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Tag: nutrition

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

Pseudoarthrosis After Spinal Fusion Surgery Explained

What is pseudoarthrosis of the cervical and lumbar spine?

Pseudoarthrosis of the cervical and lumbar spine

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

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

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

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

In many cases, revision surgery is needed.

Surgery-Related

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

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

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

Number of Vertebrae Being Fused

Hardware

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

Bone Graft

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

Risk Factors

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

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

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

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

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

Symptoms

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

Diagnosis

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

Treatment

Treatment for pseudoarthrosis will likely start with:

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

Injury Medical Chiropractic and Functional Medicine Clinic

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

Enhancing Health Together

References

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

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

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

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

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

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

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

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

Pilates Nutrition for Enhanced Performance and Recovery

Many ask, what and when should you eat before, during, and after engaging in Pilates exercises?

Pilates Nutrition Plan

Pilates involves a lot of core work on the mat. However, it does not require a special diet. To fully utilize Pilates nutrition, individuals should consider what foods keep their bodies feeling the most balanced. A balanced nutrition plan can enhance Pilates practice by:

  • Providing sustained energy
  • Supporting muscle recovery
  • Promoting overall well-being

Pre-Pilates

Timing

  • Eat a light meal or snack 2-3 hours before a class or a smaller snack 30 minutes before.

Food Options

  • Eat complex carbohydrates like whole grains, fruits, and vegetables for sustained energy.

Avoid

  • Heavy, greasy, or spicy foods may cause discomfort during exercise.
  • Foods that will make you gassy or cause queasiness.

During the Workout

Complex carbohydrates and lean proteins, with a little healthy fat, are good pre-Pilates meals, as they sustain energy better than simple carbs or sugary snacks. (American Heart Association, 2024) Suggestions for a pre-Pilates meal.

  • Individuals can adjust the portion size.
  • A protein shake that uses fruit can be convenient.
  • Peanut butter on whole-grain bread offers a quick source of complex carbohydrates and protein.
  • Yogurt with fruit.
  • Small portion of oatmeal.

Because Pilates emphasizes using the abdominal muscles, individuals will want to ensure that any food they’ve eaten before their session is fully digested. Try to eat light before, like snacking on a banana or sipping on a smoothie for some carbohydrates for energy. Regardless of what is eaten, nutrition experts recommend waiting two to three hours after eating before exercising.

Maintain Hydration

  • Drink water and/or eat hydrating fruits throughout the day, especially before and during the workout or class.

After Working Out

Individuals want to ensure their bodies have enough nutrients to strengthen their muscles and replenish their energy. Try a protein green smoothie afterward or a light snack with lean protein like fish or chicken and carbohydrates like whole grains. The diet between workouts will depend on weight loss goals.

Timing

  • Consume a protein-rich snack or meal within 30-60 minutes after your class to aid muscle recovery.

Food Choices

  • Focus on protein for muscle repair and carbohydrates to replenish energy stores.

Hydration

  • Continue to hydrate to replenish fluids lost through perspiration.

While Pilates can complement cardiovascular exercise as part of a fat-burning workout program, health experts advise that losing weight will not come from exercise alone. Individuals will need to work on reducing their calorie intake overall. (Centers for Disease Control and Prevention, 2023)

Injury Medical Chiropractic and Functional Medicine Clinic

As a Family Practice Nurse Practitioner, Dr. Jimenez combines advanced medical expertise with chiropractic care to address various conditions.

  • Wellness & Nutrition: Personalized plans to optimize health and prevent disease.
  • Sports Injuries & Orthopedic Care: Treatment for sprains, strains, and complex injuries.
  • Chronic Pain Management: Non-invasive solutions for fibromyalgia, sciatica, and low back pain.
  • Personal Injury & Auto Accident Care: Tailored rehabilitation for whiplash, soft tissue injuries, and more.
  • Functional Medicine: Root-cause analysis for chronic disorders, incorporating nutrition, lifestyle, and environmental factors.
  • Neuromusculoskeletal Health: Care for neck pain, migraines, herniated discs, and scoliosis.

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

Home Exercises for Pain Relief

References

American Heart Association. (2024). Food as fuel before, during, and after workouts. https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/nutrition-basics/food-as-fuel-before-during-and-after-workouts

Centers for Disease Control and Prevention. (2023). Tips for Maintaining Healthy Weight. Retrieved from https://www.cdc.gov/healthy-weight-growth/about/tips-for-balancing-food-activity.html?CDC_AAref_Val=https://www.cdc.gov/healthyweight/calories/index.html

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

The Throwing Motion and Its Impact on Performance

Can understanding the mechanics of the throwing motion help to understand why it may cause shoulder pain, the symptoms of a shoulder problem, the diagnosis, and the treatment options available?

Throwing a Ball and Shoulder Pain

The throwing motion is a complex shoulder movement that requires the mechanics of muscles, tendons, joints, ligaments, and bones. They all must move in a synchronized and stable pattern to move the shoulder joint. When these mechanics are interrupted or altered, inflammation can result in pain symptoms. (Wardell M., Creighton D., & Kovalcik C., 2022)

Throwing Motion

Distinct phases characterize the throwing motion:

  • The wind up
  • Cocking
  • Acceleration
  • Follow-through
  • Deceleration
  1. The rotator cuff and shoulder muscles sequentially guide the movements for effective throwing mechanics. (Wardell M., Creighton D., & Kovalcik C., 2022)
  2. The labrum stabilizes the ball in the socket of the shoulder.
  3. The shoulder blade rotation coordinates with the arm to ensure mobility. (Itoigawa Y. et al., 2023)

The throwing motion generates high torque and acceleration forces acting on the shoulder joint and the surrounding muscles, ligaments, and tendons.

Causes of Pain

Pain when throwing can come from the:

  • Shoulder blade
  • Shoulder joint – cartilage and labrum
  • Rotator cuff muscles and tendons
  • Nerves that control the muscles’ function 

The shoulder blade is attached to the upper back by ligaments, muscles, and tendons. The various muscles and tendons that control the movement of the shoulder blade impact movements. Abnormalities of any area can lead to shoulder dysfunction and pain when throwing. (Wardell M., Creighton D., & Kovalcik C., 2022) The most common is the tightness of the posterior shoulder capsule, causing a loss of normal internal rotation of the shoulder. If this is causing pain, individuals may notice that they can’t reach up as high on the side with the painful shoulder when reaching behind their back.

Symptoms

Whether an athlete or playing catch in the backyard, shoulder function abnormalities can cause significant pain. Some symptoms include.

Aching Pain

  • Often deep in the shoulder or extending down the upper arm.

Dead Arm

  • Lack of strength in the throwing motion.

Pain at Night

  • Pain can awaken you from sleep.

Diagnosis

Finding a healthcare provider familiar with sports injuries can be helpful. They can best determine if a structural abnormality needs to be addressed. (American Academy of Orthopaedic Surgeons, 2021)

Treatment

Most can improve with nonsurgical treatments. The earliest phase of treatment is resting the joint and reducing inflammation. Treatments can include:

  • Ice
  • Anti-inflammatory medications
  • Cortisone injection

Once the inflammation has subsided, the source of the discomfort can be addressed.

