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Tag: integrative chiropractic care

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Hormones: A Comprehensive Guide for Thyroid Optimization

Learn about thyroid optimization for hormones and their vital role in your health. Optimize your thyroid for improved vitality and balance.

Abstract

I wrote this educational post to share how I evaluate and treat persistent hypothyroid symptoms when traditional, TSH-centered therapy falls short. Drawing on my personal journey of living without a thyroid and more than a decade in integrated clinical practice, I explain why patients can feel hypothyroid with “normal” lab values, how the deiodinase system and reverse T3 shape symptoms, and where free T3 offers a more reliable clinical compass. I also detail why some people do better on combination T4/T3 therapy or desiccated thyroid, how nutrient cofactors like iron and selenium transform outcomes, and why lab timing and dose splitting matter. I show where integrative chiropractic care fits by improving autonomic balance, pain, sleep, and movement capacity—factors that directly influence hormone conversion and tissue response. Throughout, I integrate modern, evidence-based research and reference leading studies in endocrinology, cardiology, neurology, and rehabilitation. You will find a precise, step-by-step framework to help patients move from biochemical uncertainty to functional recovery.

The Journey Without a Thyroid and How It Shapes My Care

I practice medicine and chiropractic with a unique perspective. Many patients were required to complete thyroid removal. In the era before recombinant TSH, I experienced diagnostic withdrawal phases that pushed my TSH above 150 mIU/L. They felt the hard edge of metabolic shutdown—cold intolerance, constipation, bradypsychia (slowed thinking), and the kind of profound fatigue that flattens life.

Those deeply personal experiences transformed how I listen to and care for patients. Over the last 14 years, I have provided longitudinal care for more than 9,000 patients with thyroid-related conditions. I repeatedly see the gap between “lab-normal” and truly feeling normal in daily life. Many arrive with TSH values in range on levothyroxine yet still grapple with persistent symptoms.

In my chiropractic practice, I integrate precise spinal adjustments to optimize nervous system function and autonomic balance, thereby directly supporting endocrine regulation and helping close that gap. Patients often describe the full spectrum of thyroid imbalance: classic hypothyroid effects such as fatigue, weight gain, hair thinning, low mood or depression, brain fog, slowed cognition, dry skin, muscle weakness, constipation, cold intolerance, and exercise intolerance; as well as disruptive hyperthyroid symptoms including unintended weight loss despite increased appetite, heat intolerance, anxiety or irritability, rapid heartbeat or palpitations, diarrhea, tremors, restlessness, insomnia, and excessive sweating.

Many therapeutic journeys have reached the same conclusion: many patients need a more nuanced approach than T4 replacement alone—sometimes adding T3, correcting nutrient gaps, addressing gut-liver dysfunction, or resolving autonomic imbalance. These lived lessons anchor the whole-person framework I share here.
References for clinical updates and case observations:
ChiroMed: https://chiromed.com/
LinkedIn: https://www.linkedin.com/in/dralexjimenez/

Thyroid Physiology And Why A Normal TSH Can Mask Low Tissue Thyroid Action

To fully explain persistent symptoms, I begin with the hypothalamic-pituitary-thyroid (HPT) axis and tissue-level control:

  • The hypothalamus releases TRH, prompting the pituitary to release TSH, which signals the thyroid to make T4 and T3.
  • T3 is the bioactive hormone that binds to nuclear thyroid receptors (TRα, TRβ), upregulates mitochondrial and metabolic genes, and drives energy production.
  • Most circulating T3 is made in peripheral tissues by deiodinases. D1 and D2 convert T4 to T3, while D3 shunts T4 into reverse T3 (rT3)—an inactive isomer that competes with T3 for receptor access.

When inflammation, stress, or nutrient deficiency suppress D1 and favor D3, the result is a “low T3–high rT3” pattern. The pituitary, cushioned by local D2 activity, may “feel” replete and keep TSH within range, while muscles, brain, liver, and heart remain T3-deficient. This is how people feel hypothyroid despite a “normal” TSH.

  • Deiodinase and tissue signaling overview: (Bianco & Kim, 2018)
  • Non-thyroidal illness and low T3 physiology: (Peeters, 2017)
  • Transporter and receptor influences on intracellular signaling: (Friesema et al., 2010)

Citations:

Why Free T3 Predicts Function Better Than TSH During Treatment

In practice and research, free T3 correlates more tightly with energy, thermoregulation, cognition, and cardiometabolic outcomes than TSH when therapy is underway. While TSH is an excellent screening tool in untreated populations, it does not reliably reflect tissue thyroid status once exogenous hormone is introduced. Peripheral tissues depend on D1, which is easily downregulated by stress and illness. The pituitary’s reliance on D2 allows TSH to normalize even as free T3 remains low or rT3 rises.

  • Cardiovascular findings consistently link low T3 with worse outcomes; TSH often shows weak or no association (Dimitriadis et al., 2014; Iervasi et al., 2010).
  • In critical illness and ARDS, low T3 predicts higher mortality and delayed recovery (Wajner & Maia, 2015).

Citations:

The Reverse T3 Brake And The Conversion Ecology

I teach patients to think of reverse T3 as a physiologic brake. Under stress, inflammation, infection, caloric restriction, or high T4 loads, D3 increases and shunts T4 into rT3. Elevated rT3 effectively blocks T3’s action by competing for receptor and transport access.

  • Symptoms of high rT3/low T3: fatigue, cold intolerance, constipation, dry skin, sluggish thinking, reduced exercise tolerance.
  • Clinical reasoning: Adding more T4 in a high rT3 state often worsens the problem by feeding the brake. We must address stressors, reduce inflammation, optimize cofactors, and, when indicated, add physiologic T3.

Mechanistic reviews:

Levothyroxine Alone: When The Assumptions Fail

The traditional assumption was that T4-only therapy would convert adequately to T3 and fully resolve symptoms. Many patients do improve on levothyroxine. Yet a meaningful proportion remain symptomatic because of impaired conversion or high rT3.

  • Genetic polymorphisms (e.g., DIO2 Thr92Ala) and inflammatory states alter T3 production and action (Panicker et al., 2009).
  • Caloric restriction, illness, and iron deficiency shift deiodinase activity away from T3 (Stott et al., 2019).

A physiologic alternative is to use combination therapy (T4 + T3) or desiccated thyroid (DTE) for select patients with persistent symptoms, carefully titrated and monitored for safety.
Citations:

The Testosterone Connection And Metabolic Synergy

Thyroid hormones and androgens co-regulate metabolic rate, muscle protein synthesis, and mitochondrial efficiency:
Hypothyroidism can downregulate androgen receptors; low testosterone reduces muscle mass and worsens fatigue (Kelly & Jones, 2015).

  • Thyroid hormones increase SHBG, thereby altering the free fractions of testosterone and estradiol (Davis & Wahlin-Jacobsen, 2015).
  • Visceral adiposity increases aromatase activity, further lowering free testosterone. Optimizing thyroid action reduces central fat and indirectly improves androgen balance.

Citations:

An Evidence-Guided Evaluation Framework I Use In Clinic

To identify root causes of persistent symptoms, I apply a structured model:

  • Comprehensive thyroid panel and dynamics
    • TSH, free T4, free T3, and reverse T3 to map supply, conversion, and braking.
    • Thyroid antibodies (TPOAb, TgAb) for autoimmunity surveillance.
    • Consistent lab timing relative to dosing.
  • Nutrient and hematologic status
    • Ferritin, iron indices, selenium, zinc, vitamin D, vitamin A, B12; iodine assessment when indicated and carefully monitored.
    • Rationale: cofactors enable hormone synthesis and conversion (Zimmermann & Köhrle, 2002).
  • Inflammation and metabolic health
    • hsCRP, fasting insulin, HOMA-IR, lipids, liver enzymes; body composition for lean mass and visceral fat.
  • Gut-liver axis
    • Screen dysbiosis/SIBO symptoms, celiac markers, NAFLD risk, bile flow, and constipation patterns (Docimo et al., 2021).
  • Autonomic nervous system and stress load
    • HRV, orthostatic vitals, sleep quality, perceived stress.
  • Sex hormones and adrenal rhythm (as indicated)
    • Total and free testosterone, SHBG, estradiol, LH/FSH; DHEA-S; consider cortisol profiles when warranted.

Citations:

Precision Dosing: Why Lab Timing And Dose Splits Matter

When I incorporate T3 (liothyronine) or use desiccated thyroid, I standardize lab draws at five to six hours after the morning dose and split doses to avoid peaks:

  • Pharmacokinetics: Oral T3 peaks about 1–2 hours after ingestion and declines over the next several hours. Drawing at 5–6 hours captures a mid-curve snapshot that is comparable across visits (Ross, 2022; Jonklaas et al., 2019).
  • Dose splitting: I typically use BID or TID schedules (e.g., 6:00 a.m., 12:00 p.m., 6:00 p.m.) to maintain steady intracellular T3 for mitochondrial throughput, cognitive function, and thermoregulation. This dramatically reduces palpitations and anxiety tied to early peaks.
  • Wearables: I ask patients to track heart rate and sleep. Post-dose pulse spikes confirm kinetic peaks and guide redistribution.

Citations:

Combination Therapy And Desiccated Thyroid: How I Use Them And Why

I consider combination T4/T3 or desiccated thyroid extract (DTE) for patients with persistent symptoms and a lab pattern of low free T3 and/or elevated rT3:

  • Start low and titrate slowly
    • Introduce small, divided T3 doses to avoid peak-related side effects.
    • Maintain a baseline T4 level for substrate, while ensuring receptor activation by T3.
  • DTE practicals
    • Typical starting range: 1–1.5 grains (60–90 mg) daily, individualized to prior T4 dose and sensitivity.
    • Transition approach: a two-week half-and-half overlap (half prior T4 dose plus half new DTE dose) to avoid T3-naïve jitters.
    • Limit large single doses; distribute across the day if a higher total daily dose is needed.
  • Monitoring
    • Symptoms, free T3, free T4, and safety markers (heart rate, blood pressure).
    • Long-term: bone density surveillance when higher T3 exposures are used in specific populations.

Evidence-based and patient preference data:

Nutrient Therapy That Changes Outcomes: The Thyroid

The thyroid hormone is a signal, but the body needs substrates and cofactors to translate that signal into action. I routinely assess and treat:

  • Iron repletion when ferritin is low (often targeting >50–70 ng/mL for thyroid optimization)
    • Iron supports thyroid peroxidase and deiodinase function; low ferritin levels blunt T4-to-T3 conversion and can mimic hypothyroid symptoms.
  • Selenium (100–200 mcg/day from diet/supplement)
    • Supports deiodinase activity and antioxidant defense; may modestly reduce TPO antibodies (Winther et al., 2020).
  • Zinc, vitamin D, vitamin A, and B12
    • Zinc facilitates receptor function; vitamin D modulates immune tone and muscle; vitamin A supports epithelial and receptor dynamics.
  • Protein sufficiency (often 1.2–1.6 g/kg/day)
    • Supports thyroid transport proteins, hepatic conversion, and muscle mass.

Citations:

Integrative Chiropractic Care: Autonomic Regulation, Pain Reduction, And Metabolic Performance

As a DC and APRN, I see daily how neuromusculoskeletal health and the autonomic nervous system shape endocrine outcomes. Integrative chiropractic care fits into thyroid optimization by:

  • Autonomic regulation
    • Gentle spinal manipulation and soft-tissue techniques reduce nociceptive input and sympathetic overdrive, improving vagal tone and HRV. Lower stress signaling supports D1 activity, reduces rT3, and improves sleep quality.
  • Pain reduction
    • By reducing chronic pain, we lower inflammatory cytokines (e.g., IL-6, TNF-α) that suppress deiodinases and disrupt sleep, thereby enabling better hormone conversion and tissue responses.
  • Movement-based care
    • Structured resistance training and aerobic intervals, guided by movement assessment, improve insulin sensitivity, GLUT-4 translocation, and mitochondrial density, amplifying T3’s metabolic impact.
  • Breath and posture
    • Thoracic mobility and diaphragmatic breathing enhance oxygenation, vagal tone, and sleep—key supports for endocrine stability.


Clinical observations:
In my practice at ChiroMed, patients who pair optimized thyroid therapy with chiropractic autonomic optimization, mobility work, and progressive strength programming recover faster, maintain better energy, and sustain fat loss more reliably. See clinical reflections and case pearls:

Metabolic Rehabilitation: Building A Physiology That Welcomes T3

Thyroid optimization alone rarely solves modern metabolic challenges. I employ a pragmatic blueprint:

  • Build muscle first
    • Two or more weekly full-body resistance training sessions with progressive overload. More muscle equals a higher basal metabolic rate and better glucose disposal.
  • Walk the thermostat
    • 7,000–10,000+ daily steps, with postprandial 10–15-minute brisk walks, to blunt glucose excursions and lower inflammation.
  • Prioritize sleep and rhythm.m
    • Stable sleep-wake times, morning light exposure, and evening light reduction improve HPT-axis signaling and insulin sensitivity.
  • Protein-forward nutrition
    • 25–40 g protein per meal; fiber-rich plants and healthy fats; minimize ultra-processed foods.
  • Micronutrient sufficiency
    • Emphasize seafood (selenium, iodine), lean meats (iron, zinc, B12), eggs (vitamin A), and leafy greens (folate, magnesium).
  • Stress modulation
    • Breathing practices, HRV-guided recovery, and time in nature lower cortisol and rT3.
  • Manual and chiropractic care
    • Identify and correct joint restrictions and postural dysfunctions that limit training and raise sympathetic tone.

Epidemiologic context: U.S. obesity prevalence continues to rise, underscoring the need to embed thyroid care within a broader metabolic strategy (CDC, 2023).
Citation:

Thyroid Dysfunction-Video

Safety And Monitoring: Cardiac And Bone Health With T3

I titrate T3 conservatively and monitor:

  • Cardiac status (resting pulse, symptoms; ECG as indicated in arrhythmia-prone patients).
  • Bone health (ensure adequate calcium and vitamin D, prioritize resistance training, and follow DEXA for at-risk individuals).
  • Symptoms and function (energy, thermoregulation, bowel rhythm, cognition, sleep).
  • Free T3/Free T4, with TSH interpreted cautiously under T3-containing regimens.

A key clinical distinction: TSH suppression on therapy is not the same as endogenous hyperthyroidism. In thyroid cancer cohorts, carefully managed TSH suppression does not universally increase atrial fibrillation or osteoporosis risk when free hormones and clinical markers are appropriately monitored. We individualize targets rather than relying on a single lab threshold.
Reviews:

Standardizing Testing: Reducing Noise And Improving Decisions

The most powerful lever in precision thyroid care is standardization:

  • Fix dosing times (e.g., 6:00 a.m., 12:00 p.m., 6:00 p.m.).
  • Lock blood draws at five to six hours after the morning dose.
  • If patients arrive outside the window, reschedule to keep results comparable.
  • Use simple EMR notes to track outcomes: “Free T3 improved; patient reports better focus and energy; no adverse effects at standard draw; pulse stable.”

This rigor transforms guesswork into reliable, reproducible decisions.
Citations:

Case Patterns From Practice: How The Physiology Plays Out

The “stuck but strict” patient

  • A woman on levothyroxine with normal TSH but persistent fatigue and weight gain. Ferritin was 18 ng/mL; vitamin D was 22 ng/mL; rT3 was elevated. After iron and vitamin D repletion, post-meal walking, and low-dose T3 add-on, energy rose within weeks. Resistance training resulted in a 6% relative reduction in body fat over four months; we later tapered levothyroxine as conversion normalized.

The “pain-metabolism loop.”

