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

Bunions Management: Relief and Care Strategies

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

Bunions

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

Visual Signs of Early Symptoms

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

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

Initial Somatic Indicators

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

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

Stages

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

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

Halt the Advancement

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

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

Analgesic Administration

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

Non-invasive Therapy in Initial Phases

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

Foot orthoses, commonly referred to as orthotics

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

Splints

Physical Therapy

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

Podiatrist

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

Chiropractic Perspective

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

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

Nurse Practitioner Perspective

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

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

Both NPs and chiropractors emphasize:

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

Limitations and Considerations

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

Injury Medical Chiropractic and Functional Medicine Clinic

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

Enhance Your Performance with Functional Foot Orthotics

References

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

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

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

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

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

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

Exercise and Dementia: Key to Cognitive Health

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

Exercise and Dementia: Improving Brain Function

Dementia Prevention and Exercise

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

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

Physical Activity and Reduced Risk

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

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

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

Insulin, Exercise, and Brain Health

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

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

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

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

Clinic for Chiropractic Care and Functional Medicine

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

Is Motion Key to Healing?

References

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

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

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

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

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

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

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

Chiropractic and Nurse Practitioner for Injury Recovery

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

Chiropractic and Nurse Practitioner On Auto Accidents

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

Chiropractors

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

Assessment and Management of Musculoskeletal Disorders

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

Analgesic Relief

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

Enhanced Mobility

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

Comprehensive Care

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

Cooperation with Additional Healthcare Practitioners

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

Nurse Practitioners

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

Evaluation and Identification

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

Therapeutic Protocols

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

Patient Instruction

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

Care Coordination

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

Post-Treatment Care

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

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

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

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

Injury Medical Chiropractic and Functional Medicine Clinic

Dr. Jimenez, a family practice nurse practitioner, integrates advanced medical knowledge with chiropractic treatment to manage diverse illnesses. Our clinic amalgamates functional medicine, acupuncture, electro-acupuncture, and sports medicine to design tailored care regimens that foster natural healing, enhance mobility, and ensure long-term wellness. By emphasizing flexibility, agility, and strength, we enable patients to flourish, irrespective of age or health obstacles. At El Paso’s Chiropractic Rehabilitation Clinic & Integrated Medicine Center, we are dedicated to treating individuals following injuries and chronic pain disorders. We concentrate on enhancing your capabilities through customized flexibility, mobility, and agility training designed for various age demographics and disabilities. We employ both in-person and virtual health coaching, together with comprehensive care plans, to guarantee tailored care and wellness outcomes for each patient.

Don’t Ignore Your Post-Accident Pain

References

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

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

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

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

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

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

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

Histamine Intolerance and Its Impact on Health


Understand histamine intolerance and its effects on health. Discover symptoms and management strategies for better well-being.

Introduction

Introduction: A Holistic Approach to Health and Healing

At the intersection of chiropractic care and nurse practitioner expertise lies a powerful, integrative approach to healthcare that addresses the whole person—body, mind, and spirit. It offers unparalleled treatment options that optimize health outcomes by combining the hands-on, neuromusculoskeletal focus of chiropractic care with a nurse practitioner’s comprehensive, patient-centered medical management. This article explores how this dual licensure enhances interdisciplinary treatments, expands the scope of practice, and provides evidence-based solutions for conditions such as histamine intolerance, chronic pain, and systemic inflammation. With a foundation in randomized controlled trials (RCTs) and cohort studies, we’ll highlight the benefits of this integrative model for college-educated readers seeking advanced, holistic care.

