Conditions Treated: Chronic Pain, Auto Accident Care, Back Pain, Low Back Pain, Back Injuries, Sciatica, Neck Pain, Work Injuries, Personal Injuries, Sports Injuries, Migraine Headaches, Scoliosis, Complex Herniated Discs, Fibromyalgia, Wellness & Nutrition, Stress Management, and Complex Injuries.
As El Paso’s Chiropractic Rehabilitation Clinic & Integrated Medicine Center, we are focused in treating patients after debilitating injuries and chronic pain syndromes. We focus on improving your ability through flexibility, mobility and agility programs tailored for all age groups and disabilities.
If Dr. Alex Jimenez feels you need other treatment, then you will be referred to a clinic or Physician that is best suited for you.Dr. Jimenez has teamed with the top surgeons, clinical specialist, medical researchers and premiere rehabilitation providers to bring El Paso the top clinical treatments to our community.Providing the top non-invasive protocols is our priority.The clinical insight is what our patients demand in order to give them the appropriate care required. For Answers to any questions you may have please call Dr. Jimenez at 915-850-0900
All can help relax muscles, relieve pain and increase mobility.
Proven Reduced Back Pain with *FOOT ORTHOTICS* | El Paso, Tx
Kent S. Greenawalt, President, and CEO of Foot Levelers discuss how custom foot orthotics can help reduce back pain, low back pain, and sciatica.
In a recent research study published by the American Congress of Rehabilitation Medicine (ACRM), researchers demonstrated that Foot Levelers custom foot orthotics help considerably reduce back pain and several of its associated health issues.
The research study also demonstrated that Foot Levelers custom foot orthotics and chiropractic care help tremendously reduce low back pain and sciatica.
Foot Levelers custom foot orthotics and chiropractic care helped improve the patient’s overall health and wellness.
Dr. Alex Jimenez is a chiropractor in El Paso, TX. can help provide these benefits through the utilization of chiropractic care and Foot Levelers custom foot orthotics, among other treatments.
Pain in the upper and/or mid-back is not as common as lower back or neck pain. The upper back is called the thoracic spinal column, and it is the most secure part of the spine. The reach of movement in the upper back is limited because of the backbone’s attachments to the ribs (rib cage).
Upper back pain is generally caused by soft tissue injuries, like sprains or strains, muscle tension caused by bad posture, or looking downward for long time spans (eg, texting, mobile phone use).
A doctor will rule out these causes to make a proper diagnosis.
A doctor utilizes medical history and physical exam to diagnose coccydynia.
Imaging scans are usually not necessary, but a doctor may order:
Computed tomography (CT) scan
Magnetic resonance imaging (MRI) scan
If they believe a separate:
Problem to be the cause of tailbone pain.
Medical history is important, a doctor wants to know if a
Might have caused the pain.
A physical exam is next in line along with symptoms.
The pain is usually localized in the tailbone, making it straightforward to diagnose.
A doctor will want to know if the pain strikes when sitting or leaning back and which is worse.
A doctor might ask the patient to point to where they’re feeling the pain.
Pointing could be enough for the doctor to tell if the pain is coccydynia when compared to other low back pain conditions.
The doctor will want to palpate the tailbone area for signs of inflammation.
Conservative treatment is extremely effective for coccydynia.
Ninety percent of people experience pain reduction using non-surgical means or any medical intervention.
It is first treated with noninvasive methods:
Ice or heating pad can help provide immediate, short-term relief.
Donut/Wedge cushion provides extra padding taking the pressure off the coccyx when sitting. These cushions are available at pharmacies.
Avoid sitting for long times, like a long flight will help prevent additional pain and injury.
Rest is very important to help avoid further injury during recovery.
If there is still pain after these therapies, a doctor may recommend over-the-counter or prescription-strength non-steroidal anti-inflammatory drugs (NSAIDs) or other pain medications.
If the medication doesn’t work then a doctor may try cortisone injection or local spine blocker to send strong medicine directly to the tailbone area.
If none of the conservative treatments work then surgery could be the next step.
The procedure is called a coccygectomy, which means the removal of the tailbone.
A surgeon will discuss the procedure in great detail before it is performed.
These risks include:
Hematoma (abnormal collection of blood outside an artery or vein)
Perineal hernia (weakened pelvic muscles)
A small portion of people can develop chronic coccydynia, which means the pain lasts for more than 2 months.
Chronic coccydynia can take a major toll on the quality of life. Talk to a doctor if symptoms are not resolving.
They may refer you to a doctor that specializes in coccydynia management.
Protecting the Tailbone
There is no exact way or method to prevent coccydynia,
However, reducing the risk of tailbone pain can be achieved by using caution when participating in sports like:
Skating – Ice, Inline, and Roller
And take extra care when walking on icy/slippery/hazardous conditions so nobody falls.
El Paso, TX Severe Back Pain Chiropractic Treatment
Gale Grijalva suffered from acute back pain because of an automobile incident injury. Where it was once very tough to do her routine daily tasks, Gale Grijalva is now able to take part in physical activities she was not able to engage in earlier thanks to Dr. Alex Jimenez, a chiropractor in El Paso, TX. Gale Grijalva clarifies how patient Dr. Jimenez is and she discusses how completely he’s been able to help her, such as answering any concerns she might have.
Severe chronic back pain is a serious, recurring condition that affects an individual’s everyday life. Back pain lasting over three weeks is deemed chronic. The backbone is an essential component of the body. Severe chronic back pain might be the backbone’s way of telling the body that there’s a problem. The spine consists of bony vertebrae, soft spinal discs, facet joints, tendons, ligaments, and tendons. Within the bony vertebral artery lies that the spinal cord, the delicate but effective nerve pathway of the central nervous system.
Before you run screaming in horror to the medicine cabinet, one of the best reasons to participate in chiropractic treatment is that it helps reduce the chance of a recurrence. By working on the total body and getting it in the best shape possible, the patient is stronger and more balanced to handle their workload and other strenuous activities. Chiropractors also impart advice on how to minimize the chances of re-aggravating the lower back.
Millions of people suffer from back pain each year, and some never visit a chiropractor. Those who do choose chiropractic treatment are privy to treatment that reduces their pain, increases healing, shortens their downtime and lessens their chances of a recurrence. If over the counter medication and ice packs haven’t worked within a few days, it’s time to make an appointment for a consultation with a licensed chiropractor. You will be happy you did.
Myofascial syndrome, what is it? You’re probably thinking I don’t have that, but more than likely, you have.
Myo means muscle and fascia refer to the tissue bands that cover and connect the muscles/organs.
In the neck/back, then myofascial pain syndrome could be the cause.
Myofascial syndrome is a very common condition. It affects about 44 million people in the United States.
Trigger Points The Areas Where Pain Can Develop
Myofascial pain is associated with trigger points. These are areas that can become tender and stiff inside muscle tissue that reduce the range of motion.
Myofascial pain syndrome can happen when you have several active trigger points.
Trigger points are often referred to as knots because they feel tight and balled up compared to the softer relaxed surrounding muscle/s.
If the muscle becomes tight, it can cut off its blood supply, that can trigger:
Trigger points can form all over the body which includes:
Common characteristics of trigger points are that they cause pain that travels or spreads to the surrounding area. For example, shoulder pain can radiate across the upper back.
The muscles can also twitch when touched.
Pretty much everyone has trigger points, but not all triggers cause symptoms.
Dormant or latent trigger points can reduce the range of motion but only cause pain when directly palpated or compressed,
Active trigger points are painful any time, even when at rest.
Lifestyle factors like:
Can make a dormant trigger point become active.
Trigger Point Causes in the Spine
Spinal injury or trauma can result in myofascial pain syndrome, but lifestyle factors usually have a hand in the condition.
Poor posture over a long period, for example, sleeping in an awkward position can cause physical muscular stress on the spinal muscles.
Mental and emotional stress can present itself through muscle tension that helps the development of trigger points.
The trapezius muscle, that extends from the back of the neck down the shoulders and upper back, is the most common site of spinal trigger points and myofascial pain because of the significant amount of pressure that the muscle has to bear and its susceptibility to whiplash.
The Difference Myofascial Syndrome and Fibromyalgia
Because myofascial syndrome is linked to triggering points, fibromyalgia and its tender points bring out a comparison of the two.
Myofascial pain syndrome and fibromyalgia are two distinct conditions, and the table below outlines the primary differences.
Because they are unique conditions, there is a possibility to develop both conditions.
Doctor(s) can help craft a treatment approach that addresses the pain of both trigger points and tender points.
Diagnosis can be difficult
Myofascial pain syndrome is common but can be difficult to diagnose.
The challengingreasons behind diagnosing include:
Scientists are not sure how these trigger points cause pain.
The condition is often confused for other spinal disorders and conditions.
An example is having low back pain caused by myofascial syndrome in the lumbar spine. But low back pain brought on by arthritis can cause similar pain. That’s when the cause needs to be carefully and properly assessed.
There is no standard test for myofascial pain syndrome diagnosis yet.
There’s no standard diagnosing protocol but manual palpation or use of the hands to feel for:
Tightness around the area
Is the most common way doctors diagnose the condition.
Some doctors might only utilize manual palpation but ultrasound is emerging as a diagnostic tool for myofascial pain syndrome.
Ultrasound produces clean images of the soft tissues and shows the active trigger points.
However, more research is needed to secure its place as a diagnostic method and tool.
A personal or primary care doctor can diagnose myofascial syndrome, but they may refer you to a pain specialist or a spine specialist like:
Many people who have trigger points or myofascial pain syndrome in their spine have knots and tightness throughout their back and neck.
