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Tag: Injury

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

Understanding the Impact of Whiplash Before Going Back To Work

Discover the impact of whiplash on your health and learn effective strategies for recovery and management before going back to work.

Returning to Work After Motor Vehicle Accidents: Understanding Whiplash, Treatments, and Clinical Insights

Introduction

Getting back to work after a motor vehicle accident (MVA) can feel like trying to solve a puzzle with missing pieces, especially when whiplash is involved. Whiplash, a frequent injury from car crashes, can turn simple tasks like typing or lifting into a real pain in the neck (pun intended!). But with the right care, many people can return to their jobs and lives with confidence. In this in-depth guide, we’ll explore whiplash, its impact on work, nonsurgical treatments, and the clinical rationale for getting back to work. We’ll also spotlight Dr. Alexander Jimenez, a leading chiropractor and nurse practitioner in El Paso, Texas, whose expertise in personal injury cases helps patients navigate recovery and legal processes. Let’s dive into this journey of healing, with a sprinkle of humor to keep things light—because who said recovery can’t have a few laughs?

What is Whiplash?

Definition and Causes

Whiplash is a neck injury caused by a sudden, forceful back-and-forth movement of the head, much like the crack of a whip. This rapid motion can strain or tear the muscles, ligaments, and tendons in the neck, leading to a range of symptoms. The most common cause is rear-end car collisions, but whiplash can also occur from sports injuries, falls, or even an overly enthusiastic head-banging session at a concert (though we’ll stick to MVAs for now). Research estimates that whiplash affects over one million people annually in the U.S., with societal costs reaching up to $29 billion (Lovell & Galasko, 2002).

The mechanics of whiplash are no joke. When a car is hit from behind, the head accelerates backward and then snaps forward, stretching soft tissues beyond their normal limits. MRI and autopsy studies have shown that whiplash can cause injuries to cervical ligaments, discs, and facet joints, which are critical for neck stability (Kaale et al., 2005). These injuries, often invisible on standard X-rays, can lead to persistent pain if not addressed early.

Symptoms of Whiplash

Whiplash symptoms are as varied as the toppings on a pizza—and just as likely to linger if not handled properly. Common symptoms include:

  • Neck Pain and Stiffness: The hallmark of whiplash, often described as a tight, aching sensation.
  • Headaches: Frequently starting at the base of the skull.
  • Dizziness: Making you feel like you’re on a merry-go-round that won’t stop.
  • Fatigue: Because your body is working overtime to heal.
  • Shoulder, Back, or Arm Pain: Pain can radiate beyond the neck.
  • Numbness or Tingling: Often in the arms, signaling nerve irritation.
  • Blurred Vision, Ringing in the Ears: Less common but still disruptive.
  • Cognitive Issues: Trouble concentrating or remembering, as if your brain took a vacation.
  • Sleep Disturbances, Irritability, Depression: Because chronic pain is a mood-killer.

These symptoms may not show up right away, sometimes taking days or weeks to appear, which is why seeing a doctor ASAP is crucial (Sterner & Gerdle, 2004). Think of it like a sneaky ninja—whiplash can creep up when you least expect it.

SymptomDescription
Neck Pain/StiffnessAching or tightness, limiting neck movement.
HeadachesOften starting at the skull base, can be persistent.
DizzinessFeeling unsteady or lightheaded.
FatigueGeneral tiredness due to the body’s healing efforts.
Radiating PainPain spreading to shoulders, back, or arms.
Numbness/TinglingNerve-related sensations in arms or hands.
Cognitive/Sleep IssuesDifficulty focusing, remembering, or sleeping; irritability or depression.

Impact of Whiplash on Work

Whiplash can throw a wrench into your work life faster than a Monday morning traffic jam. The pain and stiffness can make it tough to sit at a desk, lift boxes, or even focus on a computer screen. Research paints a sobering picture:

  • A BMC Public Health study found that only 44% of whiplash patients returned to work after two years (Freeman et al., 1999).
  • A Danish study of 104 patients reported 56% were still on sick leave two years post-injury (Kasch et al., 2001).
  • Between 19% and 60% of patients experience symptoms six months after injury, with up to half unable to return to work within a year (Sterner & Gerdle, 2004).
  • A 2001 study noted that 12% of whiplash patients hadn’t resumed normal activities or modified job functions a year later (Spitzer et al., 1995).