  • A man with low back pain avoided exercise and gained weight while on stable thyroid replacement therapy. Integrative chiropractic care reduced pain and improved mobility. We added a graded strength plan and sleep coaching; HRV improved. With modest T3 addition, he reported clearer thinking and greater stamina.

The”testosterone trap.”

  • A man sought testosterone for fatigue and low libido. Evaluation revealed low-normal free T3, elevated rT3, high stress, and poor sleep. We prioritized thyroid optimization, sleep, and resistance training. Free testosterone improved without exogenous testosterone; symptoms resolved.

Clinical notes and similar cases:

Practical Steps For Patients And Clinicians

Patients

  • Ask for a comprehensive thyroid panel: TSH, free T4, free T3; consider reverse T3 if symptoms persist.
  • Check ferritin, selenium, zinc, vitamin D, and B12; discuss iodine only with clinical guidance.
  • Standardize dosing times and lab draw timing; split doses if needed to reduce peaks.
  • Build muscle, walk after meals, and protect sleep; track pulse and sleep with wearables if possible.
  • Consider integrative chiropractic care to improve pain, autonomic balance, and movement capacity.

Clinicians

  • Treat the person, not just the lab. If symptoms persist with “normal” TSH, investigate conversion ecology, cofactors, and comorbidities.
  • Consider cautious T4/T3 combination or DTE trials with standardized monitoring and safety tracking.
  • Pair endocrine therapy with nutrition, sleep, stress care, and chiropractic/rehab partners.
  • Reassess as inflammation, body composition, and fitness improve; the right dose today may be excessive in six months.

Closing Perspective: Aligning Therapy With Physiology

Living without a thyroid taught me respect for the complexity of endocrine physiology and the limits of single-number thinking. Care improves when we align therapy with how the body actually works: ensure adequate hormone supply; correct cofactor deficiencies; calm the autonomic nervous system; build muscle; and remove friction points such as pain, inflammation, and poor sleep. When we combine personalized thyroid replacement, targeted nutrient therapy, and integrative chiropractic care within a metabolic rehabilitation framework, patients stop treading water and begin moving forward.

References

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A Modern, Integrative Approach to Thyroid Optimization

A Modern, Integrative Approach to Thyroid Optimization

A Modern, Integrative Approach to Thyroid Optimization

Abstract

For decades, the standard approach to treating hypothyroidism has centered on a single lab value—Thyroid-Stimulating Hormone (TSH)—and a single medication, synthetic T4 (levothyroxine). However, an increasing body of evidence and extensive clinical observations indicate that this approach is fundamentally flawed for a significant proportion of patients. Many individuals on T4-only therapy continue to suffer from debilitating hypothyroid symptoms like fatigue, weight gain, hair loss, and depression, despite their TSH levels appearing “normal.” This educational post will explore the intricate physiology of thyroid hormone, explaining why T4 is a prohormone and why active T3 is the key to metabolic health. We will deconstruct the limitations of TSH testing, explore the critical process of T4-to-T3 conversion, and introduce the problematic role of Reverse T3. Drawing from the latest evidence-based research and my own clinical experience, I will outline a more comprehensive, patient-centered approach to diagnosing and managing thyroid dysfunction. We will discuss the vital importance of Free T3 (FT3), the shortcomings of standard lab ranges, and the clinical benefits of combination therapy, including Natural Desiccated Thyroid (NDT). Furthermore, I will explain the critical, yet often overlooked, role of iodine and how integrative chiropractic care forms a foundational part of treatment by optimizing nervous system function and supporting the body’s innate ability to heal.

Rethinking Thyroid Care: Moving Beyond Outdated Protocols

As a practitioner with credentials spanning chiropractic, advanced practice nursing, and functional medicine (DC, APRN, FNP-BC, CFMP, IFMCP, ATN, CCST), I have dedicated my career to challenging long-held conventions in healthcare to identify what truly works for patients. Today, I want to guide you on a journey into the world of the thyroid, and in doing so, I may need to unravel some of what you’ve come to understand from conventional medical training. My goal is not to create a new, complicated system but to return to a more fundamental, physiological truth. My goal is to assist individuals in returning to a lifestyle that aligns with the natural and optimal design of our bodies.

For over a decade, I’ve focused on this physiological approach, and the feedback from patients at my clinic has been overwhelmingly positive. They feel better, their symptoms resolve, and their lives are transformed. This isn’t based on a fad; it’s grounded in pure physiology. When we appreciate and work with the body’s intricate systems instead of against them, we see profound clinical success. This is particularly true when it comes to the thyroid.

Thyroid Hormone: Your Body’s Metabolic Engine

The thyroid hormone is the master regulator of your metabolism. It dictates the speed of nearly every cellular process in your body. Think of it as the engine’s pace car. It controls:

  • Energy Production: Your overall rate of energy expenditure.
  • Temperature Regulation: Why you might feel cold when others are comfortable.
  • Growth Rates: How fast your hair and nails grow.
  • Gastrointestinal Motility: The speed of your digestive system influences constipation or diarrhea.
  • Cellular Health: Research has even linked low levels of the active thyroid hormone T3 to an increased risk of certain cancers.

The Synthroid Paradox: Normal Labs, Persistent Symptoms

The most widely prescribed thyroid medication in history is levothyroxine, with Synthroid being the most recognizable brand name. Yet, in my clinical practice, I see a daily parade of patients who are taking it and are still miserable. I recently saw a patient who had been on a stable dose of Synthroid for years. Her endocrinologist told her that her labs were perfect, with a TSH of 1.5. Yet, her chart told a different story.

  • Chief Complaint: Fatigue. She was exhausted.
  • Clinical Signs: She was wearing a thick jacket in my office… in the middle of a Texas July.
  • Other Symptoms: She was constipated, and her hair was falling out in clumps.

Her labs may have looked “normal,” but she was a walking textbook of hypothyroid symptoms. If her thyroid replacement were truly working, she would not have these symptoms. Clearly, something was not right.

This scenario is the direct result of a historical confluence of events. Synthroid was approved around 1960 based on two simple criteria: it normalized the TSH, and it didn’t cause immediate harm. It was never studied for its ability to resolve the clinical symptoms of hypothyroidism. Around the same time, the ultra-sensitive TSH assay was developed and quickly became the “gold standard” lab test.

Medical schools and residency programs immediately adopted this new paradigm: Diagnose with TSH, treat with Synthroid, and monitor with TSH. This simplistic loop became dogma. The patient’s well-being became secondary to achieving a “normal” lab number. This is a fundamental flaw in modern endocrinology, and it’s leaving millions of patients to suffer unnecessarily.

Redefining Hypothyroidism: A Deeper Look at T3 and T4

To fix this problem, we must first redefine it. The conventional definition of hypothyroidism is based on a lab test. A functional and more accurate definition focuses on the body’s physiological state.

  • Type 1 Hypothyroidism: This is a production problem. The thyroid gland itself is not producing enough hormone. This can be due to surgical removal, radioactive iodine ablation, autoimmune destruction (Hashimoto’s disease), or glandular burnout from chronic stress.
  • Type 2 Hypothyroidism: This is a conversion problem. The body is unable to effectively convert the inactive storage hormone (T4) into the active, usable hormone (T3). This is where the standard T4-only treatment model fails.
  • Type 3 Hypothyroidism: This is a receptor issue in which cellular receptors become resistant to thyroid hormone, often due to inflammation or illness.

The thyroid gland produces a hormone called thyroxine (T4), which contains four iodine atoms. To become metabolically active, it must lose one iodine atom to become triiodothyronine (T3). T3 has five times the affinity for the thyroid receptor as T4. This means T3 is the hormone that does the heavy lifting. T4 is simply the raw material we store to make T3 whenever we need it. You live off your T3.

The Critical Flaw of TSH Testing and Deiodinase Dysfunction

The TSH test was designed as a screening test for an asymptomatic population to see if they are at risk for a thyroid condition. The inventor of the assay himself stated it was never intended to be used to monitor or guide therapy for a treated patient. So why is it the cornerstone of modern treatment? Because it makes the lab reports look good, providing a false sense of security for practitioners while patients remain unwell.

A pivotal study published by Escobar-Morreale et al. (1997) shed light on this discrepancy. Researchers discovered that the concentration of T3 varied significantly in different tissues throughout the body—the liver, kidneys, and muscles. But there was one place where T3 levels remained stable, even when they were low everywhere else: the brain.

This is because the brain and pituitary gland exhibit a unique, highly concentrated expression of the enzyme deiodinase type 2 (D2). This enzyme is responsible for converting T4 into the active T3. The rest of your body—the periphery—also uses D2, but a host of common stressors can downregulate its activity there while leaving it untouched in the pituitary.

What does this mean? It means your pituitary gland—the very organ that produces TSH—lives in a “T3 bubble,” isolated from the reality of what’s happening in the rest of your body. Your muscles, liver, and fat cells can be starving for T3, but your brain’s T3 level can remain perfectly normal. Consequently, your pituitary sees no problem and keeps the TSH level low and “normal.” Your pituitary gland has no idea what the T3 level is in your big toe, and TSH cannot tell us. This is why a patient can have a “perfect” TSH and still feel terrible.

The Roadblock: Reverse T3 and Poor Conversion

The body has a protective buffer system. Under conditions of stress, inflammation, illness, or nutrient deficiency, the body can divert T4 down a different path. Instead of converting to active T3, it uses a different enzyme, deiodinase type 3 (D3), to convert T4 into an inactive form called Reverse T3 (rT3).

Reverse T3 has the same shape as active T3, allowing it to fit into the thyroid receptor. However, it is a dud. It doesn’t turn the engine on. Instead, it sits there, blocking active T3 from getting to the receptor.

When you give a patient a large dose of T4, especially if they have underlying inflammation or stress, their body often perceives it as a threat. To protect itself from becoming overstimulated, it down-regulates D2 (making less active T3) and up-regulates D3 (making more inactive Reverse T3). The result? The patient’s TSH goes down, their labs look “good,” but their symptoms get worse because their cells are being flooded with an inactive blocker hormone.

A landmark study from Israel beautifully outlines the myriad factors that impair the conversion of T4 to T3:

  • Psychological and Physical Stress: High cortisol is a potent inhibitor.
  • Insulin Resistance and Diabetes: Poor blood sugar control disrupts thyroid function.
  • Inflammation: Cytokines from injury, infection, or chronic disease impair deiodinase enzymes.
  • Autoimmune Disease: Conditions such as Hashimoto’s cause chronic inflammation.
  • Nutrient Deficiencies: Deficiencies in key minerals like iron (ferritin) and selenium are critical cofactors for deiodinase enzymes.
  • Aging: The natural process of aging reduces conversion efficiency, as noted by Duntas & Biondi (2011).

Considering this list, it’s clear that the vast majority of people are not converting T4 to T3 optimally, creating an epidemic of subclinical, functional hypothyroidism.

The Heart of the Matter: Low T3 Syndrome and Cardiovascular Risk

The medical field that has most urgently recognized the danger of this condition is cardiology. An overwhelming body of research now links Low T3 Syndrome directly to poor outcomes in cardiovascular disease. A landmark study by Iervasi et al. (2003) found that in patients with heart disease, a low T3 level was a strong prognostic predictor of death, whereas TSH had no predictive value.

Why is this the case? The myocardium, or heart muscle, is exquisitely sensitive to T3. It relies on adequate T3 for proper contractility, rhythm, and overall function. When serum T3 is low, the heart is essentially starved of its primary metabolic fuel. Historically, how did patients with profound, untreated hypothyroidism die? Almost universally from cardiovascular events. A healthy Free T3 level is a critical component of cardiovascular protection. Patients in the lower part of the lab reference range can have a 33% to 66% higher risk of all-cause and cardiovascular mortality compared to those in the upper range (Pingitore, Iervasi, & Chopra, 2008).

The Problem with “Normal”: Redefining Lab Reference Ranges

This brings me to a fundamental problem in conventional medicine: our reliance on statistically “normal” reference ranges. Let’s say the lab reference range for Free T3 is 2.2 to 4.2 pg/mL. A patient comes to me with a level of 2.3 pg/mL. They have been told their thyroid is “normal.” Yet, they are exhausted, their hair is falling out, and they can’t lose weight.

What does being in the 10th percentile of the reference range truly mean? It means 90% of the population has more of this vital, energy-giving hormone than you do. Does that sound optimal? Of course not. My approach is to move patients from the bottom of the range to a more optimal position, typically aiming for the top quartile (75th percentile and above). I am not treating a lab number; I am treating a patient.

A Modern, Evidence-Based Treatment Protocol

So, how do we put all this knowledge into practice? Here is the approach I use, which is grounded in the latest research and my clinical experience.

1. Comprehensive Lab Testing

A TSH-only screen is inadequate. I order a full panel that includes TSH, Free T4, Free T3, and Thyroid Antibodies (TPO and TgAb). If a patient is on T4-only medication and still has symptoms, I always order a Reverse T3 (RT3) test. This panel gives us the complete picture.

2. Choosing the Right Medication

The evidence and patient satisfaction surveys point to a clear conclusion: T4-only therapy is not effective for a significant portion of the population. A 2018 online survey of over 12,000 thyroid patients found that those taking Natural Desiccated Thyroid (NDT), which contains both T4 and T3 (such as NP Thyroid or Armor Thyroid), reported significantly higher satisfaction with their treatment (Peterson et al., 2018).

NDT is derived from porcine thyroid glands and contains T4 and T3 in a ratio very similar to the human thyroid. It provides the body with the active hormone it needs directly, bypassing potential conversion issues. When transitioning a patient from a synthetic T4 medication, I use a careful overlap protocol to allow the body to acclimate smoothly.

3. Standardizing Lab Draws and Dosing

T3 has a very short half-life of about 18-24 hours. To obtain meaningful and consistent data, testing must be standardized. I instruct all my patients to have their blood drawn five to six hours after taking their morning dose. This provides us with a consistent point on the absorption curve.

For my patients with Type 1 hypothyroidism—those without a functioning thyroid—a significant breakthrough has been the introduction of a second, afternoon dose of NDT. Because of T3’s short half-life, a single morning dose often leads to a “crash” by 3 or 4 p.m. By splitting their total daily dose, we maintain a more stable level of active T3, transforming their energy and quality of life.

The Critical, Overlooked Role of Iodine

I cannot overstate the importance of iodine for thyroid health and overall well-being. The Recommended Dietary Allowance (RDA) in the U.S. is a mere 150 micrograms, an amount established simply to prevent goiter, not to promote optimal health. In stark contrast, the average daily intake of iodine in Japan is over 13 milligrams (13,000 micrograms), primarily from seaweed. The correlation with cancer rates is alarming; Japan has significantly lower rates of breast and prostate cancer. As Dr. David Brownstein explains in his book, Iodine: Why You Need It, Why You Can’t Live Without It, this is likely not a coincidence.

Iodine is essential not just for the thyroid but for breast tissue, the prostate, ovaries, and every cell in the body. When you begin supplementing an iodine-deficient person, TSH will temporarily rise. This is the body’s intelligent response to produce more sodium-iodide symporters (NIS)—the gateways that pull iodine into the cells. An uninformed practitioner might see this TSH spike and wrongly conclude that the iodine is harmful. This is why I tell my patients we will not check a TSH level for at least nine months after starting iodine therapy. Free T3 and the patient’s symptoms are our true guides.

Integrative Chiropractic Care: The Neurological Connection

As a Doctor of Chiropractic (DC), I view the body through the lens of the nervous system as the master controller of all other systems, including the endocrine system. The connection among the spine, the nervous system, and thyroid function is a critical yet often-overlooked piece of the puzzle.

The thyroid gland receives its nerve supply from the cervical spine. Misalignments, or vertebral subluxations, in this area can interfere with the nerve signals traveling between the brain and the thyroid. This can disrupt the delicate feedback loop of the hypothalamic-pituitary-thyroid (HPT) axis.