To prevent myofascial pain syndrome one needs to practice a healthy lifestyle that promotes good spine health.
Stretching and exercising regularly can help keep stress under control and prevent tension from building up, which makes it harder for trigger points to activate and cause pain.
El Paso Chiropractic Back Pain Therapy
Andres “Andy” Martinez first came to see Dr. Alex Jimenez in Push Fitness after undergoing back pain and knee issues. Following a period of physical therapy and rehabilitation, Andy became engaged in Crossfit, where he learned everything he needed to know about health and wellness from the coaches at Push. Andres Martinez expresses how grateful he is to receive the amount of care he does against the staff and he clarifies how much his perspective of fitness has shifted from the first time he walked into Push Fitness. Andy has seen a family at Push who led him to a healthy, clean life and both the trainers and staff mean everything to Andres Martinez.
The knots you have probably felt in your muscles or had others identify are also known as trigger points. These tight spots are often sensitive to the touch and can be found in any muscle in your body. As they develop, they may produce symptoms like numbness, burning, weakness, pain, and tingling. Trigger points are caused by trauma to the body, such as an accident in a car or during athletics. They can also be caused by more mild, long-term trauma, such as working at a desk without proper ergonomics or making a repetitive motion over a long period of time. Chiropractors are not only good at finding trigger points, but they are also good at treating them.
The human nervous system is made up of two parts: the central nervous system, which includes the brain and the spinal cord, and the peripheral nervous system, which includes the connection nerves running from the brain and the spinal cord to the rest of the human body, including the hands and the feet.
Many patients with neuropathy may experience a variety of painful symptoms due to nerve damage or injury. But, with the proper treatment approach, neuropathy can be effectively treated and even reversed. Diagnosis of neuropathy is fundamental towards proper treatment. Dr. Alex Jimenez, a chiropractor in El Paso, TX, can help patients with neuropathy.
Peripheral Neuropathy Causes & Symptoms | El Paso, TX (2019)
Neuropathy is a medical term used to describe a collection of general diseases or malfunctions which affect the nerves. The causes of neuropathy, or nerve damage, can vary greatly among each individual and these may be caused by a number of different diseases, injuries, infections, and even vitamin deficiency states. However, neuropathy can most commonly affect the nerves that control the motor and sensory nerves. Because the human body is composed of many different kinds of nerves which perform different functions, nerve damage is classified into several types.
Neuropathy can also be classified according to the location of the nerves being affected and according to the disease-causing it. For instance, neuropathy caused by diabetes is called diabetic neuropathy. Furthermore, depending on which nerves are affected will depend on the symptoms that will manifest as a result. Below we will discuss several specific types of neuropathies clinically treated by chiropractors, physical therapists and physical medicine doctors alike, as well as briefly describing their causes and their symptoms.
Peripheral neuropathy, which is often simply referred to as “neuropathy,” is a state that happens when your nerves become damaged or injured, oftentimes simply disrupted. It’s estimated that neuropathy affects roughly 2.4 percent of the general populace and approximately 8 percent of people older than age 55. However, this quote doesn’t include people affected by neuropathy caused by physical trauma to the nerves.
Neuropathy can affect any of the three types of peripheral nerves:
Sensory nerves, which transmit messages from the sensory organs, eyes, nose to the brain
Motor nerves, which track the conscious movement of the muscles
Autonomic nerves, which regulate the involuntary functions of the body
Sometimes, neuropathy will only impact one nerve. This is medically referred to as mononeuropathy and instances of it include:
Ulnar neuropathy, which affects the elbow
Radial neuropathy, which affects the arms
Peroneal neuropathy, which affects the knees
Femoral neuropathy, which affects the thighs
Cervical neuropathy, which affects the neck
Sometimes, two or more isolated nerves in separate regions of the body can become damaged, injured or disrupted, resulting in mono neuritis multiplex neuropathy. Most often, however, multiple peripheral nerves malfunction at the same time, a condition called polyneuropathy. According to the National Institute for Neurological Disorders and Stroke, or the NINDS, there are over 100 kinds of peripheral neuropathies.
Neuropathies are often inherited from birth or they develop later in life. The most frequent inherited neuropathy is the neurological disease Charcot-Marie-Tooth disease, which affects 1 in 2,500 people in the USA. Although healthcare professionals are sometimes not able to pinpoint the exact reason for an acquired neuropathy, medically referred to as idiopathic neuropathy, there are many known causes for them, including systemic diseases, physical trauma, infectious diseases, and autoimmune disorders.
A systemic disease is one which affects the whole body. The most frequent systemic cause behind peripheral neuropathy is diabetes, which can lead to chronically high blood glucose levels that harm nerves.
Other systemic issues can cause neuropathy, including:
Kidney disorders, which permit high levels of nerve-damaging toxic chemicals to flow in the blood
Toxins from exposure to heavy metals, including arsenic, lead, mercury, and thallium
Certain drugs and/or medications, including anti-cancer medications, anticonvulsants, antivirals, and antibiotics
Chemical imbalances because of liver ailments
Hormonal diseases, including hyperthyroidism, which disturbs metabolic processes, potentially inducing cells and body parts to exert pressure on the nerves
Deficiencies in vitamins, such as E, B1 (thiamine), B6 (pyridoxine), B12, and niacin, that can be vital for healthy nerves
Alcohol abuse, which induces vitamin deficiencies and might also directly harm nerves
Cancers and tumors that exert damaging pressure on nerve fibers and pathways
Chronic inflammation, which can damage protective tissues around nerves, which makes them more vulnerable to compression or vulnerable to getting inflamed and swollen
Blood diseases and blood vessel damage, which may damage or injure nerve tissue by decreasing the available oxygen supply
Signs and Symptoms of Neuropathy
Depending on the reason and unique to each patient, signs, and symptoms of neuropathy can include:
Increased sensitivity to touch
Temporary or permanent numbness;
Dysfunction in glands or organs
Impairment in urination and
Such signs and symptoms are dependent on whether autonomic, sensory, or motor nerves, as well as a combination of them, are ultimately affected. Autonomic nerve damage can influence physiological functions like blood pressure or create gastrointestinal problems and issues. Damage or dysfunction in the sensory nerves may impact sensations and sense of equilibrium or balance, while harm to motor nerves may affect movement and reflexes. When both sensory and motor nerves are involved, the condition is known as sensorimotor polyneuropathy.
Peripheral neuropathy may result in several complications, as a result of disease or its symptoms. Numbness from the ailment can allow you to be less vulnerable to temperatures and pain, making you more likely to suffer from burns and serious wounds. The lack of sensations in the feet, for instance, can make you more prone to developing infections from minor traumatic accidents, particularly for diabetics, who heal more slowly than other people, including foot ulcers and gangrene.
Furthermore, muscle atrophy may cause you to develop particular physical disfigurements, such as pes cavus, a condition marked by an abnormally high foot arch, and claw-like deformities in the feet and palms.
We are blessed to present to you El Paso’s Premier Wellness & Injury Care Clinic.
Neuropathy can be caused by a variety of injuries and/or aggravated conditions, often manifesting into a plethora of associated signs and symptoms. While every type of neuropathy, such as diabetic neuropathy or autoimmune disease-associated neuropathy, develops its own unique group of signs and symptoms, many patients will often report common complaints. Individuals with neuropathy generally describe their pain as stabbing, burning or tingling in character.
If you experience unusual or abnormal tingling or burning sensations, weakness and/or pain in your hands and feet, it’s essential to seek immediate medical attention in order to receive a proper diagnosis of the cause of your specific signs and symptoms. Early diagnosis may help prevent further nerve injury. Visit http://www.neuropathycure.org for more details.
The first goal of treatment is to improve alignment and restore symmetry.
This can be accomplished with:
Spinal adjustments focus on providing better spinal column alignment
Exercises to help the affected muscles
Proper orthotics with a pronation wedge under the heel for long-term correction
Sometimes LLI causes a profound gait (walk) disfunction, which means physical therapy might be necessary.
Keep your bones and tissues strong and healthy with exercise and diet can help.
Avoid tobacco and excessive alcohol use, which weaken bones and can cause problems with the blood supply in the legs.
Reduce your risk of injury by adhering to safety measures (like wearing a seatbelt).
Custom orthotics provide support, stability, and shock absorption.
The body’s foundation can be made level with custom orthotics, but it does take some time to adjust to proper and healthier alignment/posture.
Talk to your doctor or chiropractor to learn more.
Scoliotic deviations of the lumbar spine
Increased risk of injury, especially in athletes
Chiropractic care does wonders for helping individuals regain their spinal alignment and loosen the joints and muscles affected by leg length inequality, and the orthotic heel lifts balance out the legs, which balances the hips and pelvis.
Reduce *PLANTAR FASCIITIS PAIN* with Custom Foot Orthotics | El Paso, TX (2019)
Foot problems can affect the overall well-being of the human body. Many health issues which affect the foot can result in poor posture, low back pain, and sciatica. These imbalances can ultimately result in a variety of other health issues. Custom-made foot orthotics can help promote and support overall well-being by relieving foot problems. The following video discusses how many health issues which affect the foot can cause a variety of foot problems, including poor posture, low back pain, and sciatica. Dr. Alex Jimenez is the non-surgical choice for foot problems and other health issues. Dr. Alex Jimenez can help promote and support overall well-being with the use of custom-made foot orthotics and other treatments approaches.
According to the American Chiropractic Association, a study found 75% of subjects who suffered from lower back pain had legs that were slightly different lengths (5 millimeters or more). This condition is called Short Leg Syndrome and causes a variety of issues for its sufferers. The symptoms can be quite severe, depending on the degree of difference in the leg length.