Physical Therapy

Therapy can include:

  • A structured shoulder stretching and strengthening program will help.
  • The physical therapist will focus on scapular mobility when managing shoulder joint problems.

Exercises may include: (American Academy of Orthopaedic Surgeons, 2024)

  • Stretching to improve internal rotation or any other lost motion can help allow a more normal throwing motion.
  • Strength exercises are often aimed at the rotator cuff, as these muscles initiate proper shoulder movements and stabilize the shoulder joint.
  • Maintaining flexibility and strength of the periscapular muscles (muscles that attach to the scapula bone) is important to ensure that the scapular movements are coordinated with the throwing motion.

Suppose improvements are not made within three months of therapy, or individuals can’t return to competitive sports within six months. In that case, the individual may need to return to their healthcare provider or see an orthopedic specialist who may recommend surgery. (American Academy of Orthopaedic Surgeons, 2024)

Injury Medical Chiropractic and Functional Medicine Clinic

As a Family Practice Nurse Practitioner, Dr. Jimenez combines advanced medical expertise with chiropractic care to address various conditions.

  • Wellness & Nutrition: Personalized plans to optimize health and prevent disease.
  • Chronic Pain Management: Non-invasive solutions for fibromyalgia, sciatica, and low back pain.
  • Personal Injury & Auto Accident Care: Tailored rehabilitation for whiplash, soft tissue injuries, and more.
  • Sports Injuries & Orthopedic Care: Treatment for sprains, strains, and complex injuries.
  • Functional Medicine: Root-cause analysis for chronic disorders, incorporating nutrition, lifestyle, and environmental factors.
  • Neuromusculoskeletal Health: Care for neck pain, migraines, herniated discs, and scoliosis.

Our clinic integrates Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine to create customized care plans that promote natural healing, mobility, and long-term wellness. By focusing on flexibility, agility, and strength, we empower patients to thrive, regardless of age or health challenges.

At El Paso’s Chiropractic Rehabilitation Clinic & Integrated Medicine Center, we passionately focus on treating patients after frustrating injuries and chronic pain syndromes. We focus on improving your ability through flexibility, mobility, and agility programs tailored for all age groups and disabilities. We use in-person and virtual health coaching and comprehensive care plans to ensure every patient’s personalized care and wellness outcomes.

Lumbar Spine Injuries in Sports: Chiropractic Healing

References

Wardell, M., Creighton, D., & Kovalcik, C. (2022). Glenohumeral Instability and Arm Pain in Overhead Throwing Athletes: A Correlational Study. International journal of sports physical therapy, 17(7), 1351–1357. https://doi.org/10.26603/001c.39800

Itoigawa, Y., Koga, A., Morikawa, D., Kubota, A., Uehara, H., Maruyama, Y., Takazawa, Y., & Ishijima, M. (2023). Posterior shoulder stiffness was associated with shoulder pain during throwing in college baseball players: assessment of shear wave elastography. European journal of orthopaedic surgery & traumatology: orthopedie traumatologie, 33(4), 1237–1244. https://doi.org/10.1007/s00590-022-03286-z

American Academy of Orthopaedic Surgeons. (2021). Shoulder Injuries in the Throwing Athlete. https://orthoinfo.aaos.org/en/diseases–conditions/shoulder-injuries-in-the-throwing-athlete/

American Academy of Orthopaedic Surgeons. (2024). Shoulder Impingement/Rotator Cuff Tendinitis. https://orthoinfo.aaos.org/en/diseases–conditions/shoulder-impingementrotator-cuff-tendinitis

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

Understanding Nerve Conduction Velocity in Health Care

Should individuals experiencing nerve pain or various sensations get a nerve conduction velocity study to examine nerve health and function?

Nerve Conduction Velocity

A nerve conduction velocity (NCV) is a noninvasive test that measures the speed and strength of nerve stimulation using electrical probes placed on the skin. It’s used to diagnose nerve damage or disease, often alongside an EMG (electromyogram) to differentiate between nerve and muscle problems. It can also evaluate sensory issues, pain, and weakness of the extremities.

  • This test involves safe electrical shocks that can be slightly uncomfortable but not painful.
  • Nerve conduction velocity (NCV) measures the speed at which electrical impulses travel along a nerve fiber, which measures how quickly electrical signals travel through a nerve.
  • This information indicates nerve health and function.
  • Electromyography (EMG) is a nerve test that involves placing tiny needles into the muscles.
  • A slower NCV can indicate nerve injury or dysfunction.

Test Uses

Generally, the test is ordered to assess peripheral nerve diseases, those that connect from the muscles, organs, and skin to the spinal cord or brain. It can help identify the type and location of nerve damage.

  • Peripheral nerve conditions typically cause pain, sensory loss, tingling, or burning.
  • Mild weakness and diminished reflexes can be detected during a neurological examination.

Conditions

Nerve conduction studies are performed to help diagnose conditions.

  • Herniated disc disease
  • Sciatic nerve problems
  • Carpal tunnel syndrome
  • Guillain-Barré syndrome
  • Nerve damage (neuropathy), such as from diabetes, chemotherapy, or autoimmune disorders
  • Charcot-Marie-Tooth disease

Nerve compression

  • Many different conditions, including trauma, inflammation, and tumors, can compress one or more nerves.

Radiculopathy

  • Often described as a pinched nerve, radiculopathy can affect an arm or a leg, causing pain and weakness.

Peripheral Neuropathy

  • This nerve damage begins in the most distal nerves, those farthest from the center of the body, such as the toes and fingers. It is often due to chronic alcohol misuse, uncontrolled diabetes, nutritional deficits, and inflammatory diseases. (Ferdousi M. et al., 2020)

Carpal Tunnel Syndrome

  • Commonly caused by inflammatory diseases or overuse of the wrists, such as from assembly line work, carpal tunnel syndrome causes numbness, pain, and weakness of the fingers and hands. (Tada K. et al., 2022)

Ulnar neuropathy

  • This common condition causes arm pain and sensory changes, usually due to repetitive movements or a prolonged position that causes pressure on the ulnar nerve.

Guillain-Barré syndrome (GBS)

  • This inflammatory condition causes demyelination, or loss of the insulating covering around nerves, which results in leg weakness.
  • It begins in the motor nerves, which send signals to muscles in the legs. (Shibuya K. et al., 2022)
  • The inflammation travels to nerves of the upper body, often affecting the muscles that control breathing.
  • Respiratory support is necessary until the condition improves.

Chronic Demyelinating Polyneuropathy (CIDP)

  • This condition is a chronic, recurrent form of GBS that usually affects the legs and causes episodes of weakness.

ICU neuropathy

  • Metabolic changes, severe illness, and not moving enough can cause nerves to develop a pattern of weakness and sensory loss.

Myasthenia gravis (MG)

  • This autoimmune condition affects the junction between the nerves and the muscles.
  • Myasthenia gravis causes drooping eyelids and weakness of the arms and shoulders.