How Chiropractic Fits In:

  • Restoring Nerve Function: Through specific, gentle chiropractic adjustments, we can correct subluxations in the cervical spine. This restores proper nerve flow, ensuring the brain and thyroid can communicate effectively. In my clinic, I have observed that patients receiving regular chiropractic care often see improvements in their thyroid function.
  • Reducing Systemic Stress: The chiropractic adjustment has a powerful effect on the autonomic nervous system, helping to shift the body from a “fight-or-flight” (sympathetic) state to a “rest-and-digest” (parasympathetic) state. Chronic stress elevates cortisol levels, which inhibit the conversion of T4 to T3. By modulating the stress response through chiropractic care, we create a more favorable hormonal environment for optimal thyroid function.
  • Holistic Support: Integrative chiropractic care encompasses nutritional counseling, lifestyle recommendations, and stress management techniques, all of which are foundational to supporting endocrine health.

By integrating chiropractic adjustments with functional medicine protocols, we address both the biochemical and neurological aspects of thyroid dysfunction, providing a truly comprehensive and powerful path to healing. Ultimately, our goal is not just to fix a lab value. It is to listen to our patients, to understand the deep physiological imbalances at play, and to use every evidence-based tool at our disposal to restore health and change lives.

References

Brownstein, D. (2014). Iodine: Why you need it, why you can’t live without it (5th ed.). Medical Alternatives Press.

Duntas, L. H., & Biondi, B. (2011). The aging thyroid: a challenge for the clinician. Nature Reviews Endocrinology, 7(9), 558–560. https://www.nature.com/articles/nrendo.2011.83

Escobar-Morreale, H. F., Obregón, M. J., Escobar del Rey, F., & Morreale de Escobar, G. (1997). Tissue-specific patterns of changes in 3,5,3′-triiodothyronine concentrations in hypothyroid rats. Endocrinology, 138(6), 2494-2503. https://doi.org/10.1210/endo.138.6.5186

Guo, T., Wang, Y., Zhang, Y., Ma, J., & Wang, F. (2022). Lower free triiodothyronine levels are associated with major depressive disorder and its symptom severity. Psychoneuroendocrinology, 146, 105952. https://doi.org/10.1016/j.psyneuen.2022.105952

Iervasi, G., Pingitore, A., Landi, P., Raciti, M., Ripoli, A., Scarlattini, M., L’Abbate, A., & Donato, L. (2003). Low-T3 syndrome: a strong prognostic predictor of death in patients with heart disease. Circulation, 107(5), 708–713. https://www.ahajournals.org/doi/10.1161/01.cir.0000048039.63811.23

Peeters, R. P., Wouters, P. J., van Toor, H., Kaptein, E., Visser, T. J., & Van den Berghe, G. (2003). Serum 3,3′,5′-triiodothyronine (rT3) and 3,5,3′-triiodothyronine/rT3 are prognostic markers in critically ill patients and are associated with postmortem tissue deiodinase activities. The Journal of Clinical Endocrinology & Metabolism, 88(10), 4559–4565. https://academic.oup.com/jcem/article/88/10/4559/2845213

Peterson, S. J., Cappola, A. R., Castro, M. R., Dayan, C. M., Farwell, A. P., Hescox, M., & … Bianco, A. C. (2018). An online survey of hypothyroid patients demonstrates prominent dissatisfaction. Thyroid, 28(6), 707–721. https://doi.org/10.1089/thy.2017.0681

Pingitore, A., Iervasi, G., & Chopra, I. J. (2008). The role of thyroid hormone in the heart. Journal of Clinical Endocrinology & Metabolism, 93(6), 1957–1964.

Shakir, M. K., Brooks, B. A., & Crooks, L. A. (2007). The significance of a suppressed TSH in hypothyroid patients on levothyroxine. Endocrine Practice, 13(1), 16-20. https://doi.org/10.4158/EP.13.1.16

Starr, M. (2005). Hypothyroidism Type 2: The epidemic. Mark Starr Trust.

Woeber, K. A. (2002). Levothyroxine therapy and serum free thyroxine and free triiodothyronine concentrations. Journal of Endocrinology and Metabolism, 87(9), 3986-3990. https://doi.org/10.1210/jc.2002-020580

Chiropractic and ESWT Support Flexibility and Movement

Chiropractic and ESWT Support Flexibility and Movement

Chiropractic and ESWT Support Flexibility and Movement

Flexibility is a big part of feeling well and moving with ease. It helps you bend, twist, reach, walk, lift, and exercise with less strain. When the body becomes stiff, tight, or out of balance, even simple daily activities can become harder. Many people notice this in the neck, shoulders, lower back, hips, knees, calves, or feet. Over time, those restrictions can affect posture, comfort, and physical performance.

At ChiroMed, an integrative chiropractic approach focuses on more than quick symptom relief. The goal is to help the body move better by improving joint alignment, reducing muscle tension, supporting nervous system function, and strengthening movement patterns. When Extracorporeal Shockwave Therapy, or ESWT, is added to the treatment plan, it can further support flexibility by addressing soft tissue problems such as scar tissue, tendon strain, and chronic tightness. Together, these therapies may help restore range of motion, reduce stiffness, and support long-term mobility (Gentle Chiropractic, 2025; San Diego NUCCA, n.d.).

Why Flexibility Is Important

Flexibility is not just for athletes or people who exercise every day. It matters for anyone who wants to move comfortably and stay active. Healthy flexibility helps muscles and joints work together so the body can move smoothly and efficiently. It also supports better posture, balance, coordination, and comfort throughout the day.

When flexibility decreases, the body often begins to compensate. One area may tighten while another area becomes overworked. This can lead to poor movement habits and ongoing discomfort.

Common signs of reduced flexibility include:

  • Stiffness when getting out of bed
  • Tightness after sitting too long
  • Trouble bending, reaching, or twisting
  • Reduced range of motion in the shoulders, hips, or back
  • Feeling sore or restricted during exercise
  • Muscle tension that keeps coming back

These problems often develop slowly. Poor posture, long hours of sitting, repetitive movements, sports-related stress, and old injuries can all worsen flexibility over time (ThinkVida, n.d.; TXMAC, n.d.-a).

How Integrative Chiropractic Care Helps the Body Stay Flexible

Integrative chiropractic care is designed to address both structure and function. Instead of focusing only on where pain is felt, it looks at how the whole body moves. This can include chiropractic adjustments, stretching, soft tissue support, posture advice, and therapeutic exercises.

This type of care helps flexibility in several ways.

Restoring Better Joint Motion

When the spine or other joints are not moving well, the body often becomes stiff and guarded. Chiropractic adjustments are used to improve motion in restricted joints. Improved joint mobility can make everyday activities easier and may reduce stress on surrounding muscles and tissues (Dubuque Chiropractic, n.d.; Rodgers Stein Chiropractic, n.d.-a).

Many people describe this change as feeling looser or less stuck after treatment. That improved motion can be especially helpful in the neck, upper back, lower back, shoulders, hips, knees, and ankles.

Reducing Muscle Tension

Tight muscles can limit flexibility even when the joints are not severely damaged. When muscles stay tense for long periods, they can pull the body out of balance and make movement feel restricted. Integrative chiropractic treatment often includes stretching and soft-tissue work to help muscles relax and function more effectively (Chiropractic Fitness, n.d.; Alter Chiropractic, n.d.).

When tension goes down, movement often becomes smoother and less painful.

Supporting the Nervous System

The nervous system helps control posture, muscle activity, balance, and coordination. Chiropractic care often focuses on improving how the spine and joints interact with the nervous system. When that system works more efficiently, muscles may respond better, and movement can become more natural (Gentle Chiropractic, 2025; Thrive Health Systems, n.d.).

This is important because flexibility is not only about tissue length. It is also about how the brain and body communicate during motion.

Improving Movement Patterns

Good flexibility is easier to maintain when the body learns better movement habits. That is why therapeutic exercises are such an important part of integrative care. Exercises help strengthen weak muscles, improve control, and support proper joint function. This makes it easier for the body to keep the benefits of treatment over time (OAA Orthopaedic Specialists, n.d.; Chiropractic Fitness, n.d.).

Why Stretching and Therapeutic Exercise Matter

Adjustments can help restore motion, but stretching and exercise help the body hold onto those gains. Stretching supports tissue length and mobility. Therapeutic exercise helps improve stability, coordination, and body control.

A flexibility-focused plan may include:

  • Gentle stretching for tight muscle groups
  • Mobility drills for stiff joints
  • Core exercises for spinal support
  • Postural exercises for daily alignment
  • Strengthening work for weak stabilizing muscles
  • Balance and coordination training

These methods work together so muscles and joints can support one another more effectively. That is one of the key ideas behind integrative chiropractic care. The body needs both mobility and stability to stay flexible and strong (Rodgers Stein Chiropractic, n.d.-b; TXMAC, n.d.-b).

What ESWT Is and Why It Helps Flexibility

Extracorporeal Shockwave Therapy, or ESWT, is a noninvasive treatment that uses acoustic waves to stimulate tissue repair. It is commonly used for chronic soft tissue problems that can limit motion and cause long-term discomfort.

Many flexibility problems are not caused by joint restriction alone. In some cases, the main issue is in the muscles, tendons, or fascia. Scar tissue, chronic inflammation, tendon overload, and soft tissue adhesions can make movement feel tight and painful. ESWT is often used to address these issues by promoting blood flow and tissue healing (Bend Total Body Chiropractic, 2023; Corrective Chiropractic, n.d.).

ESWT may help by:

  • Increasing circulation to the treated area
  • Supporting tissue repair
  • Reducing pain and inflammation
  • Breaking down scar tissue and adhesions
  • Improving tissue elasticity
  • Helping muscles and tendons move more freely

This can be especially useful when a patient has chronic tightness that does not improve enough with stretching or rest alone (InSpine Chiropractic, n.d.; Chiropractic Experience, n.d.).

Why Chiropractic Care and ESWT Work Well Together

Chiropractic care and ESWT address different aspects of the same problem. Chiropractic adjustments help restore motion in the joints and spine. ESWT helps improve the condition of the soft tissues around those joints. When both are used together, the body may respond better than it would with only one treatment.

This two-part approach can help:

  • Improve joint mechanics
  • Reduce muscle guarding
  • Break up scar tissue
  • Improve blood flow
  • Lower chronic inflammation
  • Increase range of motion
  • Support better long-term movement

This is one reason many integrative clinics combine chiropractic care and ESWT. The goal is to improve both how the body moves and the condition of the tissues that support that movement (San Diego NUCCA, n.d.; My Office Info, n.d.; Holistiq, n.d.).

Conditions That Can Limit Flexibility

A combined approach of chiropractic care and ESWT is often used for conditions involving both movement restriction and soft-tissue stress.

Frozen Shoulder

Frozen shoulder can cause severe stiffness, pain, and loss of motion. It often makes reaching overhead or behind the back very difficult. Adjustments, mobility work, and ESWT may help improve movement and reduce soft-tissue restrictions around the shoulder complex (Gentle Chiropractic, n.d.; Chiro Oklahoma City, 2025).

Achilles Tendinopathy

The Achilles tendon can become painful and tight, especially in active people or in those with faulty movement mechanics. ESWT is often used to support tendon healing, while chiropractic treatment may help improve the mechanics of the ankle, foot, knee, hip, and spine that affect how the tendon is loaded (Chiropractic First, n.d.; Dr. Alex Jimenez, 2026a).

Chronic Muscle Tightness

Long-term tightness in the neck, back, hips, or legs can come from stress, poor posture, repetitive work, or old injuries. In these cases, chiropractic care may restore joint motion while ESWT helps address stubborn tissue restrictions. This may make it easier for patients to stretch, exercise, and move without constant pulling or stiffness (Bend Total Body Chiropractic, 2023; TXMAC, n.d.-a).

Clinical Observations That Support an Integrative Approach

Dr. Alexander Jimenez, DC, APRN, FNP-BC, has published clinical material that supports a whole-body view of flexibility and recovery. His work describes a model that combines chiropractic care with rehabilitation, functional medicine, and advanced treatment strategies to improve mobility, strength, and overall function (Dr. Alex Jimenez, 2026b).

His published material on shockwave therapy also explains how ESWT can fit into a broader care plan addressing both joint mechanics and soft-tissue healing. That kind of combined strategy is useful because many movement problems involve more than one tissue type. A patient may have joint restriction, muscle tension, tendon overload, and scar tissue simultaneously. A well-rounded plan is often needed to improve function in a lasting way (Dr. Alex Jimenez, 2026a).

For a clinic like ChiroMed, that kind of integrative thinking fits naturally with patient-centered care. Instead of chasing only symptoms, the focus is on why movement is limited and how to improve it safely and effectively.

What Patients May Notice With Consistent Care

When chiropractic care, stretching, therapeutic exercise, and ESWT are used together in the right setting, patients may notice:

  • Less stiffness in the morning
  • Easier movement during daily tasks
  • Better flexibility in the shoulders, hips, and back
  • Reduced muscle tightness
  • More comfort during walking, lifting, or exercise
  • Better posture and body awareness

These improvements often build over time. Flexibility is not something that changes only from one visit. It usually improves best through consistent care, home exercises, better posture, and regular movement.

Conclusion

Integrative chiropractic care helps the body stay flexible by restoring joint alignment, easing muscle tension, and improving nervous system function. When regular adjustments are combined with stretching and therapeutic exercises, patients may experience improved range of motion, reduced stiffness, and more efficient movement in daily life.

When ESWT is added, the treatment plan can become even more effective for people dealing with scar tissue, chronic tendon problems, and long-term muscle tightness. By addressing both joint mechanics and soft-tissue limitations, chiropractic care and ESWT work together to improve mobility, support healing, and help the body remain flexible and strong.

For a practice like ChiroMed, this integrative model reflects a practical, modern approach to supporting long-term movement, recovery, and function (San Diego NUCCA, n.d.; Dr. Alex Jimenez, 2026a).

References

Alter Chiropractic. (n.d.). Why choose chiropractic for enhanced flexibility?

Bend Total Body Chiropractic. (2023, October 25). Exploring the uses, benefits, side effects of shockwave therapy

Chiro Oklahoma City. (2025, October 25). What is shockwave therapy?

Chiropractic Experience. (n.d.). Shockwave therapy – ESWT

Chiropractic First. (n.d.). How shockwave therapy complements chiropractic treatments

Chiropractic Fitness. (n.d.). Boost mobility and flexibility with chiropractic care

Corrective Chiropractic. (n.d.). Shockwave therapy

Dr. Alex Jimenez. (2026a). Shockwave therapy for healing: Understanding ESWT

Dr. Alex Jimenez. (2026b). Why choose our clinical team?

Dubuque Chiropractic. (n.d.). 5 ways chiropractic adjustments enhance flexibility

Gentle Chiropractic. (2025, March 14). Can chiropractic care improve joint flexibility and range of motion?

Gentle Chiropractic. (n.d.). Frozen shoulder relief and treatment

Holistiq. (n.d.). Chiropractic treatment and shockwave treatment

InSpine Chiropractic. (n.d.). Shockwave therapy in chiropractic care

My Office Info. (n.d.). Why you should integrate shockwave therapy into your chiropractic care plan

OAA Orthopaedic Specialists. (n.d.). How regular chiropractic visits boost mobility

Rodgers Stein Chiropractic. (n.d.-a). Why thousands trust chiropractors for greater flexibility

Rodgers Stein Chiropractic. (n.d.-b). Transform your flexibility with chiropractic care

San Diego NUCCA. (n.d.). Shockwave therapy and chiropractic adjustments

ThinkVida. (n.d.). Chiropractic and flexibility

TXMAC. (n.d.-a). Why choose chiropractic for enhanced flexibility?

