. (2023). Pseudoarthrosis. https://www.srs.org/Patients/Conditions/Pseudoarthrosis

Torres, H. M., Arnold, K. M., Oviedo, M., Westendorf, J. J., & Weaver, S. R. (2023). Inflammatory Processes Affecting Bone Health and Repair. Current osteoporosis reports, 21(6), 842–853. https://doi.org/10.1007/s11914-023-00824-4

Jiao, H., Xiao, E., & Graves, D. T. (2015). Diabetes and Its Effect on Bone and Fracture Healing. Current osteoporosis reports, 13(5), 327–335. https://doi.org/10.1007/s11914-015-0286-8