These numbers show that whiplash isn’t just a physical hurdle—it’s a career roadblock. Chronic symptoms, like persistent neck pain or cognitive difficulties, can lead to long-term work disability, especially if untreated. Imagine trying to type a report while your neck screams, “Not today!” Early treatment is the key to getting back to your desk, warehouse, or classroom without feeling like you’re auditioning for a role as a human statue.

The Power of Chiropractic Chiropractic Care In Injury Rehabilitation- Video

Clinical Rationale for Returning to Work

Returning to work after an MVA isn’t just about paying the bills (though that’s a big motivator!). It’s also about restoring normalcy, boosting mental health, and preventing the downward spiral of inactivity. From a clinical perspective, early mobilization is a game-changer. Prolonged rest can lead to muscle atrophy and increased stiffness, making recovery harder (Quebec Task Force, 1995). Think of your body like a car—if you leave it in the garage too long, it’s going to get rusty.

Healthcare providers often recommend a gradual return to work as part of rehabilitation. This might mean starting with part-time hours or modified duties, like swapping heavy lifting for lighter tasks. The goal is to keep you moving without overdoing it. Studies suggest that early, active rehabilitation—think chiropractic adjustments or physical therapy—can reduce pain and improve function, paving the way for a smoother return to work (Teasell et al., 2010).

However, the decision to return isn’t one-size-fits-all. It depends on:

  • Injury Severity: Mild whiplash might resolve in weeks, while severe cases could take months.
  • Job Demands: A desk job is easier to return to than construction work.
  • Overall Health: Pre-existing conditions can complicate recovery.

A good doctor, like Dr. Alexander Jimenez, will assess these factors and create a plan that gets you back to work without risking further injury. It’s like planning a road trip—you need a map, not just a destination.

Nonsurgical Treatments for Whiplash

Nobody wants to go under the knife if they can avoid it, and luckily, whiplash responds well to nonsurgical treatments. These approaches aim to reduce pain, restore mobility, and get you back to your daily grind. Here’s a rundown of the top options:

  1. Chiropractic Care: Chiropractors use spinal manipulation to realign the spine and relieve nerve pressure. It’s like giving your neck a gentle nudge to say, “Get back in line!” Studies show it can significantly reduce pain and improve mobility (Lord et al., 1996).
  2. Physical Therapy: Physical therapists design exercise programs to strengthen neck muscles and improve range of motion. They might also use heat, ice, ultrasound, or electrical stimulation to ease pain. It’s like a gym session tailored for your neck (Teasell et al., 2010).
  3. Exercise: Gentle exercises, like stretching or swimming, can strengthen the neck and improve posture. Think of it as physical therapy’s fun cousin—less clinical, more doable at home (McLean et al., 2014).
  4. Medications: Over-the-counter pain relievers (e.g., ibuprofen) or muscle relaxants can help manage pain and inflammation. Prescription meds may be used for severe cases (Childs et al., 2008).
  5. Injections: Corticosteroid injections can reduce inflammation in stubborn cases, offering relief when other methods fall short (Barnsley et al., 1994).
  6. Radiofrequency Neurotomy: For chronic pain, this procedure targets specific nerves to block pain signals. It’s like hitting the mute button on your neck’s complaints (Lord et al., 1996).

These treatments work best when started early, preventing symptoms from becoming chronic. Combining them, like pairing chiropractic care with exercise, can supercharge recovery. It’s like assembling a superhero team for your neck—each treatment brings its own powers!

