Posture Insights

Introduction

Pain in different body areas can excruciate the host as it can affect other regions. In the body, pain can affect the muscles, tissues, organs, and skeletal joints through environmental factors that affect the body’s systems. For example, the gut system provides the body with overall health and wellness by regulating homeostasis and metabolism, which can be affected by common factors like stress or unhealthy eating habits that can cause joint inflammation due to overproducing harmful gut bacteria. Or how about poor posture affecting the organs in the pelvic region and causing the lower back and neck muscles to have a dull ache in the body. Today’s article looks at how pelvic pain affects the somato-visceral reflexes in the body and how there are treatments for relieving pelvic pain. We refer patients to certified providers specializing in chiropractic treatments that help those with pelvic pain. We also guide our patients by referring to our associated medical providers based on their examination when it’s appropriate. We find that education is the solution to asking our providers insightful questions. Dr. Alex Jimenez DC provides this information as an educational service only. Disclaimer

Can my insurance cover it? Yes, it may. If you are uncertain, here is the link to all the insurance providers we cover. If you have any questions or concerns, please call Dr. Jimenez at 915-850-0900.

Somatovisceral Reflexes & Pelvic Pain

Have you experienced pain in your lower back or pelvic regions from sitting too long? Have you experienced bladder dysfunction that is causing you to urinate frequently? Or are you suffering from muscle cramps in the pelvic area? Studies have revealed that pelvic pain can be a chronic, persistent pain associated with co-morbidities like IBS (irritable bowel syndrome), neurological disorders, or low back pain. Pelvic pain is challenging to diagnose since it is multifactorial and shares various nerve roots that send signals to the brain. For example, individuals that suffer from pelvic pain will complain about the somatovisceral convergence affecting their reproductive organs and connective tissues. Other issues like prolonged sitting and poor posture can also affect the lumbosacral nerve root as it is being compressed, causing low back pain and pelvic organ dysfunction.

The somato-visceral reflexes of the pelvic muscles can become overstretched and compress the surrounding nerve roots like the sciatic nerve and the lumbosacral nerve, causing issues of sciatica or lower back pain. Studies have also revealed that individuals who suffer from spinal cord injuries can disrupt the somatic lumbosacral nerve pathway that is responsible for coordinating bladder function to the pelvic region. These pathways can also produce different autonomic reflex responses to the various organs and somatic afferents. For example, if a female is experiencing pain in her hips or thighs from hyper-sensitive nerve roots, the brain will register that as pain in her reproductive system. Or, if the pelvic muscles are hypersensitive to the touch, something might be affecting the genital regions.

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, licensed physician, and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

Sciatica Sleep: Poor sleep can leave the body feeling off and unable to function. Not getting the proper amount of sleep can decrease health, decrease work or school productivity, and cause burnout. If it becomes chronic, it can have serious side effects on the brain and body that include:

• Chronic Fatigue
• Memory problems
• Body discomfort, pain
• Exacerbation or trigger disease

Sciatica Sleep

When sleeping, certain positions/postures can place added pressure on the spine, irritating the nerve. The best sleeping positions maintain the spine's natural curve and are different for everybody. For example, many individuals sleep on their side. They do not start sleeping this way, but they end up on their side and wake up in pain to find their sciatica flaring up. Other individuals can turn on a specific side, and the symptoms fade or go away.

Positions

The best sleeping position for one individual may not be the best for another. A lot of this depends on the placement of the injury/pinching that can affect how certain sleep positions work, causing no symptoms, while other sleep postures generate all kinds of symptoms, especially pain. Individuals are recommended to sleep in the position that works for them, provided with the correct posture.

Side Sleepers

• Side sleepers are recommended to place a pillow between their knees for healthy sleep and pain avoidance results.
• A pillow between the legs helps to prevent twisting.
• A firm pillow will work or a soft pillow folded in half.
• It is also recommended to consider a small pillow under the waist to maintain the alignment between the ribs, hips, and the spine.

Back Sleepers

• Back sleepers can benefit from a pillow under the knees to maintain a neutral curve of the spine.
• This keeps the legs slightly elevated helping prevent the legs from tilting the pelvis and pulling the spine out of a neutral position.
• Individuals that sleep on their back but end up on their side, are recommended to use a large pillow or body pillow placed on the side they turn on to prevent this.

Stomach Sleeping Not Recommended

• Sciatic pain can become worse with sleeping on the stomach.
• Sleeping on the stomach can collapse the spine and the pelvis as there is no support underneath. This causes damage to the nerves, increasing symptoms and pain levels.
• Try to avoid sleeping on the stomach until the sciatic nerve has healed or try to train the body to sleep on the side or back.

Non-Surgical Spinal Decompression Can Help Sciatica Sleep Symptoms

Non-surgical spinal decompression therapy relieves pressure on the sciatic nerve, spine, and surrounding muscles by pulling/stretching them in small increments. The decompression creates negative pressure within the discs that floods the area with an abundance of nutrients to activate and expedite the healing response.