TXMAC. (n.d.-b). Boost mobility and flexibility with chiropractic care

Thrive Health Systems. (n.d.). How chiropractic adjustments can improve mobility and flexibility

Can Athletes Keep Training During Integrative Care

Can Athletes Keep Training During Integrative Care?

Can Athletes Keep Training During Integrative Care
A massage therapist treats an athlete’s injury. Percussion therapy for regeneration massage of the athletic body.

Athletes often worry that an injury means they have to stop training completely. In many cases, that is not true. At ChiroMed, the goal is usually not “do nothing” and wait. The goal is to keep the athlete moving in a smart, controlled way while the body heals. ChiroMed describes its approach as integrated medicine, offering chiropractic care, nurse practitioner services, rehabilitation, nutrition counseling, acupuncture, and other supportive services that work together to improve function and recovery. That kind of model fits well with athletes because sports injuries rarely affect just one part of the body. They often involve joints, muscles, nerves, movement patterns, recovery habits, and training load simultaneously.

For many athletes, complete rest is usually not the best long-term answer. A better strategy is often “optimal loading,” which means applying enough movement and stress to help healing without overloading the injured area. Research on athlete rehabilitation shows that injured athletes often do better when they follow a modified activity plan instead of becoming fully inactive. Modified training can reduce stiffness, maintain conditioning, protect skill development, and help athletes feel mentally connected to their sport during recovery.

Why Athletes Often Need Modified Training, Not Full Shutdown

When athletes stop everything for too long, the body can lose strength, coordination, and endurance. Joints can become stiffer, muscles can weaken, and movement patterns can become less efficient. That is why many sports medicine and chiropractic sources recommend relative rest rather than total rest for many non-emergency injuries. Relative rest means reducing activities that worsen symptoms while still performing safe, targeted movements to support recovery.

At ChiroMed, this type of thinking matches the clinic’s broader integrative care model. The practice explains that it combines chiropractic care with rehabilitation, nutrition counseling, acupuncture, and support from a nurse practitioner. For an athlete, that means treatment is not limited to one quick adjustment. It can include movement correction, recovery planning, soft-tissue support, and guidance on returning to training in stages.

For example, an athlete with a low back flare-up may need to pause heavy lifting or contact drills but may still be able to do walking, biking, core stability work, mobility drills, and sport-specific skills at a lower intensity. A runner with knee pain may need to stop hill sprints for a while, but may still be able to use a bike, pool running, or strength exercises that do not irritate the knee. The point is not to ignore pain. The point is to keep progress going without worsening the injury.

How ChiroMed’s Integrative Model Supports Athletes

ChiroMed presents itself as an integrated medicine and holistic healthcare practice in El Paso. The clinic states that it offers chiropractic care, nurse practitioner services, naturopathy, rehabilitation, nutrition counseling, and acupuncture. It also describes Dr. Alex Jimenez as a dual-licensed professional with chiropractic and advanced practice nursing credentials who leads a multidisciplinary, patient-centered team. For athletes, that matters because recovery is often better when multiple forms of care work together rather than in isolation.

This approach is especially helpful in sports because performance depends on more than just pain levels. An athlete may feel less pain after treatment, but that does not always mean the body is ready for full-speed cutting, jumping, sprinting, or heavy lifting. The athlete still needs enough mobility, strength, balance, endurance, and control to perform safely. ChiroMed’s sports and recovery content repeatedly points to a combined model of chiropractic care, soft-tissue support, corrective exercise, rehabilitation, and lifestyle support as the best path to stronger recovery and injury prevention.

What Care May Look Like for an Athlete

At ChiroMed, an athlete’s plan may include several layers of care working together. Based on the clinic’s services and sports-focused content, an athlete may receive:

  • Chiropractic adjustments to improve joint motion and support movement quality
  • Soft tissue work to reduce tightness and improve tissue function
  • Rehabilitation exercises to rebuild stability and coordination
  • Mobility drills to improve range of motion
  • Nutrition guidance to support tissue repair and lower inflammation
  • Acupuncture or other supportive therapies for pain and recovery
  • Medical oversight from nurse practitioner services when a broader clinical view is needed

This matters because athletes need more than pain relief. They need a plan that helps them return to performance. ChiroMed’s own sports-related material explains that sport-specific training, combined with chiropractic care, can enhance athletic performance, accelerate recovery, and reduce the risk of future injury by improving biomechanics, joint function, and flexibility.

When Athletes Can Usually Keep Training

In many situations, athletes can continue training while receiving chiropractic and integrative care, as long as their training is modified to match the stage of healing. That may mean reducing load, intensity, volume, or impact. It may also mean changing practice drills, limiting certain motions, or using cross-training to stay conditioned. The goal is to keep the athlete active while respecting tissue healing.

Safe modified training may include:

  • Light aerobic work, such as walking, cycling, or swimming
  • Gentle stretching and mobility work
  • Controlled strengthening with lighter weights
  • Non-contact drills
  • Technique practice at reduced intensity
  • Balance, coordination, or core control work
  • Cross-training that avoids aggravating the injury

This kind of plan can help athletes keep important qualities such as conditioning, timing, and confidence. It can also reduce the emotional frustration that often comes with injury. Athletes usually feel better when they know they still have a structured path forward. Instead of feeling stuck, they feel guided.

When Athletes Need to Pull Back More

Even though complete rest is not always necessary, there are times when athletes should reduce training sharply or stop certain activities for a while. Pain that worsens with activity, significant swelling, loss of strength, joint instability, numbness, severe stiffness, or major changes in movement quality should not be ignored. Those signs may mean that the tissue needs more protection or that further evaluation is needed before returning to harder activity. The clinic’s integrated structure is helpful here because it allows athletes to receive broader support when the problem is more complex than simple soreness or mild strain.

Athletes also need a more careful return-to-play plan after more serious conditions, especially head injuries. In those situations, a staged progression is important, and the athlete should not rely solely on post-treatment symptom improvement. A structured, step-by-step return is safer than rushing back, even if the body “feels better” for a day.

ChiroMed’s Role in the Return-to-Play Process

One of the strongest ideas behind the ChiroMed model is that recovery should be personalized. The clinic emphasizes patient-centered care and a combination of specialties rather than a one-size-fits-all approach. That is precisely what athletes need. A high school sprinter, a college volleyball player, a weightlifter, a golfer, and a weekend runner all place different demands on the body. Their return-to-play plans should not look the same.

A staged recovery plan often moves through these steps:

  • Calm pain and reduce irritation
  • Restore basic mobility
  • Improve stability and control
  • Build strength and endurance
  • Add sport-specific movement
  • Progress toward full-speed practice
  • Return to competition when the function is ready

This kind of progression is helpful because pain alone is not the only measure of readiness. An athlete may say, “It does not hurt much anymore,” but still lack good balance, trunk control, hip strength, or reaction timing. ChiroMed’s rehabilitation and sports content suggests that the best results come from combining hands-on care with corrective exercise and function-based progressions.

Clinical Observations of Dr. Alexander Jimenez

Dr. Alexander Jimenez, DC, APRN, FNP-BC, is presented on ChiroMed as a dual-licensed chiropractor and nurse practitioner who leads a multidisciplinary team. The site describes his work as blending chiropractic care with broader medical and rehabilitation support. ChiroMed’s content also notes that integrative care can include spinal adjustments, soft tissue therapies, mobility work, corrective exercises, and guidance on lifestyle factors that affect healing. These observations align well with athletes’ needs during recovery, as sports injuries often affect multiple systems simultaneously.

From a practical standpoint, Dr. Jimenez’s integrative model supports the idea that athletes should not view recovery as either “all rest” or “full go.” Instead, they should see treatment as a structured partnership. The chiropractor and care team help decide what to protect, what to retrain, and when to progress. That mindset can help athletes return to training faster and more safely.

Smart Advice for Athletes Receiving Care at ChiroMed

Athletes usually do best when they communicate clearly and follow a plan instead of guessing. Helpful questions include:

  • What movements should I avoid right now?
  • What activities are safe this week?
  • How hard can I train today?
  • What signs mean I need to stop?
  • What recovery work should I do between visits?
  • When can I add speed, impact, or heavier loading back in?

A positive recovery mindset includes:

  • Being honest about symptoms
  • Following load limits
  • Staying consistent with rehab exercises
  • Focusing on sleep, hydration, and nutrition
  • Progressing in stages instead of rushing
  • Thinking long term, not just day to day

Conclusion

Yes, athletes can often continue training while receiving care at ChiroMed, but the training usually needs to be modified. The safest and most effective path is usually neither a total shutdown nor reckless pushing. It is controlled, guided, personalized training built around healing. ChiroMed’s integrated model, which combines chiropractic care, nurse practitioner services, rehabilitation, nutrition counseling, acupuncture, and other supportive care, is well-suited for that kind of athlete-centered recovery.

The bigger message is simple: injured athletes do not always need to stop moving. They need the right movement, the right timing, and the right plan. With a structured return-to-play strategy and a collaborative care team, athletes can protect healing tissues, maintain conditioning, and work their way back to full, pain-free performance with more confidence.

References

ChiroMed. (n.d.). About Us.

ChiroMed. (n.d.). ChiroMed – Integrated Medicine Holistic Healthcare in El Paso.

ChiroMed. (n.d.). Contact Us.

ChiroMed. (n.d.). Enhance Recovery: Chiropractic Sport-Specific Care.

ChiroMed. (n.d.). Integrated Medicine Services El Paso TX.

ChiroMed. (n.d.). Posture Improves Athletic Performance: Key to Success.

ChiroMed. (n.d.). Sleep, Athletic Recovery, and Integrative Chiropractic.

ChiroMed. (n.d.). Tag: chiropractic athletic performance care.

ChiroMed. (n.d.). Tag: chiropractic wellness programs.

ChiroMed. (n.d.). Tag: Dr Alex Jimenez ChiroMed.

ChiroMed. (n.d.). ChiroMed’s Integrative Path to Diet and Injury Healing.

How Poor Posture Habits Develop Over Time

How Poor Posture Habits Develop Over Time

How Poor Posture Habits Develop Over Time

ChiroMed’s Integrative Chiropractic Care Can Correct Them

Poor posture affects many people today due to modern daily routines. Long hours sitting at desks, constant use of smartphones and computers, and limited movement create habits that pull the body out of alignment. These habits cause muscle fatigue, in which some muscles tire while others weaken, leading the body to slump forward for short-term comfort (Harvard Health Publishing, n.d.a; Beyond Therapy and Wellness, n.d.).

Over months or years, the body adjusts to these slouched positions. They begin to feel natural, even though they strain the spine and muscles. Tight muscles in the chest and front of the neck pull the shoulders forward, while weak back and core muscles fail to hold the body upright. This results in common issues like rounded shoulders, forward head posture (often called “text neck”), and an exaggerated curve in the lower back (OrthoCarolina, n.d.; Brown Health, n.d.).

At ChiroMed – Integrated Medicine in El Paso, TX, the team led by Dr. Alex Jimenez, DC, APRN, FNP-BC, uses a holistic approach to address these problems. By combining chiropractic adjustments, soft-tissue therapies, rehabilitation, and education on better habits, they target the root causes of poor posture to achieve lasting improvement and pain relief.

Key Factors Leading to Poor Posture

Several everyday elements contribute to poor posture habits:

  • Prolonged Sitting and Sedentary Routines: Extended periods in chairs weaken supporting muscles and encourage slouching (Foundation Health, n.d.; Better Health Channel, n.d.).
  • Heavy Technology Use: Looking down at phones or screens strains the neck, as the head’s weight pulls forward like a heavy object held out in front (Harvard Health Publishing, n.d.b; Capital Ortho, n.d.).
  • Weak Core and Back Strength: Without regular strengthening, the spine lacks support, making it harder to maintain upright positions (Hull Chiropractic, n.d.; Foundation Family Chiropractic, n.d.).
  • Stress-Induced Tension: Emotional stress tightens shoulder and neck muscles, pushing the body into a hunched shape (OAA Ortho, n.d.; Aligned Modern Health, n.d.).
  • Reduced Body Awareness: Many people ignore their posture until pain appears, and repetitive actions, such as carrying bags unevenly, worsen the imbalance (Pettett Chiro, n.d.; Denver Chiropractic, n.d.).

Dr. Alex Jimenez at ChiroMed observes these patterns in patients daily. His integrative practice recognizes that sedentary jobs and tech habits can create spinal misalignments and nerve compression, often leading to chronic discomfort (Jimenez, n.d.a; Jimenez, n.d.b; ChiroMed, n.d.a).

The Body’s Adaptation to Slouched Positions

As poor posture continues, the body remodels itself around the habit. Forward-leaning muscles shorten and tighten, while opposing ones lengthen and lose strength. This creates a cycle where good posture requires more effort. For instance, forward head posture strains the upper spine, and swayback exaggerates the lower curve (Active Posture, n.d.; Etalon, n.d.).

These changes can lead to broader health effects, such as restricted breathing from a compressed chest or increased joint wear. Stress keeps muscles locked, making reversal tougher without intervention (Harvard Health Publishing, n.d.a; Beyond Therapy and Wellness, n.d.).

In his clinical experience, Dr. Jimenez notes that these adaptations often stem from lifestyle factors. Patients with desk jobs exhibit muscle imbalances that contribute to issues such as sciatica or neck pain, underscoring the need for whole-body correction (Jimenez, n.d.a; ChiroMed, n.d.b).

Health Impacts of Ignoring Poor Posture

Beyond appearance, poor posture influences daily function and well-being:

  • Chronic Pain: Neck, back, and shoulder aches become common, often accompanied by tension headaches (Better Health Channel, n.d.; Harvard Health Publishing, n.d.b).
  • Reduced Mobility: Imbalanced muscles raise injury risk and limit movement (Capital Ortho, n.d.; Hull Chiropractic, n.d.).
  • Other Effects: Shallower breathing, fatigue, and even digestive strain from spinal pressure (Brown Health, n.d.; Foundation Health, n.d.).

ChiroMed addresses these through non-invasive methods, helping patients regain comfort and function.

ChiroMed’s Integrative Approach to Posture Correction

ChiroMed – Integrated Medicine stands out in El Paso by offering chiropractic care alongside nurse practitioner services, naturopathy, rehabilitation, nutrition counseling, and acupuncture. This multidisciplinary setup allows comprehensive treatment that goes beyond single fixes (ChiroMed, n.d.c; ChiroMed, n.d.d).

Dr. Alex Jimenez leads with evidence-based, patient-centered care. His dual licensure as a chiropractor and family nurse practitioner provides a comprehensive view of health issues.

Core elements include:

  • Chiropractic Adjustments: Gentle spinal manipulations realign the spine, ease nerve pressure, and support natural curves (OAA Ortho, n.d.; Pettett Chiro, n.d.; ChiroMed, n.d.e).
  • Soft Tissue and Rehabilitation Therapies: Techniques release tight muscles and rebuild strength for balanced support (DE Integrative Healthcare, n.d.; Zaker Chiropractic, n.d.; ChiroMed, n.d.f).
  • Personalized Education and Plans: Guidance on ergonomics, posture awareness, and daily habits prevents relapse (Jackson Healing Arts, n.d.; Thrive Chiro Health, n.d.).
  • Holistic Support: Nutrition and other services enhance recovery and overall wellness (Dr. Darold Leto, n.d.; ChiroMed, n.d.g).

This integrated method corrects misalignments from poor posture while strengthening the body against future strain.