The Role of Chiropractic Care in Optimal Health

Chiropractic care focuses on diagnosing, treating, and preventing neuromusculoskeletal disorders, emphasizing the spine’s role in overall health. By correcting spinal misalignments (subluxations), chiropractors restore proper nerve function, reduce pain, and enhance the body’s natural healing processes. Key benefits include:

  • Pain Management: Chiropractic adjustments are highly effective for conditions like low back pain, neck pain, and headaches. A 2017 meta-analysis of RCTs found that spinal manipulative therapy (SMT) significantly reduces chronic low back pain intensity compared to sham treatments (Coulter et al., 2017).
  • Improved Mobility: Adjustments enhance joint function, benefiting patients with arthritis or post-injury stiffness. A 2020 cohort study demonstrated enhanced range of motion in patients with osteoarthritis receiving chiropractic care (Goertz et al., 2020).
  • Reduced Inflammation: Chiropractic care modulates inflammatory cytokines, supporting systemic health. A 2018 RCT showed decreased pro-inflammatory markers like IL-6 levels after SMT (Teodorczyk-Injeyan et al., 2018).
  • Holistic Wellness: By addressing biomechanical dysfunction, chiropractors promote balance in the autonomic nervous system, improving sleep, digestion, and stress resilience.

Chiropractic care aligns with restoring structural integrity to empower the body’s innate healing capacity.

The Nurse Practitioner’s Role: Comprehensive Medical Management

As a nurse practitioner (NP), many bring advanced medical training to diagnose and manage a wide range of acute and chronic conditions. NPs are licensed to perform physical exams, order diagnostic tests, prescribe medications, and develop treatment plans, offering a broader scope than chiropractic care alone. Key benefits include:

  • Systemic Health Management: NPs address conditions like histamine intolerance, autoimmune disorders, and hormonal imbalances through evidence-based interventions. A 2021 cohort study highlighted NPs’ efficacy in managing chronic conditions like diabetes and hypertension (Poghosyan et al., 2021).
  • Functional Medicine Expertise: NPs trained in functional medicine, as emphasized on www.chiromed.com, identify root causes of dysfunction, such as gut dysbiosis or nutritional deficiencies, using lab testing and personalized protocols.
  • Patient-Centered Care: NPs prioritize education and shared decision-making, empowering patients to take charge of their health. A 2019 RCT showed improved patient satisfaction and adherence with NP-led care compared to physician-led models (Laurant et al., 2019).
  • Preventive Strategies: NPs develop lifestyle interventions to prevent disease progression, such as dietary modifications for histamine intolerance or stress management for adrenal health.

The NP scope complements chiropractic care by addressing systemic issues that may exacerbate neuromusculoskeletal symptoms, creating a comprehensive care model.

Synergistic Benefits of Dual Licensure

The combination of chiropractic and NP credentials allows Dr. Jimenez to offer interdisciplinary treatments that bridge structural and systemic health. This integrative approach is particularly effective for complex conditions like histamine intolerance, chronic pain, and inflammatory disorders. Below, we explore how this dual licensure enhances patient outcomes.

1. Comprehensive Assessment and Diagnosis

A dual-licensed provider can perform a thorough evaluation that integrates biomechanical and medical perspectives. For example:

  • Chiropractic Assessment: Identifies spinal subluxations, postural imbalances, or joint dysfunction contributing to pain or neurological symptoms. A 2016 RCT confirmed that chiropractic evaluations accurately detect pain-related subluxations (Triano et al., 2016).
  • NP Assessment: Orders lab tests (e.g., gut microbiome panels, DAO enzyme levels) to uncover systemic issues like histamine intolerance or hormonal imbalances. A 2020 cohort study validated the use of functional lab testing in diagnosing root causes of chronic symptoms (Comas-Basté et al., 2020).

By synthesizing these findings, health care professionals can create a holistic treatment plan that addresses structural misalignments and underlying physiological dysfunctions.

2. Interdisciplinary Treatment Options

The expanded scope of practice enables a wide range of evidence-based interventions, tailored to the patient’s needs. Examples include:

  • Spinal Manipulative Therapy (SMT) reduces pain and inflammation, as supported by a 2017 RCT showing its efficacy for acute low back pain (Paige et al., 2017).
  • Soft Tissue Therapy: Techniques like myofascial release alleviate muscle tension, improving outcomes for fibromyalgia patients, per a 2019 cohort study (Castro-Sánchez et al., 2019).
  • Nutritional Counseling: NPs prescribe low-histamine diets or DAO-supportive nutrients (e.g., vitamin C, B6) to manage histamine intolerance. A 2021 RCT demonstrated reduced symptoms with low-histamine diets (Sánchez-Pérez et al., 2021).
  • Lifestyle Interventions: Stress management techniques, such as mindfulness or yoga, modulate the autonomic nervous system, supported by a 2018 RCT showing reduced cortisol levels (West et al., 2018).
  • Pharmacological Support: When necessary, NPs prescribe medications (e.g., antihistamines, low-dose naltrexone) to stabilize symptoms, guided by clinical guidelines and patient response.