• The chiropractic physical therapy team uses motorized medical equipment with sensors linked to a computer-aided system to perform the procedure.
• The equipment is designed to adjust the pull force accordingly to prevent muscle resistance.
• The adjustable table also allows the spine to be stretched at different angles to target all areas of the back.

Relieves Pressure On The Sciatic Nerve

• Decompression stretches the nerve out and increases the space around the impinged and inflamed nerve.

Pain Relief

• Decompression relieves tension in tight, spasming, or injured muscles.
• Stimulates the nervous system to release the body's natural pain killers.
• Spinal tissue healing from fluids, cells, and other substances that enter the damaged tissue.

Restores Disc and Joint Alignment

• Decompression realigns the joints and discs, preventing pain, inflammation, mobility/flexibility problems, and dysfunction.

Encourages Sleep

• There are toxins in the body, and decompression causes these toxins to be expelled.
• This causes exhaustion because the body needs time to adjust after expelling the negative energy.
• After a short time, energy levels will return.
• The decompression relaxes the entire body which allows for more restful sleep.

DRX9000

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, or licensed physician, and is not medical advice. We encourage you to make your own healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Kim, Shin Hyung et al. “Risk factors associated with clinical insomnia in chronic low back pain: a retrospective analysis in a university hospital in Korea.” The Korean journal of pain vol. 28,2 (2015): 137-43. doi:10.3344/kjp.2015.28.2.137

Radwan, Ahmed, et al. “Effect of different mattress designs on promoting sleep quality, pain reduction, and spinal alignment in adults with or without back pain; a systematic review of controlled trials.” Sleep health vol. 1,4 (2015): 257-267. doi:10.1016/j.sleh.2015.08.001

Santilli, Valter, et al. “Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized, double-blind clinical trial of active and simulated spinal manipulations.” The spine journal: official journal of the North American Spine Society vol. 6,2 (2006): 131-7. doi:10.1016/j.spinee.2005.08.001

Posture is the positioning of the body. There are two types of posture. Dynamic posture is how individuals position themselves when moving, like walking, running, or bending to lift an object. And static posture is how individuals position themselves when not in motion, like standing, sitting, or sleeping. Minimal stress is applied to the muscles and joints when practicing healthy posture. High-stress work and school combined with unhealthy body positions can cause health consequences to the spine, extremities, and musculoskeletal imbalances.

Health Consequences

Poor postures do not always present with spine or extremity pain right away. This is because individuals will feel discomfort and have the strength and mobility to correct unhealthy/awkward positions and minimize stress. However, eventually, the pain will begin to present as the muscles and joints can only take so much that the ability to correct poor positioning does not matter as there is a developing injury taking place, causing inflammation, letting the body know there is something not right. This often leads to chronic stress and the unnecessary wearing down of the joints to compensate for the unhealthy positions.

Early Signs

Early signs of postural problems can include:

• Inability to sit or stand for a long time.
• Stiffness when rising from a chair.
• Feeling of added physical exhaustion.

Leaving the condition untreated often leads to:

• Muscle imbalances.
• Loss of normal flexibility.
• Discomfort and pain present for no apparent reason.

Unhealthy Posture Symptoms

Symptoms can include:

• Slouching
• Rounded shoulders.
• Potbelly.
• Bent knees when standing or walking.
• Muscle fatigue.
• Aches and pains.
• Back pain.
• Headache.

Postural Structure

Poor posture interferes and disrupts several of the body’s posture structures. These include:

• Nervous system feedback.
• Muscle strength and length.
• The static slow-twitch muscle fibers help maintain posture without exerting too much energy and contribute to balance by sensing the body's position.
• Static muscle fibers burn energy slowly and can work for a long time without tiring.
• The fast-twitch or phasic muscle fibers are used for movement and activity. These fibers quickly use up their energy.

Because the phasic fibers have to work overtime instead of the static fibers to maintain the body's position, muscle fatigue, weakness, and pain begin to set in.

Health

Health consequences can include:

• Misaligned musculoskeletal system.
• The advanced wearing of the spine making it fragile and prone to injury.
• Chronic pain.
• Decreased flexibility.
• Joint mobility is affected.
• Balance issues.
• Increased risk of falling.
• Difficulty digesting food.
• Difficulty breathing.

Chiropractic and Physical Therapy

Chiropractors and physical therapists specialize in evaluating and treating musculoskeletal dysfunctions and disorders, identifying and screening for postural dysfunction. Chiropractic adjustments can be highly effective combined with other treatment modalities like massaging the soft tissues to improve circulation, reduce swelling inflammation, and promote healing. Spinal decompression therapy can help stretch and realign the spine to relieve back and/or leg pain. A customized exercise program will stretch and strengthen the body to maintain a healthy posture. Health coaching combined with dietary management can help with pain and inflammation and strengthen muscles and bones.

DRX9000 Spinal Decompression

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, or licensed physician, and is not medical advice. We encourage you to make your own healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

American Chiropractic Association. Maintaining good posture. https://acatoday.org/content/posture-power-how-to-correct-your-body-alignment. Accessed Jan. 28, 2019.