Benefits of Seeking Care at ChiroMed

Patients at ChiroMed experience:

  • Targeted Pain Relief: Adjustments and therapies reduce discomfort from imbalances (Denver Chiropractic, n.d.; ChiroMed, n.d.h).
  • Improved Alignment and Posture: Restored spinal position promotes upright stance (Zaker Chiropractic, n.d.; ChiroMed, n.d.i).
  • Long-Term Results: Focus on causes leads to sustained, pain-free posture (Thrive Chiro Health, n.d.; ChiroMed, n.d.j).
  • Enhanced Daily Life: Better breathing, energy, and movement follow (Etalon, n.d.; Harvard Health Publishing, n.d.a).

Dr. Jimenez’s approach, seen in cases involving posture-related issues like scoliosis or athletic performance, combines adjustments with targeted exercises for optimal outcomes (ChiroMed, n.d.k; ChiroMed, n.d.l).

Simple Steps to Support Better Posture

Alongside professional care at ChiroMed, incorporate these habits:

  • Stand and stretch every 30 minutes during screen time.
  • Build core strength with safe exercises.
  • Position screens at eye level to avoid forward tilt.
  • Maintain awareness of shoulder and back position (OrthoCarolina, n.d.; Capital Ortho, n.d.).

These complement ChiroMed’s treatments for stronger results.

Final Thoughts

Poor posture arises from common modern habits but can lead to ongoing pain and limitations. At ChiroMed – Integrated Medicine in El Paso, TX, Dr. Alex Jimenez and the team provide expert integrative chiropractic care to reverse these effects. By addressing root causes through adjustments, therapy, and education, they help restore natural alignment and promote lasting health. If posture concerns affect your daily life, consider reaching out to ChiroMed for personalized support.

References

Active Posture. (n.d.). Understanding swayback: Causes, symptoms, and effective treatments. https://www.activeposture.co.uk/blogs/pain/understanding-swayback-causes-symptoms-and-effective-treatments

Aligned Modern Health. (n.d.). How chiropractic care helps improve posture. https://alignedmodernhealth.com/how-chiropractic-care-helps-improve-posture/

Better Health Channel. (n.d.). Posture. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/posture

Beyond Therapy and Wellness. (n.d.). Is poor posture the cause of your back pain? https://beyondtherapyandwellness.com/is-poor-posture-the-cause-of-your-back-pain/

Brown Health. (n.d.). Posture and how it affects your health. https://www.brownhealth.org/be-well/posture-and-how-it-affects-your-health

Capital Ortho. (n.d.). Why bad posture is a bad habit. https://capitalortho.com/why-bad-posture-is-a-bad-habit/

ChiroMed. (n.d.a). ChiroMed – Integrated Medicine Holistic Healthcare in El Paso, TX. https://chiromed.com/

ChiroMed. (n.d.b). Chiropractor El Paso, TX. https://chiromed.com/services/chiropractor-el-paso-tx/

ChiroMed. (n.d.c). Integrated Medicine Services El Paso TX. https://chiromed.com/services

ChiroMed. (n.d.d). ChiroMed: Combining Care for Better Health. https://chiromed.com/chiromed-combining-care-for-better-health

ChiroMed. (n.d.e). Advanced Chiropractic Care for Back and Nerve Pain. https://chiromed.com/advanced-chiropractic-care-for-back-and-nerve-pain

ChiroMed. (n.d.f). Glute Dysfunction: Chiropractic and Integrative Healing. https://chiromed.com/glute-dysfunction-chiropractic-and-integrative-healing

ChiroMed. (n.d.g). Nutrition El Paso, TX. https://chiromed.com/services/nutrition-el-paso-tx/

ChiroMed. (n.d.h). How Poor Posture Impacts Breathing and Digestion. https://chiromed.com/how-poor-posture-impacts-breathing-and-digestion

ChiroMed. (n.d.i). Posture Improves Athletic Performance: Key to Success. https://chiromed.com/posture-improves-athletic-performance-key-to-success

ChiroMed. (n.d.j). The Schroth Method & Chiropractic Care Techniques for Reducing Scoliosis. https://chiromed.com/the-schroth-method-chiropractic-care-techniques-for-reducing-scoliosis

ChiroMed. (n.d.k). ChiroMed: Traumatic Brain Injury & Posture. https://chiromed.com/chiromed-traumatic-brain-injury-posture

ChiroMed. (n.d.l). Posture Correction Exercises. https://chiromed.com/tag/posture-correction-exercises

Denver Chiropractic. (n.d.). Fixing poor posture. https://denver-chiropractic.com/fixing-poor-posture/

Dr. Darold Leto. (n.d.). 4 ways chiropractic can improve your poor posture. https://www.drdaroldleto.com/blog/1044696-4-ways-chiropractic-can-improve-your-poor-posture_2

Etalon. (n.d.). Strategies to overcome slouching. https://shopetalon.com/blogs/lifestyle/strategies-overcome-slouching

Foundation Family Chiropractic. (n.d.). Chiropractic care for posture correction. https://foundationfamilychiropractic.com/chiropractic-care-for-posture-correction/

Foundation Health. (n.d.). The importance of posture. https://www.foundationhealth.org/our_community/fhp_healthbreak/the_importance_of_posture

Harvard Health Publishing. (n.d.a). Is it too late to save your posture? https://www.health.harvard.edu/exercise-and-fitness/is-it-too-late-to-save-your-posture

Harvard Health Publishing. (n.d.b). In a slump? Fix your posture. https://www.health.harvard.edu/staying-healthy/in-a-slump-fix-your-posture

Hull Chiropractic. (n.d.). Top 5 most common causes of poor posture. https://www.hullchiropractic.com/blog/283705-top-5-most-common-causes-of-poor-posture

Jackson Healing Arts. (n.d.). How regular chiropractic visits can improve posture. https://www.jacksonhealingarts.com/how-regular-chiropractic-visits-can-improve-posture/

Jimenez, A. (n.d.a). Injury specialists. https://dralexjimenez.com/

Jimenez, A. (n.d.b). Dr. Alexander Jimenez, DC, APRN, FNP-BC, IFMCP, CFMP, ATN ♛ [LinkedIn profile]. LinkedIn. https://www.linkedin.com/in/dralexjimenez/

OAA Ortho. (n.d.). Poor posture: 3 ways chiropractic adjustments can help you stand tall. https://www.oaaortho.com/blog/poor-posture-3-ways-chiropractic-adjustments-can-help-you-stand-tall

OrthoCarolina. (n.d.). The surprising power of posture. https://www.orthocarolina.com/blog/the-surprising-power-of-posture

Pettett Chiro. (n.d.). How chiropractic care improves posture. https://www.pettetchiro.com/how-chiropractic-care-improves-posture

Thrive Chiro Health. (n.d.). The role of chiropractic care in posture correction: Improving alignment. https://thrivechirohealth.com/the-role-of-chiropractic-care-in-posture-correction-improving-alignment/

Zaker Chiropractic. (n.d.). How chiropractic care can help improve your posture. https://zakerchiropractic.com/how-chiropractic-care-can-help-improve-your-posture/

The "Reset" Pain After Holding an Awkward Position

The “Reset” Pain After Holding an Awkward Position

The "Reset" Pain After Holding an Awkward Position
The “Reset” Pain After Holding an Awkward Position

What It’s Called, Why It Happens, and How ChiroMed Integrative Care Can Help

Have you ever sat, stood, or twisted in a position that felt “fine” at first, but when you moved back to normal, you felt a sharp discomfort, stiffness, or a strange “reset” sensation in a muscle or joint? Sometimes it feels like something releases, and then you need a minute for the area to calm down.

This is a very common body experience. Most of the time, it is not mysterious. It is your nervous system and soft tissues reacting to being held in a stressful position and then quickly returning to neutral.

Clinically, this experience is usually explained by a combination of:

  • Postural strain (overload from posture)
  • Muscle tightness and muscle guarding (protective tension)
  • Trigger points (sensitive, tight spots in muscle)
  • Myofascial restriction (stiffer, less mobile fascia)
  • Temporary joint restriction (a joint not gliding normally)

At ChiroMed, this is often approached as a “whole system” issue: joints, muscles, fascia, and the nervous system all influence how you move and how you feel, especially after long periods of sitting, working, driving, or sleeping in a poor position (ChiroMed, n.d.-a; Mayo Clinic, 2024). https://chiromed.com/ ; https://www.mayoclinic.org/tests-procedures/chiropractic-adjustment/about/pac-20393513

What is this feeling called?

People describe it in different ways:

  • “My back locked up”
  • “My neck was stuck and then it popped”
  • “I moved and it had to reset”
  • “It felt like a cramp, then it let go”
  • “It hurts when I come back to normal”

From a clinical point of view, the most accurate labels usually include:

  • Postural strain
  • Muscle guarding (protective stiffness)
  • Trigger point flare (myofascial pain)
  • Joint restriction or joint dysfunction (reduced joint motion)
  • Myofascial restriction (fascia not gliding well)

You may also hear chiropractic terms like “restricted segmental motion” or “functional joint restriction.” Some people use the word “subluxation” to describe a motion problem, but in most everyday posture cases, the key issue is not a dislocation. It is a temporary movement limitation and soft-tissue tightness that causes pain when you return to neutral (Mayo Clinic, 2024). https://www.mayoclinic.org/tests-procedures/chiropractic-adjustment/about/pac-20393513

Why it happens: the simple explanation

Your body is built for variety in movement. When you stay in one awkward position too long, your body adapts to protect you. That protection can feel like tightness, stiffness, and pain when you move back.

A practical way to think about it:

  1. You hold a stressful posture.
  2. Some tissues get compressed and irritated.
  3. Muscles tighten to stabilize you (guarding).
  4. Fascia becomes less “slippery” and more stiff.
  5. A joint may stop gliding normally.
  6. When you return to neutral, everything has to “reorganize” fast.
  7. You feel a “reset” sensation, along with short-term discomfort.

Fascia matters here because it is a connective tissue network that surrounds muscles and helps them glide. When fascia gets irritated or less mobile, it can feel like tightness, pulling, or stiffness (Johns Hopkins Medicine, n.d.). https://www.hopkinsmedicine.org/health/wellness-and-prevention/muscle-pain-it-may-actually-be-your-fascia

The key parts of the “reset” experience

Tight muscles or protective guarding

Muscle guarding is your nervous system trying to prevent movement it perceives as unsafe. It can happen after:

  • Long sitting
  • Repetitive work
  • Stress and poor sleep
  • Minor strains
  • Old injuries that make you move differently

Muscle stiffness and soreness after inactivity are common symptoms and can improve as tissues warm up and circulation increases (Cleveland Clinic, 2023). https://my.clevelandclinic.org/health/symptoms/25147-muscle-stiffness

Trigger points

Trigger points are sensitive, tight spots inside a muscle. When you change position, the muscle length changes, and the trigger point can “complain.”

Common clues you are dealing with trigger points:

  • A tender spot that hurts when pressed
  • A tight band feeling in the muscle
  • Pain that can refer to nearby areas

Myofascial pain patterns like this are widely described in patient education and often respond best to a mix of movement, soft-tissue care, and addressing the underlying cause (WebMD, 2024a). https://www.webmd.com/pain-management/myofascial-pain-syndrome

Fascia restriction and “sticky” glide

Fascia is not just wrapping. It has nerves, it responds to stress and movement, and it can contribute to pain when irritated (Johns Hopkins Medicine, n.d.). https://www.hopkinsmedicine.org/health/wellness-and-prevention/muscle-pain-it-may-actually-be-your-fascia

When fascia is restricted, you may notice:

  • You feel stiff even when you stretch
  • The area feels “stuck” more than “tight”
  • You feel pulling or discomfort with certain angles

Stretching alone does not always resolve stiffness, according to some rehab sources. Often, you need mobility, strength, and better movement patterns (NYDN Rehab, 2019). https://nydnrehab.com/blog/feeling-stiff-why-stretching-may-not-be-the-best-solution/

Joint restriction and the “pop”

If a joint has not been moving normally, it can feel like it “catches” or pinches at the end range. When it finally moves again (whether naturally or through an adjustment), some people feel a release or hear a pop.

Patient education materials commonly explain that a pop can involve a pressure change and gas release in the joint (often called cavitation) (Spine Stop, 2025; Peak Performance, n.d.).
https://www.spinestop.com/blog/what-happens-during-a-chiropractic-adjustment
https://peakperformancefranklin.com/faq/

What is happening inside your body when you move back to neutral?

Joint fixation or motion loss

A joint that does not glide well can create:

  • Pain when you “push it” back to neutral
  • A sudden release sensation when it finally moves
  • Short-term soreness after movement returns

Proprioceptive “reset”

Proprioception is your body’s sense of position. When you stay in a posture too long, your nervous system may temporarily treat it as the new normal. When you return to neutral, the brain and muscles recalibrate. That recalibration can feel weird, stiff, or briefly painful, then it settles.

Short-term soreness afterward

After a release, you may feel:

  • A warm ache
  • Mild soreness
  • Less restriction, but tenderness for a few hours

This can be normal, especially if the tissues were irritated and are now moving again (Health.com, 2023; Mayo Clinic, 2024).
https://www.health.com/chiropractor-7554177
https://www.mayoclinic.org/tests-procedures/chiropractic-adjustment/about/pac-20393513

Why posture is often the root driver

Poor posture is not about looking a certain way. It is about how the load is distributed over time.

When posture is off for long periods, it can lead to:

  • Muscle strain and overuse in some areas
  • Weakness or underuse in other areas
  • Joint stress and reduced motion
  • Higher chance of recurring tightness

Several clinics and rehab resources discuss poor posture as a common contributor to tension and discomfort (Calhoun Spine Care, n.d.; Blackburn Chiropractic Clinic, n.d.; Physis Rehab, n.d.).
https://calhounspinecare.com/postures-impact-on-back-pain-treatment-success-3/
https://blackburnchiropractor.ca/conditions/postural-alterations/
https://www.physisrehab.com/poor-posture-the-main-culprit-behind-muscle-tension/

What about “somatic soreness” and stress-based tension?

Sometimes the “locked” feeling is not only mechanical. Stress can raise baseline muscle tension and make your nervous system more protective.

Some writers use the term “somatic soreness” to describe body tension that can be influenced by emotional stress and nervous system activation (On The Go Wellness, n.d.). https://onthegowellness.com/somatic-soreness-the-overlooked-difference-between-muscle-pain-and-emotional-tension-stored-in-the-body/

This does not mean the pain is imaginary. It means your system may be:

  • More sensitive to pressure and movement
  • More likely to guard and brace
  • Slower to relax after strain

An integrative plan can still help because it targets both motion and nervous system calm.

How ChiroMed’s integrative approach can help

ChiroMed presents itself as an integrative clinic that combines chiropractic care with services such as nurse practitioner care, rehabilitation, nutrition, and acupuncture, aiming for a coordinated plan rather than a one-tool approach (ChiroMed, n.d.-a; ChiroMed, n.d.-b).
https://chiromed.com/
https://chiromed.com/about-us/

When you keep getting the “reset pain,” a useful plan typically includes four pillars:

Restore joint motion (adjustment or mobilization)

Chiropractic adjustment is commonly described as a controlled force applied to improve spinal or joint motion and reduce pain in certain conditions, such as neck or back pain (Mayo Clinic, 2024). https://www.mayoclinic.org/tests-procedures/chiropractic-adjustment/about/pac-20393513

Why it can help with the “reset” pattern:

  • It helps a restricted joint move more normally
  • It reduces the need for your body to “force” a painful release on its own
  • It may decrease protective muscle guarding once motion feels safer

Address soft tissue and fascia (myofascial work)

If your pain is driven by trigger points or fascial restriction, soft tissue methods may be important:

  • Myofascial release
  • Trigger point techniques
  • Gentle stretching paired with movement retraining

Myofascial pain education commonly includes these approaches, alongside exercise, posture, and repetitive strain management (WebMD, 2024a; WebMD, 2024b).
https://www.webmd.com/pain-management/myofascial-pain-syndrome
https://www.webmd.com/pain-management/what-to-know-myofascial-release-therapy

Rehab and exercise, so it does not keep coming back

If a joint keeps getting “stuck,” there is usually a reason:

  • Weak stabilizers
  • Poor motor control
  • Limited mobility in a nearby area
  • Repetitive posture habits

Rehab that combines mobility and strength often creates longer-lasting change than stretching alone (NYDN Rehab, 2019). https://nydnrehab.com/blog/feeling-stiff-why-stretching-may-not-be-the-best-solution/

Calm the nervous system (reduce guarding)

When pain decreases and movement feels safer, guarding can ease.