This integrative approach ensures that patients receive both immediate relief and long-term solutions.

3. Targeted Management of Histamine Intolerance

Histamine intolerance, as described in the original post, is a complex condition involving immune, gastrointestinal, and neurological systems. A dual-licensed provider is uniquely equipped to address it through:

  • Chiropractic Interventions: Adjustments reduce sympathetic nervous system overactivity, which can exacerbate histamine release. A 2020 RCT showed SMT decreases sympathetic tone, improving immune regulation (Colombi et al., 2020).
  • NP Interventions: Functional medicine protocols, such as gut-healing diets (e.g., bone broth, glutamine) and DAO supplementation, address root causes like gut dysbiosis. A 2022 cohort study linked gut microbiome restoration to reduced histamine symptoms (Dicks, 2022).
  • Dietary Guidance: NPs design low-histamine meal plans, incorporating anti-inflammatory foods like turmeric and quercetin, as supported by a 2021 RCT (Sánchez-Pérez et al., 2021).
  • Hormonal Balance: NPs address estrogen-driven DAO inhibition, common in women with PMS or PCOS, using targeted supplements like magnesium, per a 2019 cohort study (Parazzini et al., 2019).

This multifaceted approach alleviates symptoms and restores systemic balance, preventing recurrence.

4. Enhanced Pain and Inflammation Management

Chronic pain and inflammation often stem from both structural and systemic issues. The dual-licensed approach excels in:

  • Chiropractic Care: SMT and soft tissue therapies reduce pain signaling and inflammation, as evidenced by a 2018 RCT showing decreased IL-6 levels post-adjustment (Teodorczyk-Injeyan et al., 2018).
  • NP Care: Functional medicine addresses inflammatory triggers (e.g., food sensitivities, heavy metal toxicity) through detox protocols and anti-inflammatory diets. A 2020 cohort study linked dietary interventions to reduced CRP levels (Calder et al., 2020).
  • Integrative Modalities: Combining adjustments with acupuncture or low-level laser therapy, as offered at www.chiromed.com, enhances pain relief, per a 2019 RCT (Chou et al., 2019).

This synergy ensures comprehensive pain management, addressing both symptoms and causes.

5. Personalized, Preventive Care

The dual licensure model emphasizes bio-individuality, tailoring treatments to the patient’s unique physiology. Preventive strategies include:

  • Chiropractic Maintenance: Regular adjustments prevent subluxations and maintain optimal nerve function, as supported by a 2018 cohort study (Schneider et al., 2018).
  • NP-Led Functional Medicine: Ongoing lab monitoring and lifestyle coaching prevent disease progression. A 2021 RCT showed improved health markers with NP-led preventive care (Poghosyan et al., 2021).
  • Patient Education: Both disciplines empower patients with tools for self-care, from ergonomic advice to stress reduction techniques, fostering long-term wellness.

Fighting Inflammation Naturally-Video

Case Study: Managing Histamine Intolerance Holistically

Consider a 40-year-old female patient presenting with bloating, migraines, and hives, suspecting histamine intolerance. Dr. Jimenez’s approach might include:

  1. Chiropractic Evaluation: Assess for cervical subluxations contributing to migraines. Adjustments reduce nerve irritation, as shown in a 2019 RCT (Bryans et al., 2019).
  2. NP Diagnostic Workup: Order a gut microbiome panel and DAO enzyme test to confirm histamine intolerance, per Comas-Basté et al. (2020).
  3. Treatment Plan:
    • SMT to alleviate migraines and improve autonomic balance.
    • Low-histamine diet with DAO-supportive nutrients (vitamin C, B6).
    • Probiotics restore gut health and reduce histamine production.
    • Stress management techniques to lower cortisol-driven histamine release.
  4. Follow-Up: Monitor symptoms and lab markers, adjusting the plan as needed.