American Academy of Orthopaedic Surgeons. Spine basics. https://orthoinfo.aaos.org/en/diseases--conditions/spine-basics/. Accessed Jan. 30, 2019.

Bauer BA. Chiropractic or osteopathic manipulation. In: Mayo Clinic Guide to Integrative Medicine. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2017.

Muscolino JE. Posture and the gait cycle. In: Kinesiology: The Skeletal System and Muscle Function. 3rd ed. Elsevier; 2017.

Wang G. Powered traction devices for intervertebral decompression: Health technology assessment update. Washington Department of Labor and Industries, June 14, 2004.

Waters, Thomas R, and Robert B Dick. “Evidence of health risks associated with prolonged standing at work and intervention effectiveness.” Rehabilitation nursing: the official journal of the Association of Rehabilitation Nurses vol. 40,3 (2015): 148-65. doi:10.1002/rnj.166

For older individuals, experiencing frequent low back pain could turn out to be a sacral fracture. They tend to occur in individuals over the age of 60 often because there has been a degree of bone loss. Sacral fractures tend not to be the first thing doctors think of when low back pain symptoms are presenting. They are often not picked up on X-rays and are either not diagnosed early enough to take steps or not diagnosed at all. However, they are common.

Sacrum

The sacrum is shaped like a triangle and comprises five segments fused into one large bone. It sits at the base of the spine,  between the two halves of the pelvis, connecting the spine to the lower half of the body. It stabilizes the body when walking, sitting, or standing. The nerves in the lower spine control the bowels bladder and provide sensation to the region.

• The two dimples that can be seen on individuals' backs are where the sacrum joins the hipbones or the sacroiliac joint.
• The point where the low back joins the sacrum can develop discomfort, soreness, and pain.
• This area experiences stress from bending, twisting, reaching, lifting, carrying during physical activities or sitting for long periods.

Sacral Fracture

Most sacral fractures result from trauma, like slips, falls, and automobile accidents. Stress fractures that happen without a specific injury are also called insufficiency fractures.

Types of Sacral Fractures

• Low-energy fractures usually happen to older individuals with weak bones due to osteoporosis.
• An individual trips on something, lands hard on their butt, lifts a heavy object awkwardly, or over-exerts themselves from some physical activity.
• Then persistent back or buttock pain begins to present.
• The pain is often centered in the lower back, the hips, and butt.
• It is more than just back achiness.
• The individual goes to the doctor, and X-rays are ordered.
• A lot of the time, these fractures are missed on X-rays.
• The doctor may diagnose a sprain, but the pain symptoms do not improve.
• Sometimes there is no apparent cause for the pain.
• It can be misdiagnosed as a lower back compression fracture or urinary tract infection.

• High-energy fractures are due to trauma and are more common among the young.
• The individual sustains injuries from an auto accident, has fallen from a significant height, or suffers a sports injury.
• It results in severe pain.
• A woman who has just had a baby and gone through some bone loss because of the pregnancy can experience a sacral stress fracture.

Diagnosis

The most common causes for low back pain include:

• Frequent improper posture.
• Muscle weakness or tightness.
• Ligament strain.
• Joint inflammation.
• A pilonidal cyst or an anal fissure can also cause pain.

For individuals that have been to a doctor and had an X-ray that reveals no fracture, and there is no improvement after 5 to 7 days, it is recommended to schedule another appointment and ask for a CAT scan or MRI, which is highly effective at finding a sacral fracture.

Treatment

Treatment consists of resting the bone but still being safely active in most cases.

• Medication is prescribed for pain relief.
• Many individuals have been found to do well with anti-inflammatory medications, topical medications, and lidocaine patches.
• Older individuals may be recommended to use a walker during the treatment/healing process.
• Depending on the severity, crutches may be recommended.
• Engaging in regular exercise is not recommended, but too much bed rest is also not recommended.
• Too much rest may not allow the injury to heal correctly, worsen the injury, and/or cause new injuries.
• Chiropractic and physical therapy are not recommended to let the sacrum naturally heal.
• After the pain subsides, chiropractic and physical therapy can be implemented to maintain agility and flexibility and strengthen the pelvic and core muscles.

In some cases, if the bone does not heal correctly or some other issue, sacroplasty could be recommended. This is a minimally invasive procedure that injects bone cement into the fracture. It offers quick and long-lasting pain relief with a low percentage of complications. It is considered low risk and can be done by an interventional radiologist or spine surgeon.

Prevention

To minimize the risk of a sacral fracture, it is highly recommended to maintain bone strength. This consists of:

• Having a balanced diet.
• Eating calcium-rich foods.
• Taking calcium and vitamin D supplements.
• Strength training.
• Regular bone density screenings.

Body Composition

Sitting Posture Adjustments

Adjust Sitting

• If allowed, sit on an exercise ball for short periods, or try a sit-stand desk. There are also treadmill desks and bicycle desks.
• If none of these are possible options, try exercises to do at a desk that works out the core muscles.

