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Tag: rehabilitation

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

Chiropractic Care After a Car Crash and Support Options

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

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

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

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

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

Key advantages of this collaborative strategy include:

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

Comprehensive and Interdisciplinary Care

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

Customized Therapeutic Strategies

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

Managing pain without relying too much on drugs

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

Faster healing and rehabilitation

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

Insurance and Legal Assistance

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

Rationale for Efficacy Post-MVC

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

Injury Medical Chiropractic and Functional Medicine Clinic

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

Personal Injury Rehabilitation

References

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

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

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

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

Exercise and Dementia: Key to Cognitive Health

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

Exercise and Dementia: Improving Brain Function

Dementia Prevention and Exercise

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

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

Physical Activity and Reduced Risk

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

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

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

Insulin, Exercise, and Brain Health

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

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

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

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

Clinic for Chiropractic Care and Functional Medicine

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

Is Motion Key to Healing?

References

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

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

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

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

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

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

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

Length of Time for Muscle Tightness Relief

For individuals dealing with or experiencing muscle pain and stiffness, how long does it take to loosen tight muscles?

Length Of Time to Loosen Tight Muscles

Tight muscles are often caused by overuse or strain, combined with muscle soreness, a common symptom of tight muscles. The soreness peaks around the third day and begins to subside, typically resolving within a few days. But if tightness persists or is accompanied by other symptoms like numbness, inability to move, or swelling, it’s important to consult a medical provider. (Spine Medicine and Surgery of Long Island, 2024) However, it can take much longer for individuals who have never stretched and have had tight muscles for years, depending on the severity, injury history, and underlying causes.

Factors Influencing Timeline

Consistent stretching can take anywhere from a few weeks to a few months to noticeably loosen tight muscles and improve flexibility. The specific time frame depends on factors like the severity of the tightness, underlying causes, and individual consistency with stretching. (Peterson Physical Therapy, 2024)

Severity of Tightness

  • Muscle knots and significant limitations in range of motion may take longer to resolve than minor stiffness.

Underlying Causes

  • If tightness is due to a specific injury or condition, addressing that cause is important for lasting and maintaining improvements. (Healthline, 2023)

Individual Factors

  • Genetics, age, and overall health can influence how quickly muscles adapt to stretching.

Consistency

  • Regular stretching, ideally daily or several times a week, is essential for feeling progress. (Mayo Clinic, 2023)

Stretching Routine

The length of time can vary based on the starting flexibility level and the specific stretching routine. (Mayo Clinic, 2023) It typically takes several weeks of consistent stretching, at least 3-4 times a week, to notice flexibility improvements. Longer-term changes, beyond the initial feeling of being looser, usually take 8 to 12 weeks.

Consistency

Hold Time

  • Hold static stretches for at least 30 seconds.
  • Longer holds (1-2 minutes) can provide deeper benefits.

Long-term Gains

  • For substantial and sustained improvements, stretching consistently for several months is recommended. (Mayo Clinic, 2023)

Initial Changes

  • Individuals may notice small improvements in the first few weeks, especially starting from a more inflexible position.

Influencing Factors and Results

  • Individual genetics, current flexibility level, and the specific exercises can affect how quickly improvements are seen and felt. (Peterson Physical Therapy, 2024)

What To Expect

Improvements

  • Within a few weeks, individuals might notice a decrease in the sensation of tightness or increased ease in reaching a stretch. (Peterson Physical Therapy, 2024)

Longer-Term Changes

  • Significant muscle length and flexibility improvements may take several weeks to months of consistent effort.

Maintenance

Treatment Options

  • Stretching, physical therapy, massage, and other therapies can help alleviate tight muscles and promote recovery. (Spine Medicine and Surgery of Long Island, 2024)
  • Consider professional guidance for specific concerns or limitations. Consult a physical therapist or healthcare provider for personalized recommendations.

The length of time to see results means consistency and patience are important.

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.

Understanding Long-Lasting Injuries

References

Spine Medicine and Surgery of Long Island. (2024). How Long Do Muscle Knots Last? Spine Medicine and Surgery of Long Island. https://www.spinemedli.com/how-long-do-muscle-knots-last/#:~:text=The%20duration%20of%20a%20muscle,chronic%20pain%20if%20left%20untreated.

Peterson Physical Therapy. (2024). How Long Does It Take to Improve Flexibility? https://petersenpt.com/how-long-does-it-take-to-improve-flexibility#:~:text=Over%20the%20years%2C%20I’ve,takes%20to%20become%20more%20flexible.

Healthline. (2023). Everything You Need to Know About Muscle Stiffness. https://www.healthline.com/health/muscle-stiffness

Mayo Clinic. (2023). Stretching: Focus On Flexibility. https://www.mayoclinic.org/healthy-lifestyle/fitness/in-depth/stretching/art-20047931#:~:text=Stretch%20in%20a%20smooth%20movement,hold%20for%20around%2060%20seconds.

Harvard Health Publishing. (2022). Everyday Stretching. https://www.health.harvard.edu/everyday-stretching#:~:text=A%20daily%20regimen%20will%20deliver,or%20three%20times%20a%20week.