Amyotrophic lateral sclerosis (ALS)

  • ALS is a serious, degenerative disease affecting the spinal cord’s motor neurons.
  • Amyotrophic lateral sclerosis progresses rapidly, resulting in substantial weakness of muscles throughout the body.

How it’s Done

  • Surface electrodes are placed on the skin over nerves, and a small electrical current is applied to stimulate the nerve.
  • The time it takes for the electrical signal to travel between the electrodes is measured, and this time is used to calculate the NCV.

Values

Normal NCV values are generally between 50 and 70 meters per second. However, these values can vary depending on the nerve and the individual.

NCV Factors

Various factors can influence NCV.

  • Age
  • Sex
  • Medical conditions like diabetes

Interpretation

  • A slower NCV can indicate nerve damage or demyelination (loss of the myelin sheath, which insulates nerve fibers), while an EMG can help determine if the problem is with the nerve or the muscle.

Results

The results of NCV testing can be used to determine the type, severity, and location of nerve damage. The results will be ready in report form about a week after the test.

  • The test measures velocity (how fast a nerve transmits signals) and amplitude (how many nerve fibers were activated). (Tavee J. 2019)
  • The measurements are transmitted to a computer and shown as waves and numerical values.
  • The values are compared to a standard measurement based on the tested nerve.
  • The distance between the electrodes.
  • The person’s age.

Compared to the standard, the NCV results can identify certain patterns of nerve damage. (Tada K. et al., 2022) Outcomes include: (Tavee J. 2019)

  • If one or more nerves are affected.
  • If motor nerves (control movement), sensory nerves (transmit sensory signals), or both are affected.
  • Whether a nerve is blocked or damaged.
  • The severity of the damage.
  • The type of nerve damage
  • Axonal (damage to the nerve itself)
  • Demyelination (damage to the protective fatty layer around the nerve)

The results can help point to certain diagnoses.

Preparation Before the Test

Individuals will not need to change their diet before having an NCV. However, patients will be asked to avoid lotions or creams on their skin before the test. Individuals who are also having an EMG at the time of their NCV might be asked to stop taking medications or supplements that increase the risk of bleeding and bruising. If a healthcare provider says not to stop taking the medicines for health reasons, the patient might be warned that they could have some bruising after the EMG test.

  • NCV may advise against getting the test for those with electrical device implants.
  • Make sure your healthcare providers are aware of your whole medical history.

Injury Medical Chiropractic & Functional Medicine Clinic

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

Peripheral Neuropathy and Chiropractic Care

References

Ferdousi, M., Kalteniece, A., Azmi, S., Petropoulos, I. N., Worthington, A., D’Onofrio, L., Dhage, S., Ponirakis, G., Alam, U., Marshall, A., Faber, C. G., Lauria, G., Soran, H., & Malik, R. A. (2020). Corneal confocal microscopy compared with quantitative sensory testing and nerve conduction for diagnosing and stratifying the severity of diabetic peripheral neuropathy. BMJ open diabetes research & care, 8(2), e001801. https://doi.org/10.1136/bmjdrc-2020-001801

Tada, K., Murai, A., Nakamura, Y., Nakade, Y., & Tsuchiya, H. (2022). In Carpal Tunnel Syndrome, Sensory Nerve Conduction Velocities Are Worst in the Middle Finger Than in the Index Finger. Frontiers in Neurology, 13, 851108. https://doi.org/10.3389/fneur.2022.851108

Shibuya, K., Tsuneyama, A., Misawa, S., Suzuki, Y. I., Suichi, T., Kojima, Y., Nakamura, K., Kano, H., Ohtani, R., Aotsuka, Y., Morooka, M., Prado, M., & Kuwabara, S. (2022). Different patterns of sensory nerve involvement in chronic inflammatory demyelinating polyneuropathy subtypes. Muscle & Nerve, 66(2), 131–135. https://doi.org/10.1002/mus.27530

Tavee J. (2019). Nerve conduction studies: Basic concepts. Handbook of Clinical Neurology, 160, 217–224. https://doi.org/10.1016/B978-0-444-64032-1.00014-X

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

Bone Density Test and Its Importance for Health

What is a bone density test, how is it performed, and what do the results mean?

Bone Density Test

A bone density test examines bone mass, which indicates overall bone strength. Assessing bone density or mass is necessary for diagnosing osteopenia or osteoporosis, conditions that increase the risk of broken bones. The scan is performed through dual-energy X-ray absorptiometry (DEXA), which examines the thickness of the bones. Results from DEXA scans are compared to standardized values to determine whether bone density is lower than normal and whether osteopenia or osteoporosis is present.

Examination

The procedure examines bone density, or bone mass. The bones’ density, or mass, is an overall indicator of bone strength. The greater the bone density, the thicker and stronger the bones are. The test is used to diagnose osteoporosis, a condition characterized by brittle bones at risk of breaking due to significantly low bone density. A bone density test can also diagnose osteopenia, a condition characterized by lower than normal bone mass that can lead to osteoporosis. (National Institute of Arthritis and Musculoskeletal and Skin Diseases, 2025) It is recommended that all women aged 65 and older and all men aged 70 and older have a bone density scan to screen for bone loss to help prevent fractures. (Kling J. M., Clarke B. L., & Sandhu N. P. 2014)

  • Bone density scans can establish a baseline level of bone density and track changes over time.
  • For individuals with osteoporosis or osteopenia, a bone density scan can help track how well their bones respond to treatment.

Procedure

The most common bone density test is a dual-energy X-ray absorptiometry, or DEXA, scan. A DEXA scan is similar to getting an X-ray taken, but it uses two beams to produce a more detailed and sensitive reading. (National Institute of Arthritis and Musculoskeletal and Skin Diseases, 2025)

  • During a DEXA scan, the patient will lie on their back on a table with their legs elevated on a padded platform.
  • An X-ray scanner will pass over the spine and hips while another scans beneath.
  • While the scan takes place, the patient will be asked to hold very still to obtain an accurate image.
  • The scan will obtain bone density readings from the spine and hip, the two most commonly fractured bones, and generally takes less than 30 minutes.

Results

A DEXA scan measures bone density in grams per centimeter squared (g/cm²). This number indicates how densely bone cells are packed together in a specific area of bone. This bone density reading is then compared to a standardized value to determine if bone density is within a normal range or lower than average.

For postmenopausal women and men aged 50 and older, bone density values are given a T score. The T-scores are then compared to a standardized bone density level of a healthy 30-year-old adult with peak bone density levels. (Kling J. M., Clarke B. L., & Sandhu N. P. 2014) Scores indicate the following: (Kling J. M., Clarke B. L., & Sandhu N. P., 2014)

  • Equal to minus 1.0 or above: Normal bone density
  • Between minus 1.0 and minus 2.5: Low bone density (osteopenia)
  • Equal to minus 2.5 or below: Osteoporosis
  1. Bone density values are reported as a Z score for women who have not undergone menopause and men under 50 years old.
  2. Z scores are compared to bone density levels of individuals of the same age and sex.
  3. A Z score of minus 2.0 or lower indicates low bone density, which can be caused by factors other than aging, such as medication side effects, nutritional deficiencies, or thyroid problems.