TreatmentBenefitsConsiderations
Chiropractic CareReduces pain, improves spinal alignment and mobility.Requires skilled practitioner; multiple sessions.
Physical TherapyStrengthens muscles, enhances flexibility, reduces pain.Time-intensive; needs patient commitment.
ExerciseImproves posture, strengthens neck, accessible at home.Must be done correctly to avoid strain.
MedicationsQuick pain and inflammation relief.Temporary; potential side effects.
InjectionsTargeted relief for severe inflammation.Invasive; not first-line treatment.
Radiofrequency NeurotomyLong-term pain relief for chronic cases.Specialized procedure; not widely available.

Dr. Alexander Jimenez’s Approach to Personal Injury Cases

In El Paso, Texas, Dr. Alexander Jimenez, DC, APRN, FNP-BC, stands out as a beacon of hope for MVA victims. With over 25 years of experience, Dr. Jimenez combines his expertise as a chiropractor and nurse practitioner to offer integrative care that addresses both the physical and medical aspects of whiplash (Injury Medical Clinic). His clinic, Injury Medical & Chiropractic Clinic, specializes in treating severe pain conditions, including neck pain, back pain, sciatica, and whiplash, using advanced therapies focused on mobility, health, and wellness.

Advanced Diagnostics and Treatment

Dr. Jimenez employs advanced imaging, like MRI and CT scans, to pinpoint injuries that might not show up on standard X-rays. These tools help him identify damage to ligaments, discs, or facet joints, ensuring accurate diagnoses (Jimenez, n.d.). He also uses diagnostic evaluations, such as range-of-motion tests and neurological assessments, to create personalized treatment plans. His dual-scope approach—combining chiropractic adjustments with medical management—ensures holistic care that tackles both symptoms and underlying causes.

Bridging Medical and Legal Needs

Personal injury cases often involve legal battles, and Dr. Jimenez excels as a liaison between medical care and legal documentation. He provides detailed reports that link injuries to the MVA, supporting patients’ claims in court. This is crucial in El Paso, where personal injury cases are common due to frequent MVAs. His ability to translate complex medical findings into clear, legally admissible documentation makes him a trusted partner for both patients and attorneys (Personal Injury Doctor).

Patient-Centered Care

Patients rave about Dr. Jimenez’s compassionate approach. One patient noted, “Dr. Jimenez and his staff genuinely care about your recovery,” highlighting his dedication to improving mobility and reducing pain (Yelp Reviews). His clinic also emphasizes education, teaching patients about injury prevention and wellness to prevent future issues. It’s like getting a personal coach for your health, minus the whistle!

Personal Injury Cases in El Paso

El Paso, a bustling border city, sees its fair share of MVAs, leading to numerous personal injury cases. Whiplash and other soft tissue injuries are common, and navigating the medical and legal landscape can be overwhelming. Dr. Jimenez’s expertise is a game-changer here. His ability to provide comprehensive care while supporting legal claims makes him a go-to practitioner for accident victims. His clinic’s focus on conditions like whiplash, sciatica, and neck pain ensures that patients get back on their feet—and back to work—as quickly as possible (Auto Accident Treatment).

In personal injury cases, medical evidence is critical. Dr. Jimenez’s use of advanced imaging and diagnostics provides solid proof of injury, which can make or break a legal case. His integrative approach also means patients don’t have to bounce between specialists—he handles both the chiropractic and medical sides, streamlining recovery and documentation.

A Touch of Humor

Let’s face it—dealing with whiplash is about as fun as a root canal during a power outage. But here’s a silver lining: with the right care, you can go from “ouch” to “I’ve got this!” faster than you can say “chiropractic adjustment.” Picture your neck as a grumpy cat—stiff and uncooperative at first, but with a little TLC from Dr. Jimenez, it’ll be purring (or at least not hissing) in no time. Humor aside, recovery is serious business, and the right treatment can make all the difference.

Conclusion

Returning to work after an MVA, especially with whiplash, requires a strategic approach that blends timely treatment, personalized care, and expert guidance. Dr. Alexander Jimenez’s integrative methods, advanced diagnostics, and role as a medical-legal liaison make him a standout in El Paso’s personal injury landscape. By addressing whiplash with nonsurgical treatments and supporting patients through recovery and legal processes, he helps them reclaim their lives and livelihoods.