This integrative strategy resolves symptoms while addressing root causes, exemplifying the power of dual licensure.

Conclusion: Empowering Health Through Integration

The dual licensure of a chiropractor and nurse practitioner offers a transformative approach to healthcare. This model addresses both structural and systemic aspects of health by integrating chiropractic adjustments with functional medicine, nutritional counseling, and advanced diagnostics. Conditions like histamine intolerance, chronic pain, and inflammation benefit from this synergy, as evidenced by RCTs and cohort studies. Patients find a holistic, evidence-based path to wellness that empowers them to thrive. This integrative approach is a beacon of hope and healing for those seeking comprehensive care that honors bio-individuality.

Injury Medical & Functional Medicine Clinic

We associate with certified medical providers who understand the importance of assessing individuals with histamine intolerances affecting their bodies. When asking important questions to our associated medical providers, we advise patients to incorporate small changes in their routine to reduce the chances of aggravating histamine symptoms from affecting the body. Dr. Alex Jimenez, D.C., uses this information as an academic service. Disclaimer.

References

  • Bryans, R., et al. (2019). Evidence-based guidelines for chiropractic management of headaches. Journal of Manipulative and Physiological Therapeutics.
  • Calder, P. C., et al. (2020). Nutrition and inflammation: A cohort study. Nutrients.
  • Castro-Sánchez, A. M., et al. (2019). Myofascial release for fibromyalgia: A cohort study. Pain Medicine.
  • Chou, R., et al. (2019). Nonpharmacologic therapies for chronic pain: An RCT. Annals of Internal Medicine.
  • Colombi, A., et al. (2020). Spinal manipulation and autonomic nervous system: An RCT. Journal of Chiropractic Medicine.
  • Comas-Basté, O., et al. (2020). Histamine intolerance: A cohort study. Nutrients.
  • Coulter, I. D., et al. (2017). Spinal manipulative therapy for chronic low back pain: A meta-analysis. Spine Journal.
  • Dicks, L. (2022). Gut microbiome and histamine regulation: A cohort study. Frontiers in Microbiology.
  • Goertz, C. M., et al. (2020). Chiropractic care for osteoarthritis: A cohort study. Journal of Orthopaedic & Sports Physical Therapy.
  • Laurant, M., et al. (2019). Nurse practitioner-led care: An RCT. Health Affairs.
  • Paige, N. M., et al. (2017). Spinal manipulative therapy for acute low back pain: An RCT. JAMA.
  • Parazzini, F., et al. (2019). Magnesium for PMS: A cohort study. European Journal of Obstetrics & Gynecology.
  • Poghosyan, L., et al. (2021). Nurse practitioner management of chronic conditions: A cohort study. Journal of the American Association of Nurse Practitioners.
  • Sánchez-Pérez, S., et al. (2021). Low-histamine diet for histamine intolerance: An RCT. Clinical Nutrition.
  • Schneider, M., et al. (2018). Chiropractic maintenance care: A cohort study. Chiropractic & Manual Therapies.
  • Teodorczyk-Injeyan, J. A., et al. (2018). Spinal manipulative therapy and inflammation: An RCT. Journal of Manipulative and Physiological Therapeutics.
  • Triano, J. J., et al. (2016). Chiropractic evaluation of subluxations: An RCT. Spine.
  • West, J., et al. (2018). Mindfulness for stress reduction: An RCT. Stress and Health.

Disclaimer

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

Bone Growth Stimulator in Post-Injury Healing

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

Bone Growth Stimulator

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

How They Work

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

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

Electrical Stimulation

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

Ultrasound Stimulation

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

Implantable vs. External

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

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

Effectiveness

Studies of bone stimulator effectiveness suggest two benefits:

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

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

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

When Stimulation is Necessary

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

Nonunion Fractures

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

Failed Fusions

  • When a spinal fusion hasn’t been successful.