Change Chair

• Try a solid wooden chair if unable to use a ball or sit-stand desk.
• It will make the body sit up straight and increase proper posture.

Move Around Alarm

• Set a timer every hour for two minutes of movement.
• Try to keep moving with different exercise stretches, or take a lap around the building.

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, licensed physician, and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Gibbs, Wende Nocton, and Amish Doshi. "Sacral Fractures and Sacroplasty." Neuroimaging clinics of North America vol. 29,4 (2019): 515-527. doi:10.1016/j.nic.2019.07.003

Holmes, Michael W R, et al. "Evaluating Abdominal and Lower-Back Muscle Activity While Performing Core Exercises on a Stability Ball and a Dynamic Office Chair." Human factors vol. 57,7 (2015): 1149-61. doi:10.1177/0018720815593184

Santolini, Emmanuele et al. “Sacral fractures: issues, challenges, solutions.” EFORT open reviews vol. 5,5 299-311. 5 May. 2020, doi:10.1302/2058-5241.5.190064

Setting spinal goals is important for an individual's treatment plan to ensure a thorough and successful recovery following:

• Surgery
• Trauma
• Spinal condition

When developing goals with a surgeon or spine specialist, utilizing a well-known method known as SMART is recommended. Individuals are encouraged to set goals to accomplish personal growth and improvement. It is a model for forming goals and objectives that for medical purposes include:

• Pain management
• Physical Rehabilitation
• Mental health
• Exercises
• Stretching
• Anti-inflammatory diet

S.M.A.R.T Spinal Goals

The acronym stands for:

Specific

• Target a specific area for improvement.

Measurable

• Find ways to track progress.
• This could be fitness trackers, daily journaling - writing, video, health coach, etc. 

Attainable

• Determine if the goal is achievable.
• Figure out what tools or skill sets are needed to reach the goal.

Realistic

• Results-oriented goals.
• Measure results or output, including accomplishments.

Time Frame

• Set goals within a doable time frame.

Goal setting helps individuals monitor their progress when recovering from injury, surgery, and/or spinal conditions. Making goals smaller makes it easier to achieve improvements. It’s recommended to have a partner assistant during the goal-setting because the pain can compromise decision-making. Pain affects the mind's abilities to assess improvement and treatment response rationally. Taking the most important goals and focusing on small building blocks helps individuals maintain motivation during a long recovery process.

Difference Between Goal Setting and Treatment

A standard treatment plan is structured for a specific result and is not set up for adjusting the way goal setting does. A treatment plan is created and prescribed to a patient with little patient input. Goal setting is a collaboration between a patient and a doctor setting objectives as stepping-off points to achieve goals. Goal setting empowers patients with education, skillsets, and tools to succeed and continue that mindset as their lives move on. Achieving short-term goals helps individuals reflect positively on small gains that set a solid foundation for more challenging future goals.

Spinal Treatment Goals

Goals are personalized/custom-tailored to the individual's case and condition. For example, a patient could set a goal of returning to weekend sports activities. Therefore, achieving the goal could require the individual to engage in exercise five days a week for the next two weeks that could include physical therapy rehabilitation:

• Basic stretching
• Range of motion exercises
• Isometric strengthening
• Balance training
• Stability training
• Eccentric strengthening
• Force absorption
• Walking
• Light jogging

These activities are small goals that help the body adapt to handling additional physical stress.

Goal Setting When In Recovery

Spinal issues are dealt with by creating reasonable small objectives to reach a goal. SMART goal setting is an instrumental framework for medical providers to help identify what is important to the patient. Modifications on SMART goals can be done to adjust to the individual's needs. Spinal goals help patients accomplish what is necessary, keeping them empowered and motivated.

Body Composition

Too Comfortable With Goals

An individual may have a great deal of success doing the same workouts initially but then notice they’re getting easier and are not seeing the same rate of progression. That same workout routine, same weights, and equipment will only go so far in goal achievement. In recovery, as the body gets stronger and fitness levels improve, it is recommended to consistently challenge yourself to avoid falling into a rehabilitation fitness plateau. Part of the recovery process is to change up workouts to challenge the body to achieve optimal health and healing. Individuals are recommended to:

Increase weight and or reps

• Increase the amount of weight or the number of reps in each set.

Increase or decrease the tempo

• Shorten the rest period between sets to keep the heart rate high or slow down to focus on muscle contraction.

Experiment with different types of workout sets

• If you’ve been doing the same kinds of lifts, try drop sets, supersets, or AMRAP (as many reps as possible) to challenge your muscles differently.

Learn new exercises

• Individuals doing a lot of weightlifting are recommended to engage in plyometric body exercises.
• Individuals doing high-intensity interval training are recommended to incorporate a long run or bike ride.

Changing the workout routine will keep challenging the body, which is great for health progress.