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, Physio , , , , , , , , , , , , , , , , , ,

Postural Assessment for Optimal Movement Efficiency

Can postural assessments help identify problems with how a person stands or sits, which can lead to various musculoskeletal issues?

Postural Assessment

Proper posture is an exercise in which the muscles support the skeleton in a comfortable, stable, and efficient alignment. Healthy posture is present when the body is still and when moving. However, numerous factors can affect and hinder posture. These include daily wear and tear, injury, illness, or a condition. A posture assessment is a process that identifies posture issues and their root causes, often using visual and palpation techniques, and can help determine appropriate treatment or exercises. (Science Direct, 2007)

Visual Assessment

  • Observing the body’s alignment and symmetry from different angles (anterior, posterior, and lateral views).

Palpation

Movement Analysis

  • Assessing how a person moves and if there are any limitations or compensations. (Physiopedia, 2025)

Importance and Benefits

Early Identification

  • Helps identify potential problems early, before they become more serious.

Targeted Treatment

  • Allows for the development of personalized treatment plans to address specific postural issues.

Injury Prevention

  • It can help prevent injuries by addressing underlying postural imbalances.

Postural Assessment Tools

Some tools used include:

Basic Assessment

Stand Upright

  • The patient stands with their feet shoulder-width apart, arms relaxed at their sides, and looks straight ahead. (Science Direct, 2007)

Alignment Observation

  • Head: Is the head aligned over the shoulders, forward, or tilted?
  • Shoulders: Are the shoulders level, or are they rounded forward?
  • Back: Is the back straight, or is there excessive curvature (kyphosis or lordosis)?
  • Pelvis: Is the pelvis level or tilted forward or backward?
  • Knees: Are the knees straight or slightly bent?
  • Feet: Are the feet flat on the ground, or is there excessive arch or pronation?

Palpate for Muscle Imbalances

Consider the Patient’s Activity Level and History

Wall Test

  • The patient stands against a wall with their feet shoulder-width apart and heels about 6 inches from the baseboard.
  • If they have good posture, their ears will be vertically aligned with their shoulders, and their head will be no more than three finger widths from the wall. (Physiopedia, 2025)

Postural Issues Examples

Rounded Shoulders (Hyperkyphosis)

  • Forward rounding of the upper back.

Forward Head Posture

  • Head positioned too far forward.

Lordosis

  • Excessive inward curve of the lower back.

Flat Back

  • Reduced natural curve of the lower back.

Muscle Imbalances

Professionals Who Can Perform a Posture Assessment

Physiotherapists

  • Professionals trained in assessing and treating musculoskeletal problems.

Chiropractors

  • Professionals who focus on the spine and nervous system.

Fitness Professionals

  • Personal trainers or other fitness professionals can use posture assessments to help clients improve their posture and movement.

Ergonomists

  • Professionals who specialize in designing workspaces and environments to promote good posture and reduce strain.

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.

Multidisciplinary Evaluation and Treatment

References

ScienceDirect. (2007). Postural Assessment – an Overview. Evidence-Based Manual Medicine, 2007. https://www.sciencedirect.com/topics/medicine-and-dentistry/postural-assessment#recommended-publications

Singla, D., & Veqar, Z. (2014). Methods of postural assessment used for sports persons. Journal of clinical and diagnostic research: JCDR, 8(4), LE01–LE4. https://doi.org/10.7860/JCDR/2014/6836.4266

Du, S. H., Zhang, Y. H., Yang, Q. H., Wang, Y. C., Fang, Y., & Wang, X. Q. (2023). Spinal posture assessment and low back pain. EFORT open reviews, 8(9), 708–718. https://doi.org/10.1530/EOR-23-0025

Physiopedia. (2025). Sports Screening: Postural Assessment. https://www.physio-pedia.com/Sports_Screening:_Postural_Assessment#:~:text=Postural%20assessment%20as%20part%20of,tone%20can%20cause%20postural%20faults.

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

Antinutrients and Their Impact on Nutrition

Can understanding antinutrients and the importance of a balanced diet help individuals get the most out of their foods?

Antinutrients

Antinutrients are compounds in some plant foods that can reduce the body’s ability to absorb and use certain nutrients. (Petroski W., & Minich D. M. 2020) The purpose of these compounds is to protect the plants from infections and insects, which benefits the plant. It can also lower the human body’s ability to absorb nutrients properly. They are found in many grains, legumes, seeds, nuts, fruits, and vegetables. Plant-based foods high in antinutrients have beneficial nutrients, such as antioxidants, fiber, and other vitamins and minerals, and have been associated with a lower risk of chronic disease. The antinutrients may prevent the digestion and absorption of some minerals and have other negative effects that include:

  • Altered gut function
  • Increased inflammation
  • Endocrine disruption
  • Increased risk of calcium kidney stones

Common Types

Some of the main antinutrients of concern include phytates, lectins, oxalates, tannins, and phytoestrogens.