Arthritis Diagnosis 

Because a DEXA scan only measures the thickness of bones, it doesn’t work to diagnose arthritis. An X-ray of the affected joint is currently the most accurate way to diagnose arthritis. The Kellgren-Lawrence classification system categorizes the extent of arthritis based on the severity of joint damage seen on an X-ray. According to this system, arthritis can be classified as: (Kohn M. D., Sassoon A. A., & Fernando N. D. 2016)

Grade 1 (minor)

  • Minimal or no joint space narrowing, with possible bone spur formation.

Grade 2 (mild)

  • Possible joint space narrowing, with definite bone spur formation.

Grade 3 (moderate)

  • Definite joint space narrowing, moderate bone spur formation, mild sclerosis (abnormal thickening of bone), and possible deformation of bone ends.

Grade 4 (severe)

  • Severe joint space narrowing, large bone spur formation, marked sclerosis, and definite deformation of bone ends.

Injury Medical Chiropractic & Functional Medicine Clinic

Exercise can be incredibly beneficial for improving bone density, joint mobility, and the strength of surrounding muscles, which support and protect joints and bones. Talk to a healthcare provider to learn what interventions and available treatment options would be the most effective. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.

Osteoporosis

References

National Institute of Arthritis and Musculoskeletal and Skin Diseases. (2025). Bone mineral density tests: what the numbers mean. Retrieved from https://www.niams.nih.gov/health-topics/bone-mineral-density-tests-what-numbers-mean

Kling, J. M., Clarke, B. L., & Sandhu, N. P. (2014). Osteoporosis prevention, screening, and treatment: a review. Journal of women’s health (2002), 23(7), 563–572. https://doi.org/10.1089/jwh.2013.4611

Kohn, M. D., Sassoon, A. A., & Fernando, N. D. (2016). Classifications in Brief: Kellgren-Lawrence Classification of Osteoarthritis. Clinical orthopaedics and related research, 474(8), 1886–1893. https://doi.org/10.1007/s11999-016-4732-4

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

Running Fartlek Training for All Skill Levels

Can adding fartlek training improve speed and endurance for runners and running enthusiasts?

Running Fartlek Training

Fartlek training, which means speed play in Swedish, is a form of running training that involves alternating between bursts of fast running and slower recovery jogging.

  • It is a form of interval or speed conditioning.
  • It involves varying one’s pace throughout their run, alternating between fast treks and slow jogs.
  • Workouts are unstructured and allow runners to decide the duration and intensity of the fast and slow sections.
  • Unlike formal interval training, this flexibility offers a new way to improve speed, endurance, mental preparedness, and stamina.

Training Benefits

Traditional interval training uses specific timed or measured segments. Fartleks are more unstructured, with work-rest intervals based on how the body feels. With fartlek training, individuals can experiment with pace and endurance as they run, which helps them tune in to their body and adjust how it performs. Many runners enjoy the training because it involves speed work and is more flexible and less demanding.

  • A stopwatch is not needed for time intervals.
  • Training doesn’t have to be done on a track and can be performed on all terrain, such as roads, trails, or hills.
  • The training stresses the body’s systems, leading to faster speeds and improving anaerobic threshold. (Bacon, A. P. et al., 2013)
  • Improves the anaerobic threshold and increases the body’s ability to train longer at higher intensities. (Mazurek K. et al., 2016)
  • This is due to an increased VO2 max, which measures how much oxygen the body can take in and use.
  • A better VO2 Max generally leads to improved performance. (Scribbans T. D. et al., 2016)

Disadvantages

  • Training includes a higher risk of injury and strain.
  • Beginners are more prone to shin splints.
  • The training is demanding, so it should not be done daily.

Workout

The method is to vary brief periods of slightly higher pace into regular runs (Kumar P. 2015). Maintain a faster pace for a short distance or time interval, such as 200 meters or 30 seconds. Intervals can vary throughout the workout, and landmarks such as streetlights or telephone poles can be used to mark segments instead of measuring miles or meters. Once a fast segment is completed, slow to below-normal running cadence until the body fully recovers and breathing returns to normal. Return to running normally and incorporate slightly faster intervals later in the run.

  • Fartleks should be short because they are intense.
  • The actual higher-pace portion of the run should last up to 30 seconds.
  • Gradually add more time to the faster-paced portion as conditioning improves, up to 60 seconds.

Training Example

An example of a 40- to 45-minute fartlek workout suitable for beginners.

  • 10-minute warm-up at a light pace
  • 1 minute on (fast pace)
  • 2 minutes off (easy)
  • 2 minutes on
  • 1 minute off
  • Repeat the set 3 to 4 times
  • 10-minute cooldown at an easy pace

Remember that beginners should go slow when introducing fartlek training into their workouts. It is more intense and can increase the risk of injuries and strains, such as shin splints. Get help from a running coach or trainer if you are unsure how to incorporate the training into your routine.

Training on a Treadmill

Speed play can be done on a treadmill. The idea is to find ways to create speed variation intervals and help relieve treadmill boredom. Some examples include:

  • If watching television, use commercials to go into speed intervals.
  • At the gym, make a game out of the sprints and/or
  • Speed up during certain parts of songs where you can feel the energy moving you faster.

One precaution is learning to use the treadmill’s buttons to increase and decrease the pace. This can slow you down and disrupt form, so maybe do longer durations for each phase so there is less contact with the control panel.

Injury Medical Chiropractic & Functional Medicine Clinic

Fartlek training is an excellent way to add variety, fun, and interest to running. This speed work can also enhance performance, increase cardiovascular output, and allow individuals to run at higher intensities for longer periods. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. We can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.

Building a Stronger Body

References

Bacon, A. P., Carter, R. E., Ogle, E. A., & Joyner, M. J. (2013). VO2max trainability and high-intensity interval training in humans: a meta-analysis. PloS one, 8(9), e73182. https://doi.org/10.1371/journal.pone.0073182

Mazurek, K., Zmijewski, P., Krawczyk, K., Czajkowska, A., Kęska, A., Kapuściński, P., & Mazurek, T. (2016). High-intensity interval and moderate continuous cycle training in a physical education programme improves health-related fitness in young females. Biology of Sport, 33(2), 139–144. https://doi.org/10.5604/20831862.1198626

Scribbans, T. D., Vecsey, S., Hankinson, P. B., Foster, W. S., & Gurd, B. J. (2016). The Effect of Training Intensity on VO2max in Young Healthy Adults: A Meta-Regression and Meta-Analysis. International journal of exercise science, 9(2), 230–247. https://doi.org/10.70252/HHBR9374

Kumar, P. (2015). Effect of fartlek training for developing endurance ability among athletes. Int J Phys Ed Sports Health., 2(2), 291-293. https://www.kheljournal.com/archives/2015/vol2issue2/PartE/3-3-75-957.pdf

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

Tai Chi for Gut Health and Improved Digestion

For individuals dealing with digestive issues and conditions, can incorporating Tai Chi help improve gut health?

