 Your new post is loading...
Your new post is loading...
El Paso, TX. Chiropractor Dr. Alexander Jimenez presents an introduction to the cerebellum. The brain is a complex structure that has billions of nerve cells. The basic anatomy is easily understandable. But there is one part of the brain, the cerebellum, which is involved in virtually all movement. This is the part of the brain that helps a person drive, throw a ball, or walk across the street. Problems with the cerebellum are uncommon and mostly involve movement and coordination difficulties. This article will give an overview of the anatomy, purpose, and disorders of the cerebellum, as well as, how to keep the brain healthy. FAGIOLINI ET AL. EPIGENETIC INFLUENCES ON BRAIN DEVELOPMENT AND PLASTICITY CURR OPIN NEUROBIOL, 2009 - “Enhancing plasticity in the adult brain is an exciting prospect and there is certainly evidence emerging that suggest the possible use of epigenetic factors to induce a “younger” brain.”
- “Recent findings support a key role of epigenetic factors in mediating the effects of sensory experience on site-specific gene expression, synaptic transmission, and behavioral phenotypes.”
TAYLOR ET AL. CUTTING YOUR NERVE CHANGES YOUR BRAIN BRAIN, 2009 - “Animal studies have established that plasticity within the somatosensory cortex begins immediately following peripheral nerve transection, and that 1 year after complete nerve transection and surgical repair, cortical maps contain patchy, noncontinuous representations of the transected and adjacent nerves.”
- “Here, we have demonstrated for the first time that there is functional plasticity and both grey and white matter structural abnormalities in several cortical areas following upper limb peripheral nerve transection and surgical repair.”
THE CEREBELLUM IMPORTANT FUNCTIONAL AREAS OF THE CEREBELLUM -
Spinocerebellum -
Vestibulocerebellum -
Cerebrocerebellum SPINOCEREBELLUM -
Responsibilities: - Regulation of muscle tone for posture and locomotion
- Balance
-
Patient Complaints: - Difficulty with balance
- Difficulty walking in the dark
- Difficulty going down stairs
- Sway to one side while walking
-
Examination Findings: - Wide based gait
- Sway in Romberg’s position
http://www.neuroexam.com/neuroexam/content.php?p=37 WHAT DO YOU SEE? WHAT CAN YOU DO? -
Have the patient perform balance exercises: - Practice Romberg’s
- Practice one leg standing
- Bosu Ball exercises
- Foam Pad exerscises
- Balance Board exercises
-
Increase core stability: - Plank’s
- Yoga
-
Increase proprioception: - Adjust!
- But which side?
VESTIBULOCEREBELLUM - Responsibilities:
- Regulation of vestibular system
- Regulation of balance
- Assistance with eye movements (encoding retinal slip)
-
Patient Complaints: - Postural muscle fatigue
- Dizziness
- Disorientation
- Difficulty riding in a car
- Nausea
-
Examination Findings: - Wide based gait
Sway in Romberg’s position - Nystagmus
- Impaired VOR
- Impaired smooth pursuits
- Hypermetric Saccades
http://www.neuroexam.com/neuroexam/content.php?p=37 VOR WHAT DO YOU SEE? EYE MOVEMENT REVIEW WHAT CAN YOU DO? -
Have the patient perform gaze stability exercises: - Sit arms length away
- Fixate on dot
- Rotate head in different directions
-
Rotation exercises: - Activate VOR
- Activate side less active
-
Provide OPK stimulation: - Which side do you stimulate?
CEREBROCEREBELLUM - Responsibilities:
- Coordination of fine movements
- Coordination of speech
- Coordination of thought
-
Patient Complaints: - Clumsiness with hands
- Clumsiness with feet
- Tripping over feet
- Hand shaking with intention
-
Examination Findings: - Intention tremor
- Termination tremor
- Dysmetria
- Dysdiadochokinesia
http://www.neuroexam.com/neuroexam/content.php?p=37 WHAT CAN YOU DO? - Have the patient perform coordinated movements!
- Example: piano playing, finger taping, finger to nose, etc.