Supportive factors include:

  • Better sleep
  • Breath work
  • Gentle daily movement
  • A plan that progresses gradually (not too aggressive)

ChiroMed’s integrative model emphasizes multidisciplinary support and collaboration when needed (ChiroMed, n.d.-c). https://chiromed.com/elpaso-texas/

Clinical observations: Dr. Alexander Jimenez, DC, APRN, FNP-BC

ChiroMed’s website states it is led by Dr. Alex Jimenez and highlights a multidisciplinary approach that blends chiropractic care with nurse practitioner-level evaluation and integrative wellness strategies (ChiroMed, n.d.-d). https://chiromed.com/contact-us/

From an integrative clinical perspective, the “reset pain” pattern is often treated more effectively when the plan includes:

  • A movement and posture assessment
  • Joint mechanics plus soft tissue evaluation
  • Progressive rehab to build stability
  • Attention to nervous system load (stress, sleep, recovery)

This “full picture” approach is also consistent with how Dr. Jimenez presents integrative care across his professional platforms (ChiroMed, n.d.-d). https://chiromed.com/contact-us/

What you can do today: quick steps that reduce the “reset” problem

You do not have to wait until it is severe.

Movement habits that help

  • Change positions every 30 to 60 minutes
  • Take “movement snacks” during the day:
    • 30 seconds of standing and walking
    • gentle shoulder rolls
    • easy neck turns (pain-free range)
    • hip shifts or mini-squats

A simple 2-minute reset routine

  • 5 slow breaths (longer exhale)
  • 10 shoulder blade squeezes
  • 10 gentle hip hinges or sit-to-stands
  • 30 to 60 seconds of walking

Posture upgrades that matter

  • Screen at eye level
  • Feet supported
  • Hips and knees comfortable (not tucked under)
  • Avoid one-sided leaning for long periods

When you should get evaluated

Get checked sooner if you have:

  • Numbness or tingling that is new or worsening
  • Weakness in an arm or leg
  • Severe pain after an accident or fall
  • Fever, unexplained weight loss, or night pain
  • Bowel or bladder changes

For severe, persistent, or unimproving back pain, patient guidance commonly recommends seeking evaluation from a qualified professional (Healthgrades, 2020). https://resources.healthgrades.com/right-care/back-pain/when-to-see-a-doctor-for-back-pain

Bottom line

The “reset” pain after holding an awkward position is usually a mix of:

  • Postural strain
  • Muscle guarding
  • Trigger points
  • Fascial restriction
  • Temporary joint restriction
  • A nervous system recalibrating proprioception

An integrative plan can help by restoring motion, treating soft-tissue restrictions, strengthening weak links, and reducing the nervous system’s need to guard. ChiroMed describes a multidisciplinary model that combines these strategies into a single coordinated plan (ChiroMed, n.d.-a; ChiroMed, n.d.-b).
https://chiromed.com/
https://chiromed.com/about-us/

References

Chiropractic Care and Digestive Wellness

Chiropractic Care and Digestive Wellness

Chiropractic Care and Digestive Wellness

How the Spine, Nerves, and Stress Can Affect Your Gut

Digestive problems are common. People often experience symptoms such as bloating, constipation, diarrhea, heartburn, reflux, or “mixed” symptoms that fluctuate in frequency. Sometimes the trigger is obvious (food choices, alcohol, certain medications, poor sleep). Other times, the pattern feels confusing: symptoms flare during stressful weeks, after long hours sitting, or when back and rib pain is also acting up.

Many chiropractors and integrative clinics talk about a “gut–brain–spine” connection. The basic idea is simple:

  • Your brain and spinal cord help control digestion through the autonomic nervous system (your “automatic” control system).
  • The thoracic (mid-back) and lumbar (low-back) spinal levels are closely linked to nerve pathways that influence gut motility, secretion, and blood flow.
  • Pain, muscle guarding, poor breathing mechanics, and chronic stress can push the body into a more “fight-or-flight” pattern, which often slows digestion and increases sensitivity.

Some people report digestive improvements during chiropractic care. Research is mixed: there are case reports and some clinical studies suggesting benefit for certain problems, but reviews conclude that the evidence is not strong enough to claim that chiropractic “treats” GI disease. The most accurate, helpful approach is to understand what chiropractic may support, what it cannot replace, and how an integrative plan can be built around safe, evidence-informed steps.

The Gut–Brain–Nerve Connection in Plain Language

Digestion is not just “your stomach doing its job.” It’s a coordinated rhythm involving:

  • Muscle contractions (motility/peristalsis)
  • Sphincters opening and closing at the right time
  • Stomach acid and digestive enzymes
  • Blood flow to digestive organs
  • Immune signals and inflammation control
  • Nerve signals between the gut, spinal cord, and brain

Two major nerve control systems matter here:

  • Enteric nervous system (ENS): the “local” nerve network in the gut
  • Autonomic nervous system (ANS): the “command” system that shifts digestion up or down depending on stress and safety cues

When stress stays high, the body tends to lean toward sympathetic dominance (“fight-or-flight”), which can reduce normal digestive activity. When the body feels safer and calmer, it can shift toward parasympathetic activity (“rest-and-digest”), which is strongly linked to the vagus nerve.

Why the thoracic and lumbar spine are mentioned so often

From a physiology standpoint, it’s true that sympathetic control of the GI tract involves spinal cord levels in the thoracic and lumbar regions. For example, research reviews describe sympathetic pathways to the gut arising from thoracic and lumbar spinal cord segments, with different regions influencing different parts of the GI tract.

That does not automatically prove that every spinal joint problem causes gut disease. But it does help explain why posture, rib mobility, diaphragm function, and stress-related tension patterns can be linked with digestive comfort and regularity.

What Chiropractors Mean by “Subluxation” and Why People Connect It to Digestion

In chiropractic, “subluxation” is often used to describe joint dysfunction (restricted motion, irritation, altered mechanics) that may influence muscle tone and nervous system balance.

In mainstream medicine, the word “subluxation” usually means a partial dislocation seen on imaging, which is different. Because the term is used differently across fields, it’s better to focus on the practical, testable issue:

  • Is there restricted spinal or rib motion?
  • Is there muscle guarding?
  • Is posture or breathing mechanics limited?
  • Is pain and stress high enough to affect sleep, movement, and digestion?

Many chiropractic articles argue that spinal adjustments may help digestion by reducing “nerve interference” and supporting the body’s normal control systems.

How Chiropractic Care May Support Digestive Wellness

Better movement and less guarding can support gut motility

The intestines move food by coordinated muscle contractions. If someone is stuck in a pattern of:

  • shallow breathing
  • tight abdominal wall
  • stiff mid-back and ribs
  • high stress and poor sleep

…then gut motility can feel “off.” Some clinics report that adjustments, along with soft-tissue work and breathing retraining, may help people feel less tight and more regular.

Common supportive steps used alongside adjustments include:

  • rib and thoracic mobility work
  • diaphragm breathing practice
  • gentle walking after meals
  • hydration and fiber adjustments (when appropriate)
  • stress regulation habits (sleep, pacing, recovery)

(These lifestyle steps matter because digestion is highly responsive to stress load and daily rhythm.)

Stress regulation is a big “hidden” gut factor

A major integrative message across many sources is that chiropractic care may support digestion, in part, by helping the body shift out of constant fight-or-flight patterns.

This does not mean an adjustment magically “fixes” IBS. It means care that reduces pain, improves sleep, and supports calmer breathing can indirectly help the gut function more normally.

Posture and spinal mechanics can affect breathing and pressure systems

Breathing and digestion share anatomy and pressure control:

  • The diaphragm influences abdominal pressure.
  • Slumped posture can reduce rib expansion and change abdominal pressure patterns.
  • Pressure changes can influence reflux symptoms in some people.

Dr. Alexander Jimenez often discusses how posture, thoracic mechanics, breathing patterns, and stress physiology can affect digestive comfort in an integrative model.

Conditions People Commonly Ask About

Irritable Bowel Syndrome (IBS)

IBS is complex. It involves gut sensitivity, changes in motility, brain–gut signaling, stress response patterns, and sometimes food triggers.

Some chiropractic and wellness sources suggest that supporting nervous system regulation may help reduce the severity of IBS symptoms for some individuals.

There are also clinical studies on spinal manipulation approaches in IBS populations. For example, PubMed-indexed trials exist that report symptom improvements after spinal manipulation protocols in IBS groups—though results, methods, and generalizability can vary, and this does not mean chiropractic is a stand-alone cure for IBS.

If you have IBS, an integrative plan often works best:

  • rule out red flags (bleeding, anemia, unexplained weight loss, fever)
  • identify triggers (sleep loss, stress spikes, certain foods)
  • build a steady routine (meals, hydration, movement)
  • consider guided nutrition strategies with a qualified clinician
  • use supportive manual therapy for mobility, pain, and stress load (when appropriate)

Constipation

Constipation can be driven by diet, hydration, fiber tolerance, pelvic floor issues, thyroid problems, medications, or low activity. Some case reports in the literature describe improvements in bowel movement frequency alongside chiropractic care, but case reports are not the same as large, high-quality trials.

If constipation is chronic, an integrative clinic may also look at:

  • pelvic and hip mechanics
  • breathing and abdominal pressure strategy
  • activity level (walking is underrated)
  • medication review
  • lab work or referral when appropriate

Acid reflux/GERD-like symptoms

Some chiropractic sources claim spinal adjustments may help reflux by influencing posture, rib mechanics, stress response, and possibly vagal/autonomic balance.

However, when it comes to GERD specifically, the published chiropractic literature is often described as sparse, with limited case reports rather than definitive trials.

Important: If you have frequent reflux, chest pain, trouble swallowing, black stools, vomiting blood, or unexplained weight loss, it needs medical evaluation.

What the Research Says (Supportive Signals + Real Limits)

It’s easy to find confident marketing claims online. The science picture is more mixed.

Supportive signals

  • A 2015 review in Explore (NY) examined chiropractic care for GI conditions and summarized a range of study types (from case reports to trials), with many reports describing mild to moderate symptom improvement and few adverse effects reported in those papers.
  • Some IBS trials report improvements in symptom scores with spinal manipulation protocols.

Cautionary conclusions

  • A 2011 review by Edzard Ernst concluded there was no supportive evidence that chiropractic treatments are effective for gastrointestinal problems (based on the evidence base as reviewed at that time).

The most honest takeaway

Chiropractic care may be a supportive strategy for certain people—especially when digestive symptoms are strongly tied to stress, pain, posture, breathing mechanics, and overall nervous system load. But it should be positioned as part of a broader plan, not as a guaranteed “treatment” for GI disease.

An Integrative Chiropractic Approach to Digestive Wellness

Many clinics combine adjustments with practical lifestyle steps. Across your provided resources, common themes include spinal alignment, nervous system support, stress reduction, and nutrition pairing.

A practical, patient-friendly plan (often used in integrative settings)

Step 1: Screen for red flags

  • blood in stool, black stools
  • persistent fever
  • severe or worsening pain
  • unexplained weight loss
  • vomiting that won’t stop
  • trouble swallowing
  • anemia or significant fatigue

Step 2: Look for mechanical drivers

  • rib and thoracic stiffness
  • low-back and pelvic motion limits
  • abdominal wall guarding
  • shallow breathing and poor diaphragm function
  • forward-head posture with upper back rounding

Step 3: Start with conservative care

  • chiropractic adjustments (as appropriate)
  • mobility work for the thoracic spine and hips
  • soft-tissue techniques to reduce guarding
  • breathing drills to support “rest-and-digest.”

Step 4: Pair with gut basics

  • consistent meal timing
  • hydration
  • fiber changes based on tolerance (some IBS patients do worse with sudden fiber increases)
  • protein + plants + healthy fats
  • reduce ultra-processed triggers when possible

Step 5: Track outcomes

  • stool frequency/consistency
  • reflux days per week
  • bloating severity
  • sleep quality
  • stress rating
  • pain and mobility changes

Helpful tracking tip: Don’t track 20 things. Track 3–5 simple measures for 2–4 weeks.

Dr. Alexander Jimenez’s Clinical Lens (Chiropractic + Nurse Practitioner + Functional Medicine)

Dr. Alexander Jimenez, DC, APRN, FNP-BC, frequently frames digestive wellness as part of a bigger integrative picture—especially the overlap between:

  • spinal mechanics and posture
  • stress physiology and nervous system balance
  • nutrition strategies that reduce inflammation load
  • step-by-step habits patients can maintain

On his clinical site, gut and intestinal health are described in terms of digestion, absorption, assimilation, and whole-body impact, emphasizing how gut function connects to broader wellness.

In his integrative “gut health and detox” discussions, he also highlights practical components such as calming the system, supporting daily digestion, and combining chiropractic care with nutrition and lifestyle support.

That dual-scope model (chiropractic + NP lens) is especially useful when digestive symptoms overlap with:

  • chronic pain and inflammation patterns
  • stress-related sleep disruption
  • medication considerations
  • the need to rule out medical red flags while also building conservative, day-to-day solutions

Safety Notes: When Chiropractic Is Not the Right Tool (or Not Enough)

Chiropractic care is generally considered safe when performed by a licensed professional for appropriate conditions, but no treatment is risk-free. Mild soreness can happen, and rare serious events have been discussed in safety reviews.

Seek medical care quickly if you have:

  • severe abdominal pain with fever
  • persistent vomiting
  • blood in stool or black/tarry stool
  • chest pain, fainting, or shortness of breath
  • trouble swallowing or choking
  • unexplained weight loss

And if you have a known GI diagnosis (Crohn’s, ulcerative colitis, celiac disease, significant GERD complications), chiropractic care should be considered adjunctive—not a replacement for medical management.

Bottom Line

Chiropractic care may support digestive wellness in a few realistic ways:

  • improving thoracic/lumbar mobility and reducing muscle guarding
  • supporting calmer breathing mechanics and stress regulation
  • reducing pain-driven stress load that can disrupt gut function
  • fitting into a broader integrative plan that includes nutrition, sleep, movement, and medical screening when needed

The evidence base is mixed. Some studies and case reports suggest symptom improvement in certain GI complaints, while other reviews argue evidence is insufficient for firm claims. The best approach is honest, practical, and patient-centered: use chiropractic care as one supportive tool inside a full, common-sense digestive wellness strategy.

References

Optimal Joint Movement: Achieving Pain-Free Mobility

Optimal Joint Movement: Achieving Pain-Free Mobility

Optimal Joint Movement: Achieving Pain-Free Mobility

ChiroMed Integrated Medicine

Optimal joint movement is essential for living an active, comfortable life. It’s defined as the ability to move a joint through its full, anatomically intended range of motion (ROM) in a smooth, coordinated, and pain-free way. This is often known as high-quality mobility, blending flexibility with active control to support daily activities and sports performance (Anschutz Medical Campus, n.d.). At ChiroMed Integrated Medicine in El Paso, TX, we understand how crucial this is. Our holistic approach combines chiropractic care, rehabilitation, and nutrition to help restore and maintain optimal joint function.