Tai Chi For Gut Health

Tai Chi is an exercise that has been referred to as moving meditation. The practice is rooted in Chinese medicine, which fuses martial arts and meditation. The art of Tai Chi is used to improve physical health. It can also positively impact gut health by improving digestive function, reducing inflammation, and influencing the gut microbiota composition. The slow, controlled movements and deep breathing can stimulate abdominal and pelvic organs, promoting digestion. Additionally, it has been shown to reduce inflammation in the gut and increase the diversity of gut bacteria, including beneficial butyrate-producing bacteria. (Kang D., Wang X., & Wang J., 2023)

Types

The idea is to slow down your mind and body by repeating rhythmic choreography and breathwork for about 30 to 60 minutes, culminating in finding a sense of inner peace and tranquility.

Primary Forms/Styles

These include Chen, Yang, Wu, Sun, and Wu/Hao. Each follows the same origins and principles with variations. (Tai Chi for Health Institute, 2007)

Chen Style

  • Considered the oldest and original style, the Chen style is characterized by explosive power, low stances, and a combination of fast and slow movements, including jumping, kicking, and striking.
  • Chen also utilizes a movement called “silk reeling,” a spiral-esque, flowing movement that starts at the feet and moves into the hands.

Yang Style

  • Yang is often considered the most popular form of Tai Chi and is practiced worldwide.
  • Yang Tai Chi focuses more on improving flexibility through grand, sweeping movements executed slowly and gracefully.

Wu Style

  • Wu Tai Chi emphasizes small, compact movements and a medium stance. Its focus is on extending the body by leaning forward and backward.

Sun Style

  • Sun Tai Chi combines elements of Tai Chi, Xing Yi, and Ba Gua, resulting in a unique style with fluid, circular movements.

Hao Style

  • This style is characterized by small-frame movements focusing on accurate position and internal strength.

Gut Health

By improving various aspects of gut health, Tai Chi can contribute to overall well-being. (Kang D., Wang X., & Wang J., 2023)

Relieves Stress and Anxiety

  • Stress can lead to digestive problems
  • Tai Chi can indirectly benefit gut health by reducing stress levels.
  • Its emphasis on slow movements and deep breathing can help reduce stress.
  • Combining meditative practices with physical movement can help calm the mind, improve focus, and even trigger the release of endorphins.

Improved Digestion

  • Gentle, flowing movements, particularly those involving the diaphragm, can massage and stimulate the abdominal and pelvic organs, aiding the digestive process.

Reduced Inflammation

  • Tai Chi can help reduce gut inflammation, a common issue in conditions like inflammatory bowel disease (IBD).

Gut Microbiota Changes

  • Tai Chi has been found to positively influence the gut microbiota composition, increasing the diversity and abundance of beneficial bacteria.

Improved Gut Barrier Function

  • Tai Chi may help improve the integrity of the gut barrier, which is essential for preventing harmful substances from entering the bloodstream and causing inflammation.

Increased Butyrate Production

  • Tai Chi can promote the growth of butyrate-producing bacteria, which are important for intestinal health and can reduce inflammation.

Overall Health Benefits

Increases Cognitive Function

  • In addition to improving your mental well-being, Tai Chi has also been found to boost cognitive abilities.
  • A meta-analysis stated that physical exercise, in general, improves cognitive function, and researchers specifically recommended Tai Chi for elderly individuals since it’s a gentler and more accessible form of physical exercise that also combines mental exercises through repeated choreography. (Yin Wu, et al., 2013)

Increases Flexibility and Agility

  • Similar to yoga, Tai Chi often involves body extensions that can improve flexibility and agility.
  • This is useful in daily activities and makes you more agile and capable in other sports.

Improves Balance and Coordination

  • In addition to improving flexibility and agility, the intricate movements can help balance and coordination.
  • This skill is useful in daily life.
  • It can help with fine motor skills and even prevent trips, stumbles, falls, and other sports.

Enhances Strength and Stamina

  • As with any form of physical exercise, Tai Chi can build upon existing strength and stamina.
  • With ongoing practice, individuals become leaner, their muscles are more defined, and they can exercise longer.

Injury Medical Chiropractic & Functional Medicine Clinic

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

Body Maintenance

References

Kang, D., Wang, X., & Wang, J. (2023). Intervention study of tai chi training on the intestinal flora of college student basketball players. Medicine, 102(36), e35044. https://doi.org/10.1097/MD.0000000000035044

Wu Y, W. Y., Burgess EO, Wu J. (2013). The effects of Tai Chi exercise on cognitive function in older adults: A meta-analysis. Journal of Sport and Health Science, 2(4), 193-203. https://doi.org/https://doi.org/10.1016/j.jshs.2013.09.001

Tai Chi for Health Institute. (2018). History of Tai Chi. https://taichiforhealthinstitute.org/history-of-tai-chi/#:~:text=Based%20on%20Qigong%20and%20martial%20art%20techniques,It%20contains%20explosive%20power%20and%20low%20stances.

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

Pigeon Toed: Causes and Treatment Options

Children walking with their toes pointed in may be pigeon-toed. What are the causes, conditions associated with it, and treatments?

Pigeon-toed Walking

If a child walks with their feet turned inward at the toes, it is usually described as being pigeon-toed. This pointing inward of the feet occasionally occurs as a child learns to walk and may continue through toddlerhood. It is noticed more often in children than adults, but older individuals can experience it. Pigeon-toed walking is rarely a major orthopedic problem and usually disappears without treatment. However, there are times when it may impact a child’s lower extremities and hips. Bracing or surgery may be necessary in these cases to correct the problem. (Paramanandam V. et al., 2019) This condition is common and typically is caused by abnormal birth positions in utero. Sometimes, slight issues may lead to noticeable functional characteristics. Mild changes in bone shape and positioning usually cause pigeon toes. Often, it subsides in a few years as the child continues to develop.

What Does It Mean?

There is usually no need to worry, as this condition is likely not permanent and will go away in a few years. (Paramanandam V. et al., 2019) However, it is recommended that you check in with your healthcare provider to ensure the child is developing normally. Some adults walk with their toes turned in. This may be due to a birth defect, a weakness, or a rare case of pigeon-toed walking as a youth that was left untreated or did not go away.

Causes

There are various reasons for pigeon-toed walking. To determine the cause, a healthcare provider can assess the child’s condition and make a diagnosis, including:

Metatarsus Adductus

  • A condition where the front part of the foot is turned inward.
  • The metatarsals are the long bones of the forefoot.
  • This is when the bones of the foot point inward, leading to pigeon-toed walking.
  • A clinical examination and X-ray can confirm the metatarsus adducts as a cause of pigeon-toed walking.