The premise of this condition is that the leg length inequality disrupts the body’s entire balance, possibly resulting in issues in the knees, hips, and back. The spinal system is designed to bear weight evenly, and, when one leg is shorter than the other, this places additional weight and stress on one side. According to The Back Pain Authority, common causes of Short Leg Syndrome are a past history of fractures, hip or knee issues, or the individual was simply born that way.
Kyphosis is a condition that is most typically identified by a humped mid to upper back. It can be frustrating to find yourself diagnosed with kyphosis, both due to the unusual appearance it causes and the physical discomfort that can come with the condition. Fortunately, chiropractic offers a variety of treatment options for kyphosis that are non-invasive, drug-free and quite effective. With the right approach, it should be possible to get significant relief for your symptoms through chiropractic care.
Many times kyphosis is caused by poor posture. Years of hunching your back can cause the body to change the way the vertebrae sit atop one another—leading to stretching of soft tissues and a resting position that is hunched instead of upright.
Not all cases of kyphosis are the result of poor posture, however. There are some people who are born with kyphosis. There are also those that develop kyphosis following trauma or due to disease. One of the most common diseases that result in kyphosis is Scheuermann’s disease.
Chiropractic can often help resolve kyphosis that is caused by poor posture. If your kyphosis is due to trauma or other issues, chiropractic can still provide a much-needed relief from many of your symptoms—including pain and stiffness.
How Chiropractic Helps With Kyphosis
HEALTHCARE AND MEDICAL CONCEPT: KYPHOSIS
Diagnosing the Cause
Your first visit to the chiropractor will begin with a comprehensive examination to determine the cause of your condition. An accurate diagnosis is key to developing an effective treatment plan. The examination will most likely include imaging tests like an x-ray or MRI. It may also include a physical examination to figure out how your body currently moves, where you are tender and/or in pain, etc.
Your chiropractor will never move forward with treatment until he or she has explained your options and gotten your permission to begin. The treatment plan you are offered may include:
The joint in the human body, particularly the spinal joints, have an ideal alignment where everything fits together best. The more you can achieve and maintain this alignment, the less pain, stiffness and other disruptions you can expect to experience. Chiropractic adjustments aim to bring your body back into alignment.
Regular adjustments should help to improve your spinal alignment and straighten your back. In the case of poor posture, adjustments can aid you in learning how to improve your posture and keep those improvements over the long term.
The curving of the back typical of kyphosis can lead to a lot of stiffness in the spine and surrounding soft tissues. Lack of mobility makes everything you do more difficult, so it makes sense to try and increase your mobility when possible.
Chiropractic adjustments and complementary therapies are ideal for relaxing the soft tissues that may have become stiff as the kyphosis developed. One of the great things about improving the mobility of the spine is that it allows you to improve your posture. Over time, it should become easier to keep your back in a more healthy alignment.
Pain is common with kyphosis. The spine is not meant to hump as it does with kyphosis, which explains why pain is so typical with the condition. Chiropractic is very useful for decreasing pain related to spinal issues. Many patients get relief immediately following their first adjustment.
Schedule an Appointment With Us Today
If you are suffering from kyphosis, please contact us to schedule an appointment. Our chiropractic team is standing by to answer your questions and help you get treatment for your condition.
What is a Pronated Foot & What Can Custom Orthotics Do?
When a foot is pronated, it means its arches have fallen and the foot is flat. Flat feet do not absorb shock as well and make for a less stable base for—the bones, muscles, ligaments, and tendons. They can also:
Shift the body’s alignment out of order
Cause aches and pains in the feet, knees, hips, neck and/or spine
Lead to injury and problems like shin splints, Achilles tendinitis, and plantar fasciitis
Up to a third of people suffer from flat feet
The connective tissue, called the plantar fascia, on the underside of the foot is what maintains the foot’s healthy arch shape. Injury and health conditions can cause the fascia to stretch out and flatten. But so can everyday walking and standing. Once the fascia stretches out, it is unable to spring back. When the foot structure becomes flattened, the body’s foundation is prone to injury and health conditions.
Chiropractic adjusting to ensure proper positioning of bones and joints
Custom orthotics in every pair of shoes for pronation control, support, and comfort
Get Rid of *Foot Pronation* with *FOOT ORTHOTICS* | El Paso, Tx (2019)
Pronation describes the way that the foot rolls inward during its normal motion. The foot turns inward, flattening out, as the heel’s outer edge strikes the ground. For the foot to function correctly, there must be a significant degree of pronation. However, excessive pronation, or overpronation, can cause injury and damage to the foot and ankle. It creates the arch in the foot to flatten, and the ligaments, tendons, and muscles under the foot overstretch. For instance, overpronation of the foot causes a series of internal changes that extend up through the leg. The femur may rotate causing hip pain and inflammation of the sacroiliac joint which leads to back pain. Other misalignments in the body that are caused by foot problems can also lead to chronic lower back pain as well.
Sometimes there are abnormalities of the spine and it causes a misalignment of the natural curvatures or some curvatures may be exaggerated. These unnatural curvatures of the spine are characterized by three health conditions called lordosis, kyphosis, and scoliosis. They gently curve, sloping slightly inward at the small of the back, and again slightly at the neck. The pull of gravity, combined with body movement, can put a great deal of stress on the spine and these slight curves help absorb some of the impact. Spinal manipulations for spinal curvature disorders have been shown to be very effective. Chiropractic helps restore the spine’s natural balance even if the patient has one of these types of conditions.
When you struggle with anxiety, it can make living your day-to-day life more difficult. Anxiety comes in a variety of forms and varies by individual. The treatments that are most effective for one person may not be as effective for another, but there is some general guideline for dealing with anxiety that most sufferers can benefit from. Regular chiropractic care, including a focus on improving overall health, can serve as a foundation for navigating the difficulties of anxiety.
Ways Chiropractic Can Help
1. Keeping track of triggers.
Chiropractors are big fans of keeping diaries surrounding any type of health issue you are dealing with—and anxiety is no exception. Just like keeping a food diary can help you identify a food allergy, keeping an anxiety diary can help you see what things in your life are triggering your anxiety. Triggers for anxiety can include a wide range of things, not all of them related to human interactions. Some of these triggers can include:
Allergies to certain foods
Consumption of alcohol
Consumption of caffeine
Vitamin deficiencies, particularly B vitamins, calcium, and magnesium
Consumption of sugar
Your chiropractor can tell you how to keep a diary that will help you see what you do in your day-to-day life, and how those actions relate to your anxiety.
2. Keeping your body in Top Form.
The relationship between the body and the mind is still far from being fully understood. However, there is no denying the significant connection between our physical health and our mental health. When your body is healthier, your mood is more level and positive.
Chiropractic care is focused on treatments that improve your health. These can include chiropractic adjustments, massage therapy, spinal decompression, ultrasound and more. Which treatments are right for you will depend on the results of your physical examination with the chiropractor. What you can be sure of is that your chiropractor will do everything possible to ensure your body is healthy and functioning at an optimal level.
3. Maintaining Spinal Alignment.
There are many ways that the nervous system affects the body and the brain—and the full effects are not totally clear as of yet. What we do know is that many chiropractic patients report improvements in their health seemingly unrelated to the pain in their back or neck. A few adjustments into a treatment plan and patients discover that some other health issue gets resolved.
Adjustments are designed to put your vertebrae back into proper alignment. With proper alignment, your nervous system can function optimally. The results may or may not improve your anxiety directly, but they will make you feel better and keep your body running the way it was intended to.
4. Improving Your Diet.
What you eat plays a huge role in your overall health. Improving your diet could lead to an improvement in your anxiety symptoms, which is why your chiropractor will try to help you make healthy changes to what you eat. Chiropractors are trained in the latest research in nutrition and are well-versed in the benefits of various approaches to a healthy diet. You can work with your chiropractor to shift your diet from its current state to one that includes more healthy options.
Other Healthcare Providers & Your Chiropractor
If you are seeing a mental healthcare professional for your anxiety, your chiropractor will strive to work with your provider to ensure the best possible outcomes. Sometimes the best way to improve your health is to take a multi-pronged approach—which your chiropractor can help you with!
Please contact us today to schedule an appointment with our chiropractic team. We look forward to seeing you.
Depression & Chronic pain | El Paso, Tx
Chronic pain caused by accidents and/or aggravated conditions can often be one of the primary reasons for depression in patients. When painful symptoms induce patients to struggle with their everyday physical activities, their mental health can be tremendously influenced. Chiropractic care utilizes spinal adjustments and manual manipulations which could help restore the initial integrity of the backbone. Patients describe how chiropractic care has helped them recover their well-being and they highly recommend Dr. Alex Jimenez, doctor of chiropractic, as the non-surgical choice for chronic pain and depression, one of a variety of other common health issues.
Gait Related Low Back Pain
Currently, more than 2 million Americans are dependent on opioids. For many, their addiction comes from seeking pain management for an injury or chronic condition. Opioids are a convenient and fast remedy, but only provide pain relief and not actual treatment of the cause. Therefore, opioids should be a last resort when experiencing pain and discomfort. Starting at the foundation (feet) of the body with orthotics can help the rest of the body stay aligned.
If you are suffering from depression or anxiety, you may feel hopeless and helpless. You may be less apt to seek or follow treatment, believing there is nothing you can do to make it better. When you have a chronic medical condition, it doesn’t just impact your health. Often you can’t work or miss time at work, you may have financial problems. Relationships frequently suffer when one partner is sick. While these can be true for all chronic conditions, when you add in depression or anxiety, coping is even more difficult.