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, licensed physician, and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Alexanders, Jenny et al. “Goal setting practices used within anterior cruciate ligament rehabilitation: An exploration of physiotherapists understanding, training, and experiences.” Musculoskeletal care vol. 19,3 (2021): 293-305. doi:10.1002/msc.1535

Bovend'Eerdt, Thamar J H et al. “Writing SMART rehabilitation goals and achieving goal attainment scaling: a practical guide.” Clinical rehabilitation vol. 23,4 (2009): 352-61. doi:10.1177/0269215508101741

Haas, B et al. “Rehabilitation goals of people with spinal cord injuries can be classified against the International Classification of Functioning, Disability and Health Core Set for spinal cord injuries.” Spinal cord vol. 54,4 (2016): 324-8. doi:10.1038/sc.2015.155

Posture is how we hold our bodies while standing, sitting, or lying down. A healthy posture is the correct alignment of the body supported by the right amount of muscle tension. Our everyday movements and activities affect the body's alignment. A postural imbalance can impact the body's health in various ways. It can cause:

• General soreness
• Back pain
• Muscular pain
• Fatigue
• Digestive problems
• Poor self-esteem

Unhealthy posture can increase the risk of spinal dysfunction, joint degeneration, stress joints, and muscles, resulting in permanent damage if left untreated. The best way to prevent postural imbalances is to be aware of the causes utilize proper ergonomic and movement strategies that can help avoid these problems. As the everyday bad habits, behaviors, and activities are understood, it is much easier to prevent and correct them.

Everyday Posture Is Important

Specific muscles maintain the body's posture, so we don't have to think about it and constantly adjust. Muscle groups, including the hamstrings and large back muscles, are essential in maintaining healthy positions. When the muscles function correctly, the postural muscles prevent gravity from pushing the body forward. Postural muscles also maintain balance when moving. A healthy posture reduces strain on the supporting muscles and ligaments during everyday movement and weight-bearing activities. Engaging in healthy posture helps:

• Keep the bones and joints in correct alignment so that the muscles function correctly.
• Decrease the abnormal wearing of joints resulting in degenerative arthritis and joint pain.
• Reduce the stress on the ligaments holding the spinal joints together, preventing injury.
• Allow muscles to work more efficiently.
• The body exert less energy.
• Prevent muscle fatigue and muscle pain.
• Prevent muscle strain and overuse disorders.

Unhealthy Posture

Unhealthy posture results when the body sits or stands with the spine in an abnormal position. When an individual practices unhealthy posture over a long period, it progressively leads to muscles and ligaments becoming elongated and weak, while others become short and tight. This creates a physical imbalance that leads to postural abnormalities like:

• Rounded shoulders
• Forward head posture
• Thoracic kyphosis or hunched back
• Lumbar lordosis
• Swayback
• Limited mobility
• Increases the risk of injury

Causes

Habits

• Individuals can begin to develop unhealthy habits that negatively impact their posture, like walking with their head looking towards the ground. This shifts the body out of alignment.

Sitting For Too Long

• Spending too much time sitting even with the correct posture will impact the spine and muscles. It weakens the muscles, ligaments, and abdominals.

Weight

• Carrying extra weight can force the spine into an awkward position. This is true for individuals with pot bellies, as it pulls the lower back forward, increasing the risk of lumbar lordosis.

Unhealthy Diet

• If the spine does not have access to the vitamins and nutrients it needs, it can struggle to maintain its strength and flexibility. It is also more difficult for the body to repair damage to the spine's muscles and ligaments.

Clothing and Footwear

• Clothing and footwear can impact posture.
• High heels, poor-fitting shoes, saggy jeans, large belts, heavy jackets, and other items can force the spine into an unnatural position.
• These are fine to wear for short periods but avoid wearing them day in and day out.

Treatment

Chiropractors specialize in issues affecting the spine, especially posture. They can:

• Perform a postural examination involving a complete assessment of the musculoskeletal system to identify any joint misalignments and issues that affect soft tissue.
• Perform adjustments of misaligned joints using various techniques.
• Recommend stretches to loosen/lengthen tight muscles and strengthen weak ones, leading to improvements. A chiropractor will develop an effective stretching regimen to target the correct muscles.
• Recommend nutritional advice, exercise, and everyday habit adjustments.

Body Composition

Insulin Resistance

Individuals who sit for extended periods, don't exercise and don't watch their diet can experience insulin resistance. Insulin resistance happens when insulin cannot transport excess blood sugar out of the blood and into the muscles. One study found that women who sat for eight hours a day had a higher chance of developing diabetes. Individuals with diabetes tend to have more fat within their bodies, particularly visceral fat, increasing insulin resistance potential. Individuals with diabetes experience a faster loss of muscle mass as they age, further intensifying symptoms and deterioration of body composition.