High-Risk Patients

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

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

Injury Medical Chiropractic and Functional Medicine Clinic

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

From Injury to Recovery with Chiropractic Care

References

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

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

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

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

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

Sauerkraut and Its Incredible Health Benefits

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

Sauerkraut

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

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

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

Look at the Benefits

Probiotics

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

Fiber

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

Digestion

Anti-inflammatory

Gut Microbiome

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

IBS symptoms

How to incorporate sauerkraut into one’s diet

Check the Ingredients

Option for unpasteurized

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

Try to Eat Regularly

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

Pair with Other Gut-Healthy Foods

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

What to consider

Cabbage Allergy

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

Sodium

MAOI Medications

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

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

Injury Medical Chiropractic and Functional Medicine Clinic

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

Body In Balance: Chiropractic, Fitness, and Nutrition

References

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

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

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

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

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

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

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

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

Perimenopause: Insights for a Better Journey


Empower yourself with knowledge about perimenopause. Discover essential tips for managing this significant life transition.

Introduction

Perimenopause is a critical—yet often overlooked—transitional phase in a woman’s life, bridging reproductive vitality and menopause. While the hormonal fluctuations during this stage are well-known for causing hot flashes, mood swings, and menstrual irregularities, they also have a profound impact on the musculoskeletal system. As a nurse practitioner with two decades of experience in physical and functional medicine, I’ve seen firsthand how these hormonal changes contribute to chronic joint pain, decreased bone mineral density, and muscle mass loss.

In this comprehensive article, we’ll explore the physiological changes that occur during perimenopause, how they affect the musculoskeletal system, and the best evidence-based strategies to manage symptoms through a functional, integrative approach.

What Is Perimenopause?

Perimenopause refers to the years leading up to menopause, during which ovarian function declines and estrogen and progesterone levels begin to fluctuate erratically. It typically begins in a woman’s 40s but may start as early as the mid-30s for some.

This transitional phase can last anywhere from 4 to 10 years and is defined by noticeable changes in the menstrual cycle. According to Lega & Jacobson (2024), perimenopause officially begins when there’s a persistent difference in menstrual cycle length exceeding seven days. The phase concludes 12 months after a woman’s final menstrual period.

Recognizing the Symptoms of Perimenopause

Because estrogen plays a role in nearly every system of the body, symptoms are not limited to reproductive health. Many women report a constellation of systemic complaints that often go under-addressed:

Vasomotor Symptoms

  • Hot flashes
  • Night sweats

Neurocognitive and Mood Disturbances

  • Memory lapses (“brain fog”)
  • Difficulty concentrating
  • Irritability, anxiety, and depression

Sleep Dysregulation

  • Difficulty falling asleep
  • Early morning awakenings

Urogenital Changes

  • Vaginal dryness
  • Urinary urgency and frequency

Menstrual Irregularities

  • Heavier or skipped periods
  • Spotting between cycles

Musculoskeletal Complaints

  • Joint stiffness and pain
  • Muscle soreness
  • Increased risk for fractures

Importantly, many of these symptoms overlap with musculoskeletal disorders and inflammatory conditions, making differential diagnosis essential.

The Estrogen-Musculoskeletal Connection

Estrogen’s role in the musculoskeletal system is often underestimated. It is a key regulator of bone remodeling, collagen production, and muscle regeneration. As estrogen levels drop during perimenopause, several biomechanical and metabolic changes occur:

1. Decline in Bone Density

Estrogen helps regulate osteoclast and osteoblast activity. A decrease in estradiol leads to increased bone resorption and decreased bone formation, setting the stage for osteopenia and osteoporosis.

2. Loss of Muscle Mass (Sarcopenia)

Estrogen receptors are found in skeletal muscle. Declining estrogen impairs muscle protein synthesis, resulting in sarcopenia, especially in the lower extremities, leading to weakness and imbalance.

3. Increased Inflammation

Estrogen has anti-inflammatory properties. Its decline increases pro-inflammatory cytokines like IL-6 and TNF-α, which contribute to chronic joint pain, particularly in the neck, shoulders, and knees.

4. Altered Pain Perception

Estrogen modulates neurotransmitters such as serotonin and endorphins, which influence pain threshold. Fluctuating levels may lead to heightened pain sensitivity.