Phytates (phytic acid)

Lectins

  • They are found in nearly all foods, notably legumes and grains.
  • Lectins are proteins that bind to carbohydrates.
  • They can be harmful in high amounts or when high-lectin foods, such as beans, lentils, and wheat, are consumed raw. (Adamcová A., Laursen K. H., & Ballin N. Z. 2021)

Oxalates

  • They are found in various plant foods, including fruits, vegetables, nuts, and grains. (Mitchell T. et al., 2019)
  • Oxalates bind to certain minerals, such as calcium-forming calcium oxalate.

Tannins

  • They are found in many plant foods, such as legumes, cereal grains, nuts, cacao, leafy and green vegetables, coffee, and tea. (Ojo M. A. 2022)
  • Tannins are antioxidant-phenolic compounds that can reduce the absorption of some minerals and proteins in the body.

Phytoestrogens

  • They are found in various plant foods, such as fruits, vegetables, legumes, nuts, and seeds.
  • These estrogen-like compounds have many health benefits but may also act as endocrine disruptors (interfering with hormones). (Petroski W., & Minich D. M. 2020)

Effects on the Body

Antinutrient compounds typically bind to minerals or other nutrients, which inhibits digestion and absorption. For example,

Advantages and Disadvantages

Plant foods have long been associated with improved health and a decreased risk of some chronic diseases, such as heart disease, diabetes, cancer, stroke, and others. (Craig W. J. et al., 2021) For most, the effects of antinutrients are not of major concern after processing and cooking. The benefits and drawbacks of consuming foods high in antinutrients include: (Petroski W., & Minich D. M. 2020)

Benefits

  • Some antinutrients act as antioxidants.
  • Some have cancer-fighting abilities.
  • Some may increase immune system function.
  • They are often sources of dietary fiber and other beneficial nutrients.

Drawbacks

  • It may be difficult for some individuals to digest.
  • Phytoestrogens may behave like endocrine disruptors.
  • High amounts of oxalates can contribute to kidney stones.
  • It may decrease the absorption of some minerals.

Foods

Plant foods are the highest in antinutrient compounds, including (Petroski W. & Minich D. M. 2020)

  • Coffee
  • Some teas
  • Cacao
  • Grains
  • Nuts, such as cashews, hazelnuts, and almonds
  • Legumes, such as beans, peas, peanuts, lentils and soybeans
  • Seeds like flaxseeds, sunflower seeds, and sesame seeds
  • Fruits and vegetables include apples, stone fruits, some berries, dark leafy greens, and potatoes.

Reducing Intake

Processing and cooking foods high in antinutrients can help reduce the amount of antinutrient compounds (Petroski W. & Minich D. M., 2020) (Harvard T.H. Chan School of Public Health, 2022)

  • Soaking and sprouting
  • Fermentation
  • Cooking methods to minimize antinutrient content, like boiling, steaming
  • Autoclaving – a cooking process that uses high pressure and heat to cook and sterilize food.
  • Peeling the skins of fruits and nuts is effective for reducing tannins.
  • Combining foods to enhance nutrient absorption.
  • For example, pairing high-oxalate foods with high-calcium foods.

Combining different cooking and processing methods can completely degrade and reduce many antinutrient compounds. The exception is phytoestrogens, where boiling, steaming, and fermentation can increase antinutrients. (Petroski W. & Minich D. M., 2020)

Balancing Nutrition

The Dietary Guidelines for Americans recommend consuming nutrient-dense foods across all food groups. (U.S. Department of Agriculture, 2020)

  • Including various foods in one’s diet will help ensure one gets a diverse range of nutrients to fuel the body properly.
  • When consuming high-antinutrient foods, use processing and cooking methods known to reduce antinutrient compounds.
  • Think about making balanced food pairings to optimize nutrient absorption and minimize antinutrient intake.

For example, combining foods high in vitamin C with foods containing iron in the same meal or snack can enhance iron absorption, opposing the antinutrient activity of phytates. (National Institutes of Health Office of Dietary Supplements, 2024)

Injury Medical Chiropractic & Functional Medicine Clinic

Individuals concerned about antinutrients in their diet and who want individualized advice on how to get the most out of the food they eat should consider consulting with a registered dietitian nutritionist or another healthcare professional. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution.

Smart Choices, Better Health

References

Petroski, W., & Minich, D. M. (2020). Is There Such a Thing as “Anti-Nutrients”? A Narrative Review of Perceived Problematic Plant Compounds. Nutrients, 12(10), 2929. https://doi.org/10.3390/nu12102929

Gupta, R. K., Gangoliya, S. S., & Singh, N. K. (2015). Reduction of phytic acid and enhancement of bioavailable micronutrients in food grains. Journal of food science and technology, 52(2), 676–684. https://doi.org/10.1007/s13197-013-0978-y

Adamcová, A., Laursen, K. H., & Ballin, N. Z. (2021). Lectin Activity in Commonly Consumed Plant-Based Foods: Calling for Method Harmonization and Risk Assessment. Foods (Basel, Switzerland), 10(11), 2796. https://doi.org/10.3390/foods10112796