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, licensed physician, and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Feldman, Anatol G. "The Relationship Between Postural and Movement Stability." Advances in experimental medicine and biology vol. 957 (2016): 105-120. doi:10.1007/978-3-319-47313-0_6

Jaromi, Melinda et al. "Treatment and ergonomics training of work-related lower back pain and body posture problems for nurses." Journal of clinical nursing vol. 21,11-12 (2012): 1776-84. doi:10.1111/j.1365-2702.2012.04089.x

Jung, Suk Hwa et al. "Visceral Fat Mass Has Stronger Associations with Diabetes and Prediabetes than Other Anthropometric Obesity Indicators among Korean Adults." Yonsei medical journal vol. 57,3 (2016): 674-80. doi:10.3349/ymj.2016.57.3.674

Pope, Malcolm H et al. "Spine ergonomics." Annual review of biomedical engineering vol. 4 (2002): 49-68. doi:10.1146/annurev.bioeng.4.092101.122107

Dr. Alex Jimenez and Dr. Ruja discuss why chiropractic care is important to the body’s overall wellbeing.

Why Chiropractic Works?

In today’s podcast, Dr. Alex Jimenez DC, Health Coaches Adriana Caceres and Faith Arciniega, Massage Therapist Amparo Armendáriz-Pérez, and Clinical Nutritionist Ana Paola Rodriguez Arciniega discuss today what they do and offer with Functional Medicine.

What We Do and What We Offer

There are various causes for achiness or soreness under the shoulder blades. The shoulder blade is the triangular bone that forms the back of the shoulder. This pain can range from dull, sharp, burning, or a combination between the spine and shoulder blade to tender or achy across the shoulder or upper back. Pain can spread from another body part or structure, like the neck or spine. Inflammation from injury or overuse is noticeable at onset or gradually after engaging in physical activity and can limit arm movements and interfere with regular activities.

Improper Posture

Improper poster combined with prolonged sitting can cause the spine to develop structural changes that cause pain under the shoulder blade. Habits that lead to poor posture include:

• Hunching the back.
• Tilting the head down - looking at the phone.
• Leaning to one side while sitting, working.

Poor posture habits cause the muscles to weaken, placing added pressure on the spinal discs, muscles, and ligaments. This body imbalance can contribute to upper back and shoulder pain.

Lifting Improperly 

Lifting weight above the head and not using the proper technique can leave the upper back and shoulders vulnerable to injury. Lifting an object that is too heavy or is held in an awkward way causing the spine to be misaligned creates added pressure in the upper back. This can strain the muscles, sprain ligaments, injure the shoulder joint, or spine, which can cause spreading pain under and/or near the shoulder blade.

Repetitive Overuse Injury

Painting, moving furniture, or participating in sports are activities that can overwork the upper back muscles and shoulders. Overuse can lead to muscle strains and ligament sprains. This can cause pain in the upper back between the shoulder blade and the spine. Scapulothoracic bursitis, also known as snapping scapula syndrome, is when the bursa between the shoulder blade/scapula and the thoracic spine becomes inflamed, causing pain.

Cervical Herniated Disc

A herniated disc in the cervical spine/neck happens when a disc’s outer layer/annulus fibrosus tears and the inner layer/nucleus pulposus starts to leak outward. This can cause pain and cause the nearby nerve roots to become inflamed, causing pain to run down into the shoulder, arm, and/or hand. A disc herniation in the lower part of the neck usually radiates pain into or near the shoulder blade area. Although less common, a herniation in the upper back can cause pain around or near the shoulder blade.

Dislocated Rib

An accident or fall could cause a rib to become dislocated or misaligned after repetitive/overuse strain or reaching too far overhead. Sharp pain near the shoulder blade can result from this activity and can sometimes make it challenging to take a deep breath.

Compression Fracture

A compression fracture occurs when a vertebral bone in the upper back weakens and compresses. This can lead to back pain with a heightened sensitivity across the shoulder area. The pain usually decreases with rest. Compression fractures are commonly caused by osteoporosis in older individuals. Any back or shoulder pain that persists for weeks or interferes with regular activities should be evaluated by a doctor or chiropractor. If the pain is severe or accompanied by symptoms like headache, tingling, weakness, or nausea, individuals are recommended to seek medical attention.

Body Composition

Carbohydrate/Carb Loading

Carbohydrates are macronutrients that serve a critical function in the body, as they are the body’s primary energy source. The body breaks down carbohydrates into sugar that enters the bloodstream and is stored for energy use in the muscles and liver as glycogen. The muscles only store small quantities of glycogen. And when engaging in physical activity or exercise, the energy stores get used up.

Carbohydrate loading can raise glycogen stores in the muscles from 25 to 100 percent of their average amount in men. Women have shown mixed results in studies on carbohydrate loading. Women need to take in more calories than men when carb-loading to experience the same gains in glycogen. Reasons to carb load are either to:

• Build-up stores of glycogen so an individual can use the extra energy storage to help improve endurance.
• Fill the muscles with glycogen to bring water into the muscles to help gain mass and tone.

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, licensed physician, and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Hanchard, Nigel C A et al. “Physical tests for shoulder impingements and local lesions of bursa, tendon or labrum that may accompany impingement.” The Cochrane database of systematic reviews vol. 2013,4 CD007427. 30 Apr. 2013, doi:10.1002/14651858.CD007427.pub2

Mizutamari M. et al. Corresponding scapular pain with the nerve root involved in cervical radiculopathy. J Orthop Surg. 2010; 18(3): 356–60.