Osteoarthritis is often called “wear and tear” arthritis. It results from the natural—and sometimes excessive—use of your body. While you cannot do anything to completely prevent wear and tear on your spine, knees, hips, ankles and other joints, you can help to slow the process through regular chiropractic care. You can also get some significant relief from the pain and stiffness that comes from osteoarthritis by getting your back and other joints adjusted.
Osteoarthritis is a condition that responds quite well to chiropractic. If you are currently suffering from osteoarthritis, or know someone who is, please consider chiropractic to relieve pain and improve mobility.
What is Osteoarthritis?
The term “arthritis” refers to the inflammation of a joint. There are actually several hundred types of arthritis. Osteoarthritis—the most common type of arthritis—is a degenerative joint disease that many, many people are affected by, especially older adults. It is one of the main conditions that lead to the ongoing pain and loss of mobility that is so often associated with old age.
Osteoarthritis is so common because wear and tear on the human body are inevitable. Your body wears down as you use it. In your younger years much of this wear is repaired, only to be worn down again, and then repaired again. But when you get older, your body slows down on the repairs. Cartilage starts to disappear as we get older as well. When the cartilage no longer protects your bones from one another, bone rubs on bone, inflammation occurs, spurs often result and pain is inevitable.
Render illustration of Osteoarthritis title on Medical Documents
How Chiropractic Helps
The specialties of chiropractic—reducing inflammation, decreasing pain and increasing joint mobility—are an ideal fit for treating osteoarthritis. All of the symptoms that you experience with osteoarthritis are made better through regular chiropractic adjustments and associated therapies. You also get the added benefit of improving your movement patterns, which can help avoid further damage to your joints.
Some of the benefits of chiropractic for osteoarthritis include:
Inflammation is Reduced
Inflammation is one of the big enemies of your joints. It is your body’s response to a stimulus and can be helpful from time to time—but not hour after hour, day after day, week after week. Ongoing inflammation causes damage that you want to avoid and makes everything more painful.
Chiropractic can help your body reduce inflammation by returning your joints to their proper alignment. Properly aligned joints experience improved circulation, which aids in healing. The joints are less likely to become inflamed as well as long as they are in proper alignment.
Pain is Decreased
Often the pain you experience in your joints is due to pressure being put on nerves. For instance, when your spine is misaligned the vertebrae can press on spinal nerves, leading to extreme discomfort, shooting pains, burning sensations, numbness, tingling, and other symptoms. Some patients are surprised at how much less pain they experience after just a single adjustment. Once the pressure is removed from the nerve pain is reduced significantly.
Joint Mobility is Increased
Stiffness is a well-known problem with osteoarthritis. The stiffness is caused by several factors, including the loss of cartilage in the joint and the lack of movement that results from pain in the joint. The less you move, the harder it becomes to start moving again.
If you are suffering from osteoarthritis, please contact us. Our chiropractic team is ready to get you the relief you deserve.
*REDUCE BODY PAIN* & Imbalance with Custom Foot Orthotics | El Paso, TX (2019)
Foot pronation is a natural movement during standing, walking, or running, however, excessive foot pronation can cause postural imbalances which can result in chronic pain, including low back pain and sciatica. Dr. Alex Jimenez, a chiropractor in El Paso, TX, can help diagnose and treat a variety of health issues associated with foot problems through the utilization of functional custom foot orthotics.
Functional custom foot orthotics are specially designed to accommodate every person’s unique foot anatomy. Excessive foot pronation can ultimately lead to poor posture, which can add unnecessary pressure to the spine and it’s surrounding structures. Dr. Alex Jimenez is the non-surgical choice for foot problems and other health issues through the use of functional custom foot orthotics.
Custom Orthotic Flip-Flops
Experience comfort and support all summer.
The first of their kind, custom orthotic flip flops are designed to offer casual footwear. Regular over-the-counter flip-flops can do serious damage to the feet and to the body.
All orthotics are hand-made flip-flops and come with supports for all 3 arches of the foot. They also include high-quality mid-layer that provides shock absorption on heel-strike and is softer and more comfortable than over-the-counter flip-flops.
If you are considering custom orthotics, a health care professional such as Doctor Jimenez and Injury Medical Chiropractic Clinic can perform a foot scan to show you what imbalances in the feet can lead to. The foot scan will show how the orthotics can help. Following the foot scan, a report will provide the caregiver a Pronation/Stability Index, Foot Assessment, and Body Assessment.
Foot Dysfunction can very easily cause a domino effect that extends all the way to the back. The feet are the foundation of the body and when there is a problem with the way they function it can cause the entire body to shift out of alignment. For instance, overpronation of the foot causes a series of internal changes that extend up through the leg. The femur may rotate causing hip pain and inflammation of the sacroiliac joint which leads to back pain. Other misalignments in the body that are caused by foot problems can also lead to chronic lower back pain as well.
About half of people diagnosed with osteoarthritis (OA) have difficulties falling asleep or staying asleep throughout the night. As a matter of fact, studies show that individuals with hip and knee osteoarthritis have a higher chance of experiencing insomnia as well as daytime fatigue than those without OA. The connection between people with OA and their ability to sleep is indisputable. The arthritis pain, common with the condition, can make getting a good night’s rest challenging for anyone.
If you or someone you love is suffering from Crohn’s disease, you know how unpleasant it can be. A chronic inflammatory bowel disease, Crohn’s can make it difficult to lead a normal life. Even when you are able to work, play and relax the way you want, the disease can still cause painful, uncomfortable symptoms that you certainly can do without.
Fortunately, chiropractic care has been helpful for a number of patients with Crohn’s disease. You may be able to get some much-needed relief for your symptoms through regular chiropractic visits.
The Symptoms of Crohn’s Disease?
In most cases, Crohn’s disease causes parts of the small bowel and colon to become inflamed. The inflammation can result in several symptoms that are nothing you want to experience if you do not have to, including regular diarrhea, malnutrition, weight loss, abdominal pain, and fatigue.
Crohn’s Disease Is Usually Treated How?
It is an unfortunate reality that Crohn’s disease has no current cure. Standard treatments include using prescription medications and sometimes surgery to eliminate symptoms. Of course, these treatments may result in unwanted side effects which can sometimes be equal to or worse than the original symptoms. That is why chiropractors prefer to use treatments that are less invasive, like adjustments and complementary therapies.
Can Chiropractic Help with Crohn’s Disease?
There have been a variety of small studies conducted to determine the effects of chiropractic on Crohn’s disease. The results of these studies have been promising. Many have shown that chiropractic adjustments have helped those with Crohn’s to feel better than they did before the adjustments. They experienced a reduction in their symptoms, with some experiencing a significant reduction.
A young man suffering from severe belly pain, being overwhelmed by the debilitating condition of celiac disease/Crohn’s disease/strong anxiety
Why Choose Chiropractic?
The best thing about using chiropractic to treat Crohn’s symptoms is that it is so gentle and free of side effects. You can try chiropractic at very little risk to yourself or the danger of experiencing an increase in your symptoms. When you consider how likely side effects are from prescription medications—you only have to watch a commercial for pharmaceuticals to see the long list of possible side effects—and the risks of surgery, it is easy to see why so many Crohn’s sufferers look to chiropractic for relief.
What is a Chiropractic Visit like when You Have Crohn’s Disease?
Chiropractors are experienced in treating a wide variety of diseases and conditions. They also know how important it is to make you feel comfortable with your experience—from start to finish.
The first thing the chiropractor will do is conduct a thorough physical examination. He or she will also ask you a number of questions to find out exactly how you feel, and what your thoughts are on your condition.
After the examination the chiropractor will design a treatment plan that may include a variety of treatments:
Chiropractic adjustments. Adjustments focus on helping your spine and body achieve optimal alignment. The chiropractor will only apply enough pressure to achieve the desired result.
Massage therapy. Massage is an excellent complementary therapy that goes hand in hand with chiropractic care. By relaxing your muscles and releasing adhesions, massage can help your adjustments stay in place and lead to improved movement and less pain.
Spinal decompression. Using a specially designed machine, your chiropractor can increase the space between your vertebrae—space that leads to increased blood flow lowers pain levels and often results in faster healing.
Reduce *LOW BACK PAIN* with Foot Orthotics | El Paso, Tx
Approximately 80 percent of the population will experience some type of back pain sometime throughout their lifetime. Low back pain and sciatica are several of the most common complaints frequently reported in a doctor office setting. But, did you know that low back pain and sciatica can be caused due to foot problems?
Custom-made functional foot orthotics can help support and promote the natural alignment of the spine. Poor posture associated with foot problems and other health issues can be corrected through the utilization of custom-made functional foot orthotics. Because every individual has unique foot anatomy, custom-made foot orthotics can be beneficial for a variety of people with foot problems and other health issues. Dr. Alex Jimenez is the non-surgical choice for foot problems.
Experiencing foot pain, there’s no doubt you checked out your foot to make sure it’s not injured or hurting from improper fitting shoes, corns, plantar fasciitis, etc. This may seem counterintuitive, but you may want to check the condition of the lumbar spine (lower back)? Most foot problems are caused by issues with the foot itself, but you might be surprised to find that pressure on the sciatic nerve can cause intense foot pain.
Before taking an opioid for pain control, give Chiropractic care and orthotics a try. The combination of Chiropractic and orthotics have been proven in clinical studies.
Researchers estimate that as many as 36 million people worldwide abuse opioids. Estimates in the U.S. alone reached 2.1 million people in 2012. In 2014, six out of ten drug overdose deaths involved an opioid – including prescription opioids for pain relief. Every day, 78 Americans die from an opioid overdose. As the Opioid drug problem continues to spiral further out of control, claiming more lives, people are looking for safer, drug-free ways to relieve their pain. Chiropractic offers such an option.