Tibial Torsion

  • A twisted shinbone (tibia) can cause the feet to turn inward in younger children.
  • The shinbone/tibia in some children may be slightly twisted.
  • The tibia can either turn outward or inward.
  • When it twists inward, it may manifest as a pigeon-toed gait.
  • Tibial torsion may accompany femoral anteversion.
  • It is diagnosed with an X-ray.
  • Children with tibial torsion typically grow out of the problem, and the pigeon-toed disappears by age 4. (Uden H., & Kumar S. 2012)

Femoral Anteversion

  • A common cause, especially in older children, is when the thighbone/femur is twisted inward.
  • If the femur turns inward and forward unnaturally, where the femoral neck meets the body of the femur, it is called femoral anteversion.
  • An outward and backward rotation of the femur is called femoral retroversion.
  • This occurs in about 10% of children. (Scorcelletti M. et al., 2020)
  • Many children with femoral anteversion appear knock-kneed with a large gap between their feet when standing with knees together, and when they walk, they appear pigeon-toed.
  • A clinical examination and X-ray diagnose it.

Symptoms

In most cases, the child does not complain of any pain. However, if pain is felt, it can include:

  • Tightness in the calf muscles
  • Aching on the outer edges of the feet
  • Knee pain

Usually, parents will notice pigeon-toes when their child is first learning to walk. Rest assured, the child most likely is not experiencing pain. They have feet and knees that turn inward when they walk and run. (Uden H., & Kumar S., 2012)

A pediatrician or primary care provider can assess the situation and make recommendations. Most pigeon-toed children begin walking and running normally after age 3 or 4, so a watch-and-wait approach is used. Parents may have to take their child to a specialist, like an orthopedic surgeon, if they complain of pain while walking. A specialist may be referred if the child cannot walk due to the inward turn of their feet.

Risk Factors

Pigeon-toed walking is not a preventable condition but rather one that develops during pregnancy. Causes may include: (Scorcelletti M. et al., 2020)

  • A pregnancy with twins or multiple births
  • Large fetus
  • Breech position in utero when the baby is positioned feet first.
  • Not enough amniotic fluid

Muscle Weakness in Adults

Adolescents or adults who notice their knees turn in and walk pigeon-toed may have weakness in the hip and leg muscles that control the position of their legs when they walk. Strengthening those muscles can help. (Scorcelletti M. et al., 2020)

Treatment

Typically, a normal gait will appear by the age of 3 or 4. Other treatments may include:

Physical Therapy Exercises and Gait Training

  • Exercises to stretch tight lower extremity muscles and strengthen hip and leg muscles can help improve walking gait.
  • See a pediatric specialist before starting, as research shows that parental stretching of a newborn with metatarsus adductus offers little benefit. (Eamsobhana P. et al., 2017)

Bracing or Casting 

  • Braces
  • Serial casting is a procedure that helps children improve their range of movement and may be done to place their lower extremities in an optimum position as they develop. (Uden H., & Kumar S., 2012)

Surgery

  • For cases in which tibial torsion is the cause, osteotomy surgery, which involves cutting and/or removing bone, may be recommended to correct the structural deformity of the shinbone.

Injury Medical Chiropractic & Functional Medicine Clinic

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

Foot Pronation

References

Paramanandam, V., Lizarraga, K. J., Soh, D., Algarni, M., Rohani, M., & Fasano, A. (2019). Unusual gait disorders: a phenomenological approach and classification. Expert review of neurotherapeutics, 19(2), 119–132. https://doi.org/10.1080/14737175.2019.1562337

Uden, H., & Kumar, S. (2012). Non-surgical management of a pediatric “intoed” gait pattern – a systematic review of the current best evidence. Journal of Multidisciplinary Healthcare, 5, 27–35. https://doi.org/10.2147/JMDH.S28669

Scorcelletti, M., Reeves, N. D., Rittweger, J., & Ireland, A. (2020). Femoral anteversion: significance and measurement. Journal of Anatomy, 237(5), 811–826. https://doi.org/10.1111/joa.13249

Eamsobhana, P., Rojjananukulpong, K., Ariyawatkul, T., Chotigavanichaya, C., & Kaewpornsawan, K. (2017). Does the parental stretching programs improve metatarsus adductus in newborns?. Journal of Orthopaedic Surgery (Hong Kong), 25(1), 2309499017690320. https://doi.org/10.1177/2309499017690320

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

Pregnancy Indoor Cycling: Stay Active and Strong

During pregnancy, is indoor cycling a safe and recommended way to maintain fitness?

Pregnancy Indoor Cycling

Exercising during pregnancy is highly recommended for both the parent and the baby. Staying physically active can:

  • Increase blood circulation
  • Increase energy
  • Reduce backaches
  • Improve digestion and sleep
  • Enhance mood
  • Help manage weight
  • Promote muscle tone, strength, and endurance. (Hinman, S. K. et al., 2015)

The American College of Obstetricians and Gynecologists, or ACOG, advises pregnant individuals to exercise regularly during pregnancy. (The American College of Obstetricians and Gynecologists, 2024) The guidelines indicate that individuals who regularly engage in vigorous-intensity aerobic exercise before pregnancy should continue these activities during their pregnancy. (Syed H., Slayman T., & DuChene Thoma K. 2021) According to ACOG, observational studies of pregnant individuals who exercise show benefits such as:

  • The reduced risk of gestational diabetes mellitus
  • Cesarean birth
  • Operative vaginal delivery
  • Reduced postpartum recovery time
  • Exercise can also help prevent postpartum depression. (Syed H., Slayman T., & DuChene Thoma K. 2021)

Stationary cycling has been extensively studied in pregnancy and found safe and beneficial (American College of Obstetricians and Gynecologists, 2024).

Safety

Indoor cycling is ideal because individuals won’t have to deal with balance challenges or generate a heavy impact on their joints. There are many indoor cycling workouts to try, whether spin or on-demand classes. Indoor cycling is safer during pregnancy than outdoor cycling, which is not recommended because of the risk of falls from traffic and weather conditions. Although indoor cycling is generally considered safe during pregnancy, individuals should get clearance from their OB/GYN if they have any underlying medical conditions that might limit physical activity options.

Cycling Classes

Taking cycling classes during pregnancy is safe if a healthcare provider has no concerns. It’s important to take precautions.

  • It’s recommended to continue with any exercise you were doing before pregnancy rather than start a new routine.
  • Remember that this is an exercise for two, so the heart rate will elevate quickly and become overheated more easily.
  • Take it easier on the bike, and don’t push too hard.

Consult With the Instructor

It’s recommended to seek out an instructor with some prenatal exercise training. Individuals may benefit from sticking with the same instructor whenever possible to get to know them and familiarize themselves with their modifications and needs. Whether or not you’re showing, tell the instructor that you’re pregnant before the class starts. This way, they can monitor progress and will not push too hard. The instructor can also give important pointers on modifying the ride to suit your needs.

Modify Bike Set-Up

Individuals may need to adjust the saddle position and raise the handlebars to stay comfortable as their bodies change. Sitting more upright is recommended to relieve strain on the lower back, and increasing the handlebars and bringing them closer instead of leaning forward is another goal. Another goal is to keep the weight more evenly distributed between the hands and body. Also, avoid movable indoor bikes that mimic outdoor riding. They can lean sideways, which might cause a fall.