Sergienko, Stanislav, and Leonid Kalichman. “Myofascial origin of shoulder pain: a literature review.” Journal of bodywork and movement therapies vol. 19,1 (2015): 91-101. doi:10.1016/j.jbmt.2014.05.004

Relaxing the low back muscles. The low back supports the weight of the upper body and provides mobility. The lumbar spine/low back is a complex structure of interconnecting:

• Bones
• Joints
• Nerves
• Ligaments
• Muscles
• All work together to provide support, strength, and flexibility.

However, this complex structure is highly susceptible to injury and pain. The muscles in the low back support the spinal column and are responsible for flexing, rotating the hips when walking. The nerves in the low back supply sensation and power the muscles in the pelvis, legs, and feet. The most common acute low back pain cases are brought on from injury to the:

• Muscles
• Ligaments
• Joints
• Discs

The body also reacts to injury by triggering an inflammatory response. Inflammation can cause severe pain. The key is relaxing the muscles and keeping them loose.

Lower back pain causes

The most common cause is muscle spasms, which can be triggered by:

• Constant improper posture
• Repetitive and overuse motions
• Chronic inflammation brought on by underlying condition/s
• Quick awkward movements like twisting, reaching, and/or bending at the wrong angle can set off pain symptoms.
• If the same back muscles are getting strained and/or pulled continuously, this could indicate an underlying problem with a misaligned vertebra.

Correct improper postures

Improper posture and body positioning eventually present with discomfort and pain. Individuals are constantly hunched over and slumped in front of computers and devices, along with sitting with crossed legs, sleeping on a non-supportive mattress, and there is a perfect recipe for low back pain. Adjusting sitting, desk, and computer ergonomics and using smart devices with posture awareness will go a long way to correct improper posture. 

Stretch and loosen tight muscles

Stretch out throughout the day and before going to bed. Sitting all day at work, then going home and sitting all evening is not healthy for the body's muscles. The muscles shorten, as do the ligaments and tendons. Stretching keeps the body loose and limber. Try out different forms of stretching, as well as foam rolling for the back.

Get the body moving

Cramped or pulled muscles need time to recover. Too much rest or being completely inactive makes sense but is not recommended. Light movement keeps the blood flowing, especially in and around the injured/sore area. This increases healing and shortens recovery time.  Just some light walking is recommended. Getting up and moving while relaxing around the house will get the muscles back in shape.

Body Composition

Benefits of collagen

Gastrointestinal Health

Collagen generates a protective barrier effect on the intestinal mucosa that lines the digestive tract. One study found that collagen supplementation protects against the breakdown of the intestinal wall after a burn injury. A lack of collagen from aging or other factors could impair the structure of the intestinal mucosa. This could lead to digestive problems like leaky gut syndrome and irritable bowel syndrome.

Joint Health and Mobility

Collagen provides structure and cushion in the joints. As the body ages, the cushion wears down, and joint mobility decreases. This increases the risk of injury. Taking collagen supplements can help improve symptoms of osteoarthritis, rheumatoid arthritis, and other conditions.

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, licensed physician and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Finta, Regina et al. “The effect of diaphragm training on lumbar stabilizer muscles: a new concept for improving segmental stability in the case of low back pain.” Journal of pain research vol. 11 3031-3045. 28 Nov. 2018, doi:10.2147/JPR.S181610

Lugo, James P et al. “Efficacy and tolerability of an undenatured type II collagen supplement in modulating knee osteoarthritis symptoms: a multicenter randomized, double-blind, placebo-controlled study.” Nutrition journal vol. 15 14. 29 Jan. 2016, doi:10.1186/s12937-016-0130-8

National Institute of Neurological Disorders and Stroke. Pain: Hope Through Research. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Hope-Through-Research/Pain-Hope-Through-Research. June 9, 2017.

Many individuals do not realize the importance of the type of pillow they use for sleep. Sleeping on the wrong pillow is the perfect set-up for neck, shoulder, and back pain. Here are a few chiropractic tips on what to know about picking the best pillow. Knowing which is the right pillow for you can be the key to proper sleep and waking up pain-free.

Importance of Pillows

Neck and shoulder pain can be a nightmare, especially when the body cannot get decent rest. The right pillow/s can help with neck and back pain symptoms and recover from injuries quicker. When the head is in an awkward position for sleep duration, this causes neck, shoulder, and headache problems. The importance of finding the right pillow follows a set of guidelines.

Shape

The shape of the pillow has a definitive role in the cervical/neck's curvature.

Posture

Sleep posture is important in preventing neck, shoulder, and back musculoskeletal pain.

Sleep quality

Craniocervical pressures and cervical spine alignment are height-specific. Any changes can affect an individual's sleep quality.

Height

Cervical alignment can become significantly impacted by the shape and height of the pillow.