When joint balance is disrupted by injury or a sedentary lifestyle, mobility decreases, leading to compensatory movements elsewhere. This can create a chain of issues, like back pain from stiff hips. Optimal joint movement means joints move through their natural ROM smoothly, efficiently, and without pain. It balances mobility (active movement) and stability (joint control), enabling muscles, ligaments, and tendons to function effectively. At ChiroMed, our integrative chiropractic care uses spinal adjustments, soft tissue therapy, and movement guidance to restore function, reduce inflammation, and improve neuromuscular coordination (Mainstay Medical, n.d.).

By enhancing joint mobility, strengthening muscles, and optimizing nervous system pathways, our comprehensive methods at ChiroMed help you move with ease and efficiency and reduce your risk of injury. Located at 11860 Vista Del Sol Dr, Suite 128, El Paso, TX, we’ve provided superior expertise since 1996, with a focus on patient-centered care.

Understanding Range of Motion at ChiroMed

Range of motion (ROM) measures how far a joint can move. For instance, a normal knee bends from 0 to 135 degrees, and a shoulder reaches 180 degrees overhead (Verywell Health, 2023a). At ChiroMed, we assess ROM to tailor treatments for better daily function.

Here are typical ROM values for key joints:

  • Neck: Flexion 50 degrees, extension 60 degrees, rotation 80 degrees per side (Physiopedia, n.d.a).
  • Shoulder: Flexion 180 degrees, abduction 180 degrees, internal rotation 70 degrees (Physiopedia, n.d.a).
  • Elbow: Flexion 150 degrees, extension 0 degrees (Verywell Health, 2023a).
  • Hip: Flexion 120 degrees, extension 30 degrees, abduction 45 degrees (Physiopedia, n.d.a).
  • Knee: Flexion 135 degrees, extension 0 degrees (The GO Knee, n.d.).
  • Ankle: Dorsiflexion 20 degrees, plantarflexion 50 degrees (Baliston, n.d.).

Our team at ChiroMed uses tools such as goniometers to capture precise measurements, ensuring personalized treatment plans.

Balancing Mobility and Stability with ChiroMed’s Approach

Mobility allows free movement, while stability provides control. At ChiroMed, we follow a joint-by-joint approach: ankles and hips prioritize mobility, while knees and the lower back emphasize stability (Motus Physio, n.d.). Imbalances can cause pain, but our rehabilitation services address them.

  • Common Imbalances: Hip stiffness causing back strain, or unstable shoulders affecting the neck.
  • ChiroMed Benefits: Improved posture, enhanced athletic power, reduced injuries through targeted therapies (Activ Therapy, n.d.).

Our acupuncture and naturopathy complement chiropractic adjustments for optimal balance.

How Injuries and Sedentary Lifestyles Affect Joints – Insights from ChiroMed

Injuries cause scar tissue, limiting ROM, while prolonged sitting tightens muscles (Dr. OngKeeLeong, n.d.). This leads to compensation, such as overusing the back due to poor hip mobility (Physical Therapy FitMJC, n.d.).

At ChiroMed, we see this in patients with auto accidents or sports injuries. Our team, led by Dr. Alex Jimenez, DC, APRN, FNP-BC, uses muscle energy techniques (MET) to address imbalances, restore gait, and prevent chronic pain. Prolonged immobility worsens issues, but our rehab breaks the cycle (Frozen Shoulder Clinic, n.d.).

Key Benefits of Optimal Joint Movement at ChiroMed

Good joint movement enhances life quality. At ChiroMed, patients report:

  • Everyday Ease: Simpler tasks like reaching or walking (OneStep, n.d.).
  • Sports Edge: Greater power and agility (Activ Therapy, n.d.).
  • Injury Avoidance: Stronger joints handle stress (Anschutz Medical Campus, n.d.).
  • Pain Management: Less arthritis discomfort through lubrication (Arthritis Foundation, n.d.).
  • Improved Gait: Better balance and health (Baliston, n.d.).
  • Aging Well: Maintain independence (Chesapeake Regional, n.d.).

Our nutrition counseling supports joint health with anti-inflammatory diets.

Assessing and Enhancing Mobility with ChiroMed Services

We evaluate “end-feel” for joint health – it should be soft, not painful (Physiopedia, n.d.b). Simple tests at ChiroMed reveal deficits.

Improvement strategies include:

  • Stretching Routines: Shoulder rolls, knee bends (Chesapeake Regional, n.d.).
  • Strength Building: Weights for stability (ACE Fitness, n.d.b).
  • Mobility Exercises: Squats, lunges (Royal City Physio, n.d.).
  • Daily Walking: Boosts lower body ROM (Baliston, n.d.).
  • Mind-Body Practices: Yoga for balance (Muscle and Motion, n.d.).

For arthritis, low-impact options such as swimming can provide relief (Arthritis Foundation, n.d.).

Integrative Chiropractic Care at ChiroMed

ChiroMed offers spinal adjustments, massage, and exercises to restore joints (Rodgers Stein Chiropractic, n.d.a). Our multidisciplinary team addresses root causes.

Benefits:

  • Flexibility Boost: Freeing stuck joints (TXMAC, n.d.).
  • Coordination Improvement: Nerve pathway optimization (Evolved Health Chiropractic, n.d.).
  • Sustained Health: Preventing degeneration (Duca Chiropractic, n.d.).
  • Effortless Movement: Easier daily activities (Core Integrative Health, n.d.).

Manual therapy sessions maintain wellness (Smart Sports Med, n.d.).

Expert Insights from ChiroMed’s Dr. Alex Jimenez

Dr. Alex Jimenez, with over 25 years of experience in chiropractic and physical therapy, observes mobility loss due to poor lifestyle choices. At ChiroMed, he treats sciatica and hip pain with adjustments and MET to restore ROM quickly.

His blog covers how gait affects joints and the use of functional medicine for inflammation. Patients regain activity post-treatment for back or knee issues. Dr. Jimenez links gut health to joint health and offers detox programs.

Team members like Helen Wilmore (massage) and Kristina Castle (PT) enhance care.

Joint Movement in Daily Activities – ChiroMed Tips

In walking, joints coordinate: ankles flex, knees bend (Physiopedia, n.d.c). Limited ROM causes issues, but ChiroMed’s warm-ups and footwear advice help.

Addressing Specific Joint Challenges at ChiroMed

Shoulders are mobile but unstable (Indy Spine, n.d.). Knees need functional ROM (The GO Knee, n.d.). We treat frozen shoulder with therapy (Frozen Shoulder Clinic, n.d.).

The Kinetic Chain in ChiroMed’s Holistic View

Body parts move together; one imbalance affects all (OMassageT, n.d.). ChiroMed ensures chain-wide mobility and stability (ACE Fitness, n.d.a).

Components of Movement Health at ChiroMed

We address flexibility, strength, and coordination (Stretch Affect, n.d.), creating custom plans.

Conclusion: Partner with ChiroMed for Optimal Mobility

Optimal joint movement powers a vibrant life. At ChiroMed Integrated Medicine, our blend of chiropractic, rehab, and nutrition restores it. Reach out to us at +1 (915) 412-6680 or visit https://chiromed.com/ to begin your journey. Achieve pain-free movement today with the help of experts like Dr. Jimenez.

References

ACE Fitness. (n.d.a). Stability vs. mobility: What’s the difference?

ACE Fitness. (n.d.b). Joint mobility and stability.

Activ Therapy. (n.d.). Why improve joint movement for sporting success.

Anschutz Medical Campus. (n.d.). Flexibility, mobility, stability and injury prevention.

Arthritis Foundation. (n.d.). 8 ways exercise helps joints.

Baliston. (n.d.). How does your range of motion impact your quality of walking.

Bernstein, J. (n.d.). Integrated fixation.

Chesapeake Regional. (n.d.). Exercise to improve your arthritis symptoms.

ChiroMed Integrated Medicine. (n.d.). ChiroMed website.

Core Integrative Health. (n.d.). Chiropractic care: Moving freely with great range of motion.

DrOngKeeLeong. (n.d.). Improve shoulder mobility.

Duca Chiropractic. (n.d.). The benefits of chiropractic care for long-term joint health.

Evolved Health Chiropractic. (n.d.). Chiropractic care for joint health: Maintaining mobility and flexibility for life.

Frozen Shoulder Clinic. (n.d.). MUA frozen shoulder.

Indy Spine. (n.d.). The shoulder: The most mobile and troublesome joint in the body.

Jimenez, A. (n.d.). Dr. Alex Jimenez’s website.

Mainstay Medical. (n.d.). Relationship between joint mobility and stability.

Motus Physio. (n.d.). The joint-by-joint approach to physiotherapy: Understanding knee pain.

Muscle and Motion. (n.d.). Mobility: The key to optimal movement.

Musculoskeletal Key. (n.d.). Assessment and classification of uncontrolled movement.

NASM. (n.d.). Mobility and stability: Joint functions when we move.

OMassageT. (n.d.). Understanding the kinetic chain: How body structure affects movement.

OneStep. (n.d.). The importance of range of motion.

Peninsula WP. (n.d.). How integrative chiropractic care connects movement and recovery.

Physical Therapy FitMJC. (n.d.). How to figure out if you have a range of motion deficit.

Physiopedia. (n.d.a). Range of motion normative values.

Physiopedia. (n.d.b). End-feel.

Physiopedia. (n.d.c). Joint range of motion during gait.

Rodgers Stein Chiropractic. (n.d.a). Why do adjustments enhance mobility and flexibility.

Rodgers Stein Chiropractic. (n.d.b). 5 ways chiropractic adjustments enhance flexibility.

Royal City Physio. (n.d.). Flexibility vs. mobility: They are different and what you should know.

Smart Sports Med. (n.d.). Enhancing joint health: The role of joint mobilization in manual therapy.

Stretch Affect. (n.d.). The eight components to movement health.

The GO Knee. (n.d.). Understanding knee range of motion.

Trainerize. (n.d.). Understanding normal ranges of motion.

TXMAC. (n.d.). Why choose chiropractic for enhanced flexibility.

Verywell Health. (2023a). What is normal range of motion in a joint.

Sciatica Without Low Back Pain Symptoms

Sciatica Without Low Back Pain Symptoms

Sciatica Without Low Back Pain Symptoms

Why Your Hamstring and Foot Can Go Numb

Many people expect sciatica to feel like low back pain that shoots down the leg. But a very common (and confusing) version is this:

  • Your lower back feels okay
  • Your hamstring, calf, foot, or toes feel numb, tingly, or “asleep”

That can still be sciatica—or a condition that mimics sciatica. The key is understanding that sciatica is a symptom pattern, not a single diagnosis. It occurs when nerve tissue supplying the sciatic nerve pathway becomes irritated, compressed, or sensitized. (Penn Medicine, n.d.; Yale Medicine, n.d.; HSS, 2024)

At ChiroMed (chiromed.com), a practical way to approach this is to ask two questions:

  1. Where is the nerve getting irritated? (low back vs. buttock/hip vs. near the hamstring)
  2. What’s keeping it irritated? (movement habits, muscle tension, joint mechanics, posture, and load)

This article explains why leg numbness can happen without back pain, how to tell it apart from a hamstring strain, when to seek care, and how an integrative chiropractic plan can support recovery—while coordinating with medical evaluation when needed.

What “Sciatica” Really Means (Simple Definition)

Sciatica describes symptoms that follow a nerve pathway—usually from the buttock down the back or side of the leg. Symptoms may include:

  • Numbness
  • Tingling (“pins and needles”)
  • Burning or “electric” sensations
  • Sharp or aching pain
  • Weakness in the leg or foot (in more serious cases) (HSS, 2024; Yale Medicine, n.d.; Penn Medicine, n.d.)

Important point:
You can have numbness and tingling with minimal pain, and you can have leg symptoms even when your low back does not hurt. (Penn Medicine, n.d.; Yale Medicine, n.d.)

Why Your Hamstring and Foot Can Go Numb Without Back Pain

People often say, “If my back doesn’t hurt, how could this be sciatica?” Here are common explanations.

The “problem spot” and the “felt spot” can be different

Nerves are like wiring. If a nerve is irritated higher up, you may feel symptoms farther down. That’s why a nerve issue can feel like a hamstring or foot problem. (Penn Medicine, n.d.; HSS, 2024)

The irritation may be in the hip or buttock region

Sometimes the sciatic nerve is irritated by muscles and connective tissue in the buttock area. A well-known example is piriformis syndrome, where deep hip muscles contribute to sciatic-type symptoms. People may feel:

  • Buttock tightness
  • Hamstring “numb soreness”
  • Tingling in the calf or foot
  • Symptoms worsen with sitting or driving (Total Ortho Sports Med, 2025)

Clinical observation used in integrative care: when the pelvis and hip are not moving well, deep hip muscles may tighten as “helpers,” which can increase nerve irritation in certain people—especially if they sit a lot, train hard, or have uneven movement patterns. (Jimenez, n.d.-a)

A spinal cause can still exist even if your back feels fine

Even without back pain, symptoms can still come from the lumbar spine, such as:

  • Disc irritation (bulge/herniation)
  • Narrowing around nerve roots (stenosis)
  • Other mechanical or inflammatory causes (HSS, 2024; Penn Medicine, n.d.)

This is one reason careful evaluation matters: no back pain automatically rules out the spine.

The nerve may be irritated closer to the hamstring

Some people get sciatic nerve irritation near where the hamstring attaches to the high part of the pelvis. This can feel like:

  • Deep buttock pain
  • “Hamstring tightness” that won’t stretch out
  • Tingling or numbness down the leg (Jimenez, 2025)

Sciatica vs. Hamstring Strain: How to Tell the Difference

This is one of the most common questions ChiroMed patients ask, because the symptoms can overlap.

Hamstring strain tends to look like this

  • A clear injury moment (sprint, slip, kick, deadlift)
  • Local pain in the back of the thigh
  • Pain when you stretch the hamstring
  • Pain when you contract the hamstring
  • Tenderness or bruising (in some cases) (Ducker Physio, 2025)

Sciatica-type nerve symptoms tend to look like this

  • Tingling, buzzing, burning, or numbness
  • Symptoms that travel below the knee (often into the foot)
  • Symptoms that change with posture (sitting, bending, driving)
  • Sensations that feel “electric” or “deep” rather than sore-muscle pain (HSS, 2024; Ducker Physio, 2025)

Quick comparison:

  • More muscle: sharp pull + local tenderness + pain with stretch
  • More nerve: numbness/tingling + travel to foot + posture-dependent changes

If you are unsure, it’s safer to get assessed—because the best treatment plan depends on the true cause.

Why Numbness Deserves Respect (Even If Pain Is Mild)

Pain is loud. Numbness can be quiet, but it can signal that a nerve is not communicating well.

The American Medical Association notes that leg numbness or weakness can be an atypical symptom that warrants evaluation—especially if it progresses or is accompanied by other warning signs. (AMA, 2024)

At ChiroMed, a “rule of thumb” approach is:

  • Occasional tingling that improves quickly may respond well to conservative care.
  • Persistent or worsening numbness, especially with weakness, should be evaluated more urgently.

Red Flags: When You Should Seek Care Quickly

Seek urgent medical evaluation if you have:

  • New or worsening leg weakness
  • Foot drop (difficulty lifting the front of the foot)
  • Loss of bowel or bladder control
  • Numbness in the “saddle” area (inner thighs/groin)
  • Severe symptoms that rapidly worsen (AMA, 2024; Penn Medicine, n.d.)