Mitchell, T., Kumar, P., Reddy, T., Wood, K. D., Knight, J., Assimos, D. G., & Holmes, R. P. (2019). Dietary oxalate and kidney stone formation. American journal of physiology. Renal physiology, 316(3), F409–F413. https://doi.org/10.1152/ajprenal.00373.2018

Ojo, M. A. (2022). Tannins in Foods: Nutritional Implications and Processing Effects of Hydrothermal Techniques on Underutilized Hard-to-Cook Legume Seeds-A Review. Preventive nutrition and food science, 27(1), 14–19. https://doi.org/10.3746/pnf.2022.27.1.14

Craig, W. J., Mangels, A. R., Fresán, U., Marsh, K., Miles, F. L., Saunders, A. V., Haddad, E. H., Heskey, C. E., Johnston, P., Larson-Meyer, E., & Orlich, M. (2021). The Safe and Effective Use of Plant-Based Diets with Guidelines for Health Professionals. Nutrients, 13(11), 4144. https://doi.org/10.3390/nu13114144

Harvard T.H. Chan School of Public Health. (2022). Are anti-nutrients harmful? https://nutritionsource.hsph.harvard.edu/anti-nutrients/

U.S. Department of Agriculture. (2020). Dietary Guidelines for Americans, 2020-2025. Retrieved from https://www.dietaryguidelines.gov/sites/default/files/2021-03/Dietary_Guidelines_for_Americans-2020-2025.pdf

National Institutes of Health Office of Dietary Supplements. (2024). Iron. Retrieved from https://ods.od.nih.gov/factsheets/Iron-HealthProfessional/

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

Post Surgery Leg Strengthening Tips for Patients

What are some leg-strengthening exercises that will expedite recovery for athletes and physically active individuals who have undergone leg surgery?

Post Surgery Leg Strengthening

Leg muscles may weaken after hip, knee, ankle, or foot surgery. This happens because those muscles are not used as much during recovery. Gaining back strength and muscle endurance after an injury or surgery is an important step in recovery. Leg exercises can help regain mobility and prevent complications like blood clots and pressure sores after surgery or an injury, which is why engaging in post-surgery leg strengthening is important once the doctor gives the ok.

Benefits

post-surgery leg strengthening exercises have several benefits, including

  • Rebuilds strength and confidence
  • Retraining for optimal mobility and flexibility
  • Prevents pressure sores
  • Prevents blood clots

When the leg muscles are contracted, they move blood like a pump, maintaining proper circulation. Moving in a bed after surgery also helps prevent pressure sores from forming and blood clots. A physical therapy team will determine the right leg exercises for each individual and their injury/condition. This is an important step when moving forward after surgery. (Hoogeboom T. J. et al., 2014)

Starting Out

The first exercises should target all the major muscles of the leg. (Madara K. C. et al., 2019)

Gluteal Sets

This isometric exercise means the muscles contract while no motion occurs at the hip joints. To perform:

  • Lie on your back and tighten your buttock muscles.
  • Hold the muscles tight for 5 seconds, then relax.
  • Repeat 10 or 15 times.
  • Gluteal sets can be done several times per day.

Heel Slide

Heel slides can help regain strength in the major muscles of the leg. To perform:

  • Lie on your back.
  • Bend the knee of the surgical leg and slowly slide the heel toward your butt.
  • Slide as far as possible and hold for 5 seconds.
  • Slowly return to the starting position and repeat.

Short Arc Quad

The short arc quad, or SAQ, is a simple way to get the quadricep muscles working. To perform:

  • Lie on your back with a towel roll, small ball, or something similar under the knee.
  • Slowly straighten the knee.
  • Tighten the quad muscle on the top of the thigh.
  • Hold for 3 seconds, then relax.
  • Repeat 10 to 15 times.

Quad Set

This exercise helps get the quad muscles working. It also helps control the position of the kneecap. To perform:

  • Lie on your back.
  • Place a small towel roll under the knee.
  • Try to press the back of the knee flat against the floor.
  • Hold for 10 seconds and release.
  • Repeat 10 to 15 times.

Individuals can complete quad sets bilaterally or with both knees simultaneously. This makes the stronger leg help strengthen the weaker side.

Straight Leg Raise

To perform:

  • Lie on your back.
  • Lift your leg straight off the floor until it is at the height of the opposite bent knee.
  • Hold for 10 seconds and slowly lower.
  • Repeat 10 to 15 times.

Be sure to keep the knee straight for the entire exercise. Keep the opposite knee bent for comfort. To ensure the knee is straight, individuals can complete a quad set first and then the straight leg raise. The exercise can be more challenging by increasing repetitions or adding a 2- to 3-pound ankle weight on the thigh. For even more challenge, add the ankle weight to the ankle.

Hamstring Strengthening

Working out the hamstrings after injury or surgery is important. The hamstring muscles bend the knee and extend the hip backward. To perform:

  • Lie on your stomach.
  • Bend one knee to raise the lower limb straight in the air.
  • Hold for 5 seconds and lower slowly.
  • Repeat 10 to 15 times.