Dial Down Intensity

With indoor cycling, it’s best to exercise moderately during pregnancy. Consider wearing a heart rate monitor to ensure a safe intensity. It’s also helpful to pay attention to the Rating of Perceived Exertion scale/RPE. Even if the heart rate isn’t too high, slow down or stop exercising immediately if you’re gasping for breath or feeling lightheaded. ACOG guidelines indicate that 13-14 “somewhat hard” on the Borg RPE scale is a safe and acceptable level of exertion. The guidelines also state that RPE is a better gauge of exertion than heart rate and that the talk test (holding a conversation while exercising) can indicate safe workout intensity.

Stay Cool and Properly Hydrated

Wear comfortable, breathable clothing to help you stay cool and a bra with plenty of support. Drink lots of water throughout the workout, actually more than usual. Overheating and dehydration are common during pregnancy and can be dangerous for both parents and babies. Carrying an extra 20 to 30 pounds and having 40% more blood pumping through the body toward the end of pregnancy makes you likely to sweat more and can easily lead to dehydration. Using a fan for home gyms is highly recommended.

Avoid Standing and Stay In a Seated Position

During the early months, you may be able to ride in a standing position without any problems. But as the belly grows, it changes the body’s center of gravity, putting more pressure on the joints and making it difficult to ride standing. Joints are looser or more flexible during pregnancy, which makes standing while cycling more difficult and risky. It is still a healthy workout if you stay seated the whole time—and, most importantly, avoid overdoing it or injuring yourself.

Body Signs

Listen to the body while exercising. If you get winded, dizzy, or unwell while riding, take a break or reduce your effort by a few notches. If a 45-to-60-minute class is too intense, feel free to depart early; just let the instructor know you’re OK. Energy will likely ebb and flow during pregnancy, so pay attention to the body’s signals and take care of them accordingly. Stop exercising if you experience any of the following (Syed H., Slayman T., & DuChene Thoma K. 2021)

  • Abdominal pain
  • Dyspnea: shortness of breath before exertion
  • Headache
  • Dizziness
  • Calf pain or swelling
  • Muscle weakness affects balance
  • Chest pain
  • Amniotic fluid leakage
  • Regular painful contractions
  • Vaginal bleeding

Call your doctor if you experience sharp pain, contractions, a surge of fluid, a sudden severe headache, prolonged swelling, or decreased baby movement.

Injury Medical Chiropractic & Functional Medicine Clinic

It’s important to exercise wisely during the nine months to accommodate body changes, the extra weight, the increasingly relaxed ligaments, and the shift in the center of gravity. The stationary bike provides a personalized, low-impact workout. You get to control the intensity and the duration of the ride. Monitor your heart rate and/or RPE to avoid overdoing it. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.

Chiropractic Lower Back Pain Pregnancy Treatment

References

Hinman, S. K., Smith, K. B., Quillen, D. M., & Smith, M. S. (2015). Exercise in Pregnancy: A Clinical Review. Sports Health, 7(6), 527–531. https://doi.org/10.1177/1941738115599358

The American College of Obstetricians and Gynecologists. (2024). Exercise during pregnancy. https://www.acog.org/womens-health/faqs/exercise-during-pregnancy?utm_source=redirect&utm_medium=web&utm_campaign=int

Syed, H., Slayman, T., & DuChene Thoma, K. (2021). ACOG Committee Opinion No. 804: Physical Activity and Exercise During Pregnancy and the Postpartum Period. Obstetrics and gynecology, 137(2), 375–376. https://doi.org/10.1097/AOG.0000000000004266

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

Tofu Benefits: Nutrition and Cooking Tips

Uncover the health benefits of tofu. This nutritious ingredient is great for both your taste buds and your well-being.

Introduction

As a nurse practitioner with over two decades of clinical experience in physical and functional medicine, I’ve witnessed firsthand the transformative power of food as medicine. In particular, the role of plant-based proteins like tofu has grown increasingly significant in evidence-based interventions aimed at reducing cardiovascular risk.

From managing hypertension and dyslipidemia to reducing systemic inflammation, a heart-healthy diet is one of the most accessible and sustainable lifestyle changes patients can make. One often-underappreciated food with robust cardioprotective properties is tofu. In this article, we’ll explore the science-backed benefits of tofu, its role in functional cardiovascular care, and practical ways to integrate it into a heart-smart diet.

Why Functional Nutrition Matters for Cardiovascular Health

The heart doesn’t function in isolation—it works in concert with every other system in the body. Functional medicine recognizes that cardiovascular issues often stem from a constellation of root causes: chronic inflammation, oxidative stress, hormonal imbalances, dysregulated blood sugar, and nutrient deficiencies, just to name a few.

Rather than isolating nutrients or treating lab values in a vacuum, functional nutrition focuses on synergy—how whole foods interact with body systems to optimize health. Tofu, with its impressive nutrient density and anti-inflammatory profile, fits seamlessly into this paradigm.

What Is Tofu? A Nutritional Powerhouse from the Soybean

Tofu, also known as bean curd, is a protein-rich food derived from soybeans. It has been a staple in East Asian diets for over 2,000 years and is gaining popularity in the West for good reason.

To produce tofu, soybeans are soaked, blended, and strained into a soy milk, which is then coagulated using calcium or magnesium salts and pressed into blocks. This process preserves the soybean’s rich content of protein, calcium, iron, and bioactive compounds.

Unlike ultra-processed meat substitutes, tofu is a minimally processed, whole food source of plant protein that aligns with the foundational principles of a heart-healthy, anti-inflammatory diet.

Nutritional Profile of Tofu (Per 116g Serving of Firm Tofu)

  • Calories: 88
  • Protein: 9g
  • Fat: 6g (mostly unsaturated)
  • Saturated Fat: 0.8g
  • Carbohydrates: 2.2g
  • Fiber: 0.3g
  • Sodium: 8mg
  • Potassium: 140mg
  • Iron: 34% Daily Value (DV)
  • Calcium: 40% DV
  • Magnesium: 8% DV
  • Vitamin B6: 5% DV

Tofu also contains all nine essential amino acids, making it a complete protein—an important consideration for those transitioning away from animal products.

The Healing Diet: Combat Inflammation & Embrace Wellness- Video

The Cardiovascular Benefits of Tofu: What the Science Says

1. Lowering LDL Cholesterol

A pivotal meta-analysis published in the Journal of Nutrition (Messina, 2016) confirmed the LDL-lowering effects of soy protein. Tofu, being rich in soy protein, can help reduce low-density lipoprotein (LDL) cholesterol, often referred to as “bad” cholesterol. By displacing saturated fat and dietary cholesterol from animal proteins, tofu supports healthier lipid profiles.

2. Anti-Inflammatory and Antioxidant Properties

Tofu is rich in isoflavones, naturally occurring phytoestrogens found in soybeans. Isoflavones like genistein and daidzein have antioxidant properties and may inhibit inflammation at the endothelial level—critical for patients with atherosclerosis or at risk for coronary artery disease. According to Rizzo et al. (2023), these compounds help maintain vascular flexibility and may inhibit platelet aggregation, reducing clot risk.