Gait Style & Chronic Postural Pain
The way a person walks, their gait, can be very telling. It can reveal problems in the feet, ankles, knees, and hips – even in spinal alignment. A problem with gait can indicate pain in a patient as well as serious conditions like diabetes and arthritis. It, is a diagnostic tool for many conditions, injuries, and syndromes including autism.
When it comes to chiropractic care, a patient’s gait can offer critical clues regarding the root of their complaints, allowing for a more well-rounded, whole-body approach to treatment. If you think that the way you walk or moves doesn’t matter, think again. It most certainly does matter.
Most people don’t think of chiropractic to treat conditions that do not involve the spine, but study after study shows it is effective in treating a wide variety of health issues. Ulcerative colitis seems to have no real connection with the spine, yet patients and researches alike are touting the effectiveness of chiropractic care to treat the condition. This is due, in part to chiropractic’s approach to whole-body wellness, but spinal alignments are incorporated into the care as well. Bottom line, chiropractic care is extremely effective in treating uncreative colitis, and many patients are finding relief from their symptoms and discomfort.
Chiropractic care focuses not only on the skeletal system and joints but also on the treatment of muscle pain. The muscles are interwoven with fascia, a type of tissue that allows muscles to glide smoothly over one another. Both muscles and fascia can develop painful adhesions, often recognized by their hard or knot like texture under the skin.
Muscle pain can be quite uncomfortable and even debilitating in certain cases. When you are suffering from muscle pain, your chiropractor can provide some much-needed relief using a variety of effective treatment options.
What is it?
The word “myofascial” is a mouthful, but there is a reason it is used by chiropractors. The first part of the word, “myo”, generally refers to your muscles. The second part of the word, “fascia”, refers to the connective tissue that is found all throughout your body. Myofascial pain syndrome is used to indicate muscle pain in its various forms. This may include issues with your fascia, muscle tissue, or both.
Myofascial pain can vary considerably, ranging from mild and frustrating to completely debilitating. Fortunately, whatever the intensity of the discomfort, chiropractic treatment can provide a solution that lessens and often eliminates the pain.
The knots you have probably felt in your muscles or had others identify are also known as trigger points. These tight spots are often sensitive to the touch and can be found in any muscle in your body. As they develop, they may produce symptoms like numbness, burning, weakness, pain, and tingling.
Trigger points are caused by trauma to the body, such as an accident in a car or during athletics. They can also be caused by more mild, long-term trauma, such as working at a desk without proper ergonomics or making a repetitive motion over a long period of time.
Trigger points are challenging to identify sometimes because they occur at different spots in different people. They also produce something called “referred pain”, a pain that is felt somewhere else besides where the actual trigger point is. Chiropractors are trained to track down trigger points, though, so even if they are somewhat hidden by referred pain, they can be found eventually.
How Chiropractic Helps with Myofascial Pain Syndrome
Chiropractors are not only good at finding trigger points, but they are also good at treating them. They accomplish this using a variety of techniques. Some of the benefits of chiropractic for myofascial pain include:
Adhesion Break Up
Trauma in the muscles can cause adhesions to form. Adhesions are when muscle fibers and/or fascia bond together into a form of scar tissue. The adhesions cause the muscles to catch instead of slide smoothly, which can have a cascading effect on the body. Not only does the adhesion hurt, but it also causes joints to become misaligned and further problems to develop.
Trigger Point Pressure
Sometimes the most effective way to treat a trigger point is to apply pressure to smooth out the muscle and fascia. Chiropractors can do this with their hands or specific tools.
The cause of trigger points and muscle pain is often trauma, but sometimes the trauma is not as obvious as an accident or a trauma directly to the affected area. Misalignment in the spine or the extremities can cause the body to move incorrectly. Over time, the incorrect movement patterns can put extra strain on the muscles. Chiropractic focuses on helping your whole body become aligned, which can ease muscle pain and prevent further issues from developing.
Please contact our office to schedule an appointment with a chiropractor. Let us help alleviate your muscle pain and get you back on your feet again!
The Difference of Using *CHIROPRACTIC ORTHOTICS* | El Paso, Tx
Support for the 3 Arches
The feet are the foundation of the body. They provide the stability to perform activities by supporting the weight of the entire body using the 3-arched bond called the plantar vault.
The plantar vault provides numerous benefits:
Balances the body
Propels us forward
Absorbs heel-strike shock
Walking and running stresses adaptation
The Plantar Vault
The foot is made up of 3 arches. These arches are what keep the body balanced:
Medial longitudinal arch (A–C)
Lateral longitudinal arch (B–C)
Anterior transverse (metatarsal) arch (A–B)
Together, these 3 arches form an extremely strong, supportive “plantar vault” that distributes weight evenly throughout the entire body.
Over time, one or more of the arches will weaken due to pressure and wear and tear. This process is completely natural but injuries, a short leg, improper posture, and naturally weak ligaments and tendons can cause the collapse.
Custom-made orthotics are designed to provide the best possible support for all 3 arches:
Individually crafted from 3D scans to bolster the arches in your feet
Prescribed through Chiropractors to ensure you get the best possible orthotic
Available in a variety of styles and builds to suit your lifestyle and needs
Custom orthotics are designed to provide both the instant “ah” factor that over-the-counter orthotics like to market, and the actual needed support for your arches that will relieve pain now and prevent pain later by compensating for any and all of your weakened arches to correct your posture.
Orthotics For All Occasions
Typically, overpronation and oversupination, are caused by muscle imbalances in the foot, ankle, and lower leg. Improper shoes, misalignment in the body, and other issues can cause these muscle imbalances. The chiropractor will work with the patient to find the cause of the foot problem so that can be corrected, then work to the damage or injury done.
The human body is an intricate machine, and everything is connected so when something goes wrong in one area, it can cause problems in other areas. The back carries a lot of the stress in the body so when there is a problem with the hips, knees, or a foot dysfunction, the spine can bear at least some of the brunt of the pain and other effects.
An ankle sprain is always inconvenient, and often painful. But not all ankle sprains are equal in their severity. When diagnosing an ankle sprain, your doctor or chiropractor will classify the injury in one of three ways—first degree, second degree, and third degree. Knowing what each classification means can help you understand the nature of your injury and how careful you need to be with it. For you and your chiropractor, the classification of the ankle sprain degrees will help to direct the best treatment options.
Ankle Sprain Degrees and What They Mean
A sprain is an injury involving the stretching and/or tearing of your ligaments. With the ankle, it is possible to suffer an injury to either side of the joint, the interior or the exterior. You may have an inversion sprain or an eversion sprain. Whichever type you suffer from, it will fall into one of three categories:
Grades of ankle sprains
A first-degree sprain is one where the ligaments have not torn, only stretched further than normal. Symptoms of a first-degree sprain include discomfort when jumping, jogging or sometimes walking. Pain is usually mild and swelling is minimal. The joint may be a little stiff and slightly less stable than normal.
A second-degree sprain is the most common type of sprain people seek medical care for. The ligament is partially torn, which can lead to several uncomfortable symptoms. The sprain will make walking difficult, be moderately painful and make it hard to use the ankle. The injury will result in noticeable swelling and often bruising.
A third-degree sprain is the most severe and involves a full tear of the ligament. Pain is often severe and swelling is significant. The torn ligament makes the joint unstable, so it is not only painful but also very hard to use.
How Chiropractic Can Help
Whether you are walking, running, jumping or just standing, the ankle plays a vital role in how you move and use your body. That is why it can be so frustrating when you find yourself with an ankle injury. Fortunately, ankle sprains do heal with enough rest and the right treatment.
Your chiropractor can help you recover from an ankle injury, both reducing pain and speeding up recovery time. There is research to support the use of chiropractic for ankle sprains. One study showed that patients with ankle sprains experienced less pain when chiropractic was added to their treatment program. Chiropractic also focuses on improving mobility and range of motion, which can be quite beneficial when trying to recover from a sprain and get back to your normal life.
Some of the most common chiropractic treatments for ankle sprains include:
Adjustments can be made to more than just the spine. The bones, ligaments, and tendons in the ankle are designed to work in a certain way. A sprain can knock the ankle out of alignment, something that most traditional doctors and rehabs do not consider. An ankle adjustment will work to put things back into their proper places.
There are a variety of useful exercises that your chiropractor can take you through to improve strength and mobility in the ankle. Things like a wobble board, where you stabilize yourself on a wobbly platform and drawing on a board with a market held in your toes can be surprisingly effective at strengthening your ankle.
Call Us Today
Please contact us today to schedule an appointment with a chiropractor for your sprained ankle. Let us help you get stronger and heal faster!
A winged scapula is a debilitating condition left untreated. The condition is often spotted by the protrusion or the sticking out of the scapula from the back. Fortunately, chiropractic treatment can fix the condition. This and associated therapies can help you get relief from your symptoms, and to strengthen your shoulders to avoid further discomfort.
The symptoms of a winged scapula can include:
Protrusion of the shoulder blade from the back
Pain when sitting from pressure on the scapula
Difficulty moving the shoulder and arm
Weakness in the shoulder and arm
Sometimes the symptoms of a winged scapula are relatively minor in the beginning. You may only have a little discomfort at the start. But symptoms tend to get worse over time, so it is important for you to seek treatment sooner rather than later.
The damage to the thoracic nerve can cause muscles in the shoulder to become paralyzed, leading to winged scapula symptoms. Many times the appearance of a winged scapula indicated other problems in the back and shoulder.
Poor posture can also lead to a winged scapula. Years of poor posture can weaken the muscles that hold the shoulder in place to the point where a winged scapula is more likely to occur.