Disclaimer: This blog post is for informational purposes only and should not be taken as medical advice. Always consult a qualified healthcare professional for diagnosis and treatment of any medical condition.

Key Citations

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 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 Advanced Practice Registered Nurses (APRN), Chiropractic Care, El Paso TX, Work Injury , , , , , , , , , , , , ,

Chiropractic and Nurse Practitioner for Injury Recovery

What advantages does possessing dual licensure as a chiropractor and nurse practitioner confer in personal injury lawsuits and automobile accidents?

Chiropractic and Nurse Practitioner On Auto Accidents

Following a motor vehicle collision, chiropractors and nurse practitioners are essential in injury management and recovery facilitation. Chiropractors emphasize manual therapies, including adjustments and manipulations, to resolve musculoskeletal problems and enhance mobility, whereas nurse practitioners deliver comprehensive care encompassing assessments, diagnoses, treatment plans, and education, frequently collaborating with specialists to maximize patient outcomes. (Physicians Group, LLC. 2024)

Chiropractors

Chiropractors address musculoskeletal problems, including back and neck discomfort, frequently resulting from automobile accidents. They employ tactile methods to alleviate discomfort and enhance mobility, frequently without pharmaceuticals. Comprehensive data and expert testimony can substantiate personal injury claims, demonstrating the severity of injuries. (Dies, S., & Strapp, J. W., 1992)

Assessment and Management of Musculoskeletal Disorders

  • Chiropractors can diagnose and treat spinal misalignments, muscle spasms, and soft tissue injuries that may occur following an accident.

Analgesic Relief

  • Manual therapy, such as spine adjustments and soft tissue mobilization, can mitigate pain and diminish inflammation.

Enhanced Mobility

  • Chiropractors can restore range of motion and enhance overall function by correcting joint and muscle limitations.

Comprehensive Care

  • Chiropractors typically emphasize holistic body care and guide sustaining proper posture, ergonomics, and general wellness to avert future injuries.

Cooperation with Additional Healthcare Practitioners

  • Chiropractors can collaborate with physicians, physical therapists, and other professionals to develop a holistic treatment plan for the patient. (Physicians Group, LLC, 2024)

Nurse Practitioners

Nurse practitioners are capable of delivering comprehensive care for injuries resulting from motor vehicle accidents, encompassing (Integrity Spine & Orthopedics, 2024)

Evaluation and Identification

  • Nurse practitioners are capable of performing physical examinations, interpreting diagnostic tests, and diagnosing conditions such as whiplash, soft tissue injuries, and concussions.

Therapeutic Protocols

  • They can develop individualized treatment regimens, encompassing pharmacological therapies, physical rehabilitation, and additional interventions, to meet the patient’s distinct requirements.

Patient Instruction

  • Nurse practitioners can instruct patients regarding their injuries, the recuperation process, and self-care techniques to facilitate healing and avert complications.

Care Coordination

  • They can collaborate with other professionals, including surgeons, neurologists, and physical therapists, to guarantee a comprehensive approach to treatment.

Post-Treatment Care

  • Nurse practitioners can assess the patient’s progress, modify treatment plans as necessary, and offer continuous care during the healing process.

Personal injury cases, especially those resulting from automobile collisions, frequently entail intricate medical and legal requirements. Chiropractors and nurse practitioners, each with unique scopes of practice, are essential in diagnosis, treatment, and documentation.