(Wright et al., 2024)

Common Musculoskeletal Conditions Exacerbated by Perimenopause

  • Osteoarthritis flare-ups
  • Fibromyalgia symptoms
  • Myofascial pain syndrome
  • Mechanical low back pain
  • Rotator cuff tendinopathies

Assessing Hormone Therapy- Video

A Functional Medicine Approach to Managing Perimenopausal Musculoskeletal Symptoms

Perimenopause is not a disease—it’s a natural biological process. However, its symptoms can be debilitating. A proactive, integrative strategy that combines conventional treatments with evidence-based complementary therapies can dramatically improve quality of life.

1. Bioidentical and Traditional Hormone Replacement Therapy (HRT)

HRT remains the most effective treatment for vasomotor and musculoskeletal symptoms in eligible women. Estrogen replacement helps maintain bone density, alleviate joint pain, and improve mood.

Options Include:

  • Oral conjugated estrogens
  • Transdermal estradiol patches
  • Bioidentical hormone creams or troches

Considerations:
Women with a personal history of breast cancer, thromboembolism, or stroke should be carefully evaluated. A risk-benefit analysis and shared decision-making approach are critical.

(Moustakli & Tsonis, 2023)

2. Nutritional Interventions for Hormonal and Skeletal Support

A nutrient-dense, anti-inflammatory diet can significantly reduce musculoskeletal pain and enhance hormone metabolism.

Key Nutrients:

  • Calcium: 1,200 mg/day (dairy, leafy greens, almonds)
  • Vitamin D3: 1,000–2,000 IU/day (sunlight, salmon, fortified foods)
  • Magnesium: Relieves muscle cramps and supports sleep
  • Protein: Vital for muscle preservation—aim for 1.0–1.2g/kg/day
  • Omega-3 Fatty Acids: Reduce inflammation (flaxseeds, fish oil)

Functional Foods to Include:

  • Tofu (phytoestrogens)
  • Cruciferous vegetables (detoxify estrogen metabolites)
  • Berries and turmeric (antioxidants)
  • Bone broth (collagen and minerals)

(Erdélyi et al., 2023)

3. Exercise and Physical Rehabilitation

Physical activity is crucial for preserving musculoskeletal health during perimenopause. Exercise stimulates bone formation, reduces stiffness, and alleviates mood disorders.

Recommended Modalities:

  • Weight-bearing exercises: Walking, resistance bands, light weights
  • Tai Chi & Yoga: Improve balance, reduce fall risk, enhance joint mobility
  • Pilates: Core stabilization and postural alignment
  • Chiropractic care and physical therapy: Address joint dysfunction and improve mobility

(Li et al., 2023)

4. Mind-Body and Integrative Therapies

Complementary modalities help regulate the nervous system and reduce systemic inflammation.

Effective Options:

  • Acupuncture: Modulates pain receptors and cytokine levels
  • CBT and mindfulness-based stress reduction (MBSR): For anxiety, depression, and sleep
  • Massage therapy: Relieves muscle tension and supports lymphatic flow
  • Gua Sha therapy: Stimulates microcirculation and reduces myofascial restriction

(Zhao et al., 2023)

5. Lifestyle Optimization and Preventive Screening

  • Sleep hygiene: Maintain consistent bedtime, minimize blue light
  • Avoid smoking and alcohol: Both accelerate bone loss
  • DEXA scans: Initiate baseline bone mineral density testing in mid-40s
  • Pelvic floor therapy: For urinary and pelvic musculoskeletal concerns

Final Thoughts: Empowerment Through Education and Prevention

Perimenopause is not just about hot flashes—it’s a full-body transformation that deeply affects the musculoskeletal system. As healthcare professionals, we must recognize and validate the diverse experiences of women in this phase. With the right blend of clinical care, lifestyle interventions, and holistic support, we can offer women not just symptom relief but restored vitality.

By addressing perimenopause through a physical and functional medicine lens, we empower women to take control of their health, stay active, and live pain-free throughout midlife and beyond.