Chiropractic Care Can Help
I.D. The Cause
Because this condition can be caused by several different issues, it is important to determine the exact cause before beginning treatment. A chiropractor is well-qualified to give you a full body examination to locate the source of your injury.
Realigning The Thoracic Nerve
Chiropractors are skilled at aligning the human body, including the thoracic nerve. We can locate the point where misalignment of the nerve has occurred and often correct it.
Strengthening The Shoulders
As a winged scapula is often the result of weakened shoulder muscles, the most effective treatment is usually to strengthen the muscles. Our team can guide you in rehab exercises to return your muscle strength and support your shoulder. We can also help you learn how to activate the right muscles in the right manner to operate your shoulder properly.
The symptoms of a winged scapula can come on slowly, which makes many sufferers feel like they should try fixing the issue themselves before seeking medical care. Unfortunately, trying to heal a winged scapula on your own is not likely to be effective.
In fact, you will need some sort of assistance to even apply ice to the area, You will also need help to identify exactly what is wrong and to treat it. Seeking qualified care is recommended.
Helping You Heal
A winged scapula can be quite painful. You should not have to suffer from should pain and back pain. We encourage you to contact us to schedule an appointment and get the treatment you deserve. We are happy to help you with all your chiropractic needs.
Osteopenia and osteoporosis, two very similar conditions, that are defined as decreased bone density, but osteopenia is far less. However, it is still a problem due to an increase of breaking a bone because of bone fragility.
Osteopenia usually doesn’t cause symptoms unless a bone is broken. However, some patients who present with osteopenia complain of dull back pain.
Symptoms associated with osteoporosis include the following:
Back pain, caused by a fractured or collapsed vertebra
Loss of height over time
A stooped posture
A bone fracture that occurs much more easily than expected
The causes and those at risk?
Women (primarily small-boned Caucasian and Asian) are most at risk for both conditions, primarily those who are age 65 or older as well as women who are postmenopausal. However, men can also be affected.
Anyone who meets any of the criteria for being at risk for either of the bone conditions should be evaluated. Often, catching the conditions early can make a significant difference in the effects that they have on the body and in some cases, can even be arrested so that they don’t progress.
Some of the common causes of both conditions include:
Excessive alcohol consumption
Vitamin D deficiency
Bulimia, anorexia, and other eating disorders
Estrogen deficiency in women
Certain hormone imbalances
Certain treatments including radiation and chemotherapy
Low testosterone in men
Medications including anti-seizure, hydrocortisone, and steroids
It should also be noted that certain types of diets, particularly those that advocate extremely low fat, or no fat can also cause problems. Vitamin D is necessary for calcium absorption in the body, but vitamin D is a fat-soluble vitamin meaning the body requires some fat in order to make use of it. When there is inadequate fat, the vitamin cannot be absorbed and in turn, calcium cannot be absorbed.
A family history of osteopenia, osteoporosis, or low bone mass can increase a person risk by 50% to 85%.
Bone mineral density (BMD) tests are used to diagnose both osteopenia and osteoporosis by measuring the calcium levels in bone. This type of test can also provide an estimate of how much at risk a person is for bone fractures.
This test is painless and non-invasive. It is usually performed on the heel, shin bone, wrist, spine, finger, or hip.
Two common types of these tests are radiographs, a standard diagnostic tool for osteopenia, and Dual Energy X-ray Absorptiometry (DEXA). A DEXA scan is essentially a low energy x-ray so patients are not exposed to as much radiation as they would be if they had a regular x-ray. The results are attained by comparing the score (measurements were taken) to scans of individuals who do not have the condition.
Once the score is measured and compared, it is assessed using a chart that identifies the level or risk:
+1.0 to -1.0 – Normal bone density
-1.0 to -2.5 – Low bone density
-2.5 or higher – At risk for osteoporosis
What Treatments Is Available?
As with most conditions, prevention is the most effective treatment. If you have a family history or fall under any of the risk factors, there are things you can do to minimize the effects or prevent the conditions completely.
Your chiropractor can talk to you about lifestyle changes, exercise, and diet as well as supplements that you can take. Chiropractic adjustments can also be effective for many patients with osteopenia and osteoporosis as long as the chosen technique is a low force technique like Activator.
Many patients find these natural treatments preferable to any medications that may be prescribed. The most important thing you should do, though, is get a bone density test if you are in an at-risk category, are a woman who is postmenopausal or age 65 or older.
Bell’s Palsy is a condition that is marked by temporary facial paralysis due to trauma or damage done to the nerves in the face. The facial nerve, called the 7th cranial nerve, resided in the skull, traveling through the Fallopian canal (a bony, narrow canal in the skull) and extending from just under each ear to the muscles that are located on either side of the face.
This nerve is mostly in a hard, bony shell with just small portions that are exposed, allowing it to move the muscles on each respective side of the face. The facial nerve controls the mouth (smiling, forming words, etc.), closing the eyelids or blinking, frowning, and similar movements. It also transmits nerve impulses to the saliva glands, tear glands, taste sensations, and the muscles of the stapes (small bone located in the middle ear)
Bell’s Palsy affects the facial nerve, disrupting its function so that messages from the brain cannot reach the associated muscles. This results in facial paralysis or weakness.
This condition is not related to stroke, although some people may mistake it for a symptom of stroke. It usually only affects one side of the face. Incidences of Bell’s Palsy affecting both sides of the face at the same time is very rare.
Bell’s Palsy Symptoms
Bell’s palsy symptoms can vary widely from patient to patient, depending on severity. Some common symptoms include:
Paralysis on one side of the face
Weakness on one side of the face may range from mild to severe
Muscle twitching in the face
Drooping of one corner of the mouth
Drooping on the eyelid on one eye
Excessive tearing that occurs in only one eye
Impaired sense of taste
Discomfort of pain behind the ear and around the jaw
Tinnitus (ringing in the ears) – can be one ear or both
Sound hypersensitivity on the side that is affected
Impaired or slurred speech
Difficulty drinking or eating
The symptoms usually come on suddenly and progress fairly rapidly, reaching their full effect within about 48 hours. It can leave the face very distorted during the time that the patient is experiencing a flare-up or symptoms.
Bell’s Palsy Care
Milder cases of Bell’s Palsy are typically not treated and the symptoms will subside on their own in 10 to 14 days. More serious cases may require medical intervention such as medications like the steroid prednisone, acyclovir, and even ibuprofen or acetaminophen.
In severe cases where the eye is affected, the patient may not be able to close the eyelid so protecting that eye is a necessity as is keeping it from drying out by using lubricating eye drops. Facial massage, physical therapy, and acupuncture may also be used. Surgery for Bell’s Palsy is very rare due to its controversial nature.
The Causes of Bell’s Palsy?
The cause of Bell’s Palsy is not known. Doctors do know that it is the result of the facial nerves becoming inflamed, swollen, or compressed, but why this happens is still a mystery.
Some researchers speculate that a viral infection could be the culprit. The theory is that an illness like the common cold sore virus or viral meningitis causes the nerves to become inflamed and swell in the Fallopian canal. This causes pressure on the nerve, cutting off the oxygen and blood supply to its cells.
Some common conditions that Bell’s Palsy has been associated with include:
About 1.5 million people in the United States have rheumatoid arthritis. Rheumatoid arthritis, or RA, is a chronic, autoimmune disease characterized by pain and inflammation of the joints. With RA, the immune system, which protects our well-being by attacking foreign substances like bacteria and viruses, mistakenly attacks the joints. Rheumatoid arthritis most commonly affects the joints of the hands, feet, wrists, elbows, knees and ankles. Many healthcare professionals recommend early diagnosis and treatment of RA.
Like many autoimmune diseases, the etiology of RA is multifactorial. Genetic susceptibility is evident in familial clustering and monozygotic twin studies, with 50 percent of RA risk attributable to genetic factors.4 Genetic associations for RA include human leukocyte antigen-DR45 and -DRB1, and a variety of alleles called the shared epitope.6,7 Genome-wide association studies have identified additional genetic signatures that increase the risk of RA and other autoimmune diseases, including STAT4 gene and CD40 locus.5 Smoking is the major environmental trigger for RA, especially in those with a genetic predisposition.8 Although infections may unmask an autoimmune response, no particular pathogen has been proven to cause RA.9
RA is characterized by inflammatory pathways that lead to proliferation of synovial cells in joints. Subsequent pannus formation may lead to underlying cartilage destruction and bony erosions. Overproduction of pro-inflammatory cytokines, including tumor necrosis factor (TNF) and interleukin-6, drives the destructive process.10
Older age, a family history of the disease, and female sex are associated with increased risk of RA, although the sex differential is less prominent in older patients.1 Both current and prior cigarette smoking increases the risk of RA (relative risk [RR] = 1.4, up to 2.2 for more than 40-pack-year smokers).11
Pregnancy often causes RA remission, likely because of immunologic tolerance.12 Parity may have long-lasting impact; RA is less likely to be diagnosed in parous women than in nulliparous women (RR = 0.61).13,14 Breastfeeding decreases the risk of RA (RR = 0.5 in women who breastfeed for at least 24 months), whereas early menarche (RR = 1.3 for those with menarche at 10 years of age or younger) and very irregular menstrual periods (RR = 1.5) increase risk.14 Use of oral contraceptive pills or vitamin E does not affect RA risk.15
Patients with RA typically present with pain and stiffness in multiple joints. The wrists, proximal interphalangeal joints, and metacarpophalangeal joints are most commonly involved. Morning stiffness lasting more than one hour suggests an inflammatory etiology. Boggy swelling due to synovitis may be visible (Figure 1), or subtle synovial thickening may be palpable on joint examination. Patients may also present with more indolent arthralgias before the onset of clinically apparent joint swelling. Systemic symptoms of fatigue, weight loss, and low-grade fever may occur with active disease.