Chiropractors and nurse practitioners both contribute distinct advantages to personal injury cases. Chiropractors concentrate on musculoskeletal disorders, providing non-invasive therapies, whereas nurse practitioners address a wider range of medical requirements, including the prescription of drugs and the coordination of care. Their collaboration can improve patient results, as demonstrated in environments such as the Accident Treatment and Treatment Center, where nurse practitioners and physicians oversee treatment, augmenting chiropractic interventions. (Accident Care, 2025)

Legal resources indicate that the documentation of both professions is essential for insurance claims and settlements. Chiropractors’ meticulous reports on spinal injuries and nurse practitioners’ extensive medical records on overall health can collectively establish a compelling case for compensation. This synergy is especially apparent in automobile accident situations, where patients may necessitate both physical changes and medical supervision for complete recovery. (Chiropractic Economics, 2023)

Injury Medical Chiropractic and Functional Medicine Clinic

Dr. Jimenez, a family practice nurse practitioner, integrates advanced medical knowledge with chiropractic treatment to manage diverse illnesses. Our clinic amalgamates functional medicine, acupuncture, electro-acupuncture, and sports medicine to design tailored care regimens that foster natural healing, enhance mobility, and ensure long-term 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 are dedicated to treating individuals following injuries and chronic pain disorders. We concentrate on enhancing your capabilities through customized flexibility, mobility, and agility training designed for various age demographics and disabilities. We employ both in-person and virtual health coaching, together with comprehensive care plans, to guarantee tailored care and wellness outcomes for each patient.

Don’t Ignore Your Post-Accident Pain

References

Physicians Group, LLC. (2024). The Role of Nurse Practitioners in Managing Auto Injuries. Physicians Group, LLC. https://physiciansgroupllc.com/the-role-of-nurse-practitioners-in-managing-auto-injuries/#:~:text=Nurse%20Practitioners%20are%20vital%20in,improved%20outcomes%20and%20patient%20satisfaction.

Dies, S., & Strapp, J. W. (1992). Chiropractic treatment of patients in motor vehicle accidents: a statistical analysis. The Journal of the Canadian Chiropractic Association, 36(3), 139–145.

The Neck and Back Clinics. (2025). Why Seeing a Chiropractor After a Car Accident Is Crucial for Long-Term Recovery. https://theneckandbackclinics.com/long-term-recovery/#:~:text=Reducing%20Inflammation%20and%20Pain,each%20patient%20for%20optimal%20recovery.

Integrity Spine & Orthopedics. (2024). The 9 Steps to Recovery After an Auto Accident. https://www.integrityspineortho.com/post/the-9-steps-to-recovery-after-an-auto-accident/#:~:text=CONTACT%20INTEGRITY%20SPINE%20AND%20ORTHOPEDICS%20AFTER%20A,concussions%2C%20soft%20tissue%20damage%20and%20spine%20damage.

Accident Care and Treatment Center, Inc. (2025). Comprehensive Therapies and Treatments in One Location. https://accidentcare.com/treatment/

Chiropractic Economics. (2023). Evidence-based chiropractic: the key to personal-injury cases. https://www.chiroeco.com/evidence-based-chiropractic-the-key-to-personal-injury-cases/

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

Bone Growth Stimulator in Post-Injury Healing

Can bone growth stimulators help promote bone healing in cases where fractures or fusions fail to heal properly?

Bone Growth Stimulator

Individuals who sustain broken bones typically heal the fracture with appropriate treatment, which may include casts, realignment, and surgery. This type of surgery is performed on the spine and joints throughout the body; typically, the bone heals without a problem. Bone healing is a natural process, as bones are constantly replaced with new ones, and after an injury, the body can heal the damage to the bone. However, bone healing sometimes does not happen correctly and/or completely. Bone healing can take a long time, which is known as a delayed union, or it may not occur at all, or a nonunion. This is when a healthcare provider could recommend bone growth stimulation.

How They Work

Bone growth stimulators apply external or implanted electrical or ultrasonic energy to the fracture or fusion site, stimulating bone growth. These devices are often used when a fracture doesn’t heal within the expected timeframe (a nonunion fracture) or when a spinal fusion has not successfully fused. (FDA, 2022)

  • They come in various shapes, sizes, and technologies depending on the location of the fracture.
  • The most commonly used bone stimulators in orthopedics are electrical and ultrasound stimulators.
  • The stimulator emits a pulsed electromagnetic or ultrasonic impulse to the area where bone healing should occur.
  • Most modern bone stimulators are attached near the fracture site or fused with a small battery pack and worn for a period each day that may last minutes or hours.