Pillow Comfort Importance

Trying to find the right pillow will require trial and error. The basics to consider include:

• One sign that it’s time for a new pillow is waking up with pain.
• Age of current pillows. The recommendation is they should be replaced every year or two. This depends on the stuffing/material used as different types wear down quicker.
• If problems are getting comfortable and being able to fall asleep.
• Constantly readjusting or fluffing the pillow/s.
• The pillow has become lumpy or lost its shape.
• It is flat with no cervical support or, too high placing the head in a forward tilt.
• A new pillow to consider are those that control temperature.
• Cooling pillows are made to prevent heat retention. If a warm/hot pillow is keeping you up at night.

Temperature affects sleep quality.

• Tossing and turning all night means loss of sleep.
• The frustrating, angry, shifting movements can aggravate back and neck pain/issues.
• Consider bed linens and pillowcases that cool the body.

Pillow Types

Today's pillows are made from a variety of materials. Learning about the different kinds of materials can help make an educated choice.

• Choose a retailer or brand that offers a guarantee or fair return/exchange program.
• If the pillow isn’t right, you can return it and try another type.

Memory Foam

• This material is polyurethane that has been combined with certain chemicals to make it viscoelastic.
• These pillows return to their shape, can stretch and conform to the curves of the body.
• Different kinds of memory foam include Open cell, Egg crate, and Gel.
• They will mold to the contour of the spine, helping with misalignments.

Down Pillows and Down Alternative/polyfill

• These pillows are generally softer.
• They are made from actual down feathers or a non-allergic synthetic alternative that feels like real down.
• There is not a great deal of firmness, but they are a good option because they are soft and workable.

Latex

• These can be natural or synthetic latex, also known as rubber pillows.
• They offer soft cushioning and proper support.
• The latex is generally shredded, meaning it can be customized with more or less filling depending on the individual's needs.

Combo style

• There are combination pillows that could have a foam core with down around it for comfort and support.
• Gel cores are common, specifically in cooling pillows.

How to Choose

Tips and things to keep in mind include:

• Does it conform to the shape of your neck and spine?
• How soft is it?
• Is the pillow stiff?
• Is it too high?

Remember the importance of sleeping positions. Back, side, or stomach. Pillows that match an individual's sleeping position criteria:

• Back sleepers are recommended to use a medium-thick pillow. This keeps the head, neck, and spine properly aligned.
• Side sleepers are recommended to use a slightly thicker, firmer pillow for proper alignment.
• Stomach sleepers are a challenge because of the strain placed on the pelvis and lower back. An almost flat pillow is recommended.

Shopping

• If possible, try out the pillow before buying it.
• Most stores will allow this, and some companies take it further.
• For example, The Sleep Number company offers a service called PillowFit.
• This is an online quiz along with a personalized process in their stores.
• The process helps choose a pillow based on individual support preferences and sleep position for the best spinal alignment.
• Customizable or adjustable pillows are another option. These pillows allow the individual to change the amount of filling to fit their needs.
• Research, personal preference, and advice from a doctor and or chiropractor will help find the pillow that is right for you.
• A third of an individual's life is spent in bed, make it as comfortable as possible.

Body Health

Sleep Body Composition Importance

Not getting enough sleep makes it difficult to gain muscle.

• Not getting enough sleep means that the body experiences less short wave sleep, affecting the body's ability to secrete Growth Hormone and develop muscle.
• Testosterone is negatively affected by lack of sleep.
• Not enough sleep increases cortisol levels, impairing muscle development.

Not getting enough sleep makes it difficult to lose fat.

• Irregular sleep throws off the body's ghrelin/leptin cycles, causing hunger.
• Not getting enough sleep has been linked to eating more.
• Not getting enough sleep can cause reductions in the body's Basal Metabolic Rate, reducing total energy output.
• Tiredness reduces spontaneous movements.

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, licensed physician, and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

“Effect of sleep posture on neck muscle activity.” Journal of Physical Therapy. June 2017. https://pubmed.ncbi.nlm.nih.gov/28626314/

“Effect of pillow height on the biomechanics of the head-neck complex: investigation of the craniocervical pressure and cervical spine alignment.” PeerJ. August 2016. https://pubmed.ncbi.nlm.nih.gov/27635354/

“How Often Should You Replace Your Pillows?” Sleep Foundation, Seattle, WA. https://www.sleepfoundation.org/bedding-information/how-often-should-you-replace-your-pillows

“Improving the quality of sleep with an optimal pillow: a randomized, comparative study.” Tohoku Journal of Experimental Medicine. July 2014. https://pubmed.ncbi.nlm.nih.gov/25008402/

“The effects of pillow designs on neck pain, waking symptoms, neck disability, sleep quality and spinal alignment in adults: A systematic review and meta-analysis.” Clinical Biomechanics. May 2021. https://pubmed.ncbi.nlm.nih.gov/33895703/

Okamoto-Mizuno, Kazue, and Koh Mizuno. “Effects of thermal environment on sleep and circadian rhythm.” Journal of physiological anthropology vol. 31,1 14. 31 May. 2012, doi:10.1186/1880-6805-31-14