Once the exercise is easy to do, increase the repetitions to 30. Individuals can also try adding a 2- to 3-pound ankle weight.

Physical therapy can help individuals regain mobility after injury or surgery. A therapist may prescribe exercises as part of an at-home exercise program. Over time progress will go from simple exercises to more challenging ones to improve balance and mobility. (Madara K. C. et al., 2019)

Injury Medical Chiropractic & Functional Medicine Clinic

Before starting this or any other exercise program, consult a doctor and a physical therapist to find the right exercises for your situation. 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.

Are You Recovering From Ankle Sprains?

References

Hoogeboom, T. J., Dronkers, J. J., Hulzebos, E. H., & van Meeteren, N. L. (2014). Merits of exercise therapy before and after major surgery. Current opinion in anaesthesiology, 27(2), 161–166. https://doi.org/10.1097/ACO.0000000000000062

Madara, K. C., Marmon, A., Aljehani, M., Hunter-Giordano, A., Zeni, J., Jr., & Raisis, L. (2019). PROGRESSIVE REHABILITATION AFTER TOTAL HIP ARTHROPLASTY: A PILOT AND FEASIBILITY STUDY. International Journal of Sports Physical Therapy, 14(4), 564–581.

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

Enzymes and Their Role in Biological Functions

Enzymes’ function is to help trigger bodily processes ranging from digestion to blood clotting to growth. What is the best way to support enzyme production?

Enzymes

Enzymes are proteins that act as biological catalysts. They cause and speed up crucial chemical reactions and help the body complete necessary chemical reactions. They are vital for many biological processes, including digestion, metabolism, and molecule building and breaking down. This includes breaking down food, facilitating growth, and forming blood clots. Too little of a certain type can lead to serious health implications like a fatal buildup of toxins. Individuals missing a certain kind of enzyme or having too little of it can develop serious health conditions.

Function

They help speed up chemical reactions in the body (National Human Genome Research Institute, 2025). They facilitate chemical reactions in everything from digesting food to muscle growth. Enzymes facilitate this by binding to a cell, creating the reactions needed. With enzyme binding, chemical reactions can occur without destroying the cell. (Nemours KidsHealth, 2023) Each cell in the body has thousands of enzymes to help facilitate all the complex reactions to maintain health. (National Human Genome Research Institute, 2025)

Factors Affecting Production

In healthy individuals, the body produces the enzymes it needs. However, metabolic disorders can occur if the body does not produce enough of a certain type. (Kennedy Krieger Institute, 2025) These disorders can be serious and are usually caused by a genetic malfunction that impacts production.

Types

There are thousands of different types. Digestive enzymes, for example, aid in the breakdown of food and convert it into energy. Common enzymes that are critical for health include (Nemours KidsHealth, 2023)

Amylase

  • Digestive helps break down starches.

Aspartate aminotransaminase (AST) and Alanine Aminotransaminase (ALT)

  • Help the liver convert sugar into energy.

Creatine Kinase (CK)

  • Helps muscles create energy.

DNA Polymerase

  • Facilitates growth by allowing DNA to duplicate.

Glucose-6-Phosphate Dehydrogenase

  • Keeps red blood cells healthy by preventing damage to the cell.

Lipase

  • A digestive enzyme that helps break down fats and oils.

Protease

  • Digestive helps break down proteins.

Thrombin

  • Causes blood to clot.

Deficiencies

If the body doesn’t make enough of a certain enzyme, it cannot undergo the bodily processes that the enzyme helps facilitate. This can lead to a variety of symptoms. Some are minor, like not being able to eat lactose. Others are serious, like developmental delays caused by the build-up of toxins. (Kennedy Krieger Institute, 2025) Usually, these deficiencies are caused by genetics.

Types

There are various deficiencies. Some are very rare, while others can lead to conditions such as: (Nemours KidsHealth, 2023)

Lactose Intolerance

  • This is caused by not having enough of the enzyme that breaks down lactose, a sugar found in milk, leading to gas and bloating.

Tay-Sachs Disease

  • An often fatal disease caused by a missing hexosaminidase, which is responsible for breaking down fats

Gilbert’s Syndrome

  • This is caused by a missing enzyme that removes waste product (bilirubin) from the blood, leading to bilirubin buildup and
  • Jaundice or yellowing of the skin and whites of the eyes

Galactosemia

  • This leads to slow growth and trouble gaining weight, which is caused by the missing galactose-1-phosphate uridylyltransferase (GALT), which helps break down a sugar called galactose.

Phenylketonuria (PKU)

  • This is caused by having too little phenylalanine hydroxylase, which breaks down a protein called phenylalanine, causing brain damage.

Morquio Syndrome

  • This is caused by having too few enzymes that break down glycosaminoglycans, a type of sugar molecule.
  • This leads to bone and growth abnormalities.

Wilson’s Disease

  • A liver disease is caused by a missing protein that helps break down copper in the body.