Electrical Stimulation

  • Devices deliver low-level electrical pulses to the fracture site, which can stimulate bone cells to create new bone tissue.

Ultrasound Stimulation

  • They emit low-intensity pulsed ultrasound waves, which are absorbed by the bone and can promote bone healing.

Implantable vs. External

  • Some stimulators are surgically implanted, providing constant stimulation directly at the fracture site, while others are external and worn over the skin or cast.

The goal is to activate a series of receptors in the body to encourage a healing response. (Childs, S. G. 2003) The stimulator activates a pathway that releases chemicals within the body to promote fracture healing. This type of process in the body is called a cascade, and it happens when one signal stimulates another method, and so on until healing is complete. The bone stimulator ensures this cascade continues until the healing process is complete.

Effectiveness

Studies of bone stimulator effectiveness suggest two benefits:

  1. Less pain is associated with the bone healing process.
  2. Faster fracture healing.

However, these studies haven’t shown that these differences lead to improved patient functional outcomes. It would seem that if there is less pain and faster healing, then the patient should recover without complications. However, some researchers have suggested this is probably because the differences in pain and healing times are small and not necessarily noticeable. (Aleem, I. S. et al., 2016)

  • While bone growth stimulators can be effective, the results can vary, and their effectiveness is still under investigation.
  • Some studies have shown that stimulators can reduce pain and speed up healing time, while others have shown mixed results.
  • It’s important to discuss the benefits and risks of bone growth stimulation with a doctor to determine if it’s the right treatment option.

When Stimulation is Necessary

Bone stimulators are currently not used for routine fracture healing. It is certainly possible that bone healing stimulators will be used routinely in the future. They seem to show some benefit in non-healing fractures or fractures that are likely troublesome to heal. Some reasons individuals may have problems healing fractures are injuries to the blood supply to and around the fracture, injuries to specific bones, and overuse-related fractures. (Victoria, G. et al., 2009) These injuries may include (FDA, 2022)

Nonunion Fractures

  • When a fracture doesn’t heal within the expected timeframe.
  • Open fractures
  • Stress fractures
  • Scaphoid bone fractures
  • Talus fractures

Failed Fusions

  • When a spinal fusion hasn’t been successful.

High-Risk Patients

  • For individuals with factors that can hinder bone healing, such as smoking, diabetes, or certain medications

Bone healing typically proceeds without much problem. However, there are situations where people have issues healing after fractures or surgery. Bone stimulators are not used for routine bone healing but in situations where steps may be needed to help stimulate the body. While the improvement may be small, it may be critical if it is the difference between healing and nonhealing.

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.

From Injury to Recovery with Chiropractic Care

References

U.S. Food & Drug Administration. (2022). AccelStim Bone Growth Stimulator – P210035. Retrieved from https://www.fda.gov/medical-devices/recently-approved-devices/accelstim-bone-growth-stimulator-p210035#:~:text=What%20is%20it?,the%20transducer%20to%20the%20fracture

Childs, S. G. (2003). Stimulators of bone healing. Biologic and biomechanical. Orthopedic nursing, 22(6), 421–428. https://doi.org/10.1097/00006416-200311000-00010

Aleem, I. S., Aleem, I., Evaniew, N., Busse, J. W., Yaszemski, M., Agarwal, A., Einhorn, T., & Bhandari, M. (2016). Efficacy of Electrical Stimulators for Bone Healing: A Meta-Analysis of Randomized Sham-Controlled Trials. Scientific Reports, 6, 31724. https://doi.org/10.1038/srep31724

Victoria, G., Petrisor, B., Drew, B., & Dick, D. (2009). Bone stimulation for fracture healing: What’s all the fuss?. Indian Journal of Orthopaedics, 43(2), 117–120. https://doi.org/10.4103/0019-5413.50844

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