Injury Medical & Functional Wellness Clinic

We associate with certified medical providers who understand the importance of assessing individuals dealing with musculoskeletal issues related to perimenopause. When asking important questions to our associated medical providers, we advise patients to incorporate numerous techniques to reduce pain-like symptoms related to the musculoskeletal system. Dr. Alex Jimenez, D.C., uses this information as an academic service. Disclaimer.

References

Erdélyi, A., Pálfi, E., Tűű, L., Nas, K., Szűcs, Z., Török, M., Jakab, A., & Várbíró, S. (2023). The Importance of Nutrition in Menopause and Perimenopause—A Review. Nutrients, 16(1), 27. https://doi.org/10.3390/nu16010027

Lega, I. C., & Jacobson, M. (2024). Perimenopause. CMAJ, 196(34), E1169. https://doi.org/10.1503/cmaj.240337

Li, J., Guo, J., Wang, X., Zhang, X., Zhang, Y., Bu, M., Yao, X., & She, Y. (2023). Efficacy and safety of tai chi exercise on bone health: An umbrella review. Osteoporos Int, 34(11), 1853-1866. https://doi.org/10.1007/s00198-023-06830-7

Moustakli, E., & Tsonis, O. (2023). Exploring Hormone Therapy Effects on Reproduction and Health in Transgender Individuals. Medicina (Kaunas, Lithuania), 59(12). https://doi.org/10.3390/medicina59122094

Priyanka, H. P., & Nair, R. S. (2020). Neuroimmunomodulation by estrogen in health and disease. AIMS Neurosci, 7(4), 401-417. https://doi.org/10.3934/Neuroscience.2020025

Wright, V. J., Schwartzman, J. D., Itinoche, R., & Wittstein, J. (2024). The musculoskeletal syndrome of menopause. Climacteric, 27(5), 466-472. https://doi.org/10.1080/13697137.2024.2380363

Zhao, F.-Y., Zheng, Z., Fu, Q.-Q., Conduit, R., Xu, H., Wang, H.-R., Huang, Y.-L., Jiang, T., Zhang, W.-J., & Kennedy, G. A. (2023). Acupuncture for comorbid depression and insomnia in perimenopause: A feasibility patient-assessor-blinded, randomized, and sham-controlled clinical trial. Frontiers in Public Health, 11. https://doi.org/10.3389/fpubh.2023.1120567

Disclaimer

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

Muscles Retighten: Why Ongoing Care Is Essential

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

Muscles Retighten

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

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

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

Causes

Causes for muscles to retighten.

Underlying Issues

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

Delayed Onset Muscle Soreness (DOMS)

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

Delayed Inflammatory Response

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

Muscle Memory

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

Muscle Guarding

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

Muscle Health Maintenance

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

Individual Variation

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

Massage Treatment

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

Type of Massage

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

Muscle Fiber Manipulation

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

Dehydration

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

Lactic Acid Buildup

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

Muscle Tensions

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

Injury Medical Chiropractic and Functional Medicine Clinic

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

Secrets of Optimal Wellness

References

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

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

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

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

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

Pace Running: How to Work with Pacers

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

Pace Running

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

What is a Pace Runner?

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

Race Pacer

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

Distance Pacer

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

Record Pacer or Rabbit

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

How Are Pacers Used?

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

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

How Do They Help?

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

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

Benefits

Benefits of running with a pacer.

Prevent Running Too Fast

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

Maintain an Even Pace

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

Focus on the Race

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

Motivating

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

Disadvantages

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

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

Becoming a Pacer

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

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

Injury Medical Chiropractic & Functional Medicine Clinic

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

The Difference of Using Custom Foot Orthotics

References

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

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

Center of Gravity Explained: A Comprehensive Guide

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

Center of Gravity

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

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

Key aspects of the COG

Location

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

Shifting COG

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

Balance Impact 

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

Variations

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

Biomechanics

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

The Human Center

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

  • Arms up/down
  • Leaning
  • Turning

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

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

Chronic Lower Back Pain

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

Injury Medical Chiropractic and Functional Medicine Clinic

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

Enhance Your Lifestyle Today with Chiropractic Care

References

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

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

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

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

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