In 2010, the American College of Rheumatology and European League Against Rheumatism collaborated to create new classification criteria for RA (Table 1).16 The new criteria are an effort to diagnose RA earlier in patients who may not meet the 1987 American College of Rheumatology classification criteria. The 2010 criteria do not include presence of rheumatoid nodules or radiographic erosive changes, both of which are less likely in early RA. Symmetric arthri- tis is also not required in the 2010 criteria, allowing for early asymmetric presentation.
In addition, Dutch researchers have developed and validated a clinical prediction rule for RA (Table 2).17,18 The purpose of this rule is to help identify patients with undifferentiated arthritis that is most likely to progress to RA, and to guide follow-up and referral.
Autoimmune diseases such as RA are often characterized by the presence of autoanti- bodies. Rheumatoid factor is not specific for RA and may be present in patients with other diseases, such as hepatitis C, and in healthy older persons. Anti-citrullinated protein antibody is more specific for RA and may play a role in disease pathogenesis.6 Approxi- mately 50 to 80 percent of persons with RA have rheumatoid factor, anti-citrullinated protein antibody, or both.10 Patients with RA may have a positive antinuclear antibody test result, and the test is of prognostic impor- tance in juvenile forms of this disease.19 C-reactive protein levels and erythrocyte sedimentation rate are often increased with active RA, and these acute phase reactants are part of the new RA classification criteria.16 C-reactive protein levels and erythrocyte sedimentation rate may also be used to follow disease activity and response to medication.
Baseline complete blood count with differential and assessment of renal and hepatic function are helpful because the results may influence treatment options (e.g., a patient with renal insufficiency or significant thrombocytopenia likely would not be prescribed a nonsteroidal anti-inflammatory drug [NSAID]). Mild anemia of chronic disease occurs in 33 to 60 percent of all patients with RA,20 although gastrointestinal blood loss should also be considered in patients taking corticosteroids or NSAIDs. Methotrexate is contraindicated in patients with hepatic disease, such as hepatitis C, and in patients with significant renal impairment.21 Biologic therapy, such as a TNF inhibitor, requires a negative tuberculin test or treatment for latent tuberculosis. Hepatitis B reactivation can also occur with TNF inhibitor use.22 Radiography of hands and feet should be performed to evaluate for characteristic periarticular erosive changes, which may be indicative of a more aggressive RA subtype.10
Skin findings suggest systemic lupus erythematosus, systemic sclerosis, or psoriatic arthritis. Polymyalgia rheumatica should be considered in an older patient with symptoms primarily in the shoulder and hip, and the patient should be asked questions related to associated temporal arteritis.
Chest radiography is helpful to evaluate for sarcoidosis as an etiology of arthritis. Patients with inflammatory back symptoms, a history of inflammatory bowel disease, or inflammatory eye disease may have spondyloarthropathy. Persons with less than six weeks of symptoms may have a viral process, such as parvovirus. Recurrent self-limited episodes of acute joint swelling suggest crystal arthropathy, and arthrocentesis should be performed to evaluate for monosodium urate monohydrate or calcium pyrophosphate dihydrate crystals. The presence of numerous myofascial trigger points and somatic symptoms may suggest fibromyalgia, which can coexist with RA. To help guide diagnosis and determine treatment strategy, patients with inflammatory arthritis should be promptly referred to a rheumatology subspecialist.16,17
Rheumatoid arthritis, or RA, is the most common type of arthritis. RA is an autoimmune disease, caused when the immune system, the human body’s defense system, attacks its own cells and tissues, particularly the joints. Rheumatoid arthritis is frequently identified by symptoms of pain and inflammation, often affecting the small joints of the hands, wrists and feet. According to many healthcare professionals, early diagnosis and treatment of RA is essential to prevent further joint damage and decrease painful symptoms. Dr. Alex Jimenez D.C., C.C.S.T. Insight
After RA has been diagnosed and an initial evaluation performed, treatment should begin. Recent guidelines have addressed the management of RA,21,22 but patient preference also plays an important role. There are special considerations for women of childbearing age because many medications have deleterious effects on pregnancy. Goals of therapy include minimizing joint pain and swelling, preventing deformity (such as ulnar deviation) and radiographic damage (such as erosions), maintaining quality of life (personal and work), and controlling extra-articular manifestations. Disease-modifying antirheumatic drugs (DMARDs) are the mainstay of RA therapy.
DMARDs can be biologic or nonbiologic (Table 3).23 Biologic agents include monoclonal antibodies and recombinant receptors to block cytokines that promote the inflammatory cascade responsible for RA symptoms. Methotrexate is recommended as the first- line treatment in patients with active RA, unless contraindicated or not tolerated.21 Leflunomide (Arava) may be used as an alternative to methotrexate, although gastrointestinal adverse effects are more common. Sulfasalazine (Azulfidine) or hydroxychloroquine (Plaquenil) pro-inflammatory as monotherapy in patients with low disease activity or without poor prognostic features (e.g., seronegative, non-erosive RA).21,22
Combination therapy with two or more DMARDs is more effective than monotherapy; however, adverse effects may also be greater.24 If RA is not well controlled with a nonbiologic DMARD, a biologic DMARD should be initiated.21,22 TNF inhibitors are the first-line biologic therapy and are the most studied of these agents. If TNF inhibitors are ineffective, additional biologic therapies can be considered. Simultaneous use of more than one biologic therapy (e.g., adalimumab [Humira] with abatacept [Orencia]) is not recommended because of an unacceptable rate of adverse effects.21
NSAIDs and Corticosteroids
Drug therapy for RA may involve NSAIDs and oral, intramuscular, or intra-articular corticosteroids for controlling pain and inflammation. Ideally, NSAIDs and corticosteroids are used only for short-term management. DMARDs are the preferred therapy.21,22
Dietary interventions, including vegetarian and Mediterranean diets, have been studied in the treatment of RA without convincing evidence of benefit.25,26 Despite some favorable outcomes, there is a lack of evidence for the effectiveness of acupuncture in placebo-controlled trials of patients with RA.27,28 In addition, thermotherapy and therapeutic ultrasound for RA have not been studied adequately.29,30 A Cochrane review of herbal treatments for RA concluded that gamma-linolenic acid (from evening primrose or black currant seed oil) and Tripterygium wilfordii (thunder god vine) have potential benefits.31 It is important to inform patients that serious adverse effects have been reported with use of herbal therapy.31
Exercise and Physical Therapy
Results of randomized controlled trials sup- port physical exercise to improve quality of life and muscle strength in patients with RA.32,33 Exercise training programs have not been shown to have deleterious effects on RA disease activity, pain scores, or radiographic joint damage.34 Tai chi has been shown to improve ankle range of motion in persons with RA, although randomized trials are limited.35 Randomized controlled trials of Iyengar yoga in young adults with RA are underway.36
Duration of Treatment
Remission is obtainable in 10 to 50 percent of patients with RA, depending on how remission is defined and the intensity of therapy.10 Remission is more likely in males, nonsmokers, persons younger than 40 years, and in those with late-onset disease (patients older than 65 years), with shorter duration of disease, with milder disease activity, without elevated acute phase reactants, and without positive rheumatoid factor or anti-citrullinated protein antibody findings.37
After the disease is controlled, medication dosages may be cautiously decreased to the minimum amount necessary. Patients will require frequent monitoring to ensure stable symptoms, and prompt increase in medication is recommended with disease flare-ups.22
Joint replacement is indicated when there is severe joint damage and unsatisfactory control of symptoms with medical management. Long-term outcomes are support, with only 4 to 13 percent of large joint replacements requiring revision within 10 years.38 The hip and knee are the most commonly replaced joints.
Although RA is considered a disease of the joints, it is also a systemic disease capable of involving multiple organ systems. Extra-articular manifestations of RA are included in Table 4.1,2,10
Patients with RA have a twofold increased risk of lymphoma, which is thought to be caused by the underlying inflammatory process, and not a consequence of medical treatment.39 Patients with RA are also at an increased risk of coronary artery disease, and physicians should work with patients to modify risk factors, such as smoking, high blood pressure, and high cholesterol.40,41 Class III or IV congestive heart failure (CHF) is a contraindication for using TNF inhibitors, which can worsen CHF outcomes.21 In patients with RA and malignancy, caution is needed with continued use of DMARDs, especially TNF inhibitors. Biologic DMARDs, methotrexate, and leflunomide should not be initiated in patients with active herpes zoster, significant fungal infection, or bacterial infection requiring antibiotics.21 Complications of RA and its treatments are listed in Table 5.1,2,10
Patients with RA live three to 12 years less than the general population.40 Increased mortality in these patients is mainly due to accelerated cardiovascular disease, especially in those with high disease activity and chronic inflammation. The relatively new biologic therapies may reverse progression of atherosclerosis and extend life in those with RA.41
Data Sources: A PubMed search was completed in Clinical Queries using the key terms rheumatoid arthritis, extra-articular manifestations, and disease-modifying antirheumatic agents. The search included meta-analyses, randomized controlled trials, clinical trials, and reviews. Also searched were the Agency for Healthcare Research and Quality evidence reports, Clinical Evidence, the Cochrane database, Essential Evidence, and UpToDate. Search date: September 20, 2010.
Author disclosure: No relevant financial affiliations to disclose.