Also, schedule an evaluation soon if:

  • Numbness lasts longer than 1–2 weeks
  • Symptoms keep returning
  • Symptoms spread farther down the leg
  • You can’t work, train, or sleep normally (Penn Medicine, n.d.; HSS, 2024)

What a Good Evaluation Usually Includes

A careful sciatica-style workup often checks:

  • Where symptoms travel (hamstring only vs. foot/toes)
  • What triggers symptoms (sitting, bending, walking, lifting)
  • Sensation, strength, and reflexes
  • Hip and pelvic motion
  • Nerve tension testing
  • Whether imaging is needed (HSS, 2024; Penn Medicine, n.d.)

Why this matters: many conditions can look like sciatica. There are “musculoskeletal mimics” that can imitate nerve-root problems, so testing needs to be specific and organized.

ChiroMed’s Integrative Approach: What It Tries to Fix (Not Just “Chase Pain”)

When sciatica shows up mainly as hamstring and foot numbness, an integrative chiropractic plan often focuses on:

1: Reduce nerve irritation

Goal: decrease mechanical and inflammatory stress on the nerve pathway.

This may involve:

  • Targeted manual therapy (joint and soft tissue)
  • Position changes and activity modifications
  • Gentle mobility that doesn’t flare symptoms (HSS, 2024; Yale Medicine, n.d.)

2: Restore movement in the spine–pelvis–hip chain

Goal: improve how the low back, pelvis, and hip share load.

This may include:

  • Lumbar and pelvic mobility work (as appropriate)
  • SI/hip mechanics support
  • Posture strategies for sitting/driving (especially for desk workers) (Total Ortho Sports Med, 2025)

Clinical observations commonly emphasized in integrative settings: many recurring sciatica patterns involve combined issues—restricted hip motion, overworked deep hip muscles, and poor load sharing through the pelvis and lumbar spine—especially in active adults and people who sit long hours. (Jimenez, n.d.-a)

3: Build strength and control so symptoms don’t keep returning

Goal: stop the “flare-up cycle.”

Common focus areas:

  • Glute strength/endurance (hip stability)
  • Core/trunk control
  • Gradual return to lifting or sport
  • Movement retraining (how you hinge, squat, run, or climb) (HSS, 2024)

Common Tools Used in Integrative Chiropractic Care

Different people need different tools. The main idea is to match the tool to the driver.

Spinal and pelvic adjustments (when appropriate)

These are used to support joint motion and reduce mechanical stress in a region that may be contributing to nerve irritation. They are often paired with exercise and education rather than used alone. (Auburn Hills Chiropractic, n.d.)

Soft-tissue therapies

These may target:

  • Piriformis and deep hip rotators
  • Glutes
  • Hamstrings (especially the upper attachment area)
  • Surrounding fascia and trigger points (Total Ortho Sports Med, 2025)

Corrective exercises (the “long-game”)

These often include:

  • Hip mobility drills
  • Glute activation work
  • Controlled hamstring loading (when appropriate)
  • Core stability patterns
  • Walking progression and graded exposure back to activity (HSS, 2024)

Co-management with medical evaluation when needed

Many sciatica cases respond to conservative care, but persistent numbness, weakness, or red flags may require imaging and medical management. (Penn Medicine, n.d.; AMA, 2024)

Clinical practice guidelines often support care that includes:

  • Education
  • Exercise-based rehab
  • Manual therapy as part of a broader plan (Zaina et al., 2023)

At-Home Habits That Often Help (Simple, Practical)

These are not a diagnosis, but they can reduce flare-ups while you get evaluated.

Helpful habits

  • Take short walking breaks if sitting triggers symptoms
  • Avoid staying in one position too long
  • Use a pillow or support to reduce slumped sitting
  • Reduce aggressive stretching if it increases tingling
  • Keep training “in the safe zone” (no sharp increases in symptoms) (HSS, 2024)

Things that often make it worse

  • Long car rides without breaks
  • Deep forward bending early on (for some people)
  • “Stretching harder” into nerve symptoms
  • Ignoring weakness or worsening numbness (AMA, 2024; Penn Medicine, n.d.)

What Recovery Usually Looks Like

Many people improve over weeks to a few months with conservative care and good movement habits.

A realistic recovery path often includes:

  • Step 1: calm symptoms + restore comfortable motion
  • Step 2: rebuild strength + improve hip/spine load sharing
  • Step 3: return to normal activity with fewer flare-ups

The biggest mistake is trying to “rush” flexibility or intensity while the nerve is still irritated. For nerve symptoms, calm, consistent progress usually beats aggressive pushing.

Key Takeaways (Fast Summary)

  • Sciatica can cause hamstring and foot numbness without low back pain. (Penn Medicine, n.d.; Yale Medicine, n.d.; Total Ortho Sports Med, 2025)
  • Causes can include hip/buttock-region irritation (piriformis-related), lumbar nerve root irritation, or local nerve irritation near the hamstring. (HSS, 2024; Jimenez, 2025)
  • Numbness and weakness matter, especially if worsening or paired with red flags. (AMA, 2024)
  • An integrative plan—like the approach used at ChiroMed—often combines manual care, soft-tissue work, and corrective exercise to restore movement, reduce nerve stress, and prevent repeat flare-ups. (Zaina et al., 2023)

References

American Medical Association. (2024, November 15). What doctors wish patients knew about sciatica. https://www.ama-assn.org/public-health/prevention-wellness/what-doctors-wish-patients-knew-about-sciatica

Auburn Hills Chiropractic and Rehabilitation. (n.d.). How chiropractic adjustments can treat sciatica. https://auburnhillschiro.com/how-chiropractic-adjustments-can-treat-sciatica/

Bateman, E. A., et al. (2024). Musculoskeletal mimics of lumbosacral radiculopathy. PM&R. https://pmc.ncbi.nlm.nih.gov/articles/PMC11998970/

Ducker Physio. (2025, April 8). Tell the difference between sciatica & hamstring pain. https://www.duckerphysio.com.au/blog/difference-sciatica-and-hamstring-pain

Hospital for Special Surgery. (2024, May 24). Sciatica: Simple symptoms, complex causes. https://www.hss.edu/health-library/conditions-and-treatments/list/sciatica

International Association for the Study of Pain. (n.d.). Surgical or non-surgical management for sciatica. https://www.iasp-pain.org/publications/relief-news/article/management-for-sciatica/

Jimenez, A. (n.d.-a). Sciatica vs piriformis syndrome explained. https://dralexjimenez.com/sciatica-el-paso-chiropractor/sciatica-vs-piriformis-syndrome-explained/

Jimenez, A. (2025). Hamstring syndrome relief and muscle recovery. https://dralexjimenez.com/hamstring-syndrome-relief-and-muscle-recovery/

Penn Medicine. (n.d.). Sciatica. https://www.pennmedicine.org/conditions/sciatica

Total Ortho Sports Med. (2025, December 5). Sciatica with no back pain. https://www.totalorthosportsmed.com/sciatica-with-no-back-pain/

Yale Medicine. (n.d.). Sciatica. https://www.yalemedicine.org/conditions/sciatica

Zaina, F., et al. (2023). A systematic review of clinical practice guidelines for low back pain with and without radiculopathy. Archives of Physical Medicine and Rehabilitation. https://pubmed.ncbi.nlm.nih.gov/36963709/

Fun and Easy Ways to Get Back into Shape

Fun and Easy Ways to Get Back into Shape

After Skipping New Year’s Goals

Many people start the year with big plans to get fit, but life gets busy, and those plans fade away. If you’ve let go of your New Year’s resolutions, don’t worry. You can still find ways to move your body that feel good and fit into your day. This article looks at simple, fun activities that mix exercise with things you enjoy. We’ll also talk about other options if you don’t like regular workouts, and how experts like chiropractors and nurse practitioners can help you stay healthy. Getting active doesn’t have to be hard—it can be something you look forward to.

Starting over after dropping your fitness goals can be as easy as picking activities that don’t feel like work. Things like walking in nature or dancing to your favorite songs can get your heart pumping without the stress of a strict routine. Experts say that making movement fun is key to sticking with it over time. For example, if you tried running or gym sessions and quit, try something social or relaxing instead. This way, you build habits that last.

Rediscovering Joy in Movement: Fun Activities to Restart Your Fitness

If you’ve given up on your New Year’s promises, try activities that blend fun with fitness. These can help you get moving again without feeling forced. Start small, like 10 to 15 minutes a day, and build up slowly. This approach makes it easier to keep going.

Hiking is a great choice because it lets you explore outdoors while getting exercise. You walk on trails, breathe fresh air, and see new sights. It’s good for your heart and legs, and you can go at your own pace. Dancing is another fun option—put on music at home or join a class like salsa or Zumba. It burns calories, improves balance, and lifts your mood. Swimming works your whole body but is gentle on your joints, making it perfect if you have aches. Cycling, whether on a bike path or around the neighborhood, builds strength in your legs and core without much impact.

Group activities add a social element, making exercise more enjoyable. Pickleball combines tennis and ping-pong on a small court—it’s easy to learn and great for all ages. Tennis gets you running and swinging, improving coordination. Team sports like soccer or basketball build friendships while you stay active.

For a calmer approach, try mind-body practices. Yoga focuses on stretches and breathing to build flexibility and reduce stress. Tai Chi uses slow movements to improve balance and calm the mind. These are low-impact, meaning they don’t strain your body much.

  • Hiking Tips: Choose easy trails first. Wear comfortable shoes and bring water. Go with a friend for more fun.
  • Dancing Ideas: Try online videos if you’re shy. Styles like hip-hop or ballroom keep it exciting.
  • Swimming Basics: Use a pool for laps or just float and move. It’s great to cool off in the summer.
  • Cycling Advice: Start on flat paths. Rent a bike if you don’t own one.
  • Pickleball Perks: Courts are often free at parks. It’s less intense than tennis but still active.
  • Yoga Starter: Begin with simple poses, such as child’s pose. Apps can guide you.
  • Tai Chi Benefits: Classes are available online or in community centers. It helps with focus, too.

Studies show that starting with short sessions helps inactive people build habits. Aim for 150 minutes of moderate activity a week, like brisk walking or these fun options. This can lower stress and boost energy. Consistency is more important than intensity at first.

Many people find success by turning everyday tasks into movement. For instance, walk while talking on the phone or dance while cleaning. These small changes add up without feeling like a chore. If you like games, try geocaching—it’s like a treasure hunt that gets you walking miles.

Remember, the goal is to enjoy it. If something doesn’t click, try another. Over time, you’ll feel stronger and more motivated.

Alternatives for Those Who Dislike Traditional Exercise

Not everyone likes going to the gym or running. If standard workouts feel boring or hard, look for low-impact or social options. These keep you active in a way that’s stimulating and fun.

Swimming is ideal because the water supports your body, reducing stress on joints. You can do laps or just play around—it’s a refreshing full-body workout. Cycling offers freedom; ride for errands or leisure. It’s low-impact and builds endurance. Hiking combines adventure with exercise, allowing you to explore paths at your pace. Dancing turns music into movement, improving coordination without routine.

Rock climbing challenges your strength and mind. Indoor walls are safe for beginners and help build confidence. Recreational sports leagues, like softball or volleyball, add teamwork and laughs.

These alternatives beat traditional regimens by being engaging. Instead of counting reps, you’re having fun, which makes it easier to stick with.

  • Swimming Variations: Try water aerobics for group fun. It’s gentle for beginners.
  • Cycling Options: Use a stationary bike at home if the weather is bad.
  • Hiking Levels: Start flat, then try hills for more challenge.
  • Dancing Styles: Zumba blends fitness with dance-party vibes.
  • Rock Climbing Basics: Lessons teach safety. It’s great for arms and core.
  • League Sports: Join casual teams—no need to be a pro.

Low-impact means a lower risk of injury, especially if you’re starting out or have limitations. Add strength work, like yoga, twice a week for balance. Social aspects, like playing with friends, boost motivation.

Martial arts or self-defense classes build skills while getting fit. Or try bodyweight circuits at home—simple moves like squats in short bursts. The key is variety to keep it fresh.

How Integrative Chiropractors and Nurse Practitioners Can Help

Sometimes, physical limits make it difficult to stay active. That’s where integrative chiropractors and nurse practitioners (NPs) come in. They offer personalized care to manage pain and get you back to normal.

Integrative chiropractors look at your whole body, not just symptoms. They use adjustments to fix alignment, reducing pain in joints and muscles. This helps with issues like back pain or stiffness, making movement easier. They also suggest nutrition, exercise, and stress tips for overall health.

NPs provide check-ups and tailored advice. They work with chiropractors for complete care, especially for injuries or chronic problems.

Dr. Alexander Jimenez, DC, APRN, FNP-BC, shares observations from his practice. He sees that personalized plans help patients overcome limitations, using gentle therapies such as resistance bands and acupuncture. In his work, he notes that addressing root causes, such as gut health and inflammation, leads to better mobility. For example, he recommends core exercises and stretching to help prevent pain from prolonged sitting.

These pros guide you back to activities safely. They might start with low-impact options and build up, ensuring you avoid setbacks.

  • Chiropractic Adjustments: Fix spine issues for less pain.
  • NP Counseling: Get tips on daily habits.
  • Holistic Plans: Include diet and relaxation.
  • Injury Management: Rehab for sports or accidents.

Working with them can make your return to fitness smoother and more effective.

Wrapping Up: Stay Active Your Way

Getting back to fitness after skipping resolutions is about fun and support. Choose activities you like, start small, and seek help if needed. With time, you’ll feel healthier and happier.

References

American Fitness Professionals & Associates. (n.d.). What does a “holistic” or “integrative” approach to health and wellness really look like? https://www.afpafitness.com/blog/what-does-a-holistic-or-integrative-approach-to-health-and-wellness-really-look-like/

Blue Cross NC. (n.d.). Fun exercises that don’t feel like work. https://www.bluecrossnc.com/blog/healthy-living/fitness/exercises-for-people-who-hate-to-work-out

Buckner Parkway Place. (n.d.). Senior fitness: Exercise programs tailored for older adults. https://bucknerparkwayplace.org/news-blog/senior-fitness-exercise-programs-tailored-for-older-adults/

Delaware Integrative Healthcare. (n.d.). How chiropractic care can help alleviate joint pain. https://deintegrativehealthcare.com/how-chiropractic-care-can-help-alleviate-joint-pain/

Exercise is Medicine. (n.d.). EIM Rx series: Apparently healthy inactive. https://www.exerciseismedicine.org/assets/page_documents/EIM%20Rx%20series_Apparently%20Healthy%20Inactive(3).pdf

Impastato Chiropractic. (n.d.). Unlocking optimal health: The benefits of choosing an integrative chiropractor. http://impastatochiro.com/integrative-chiropractor/

Injury Specialists. (n.d.). Dr. Alexander Jimenez. https://dralexjimenez.com/

Integral Chiropractic. (n.d.). Chiropractic blog. https://www.integral-chiropractic.com/blog.html

Jimenez, A. (n.d.). LinkedIn profile. https://www.linkedin.com/in/dralexjimenez/

MultiCare Clinic. (n.d.). Fun activities you can try to stay active and healthy. https://www.multicareclinic.com/blog/1243687-fun-activities-you-can-try-to-stay-active-and-healthy

National Health Service. (n.d.). Physical activity guidelines for adults aged 19 to 64. https://www.nhs.uk/live-well/exercise/physical-activity-guidelines-for-adults-aged-19-to-64/

Nerd Fitness. (n.d.). 40 fun ways to exercise (without realizing it). https://www.nerdfitness.com/blog/25-ways-to-exercise-without-realizing-it/

Piedmont Wellness Center. (n.d.). Workouts for when you don’t want to work out. https://www.piedmontwellnesscenter.com/blog/workouts-for-when-you-dont-want-to-work-out/