3. Blood Pressure Regulation

Magnesium, potassium, and calcium—key electrolytes found in tofu—are all essential for regulating blood pressure. These nutrients support vascular tone and optimize endothelial function. Additionally, substituting animal-based protein with tofu helps reduce overall sodium intake, further supporting blood pressure goals.

4. Weight and Metabolic Control

With only 88 calories per serving and a high satiety value, tofu is a strategic food for weight management—an important factor in controlling cardiovascular risk. The protein-fiber-fat ratio makes it ideal for glycemic regulation and preventing insulin resistance.

5. Improved Lipid Profiles and Reduced Coronary Risk

Longitudinal studies have demonstrated that plant-based diets rich in soy protein improve HDL/LDL ratios and reduce triglycerides, especially when tofu is used to replace red meat or processed meats. According to Erdman (2000), soy-based interventions can reduce coronary heart disease risk by as much as 20% over time when combined with other healthy lifestyle changes.

Types of Tofu and Their Culinary Uses

Tofu’s versatility is one reason it’s so easy to integrate into a heart-healthy diet. Understanding its different textures can help patients and practitioners alike explore creative and satisfying meal planning.

  • Silken Tofu: Soft, custard-like texture. Excellent in smoothies, sauces, and desserts.
  • Soft Tofu: Slightly firmer than silken. Ideal for soups and gentle sautés.
  • Firm Tofu: Maintains structure well. Great for stir-fries, curries, and grilling.
  • Extra-Firm Tofu: Dense and chewy. Best for baking, frying, or as a meat substitute in hearty recipes.
  • Fermented Tofu: A flavorful condiment used in East Asian dishes. Contains probiotics and can support gut health.

Each form can be marinated, baked, crumbled, or pureed—making tofu a culinary chameleon and nutrient-rich addition to any cardiovascular prevention strategy.

Is Tofu a Reliable Protein Source for Cardiovascular Patients?

Yes—and not just for vegans or vegetarians. One of the biggest concerns in reducing animal protein intake is whether patients will meet their protein needs. Tofu alleviates this concern by offering a complete amino acid profile.

Furthermore, because tofu contains very little saturated fat and zero dietary cholesterol, it aligns with AHA (American Heart Association) guidelines for protein sources that support cardiac health. Tofu also promotes lean muscle maintenance, critical for older adults at risk for sarcopenia—a condition that compounds cardiovascular vulnerability.

Functional Medicine Tips: How to Add Tofu to a Heart-Healthy Diet

Transitioning to a more plant-based approach doesn’t have to be intimidating. Here are simple, evidence-informed ways to incorporate tofu:

  1. Tofu Scrambles: Replace eggs with crumbled firm tofu, turmeric, and vegetables for a cholesterol-free breakfast.
  2. Stir-Fries: Toss cubed tofu with olive oil, garlic, and cruciferous vegetables like broccoli or bok choy.
  3. Tofu Bowls: Combine baked tofu with quinoa, avocado, leafy greens, and tahini for a nutrient-dense lunch.
  4. Soups and Stews: Add soft tofu to miso or vegetable-based soups for added protein and satiety.
  5. Smoothies: Blend silken tofu with berries, flaxseed, and almond milk for a protein-packed snack.
  6. Marinated and Grilled: Let tofu absorb anti-inflammatory marinades (like ginger-garlic-tamari) before grilling.

Encourage patients to explore international cuisines—particularly Japanese, Korean, and Thai recipes—that have normalized tofu as a central protein source for centuries.

Addressing Common Concerns About Soy

Despite its benefits, soy has faced scrutiny—largely due to misconceptions around phytoestrogens. However, clinical research consistently shows that moderate soy intake is safe and beneficial for most populations, including breast cancer survivors and men with prostate concerns.

In fact, population studies in East Asia demonstrate lower rates of hormone-sensitive cancers and cardiovascular disease in populations consuming soy regularly. As with any food, balance and moderation are key.

Final Thoughts: Tofu as a Functional Ally for Cardiovascular Health

Tofu isn’t just a trend—it’s a time-tested, nutrient-dense, cardioprotective food with substantial clinical value. As healthcare providers, we should not underestimate the power of simple dietary substitutions. Replacing saturated fat-rich meats with plant-based proteins like tofu can reduce cardiovascular burden, support metabolic resilience, and enhance quality of life.

From a functional medicine lens, tofu exemplifies the concept of food as a therapeutic tool. Its ability to modulate inflammation, support endothelial function, and provide sustainable, complete protein makes it a cornerstone in any heart-healthy nutrition plan.

Injury Medical & Functional Medicine Clinic

We associate with certified medical providers who understand the importance of assessing individuals dealing with cardiovascular issues and are looking for natural alternatives to incorporate plant-based foods into a healthy diet. When asking important questions to our associated medical providers, we advise patients to incorporate tofu into their diet to reduce the effects of cardiovascular disorders related to the body. Dr. Alex Jimenez, D.C., uses this information as an academic service. Disclaimer.

References

Dang, Y., Ren, J., Guo, Y., Yang, Q., Liang, J., Li, R., Zhang, R., Yang, P., Gao, X., & Du, S. K. (2023). Structural, functional properties of protein and characteristics of tofu from small-seeded soybeans grown in the Loess Plateau of China. Food Chem X, 18, 100689. https://doi.org/10.1016/j.fochx.2023.100689

Erdman, J. W., Jr. (2000). AHA Science Advisory: Soy protein and cardiovascular disease: A statement for healthcare professionals from the Nutrition Committee of the AHA. Circulation, 102(20), 2555-2559. https://doi.org/10.1161/01.cir.102.20.2555

Eze, N. M., Okwume, U. G., Eseadi, C., Udenta, E. A., Onyeke, N. G., Ugwu, E. N., Akubue, B. N., Njoku, H. A., & Ezeanwu, A. B. (2018). Acceptability and consumption of tofu as a meat alternative among secondary school boarders in Enugu State, Nigeria: Implications for nutritional counseling and education. Medicine (Baltimore), 97(45), e13155. https://doi.org/10.1097/MD.0000000000013155

Messina, M. (2016). Soy and Health Update: Evaluation of the Clinical and Epidemiologic Literature. Nutrients, 8(12). https://doi.org/10.3390/nu8120754

Montgomery, K. S. (2003). Soy protein. J Perinat Educ, 12(3), 42-45. https://doi.org/10.1624/105812403X106946

Rizzo, J., Min, M., Adnan, S., Afzal, N., Maloh, J., Chambers, C. J., Fam, V., & Sivamani, R. K. (2023). Soy Protein Containing Isoflavones Improves Facial Signs of Photoaging and Skin Hydration in Postmenopausal Women: Results of a Prospective Randomized Double-Blind Controlled Trial. Nutrients, 15(19). https://doi.org/10.3390/nu15194113

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