Enzyme Production Support

Eat a healthy, well-balanced diet of fruits and vegetables to support enzyme production. Avoid processed foods, especially those that are very fatty (Johns Hopkins Medicine, 2025). The body produces all the necessary enzymes unless the individual has a genetic condition. Supplements aren’t usually required, but they can help with lactose intolerance or digestion in cystic fibrosis patients. (Nemours KidsHealth, 2023)

One supplement type, pancreatic enzyme replacement therapy (PERT), is available. PERT is an FDA-regulated prescription medication prescribed to patients with serious illnesses such as cystic fibrosis. (U.S. Food and Drug Administration, 2019)

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.

Chiropractic Care and Metabolism: The Hidden Link

References

National Human Genome Research Institute. (2025). Enzyme. Retrieved from https://www.genome.gov/genetics-glossary/Enzyme

Nemours KidsHealth. (2023). Enzymes. https://kidshealth.org/en/parents/enzymes.html

Kennedy Krieger Institute. (2025). Metabolic disorders. https://www.kennedykrieger.org/patient-care/conditions/metabolic-disorders

Johns Hopkins Health. (2025). Digestive enzymes and digestive enzyme supplements. https://www.hopkinsmedicine.org/health/wellness-and-prevention/digestive-enzymes-and-digestive-enzyme-supplements#:~:text=You’re%20better%20off%20building,your%20diet,%20especially%20fried%20foods.

U.S. Food and Drug Administration. (2019). FDA approves new breakthrough therapy for cystic fibrosis. Retrieved from https://www.fda.gov/news-events/press-announcements/fda-approves-new-breakthrough-therapy-cystic-fibrosis

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

Lidocaine Patch for Pain Relief: An Overview

For individuals experiencing lower back pain and sciatica symptoms, can using a lidocaine patch help?

Lidocaine Patch

Lidocaine patches are in a drug class called local anesthetics (MedlinePlus, 2025) (Food and Drug Administration, 2022). They relieve pain in small body areas by blocking the nerves from sending pain signals. The Food and Drug Administration approved lidocaine 5% or 1.8% patches for relieving postherpetic neuralgia (PHN) pain. These lidocaine patches are prescription-only (Food and Drug Administration, 2022). They are available either by prescription or over the counter and are commonly used for back pain and other areas. Over-the-counter lidocaine, 4% patches, can be used to relieve minor aches and pains, including back pain. However, further research is needed to recommend the use of lidocaine patches as an effective method of pain relief. (Department of Veterans Affairs/Department of Defense, 2022) (North American Spine Society, 2020)

The Patch

They are available in prescription and over-the-counter forms. Over-the-counter forms come as a 4% patch in various brands, such as (MedlinePlus, 2025)

  • Aspercreme
  • Lidocare
  • Salonpas

Prescription-only patches come in 5% or 1.8% patches and are approved to relieve long-term nerve pain from shingles in adults. Zlido is a brand name for a 1.8% lidocaine patch. Five percent lidocaine patches are available generically. (DailyMed, 2018) (Food and Drug Administration, 2021) The safety and effectiveness in children are unknown. (Food and Drug Administration, 2022)

Other Lidocaine Forms

As a local anesthetic, it is available in several other forms, including:

  • Spray
  • Topical cream
  • Lotion
  • Liquid
  • Ear drops
  • Eye gel
  • Injection
  • It is also available as a short-term intravenous infusion for abnormal heart rhythm. (DailyMed, 2025)

Effectiveness

Clinical trials have shown that the patches effectively relieve chronic low back pain. However, these studies were nonrandomized and did not include a control group to compare against the treatment group. (Santana J. A., Klass S., & Felix E. R. 2020) The results may be subject to potential biases. For this reason, further evidence is needed to support lidocaine patches’ effectiveness in reducing low back pain. (North American Spine Society, 2020) High-quality randomized and controlled clinical trials are necessary to study the effectiveness. (North American Spine Society, 2020) (Santana J. A., Klass S., & Felix E. R. 2020)

How to Use Safely

In general, keep the following in mind (MedlinePlus, 2025)

  • Use according to the directions on the box and the healthcare provider’s recommendations.
  • Do not use on broken or inflamed, swollen skin.
  • Do not apply heat like heating pads or electric blankets over patches.
  • Avoid getting water on or around the patch.
  • Avoid letting a patch near your eyes to limit eye irritation.
  • Fold the sticky sides of the used lidocaine patches together and safely throw them away, keeping them away from children and pets.

How to use (MedlinePlus, 2025)

  • Clean and dry the affected area before placing the patch.
  • Apply to the affected body area as directed.
  • Wash your hands after touching the patch.
  • Remove the patch after what is usually recommended after eight hours.

How Quickly Does It Work?