In conclusion, rheumatoid arthritis is a chronic, autoimmune disease which causes painful symptoms, such as pain and discomfort, inflammation and swelling of the joints, among others. The joint damage characterized as RA is symmetrical, meaning it generally affects both sides of the body. Early diagnosis is essential for treatment of RA. The scope of our information is limited to chiropractic and spinal health issues. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Curated by Dr. Alex Jimenez
Additional Topic Discussion: Relieving Knee Pain without Surgery
Knee pain is a well-known symptom which can occur due to a variety of knee injuries and/or conditions, including sports injuries. The knee is one of the most complex joints in the human body as it is made-up of the intersection of four bones, four ligaments, various tendons, two menisci, and cartilage. According to the American Academy of Family Physicians, the most common causes of knee pain include patellar subluxation, patellar tendinitis or jumper’s knee, and Osgood-Schlatter disease. Although knee pain is most likely to occur in people over 60 years old, knee pain can also occur in children and adolescents. Knee pain can be treated at home following the RICE methods, however, severe knee injuries may require immediate medical attention, including chiropractic care.
1. Etiology and pathogenesis of rheumatoid arthritis. In: Firestein GS, Kelley WN, eds. Kelley’s Textbook of Rheu- matology. 8th ed. Philadelphia, Pa.: Saunders/Elsevier; 2009:1035-1086. 2. Bathon J, Tehlirian C. Rheumatoid arthritis clinical and laboratory manifestations. In: Klippel JH, Stone JH, Crofford LJ, et al., eds. Primer on the Rheumatic Dis- eases. 13th ed. New York, NY: Springer; 2008:114-121. 3. Allaire S, Wolfe F, Niu J, et al. Current risk factors for work disability associated with rheumatoid arthritis. Arthritis Rheum. 2009;61(3):321-328. 4. MacGregor AJ, Snieder H, Rigby AS, et al. Characteriz- ing the quantitative genetic contribution to rheumatoid arthritis using data from twins. Arthritis Rheum. 2000; 43(1):30-37. 5. Orozco G, Barton A. Update on the genetic risk fac- tors for rheumatoid arthritis. Expert Rev Clin Immunol. 2010;6(1):61-75. 6. Balsa A, Cabezón A, Orozco G, et al. Influence of HLA DRB1 alleles in the susceptibility of rheumatoid arthritis and the regulation of antibodies against citrullinated proteins and rheumatoid factor. Arthritis Res Ther. 2010;12(2):R62. 7. McClure A, Lunt M, Eyre S, et al. Investigating the via- bility of genetic screening/testing for RA susceptibility using combinations of five confirmed risk loci. Rheuma- tology (Oxford). 2009;48(11):1369-1374. 8. Bang SY, Lee KH, Cho SK, et al. Smoking increases rheu- matoid arthritis susceptibility in individuals carrying the HLA-DRB1 shared epitope, regardless of rheumatoid factor or anti-cyclic citrullinated peptide antibody sta- tus. Arthritis Rheum. 2010;62(2):369-377. 9. Wilder RL, Crofford LJ. Do infectious agents cause rheu- matoid arthritis? Clin Orthop Relat Res. 1991;(265): 36-41. 10. Scott DL, Wolfe F, Huizinga TW. Rheumatoid arthritis. Lancet. 2010;376(9746):1094-1108. 11. Costenbader KH, Feskanich D, Mandl LA, et al. Smoking intensity, duration, and cessation, and the risk of rheu- matoid arthritis in women. Am J Med. 2006;119(6): 503.e1-e9. 12. Kaaja RJ, Greer IA. Manifestations of chronic disease during pregnancy. JAMA. 2005;294(21):2751-2757. 13. Guthrie KA, Dugowson CE, Voigt LF, et al. Does preg- nancy provide vaccine-like protection against rheuma- toid arthritis? Arthritis Rheum. 2010;62(7):1842-1848. 14. Karlson EW, Mandl LA, Hankinson SE, et al. Do breast- feeding and other reproductive factors influence future risk of rheumatoid arthritis? Results from the Nurses’ Health Study. Arthritis Rheum. 2004;50(11):3458-3467. 15. Karlson EW, Shadick NA, Cook NR, et al. Vitamin E in the primary prevention of rheumatoid arthritis: the Women’s Health Study. Arthritis Rheum. 2008;59(11): 1589-1595. 16. Aletaha D, Neogi T, Silman AJ, et al. 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative [published correction appears in Ann Rheum Dis. 2010;69(10):1892]. Ann Rheum Dis. 2010;69(9):1580-1588. 17. van der Helm-van Mil AH, le Cessie S, van Dongen H, et al. A prediction rule for disease outcome in patients with recent-onset undifferentiated arthritis. Arthritis Rheum. 2007;56(2):433-440. 18. Mochan E, Ebell MH. Predicting rheumatoid arthritis risk in adults with undifferentiated arthritis. Am Fam Physi- cian. 2008;77(10):1451-1453. 19. Ravelli A, Felici E, Magni-Manzoni S, et al. Patients with antinuclear antibody-positive juvenile idiopathic arthri- tis constitute a homogeneous subgroup irrespective of the course of joint disease. Arthritis Rheum. 2005; 52(3):826-832. 20. Wilson A, Yu HT, Goodnough LT, et al. Prevalence and outcomes of anemia in rheumatoid arthritis. Am J Med. 2004;116(suppl 7A):50S-57S. 21. Saag KG, Teng GG, Patkar NM, et al. American College of Rheumatology 2008 recommendations for the use of nonbiologic and biologic disease-modifying antirheu- matic drugs in rheumatoid arthritis. Arthritis Rheum. 2008;59(6):762-784. 22. Deighton C, O’Mahony R, Tosh J, et al.; Guideline Devel- opment Group. Management of rheumatoid arthritis: summary of NICE guidance. BMJ. 2009;338:b702. 23. AHRQ. Choosing medications for rheumatoid arthritis. April 9, 2008. http://www.effectivehealthcare.ahrq.gov/ ehc/products/14/85/RheumArthritisClinicianGuide.pdf. Accessed June 23, 2011. 24. Choy EH, Smith C, Doré CJ, et al. A meta-analysis of the efficacy and toxicity of combining disease-modify- ing anti-rheumatic drugs in rheumatoid arthritis based on patient withdrawal. Rheumatology (Oxford). 2005; 4 4 (11) :1414 -1421. 25. Smedslund G, Byfuglien MG, Olsen SU, et al. Effective- ness and safety of dietary interventions for rheumatoid arthritis. J Am Diet Assoc. 2010;110(5):727-735. 26. Hagen KB, Byfuglien MG, Falzon L, et al. Dietary inter- ventions for rheumatoid arthritis. Cochrane Database Syst Rev. 2009;21(1):CD006400. 27. Wang C, de Pablo P, Chen X, et al. Acupuncture for pain relief in patients with rheumatoid arthritis: a systematic review. Arthritis Rheum. 2008;59(9):1249-1256. 28. Kelly RB. Acupuncture for pain. Am Fam Physician. 2009;80(5):481-484. 29. Robinson V, Brosseau L, Casimiro L, et al. Thermother- apy for treating rheumatoid arthritis. Cochrane Data- base Syst Rev. 2002;2(2):CD002826. 30. Casimiro L, Brosseau L, Robinson V, et al. Therapeutic ultrasound for the treatment of rheumatoid arthritis. Cochrane Database Syst Rev. 2002;3(3):CD003787. 31. Cameron M, Gagnier JJ, Chrubasik S. Herbal therapy for treating rheumatoid arthritis. Cochrane Database Syst Rev. 2011;(2):CD002948. 32. Brodin N, Eurenius E, Jensen I, et al. Coaching patients with early rheumatoid arthritis to healthy physical activ- ity. Arthritis Rheum. 2008;59(3):325-331. 33. Baillet A, Payraud E, Niderprim VA, et al. A dynamic exercise programme to improve patients’ disability in rheumatoid arthritis: a prospective randomized con- trolled trial. Rheumatology (Oxford). 2009;48(4): 410-415. 34. Hurkmans E, van der Giesen FJ, Vliet Vlieland TP, et al. Dynamic Exercise programs (aerobic capacity and/or mus- cle strength training) in patients with rheumatoid arthri- tis. Cochrane Database Syst Rev. 2009;(4):CD006853. 35. Han A, Robinson V, Judd M, et al. Tai chi for treat- ing rheumatoid arthritis. Cochrane Database Syst Rev. 2004;(3):CD004849. 36. Evans S, Cousins L, Tsao JC, et al. A randomized con- trolled trial examining Iyengar yoga for young adults with rheumatoid arthritis. Trials. 2011;12:19. 37. Katchamart W, Johnson S, Lin HJ, et al. Predictors for remis- sion in rheumatoid arthritis patients: a systematic review. Arthritis Care Res (Hoboken). 2010;62(8):1128-1143. 38. Wolfe F, Zwillich SH. The long-term outcomes of rheu- matoid arthritis: a 23-year prospective, longitudinal study of total joint replacement and its predictors in 1,600 patients with rheumatoid arthritis. Arthritis Rheum. 1998;41(6):1072-1082. 39. Baecklund E, Iliadou A, Askling J, et al. Association of chronic inflammation, not its treatment, with increased lymphoma risk in rheumatoid arthritis. Arthritis Rheum. 2006;54(3):692-701. 40. Friedewald VE, Ganz P, Kremer JM, et al. AJC editor’s consensus: rheumatoid arthritis and atherosclerotic cardiovascular disease. Am J Cardiol. 2010;106(3): 442-447. 41. Atzeni F, Turiel M, Caporali R, et al. The effect of phar- macological therapy on the cardiovascular system of patients with systemic rheumatic diseases. Autoimmun Rev. 2010;9(12):835-839.