The amount of medication absorbed into the blood depends on how long the patch is placed on the body and how much is covered with the patch. In a study, healthy participants wore three lidocaine patches on their backs for 12 hours on and 12 hours off during 24 hours. Lidocaine levels were highest at 11 hours. At the end of the 24 hours, there was still some lidocaine left in the bloodstream. (Food and Drug Administration, 2022)

Individuals with PHN may notice a difference in pain intensity after four hours of using the patch. (Rowbotham, M. C. et al., 1996) (Food and Drug Administration, 2022) Experts may suggest using patches for four weeks for those who experience pain after their shingles rash disappears. However, if there is still pain after these four weeks, it is recommended to see a pain specialist. (Gross, G. E. et al., 2020)

Side Effects

Common side effects are typically mild skin reactions where the patch is.  These reactions are usually temporary and will disappear within a few minutes or hours. Examples include: (Food and Drug Administration, 2022)

  • Irritation
  • Itchiness
  • Abnormal or burning sensation
  • Redness
  • Swelling
  • Blisters
  • Bruises
  • Skin bumps
  • Skin color changes
  • Skin peeling

Potentially serious side effects include: (Food and Drug Administration, 2022)

Serious Allergic Reaction

  • Severe allergic reactions are rare, but it is possible.
  • Symptoms include breathing problems, itchiness, and rash.

Methemoglobinemia

  • Methemoglobinemia is a condition that makes it hard for red blood cells to carry oxygen.
  • Individuals may experience symptoms of blue-looking skin, headache, lightheadedness, shortness of breath, abnormal heart rhythm, or seizures.

Using too many lidocaine patches to cover large parts of the body or using the patches longer than 12 hours within 24 hours may cause side effects that may include heart-related effects, such as a slow heart rate and low blood pressure.  Individuals may also experience the following side effects (Food and Drug Administration, 2022)

  • Hot or cold sensation
  • Numbness
  • Dizziness
  • Ringing ears
  • Lightheadedness
  • Mood changes
  • Drowsiness to unconsciousness
  • Vision changes
  • Seizures
  • Tremors
  • Vomiting

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.

Sciatica Causes and Treatments

References

National Library of Medicine. MedlinePlus. (2025). Lidocaine transdermal patch. Retrieved from https://medlineplus.gov/druginfo/meds/a603026.html

Food and Drug Administration. (2022). Lidoderm label. Retrieved from https://www.accessdata.fda.gov/spl/data/eedfe43b-1019-19a0-e053-2995a90a7696/eedfe43b-1019-19a0-e053-2995a90a7696.xml

Department of Veterans Affairs/Department of Defense. (2022). VA/DoD clinical practice guideline for the diagnosis and treatment of low back pain. Retrieved from https://www.healthquality.va.gov/guidelines/Pain/lbp/VADoDLBPCPGFinal508.pdf

North American Spine Society. (2020). Evidence-based clinical guidelines for multidisciplinary spine care: diagnosis and treatment of low back pain. https://www.spine.org/Portals/0/assets/downloads/ResearchClinicalCare/Guidelines/LowBackPain.pdf

National Library of Medicine. DailyMed. (2018). Label: lidocaine patch. Retrieved from https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=5c66f3b9-6e04-47ab-8d94-21e89ceec154

Food and Drug Administration. (2021). Ztlido label. Retrieved from https://www.ztlido.com/wp-content/uploads/2022/12/ZTlido-LABEL.pdf

National Library of Medicine. DailyMed. (2025). Lidocaine-lidocaine hydrochloride injection, solution. Retrieved from https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=f1b26274-a55e-4321-b96c-ce0df830f205

Santana, J. A., Klass, S., & Felix, E. R. (2020). The Efficacy, Effectiveness and Safety of 5% Transdermal Lidocaine Patch for Chronic Low Back Pain: A Narrative Review. PM & R: the journal of injury, function, and rehabilitation, 12(12), 1260–1267. https://doi.org/10.1002/pmrj.12366

Rowbotham, M. C., Davies, P. S., Verkempinck, C., & Galer, B. S. (1996). Lidocaine patch: double-blind controlled study of a new treatment method for post-herpetic neuralgia. Pain, 65(1), 39–44. https://doi.org/10.1016/0304-3959(95)00146-8

Gross, G. E., Eisert, L., Doerr, H. W., Fickenscher, H., Knuf, M., Maier, P., Maschke, M., Müller, R., Pleyer, U., Schäfer, M., Sunderkötter, C., Werner, R. N., Wutzler, P., & Nast, A. (2020). S2k guidelines for the diagnosis and treatment of herpes zoster and postherpetic neuralgia. Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology: JDDG, 18(1), 55–78. https://doi.org/10.1111/ddg.14013

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

Cobb Angle: From Measurement to Treatment Decisions

The Cobb angle is a mathematical measurement tool for assessing the curvature of the spine. Along with physical exams and other tests, how is it used to evaluate scoliosis and kyphosis of the spine?

Cobb Angle

The Cobb angle is used to quantify the curvature of the spine, particularly in conditions like scoliosis. It measures the degree of side-to-side spinal curvature, a deformity called scoliosis. The angle’s size helps determine what kind of treatment is needed. Monitoring may be all that’s necessary for mild curvature. With severe scoliosis, treatment may require spinal fusion surgery. Named for orthopedic surgery pioneer John Robert Cobb, it describes the distance a scoliotic curve may deviate from being straight. (Botterbush K. S. et al., 2023) Generally, it takes at least 10 degrees of deviation from straight before scoliosis is confirmed.

X-Ray and Interpretation

An X-ray is taken to measure the Cobb angle. Side and back views are taken. The healthcare provider or examiner then views the X-rays and locates the most affected vertebra in the curve, called the apical vertebra. In a scoliotic curve, the apical vertebra is the spinal bone with the greatest degree of rotation that takes the biggest curve away from the center of a normal spine column.

Visualizing the Angle

The apical vertebra is where two lines drawn from the X-rays meet. Two lines are drawn along the edge of the top and bottom bones of the curve. The lines extend out as follows:

  • On the top bone, the line starts on the high side, continues along the top edge, and then slopes down according to the angle of the vertebra. (Jin, C. et al., 2022)
  • On the bottom vertebra, the line starts on the low side, continues along the bottom edge, and slopes upward.
  • The Cobb angle is found by measuring the angle of the two intersecting lines where they meet.

Then, the top and bottom vertebrae of the side-to-side curve are identified to create a number for the Cobb angle. These bones have the most tilt but the least rotation and displacement and are located above and below the apical vertebra. Computer software is commonly used to calculate the Cobb angle. (Jin, C. et al., 2022) Treatment is based on the:

10 Degrees Cobb Angle 

Scoliosis is diagnosed when the Cobb angle reaches 10 degrees or more. However, this is not generally considered a significant curvature (American Association of Neurological Surgeons, 2024). In around 80% of cases, the scoliosis is considered idiopathic or without congenital or other underlying causes.

Less Than 25 Degrees Cobb Angle

If a scoliotic curve is less than 25 degrees, individuals may only need to visit their healthcare provider periodically so long as the scoliosis is monitored. These are mild cases, often without symptoms, but there is a chance that the curvature can progress. This usually means reassessing the Cobb angle every four to six months in a growing child or adolescent. (National Scoliosis Foundation, 2015) A 5-degree or more progression can change the diagnosis and treatment. (Jin, C. et al., 2022)

Between 25 and 40 Degrees Cobb Angle

A Cobb angle of 25 to 40 degrees usually requires wearing a back brace and intensive physical therapy. The goal of these treatments is to help halt the curve’s progression. Braces are generally worn 16 to 23 hours every day. (National Scoliosis Foundation, 2015) The healthcare provider will provide a referral for physical therapy. Many report excellent results with the Schroth or other scoliosis-specific exercise methods. A study found that core stabilization exercise programs can decrease Cobb angles in adolescents with idiopathic scoliosis. (Ko K. J. & Kang S. J. 2017)

Scoliosis in Adults

Scoliosis is diagnosed in adults, usually in those who have had the condition, treated or not, that was identified in their youth. A study that followed various cases for 20 years found disease progression occurred in 40% of adults but was usually less than one degree per year. However, degenerative scoliosis can also occur in individuals aged 65 and older. (American Association of Neurological Surgeons, 2024)

40 Degrees or More Cobb Angle

Surgery may be recommended once the Cobb angle reaches 40 to 50 degrees. A spinal fusion is often used to force the curve to stop developing. In adults, surgery may be needed if the angle reaches 50 degrees and they experience complications, such as nerve damage or bowel/bladder dysfunction. Risk factors in adults include older age, a history of smoking, and a diagnosis of other conditions, including being overweight. (American Association of Neurological Surgeons, 2024)

Variations

Variations occur in measuring scoliosis, and it is important to understand the difference between a change in scoliosis and a change in the tools or measurement. Equipment errors, imaging errors, and the subjective reading of the healthcare provider can change the values. (Jin, C. et al., 2022) Scoliosis measurement software and intelligent medical devices continue to improve how scoliosis is evaluated and treated. Physical exams, symptoms, and careful monitoring of changes in posture or function are still critical to an accurate diagnosis. The healthcare provider will explain the Cobb angle and other test results.

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.

Academic Low Back Pain: Impact and Chiropractic Solutions

References

Botterbush, K. S., Zhang, J. K., Chimakurty, P. S., Mercier, P., & Mattei, T. A. (2023). The life and legacy of John Robert Cobb: the man behind the angle. Journal of neurosurgery. Spine, 39(6), 839–846. https://doi.org/10.3171/2023.7.SPINE23146

Jin, C., Wang, S., Yang, G., Li, E., & Liang, Z. (2022). A Review of the Methods on Cobb Angle Measurements for Spinal Curvature. Sensors (Basel, Switzerland), 22(9), 3258. https://doi.org/10.3390/s22093258

National Scoliosis Foundation. (2015). Scoliosis Media & Community Guide. https://www.scoliosis.org/nsf2/wp-content/uploads/2015/06/ScoliMediaGuide_9June3.pdf

American Association of Neurological Surgeons. (2024). Scoliosis. https://www.aans.org/patients/conditions-treatments/scoliosis/

Ko, K. J., & Kang, S. J. (2017). Effects of 12-week core stabilization exercise on the Cobb angle and lumbar muscle strength of adolescents with idiopathic scoliosis. Journal of Exercise Rehabilitation, 13(2), 244–249. https://doi.org/10.12965/jer.1734952.476