TAYLOR ET AL. CUTTING YOUR NERVE CHANGES YOUR BRAIN BRAIN, 2009 - “Animal studies have established that plasticity within the somatosensory cortex begins immediately following peripheral nerve transection, and that 1 year after complete nerve transection and surgical repair, cortical maps contain patchy, noncontinuous representations of the transected and adjacent nerves.”
- “Here, we have demonstrated for the first time that there is functional plasticity and both grey and white matter structural abnormalities in several cortical areas following upper limb peripheral nerve transection and surgical repair.”
By RYAN CEDERMARK, RN BSN MSN DC DACNB
El Paso, TX. Chiropractor, Dr. Alexander Jimenez discusses the anatomy of nerve fibers, receptors, spinal tracts and brain pathways. Regions of the Central Nervous System (CNS) coordinate various somatic processes using sensory inputs and motor outputs of peripheral nerves. Important areas of the CNS that play a role in somatic processes are separated in the spinal cord brain stem. Sensory pathways that carry peripheral sensations to the brain are referred to an ascending pathway, or tract. Various sensory modalities follow specific pathways through the CNS. Somatosensory stimuli activate receptors in the skin, muscles, tendons, and joints throughout the entire body. The somatosensory pathways are divided into two separate systems based on the location of the receptor neurons. Somatosensory stimuli from below the neck run along the sensory pathways of the spinal cord, and the somatosensory stimuli from the head and neck travel through cranial nerves. ANATOMY OF RECEPTORS, NERVE FIBERS, SPINAL CORD TRACTS AND BRAINSTEM PATHWAYSRECEPTORS AND RECEPTOR BASED THERAPYNEURONS NEED THREE THINGS TO SURVIVE!FUNCTIONAL NEUROLOGY KEY CONCEPTSThe cell needs three things to survive. - Oxygen, glucose and stimulation.
- Stimulation = Chiropractic, exercise, etc.
- Stimulation leads to neuronal growth
- Neuronal growth leads to plasticity
- Subluxations alter the frequency of firing of neurons
- Activation of one side will stimulate ipsilateral cerebellum and contralateral cortex (usually)
- Proper stimulation CAN reduce pain.
CHIROPRACTIC IS RECEPTOR-BASED THERAPYINTRODUCTION- The ongoing activity and output of the CNS are greatly influenced, and sometimes more or less determined, by incoming sensory information.
- The basis of this incoming sensory information is an array of sensory receptors, cells that detect various stimuli and produce receptor potentials in response, often with astonishing effectiveness.
- The health of the neuron, however, plays a huge role in how neurons can produce receptor potentials, the endurance of the neuron and the ability to create plasticity.
- ”Neurons that fire together, wire together.” Hebbian Theory
TYPES OF RECEPTORS- Chemoreceptors
- Smell, taste, interoceptors
- Thermoreceptors
- Temperature
- Mechanoreceptors
- Cutaneous receptors for touch, auditory, vestibular, proprioceptors
- Nociceptors
- Pain
PARTS OF RECEPTORSAlthough their morphologies vary widely, all receptors have three general parts: 1. Receptive Area
2. Area Rich In Mitochondria - Health of the neurons within the receptors will determine its response to stimulation
3. Synaptic Area To Pass Messages To The CNS RECEPTIVE FIELDS- These are particular areas in the periphery where application of an adequate stimulus causes the receptors to respond.
- Neurons in successive levels of sensory pathways (second- order neurons, thalamic and cortical neurons-also have receptive fields, although they may be considerably more elaborate than those of the receptors.
TRANSDUCTIONSensory receptors use ionotropic and metabotropic mechanisms to produce receptor potentials - Sensory receptors transduce some physical stimulus into an electrical signal – a receptor potential – that the nervous system can understand.
- Sensory receptors are similar to postsynaptic membranes as their adequate stimuli are analogous to neurotransmitters.
THE DIAMETER OF A NERVE FIBER IS CORRELATED WITH ITS FUNCTIONBIGGER = FASTERLarger fibers conduct action potentials faster than do smaller fibers. - Aα fibers are the largest and most rapidly conducting myelinated fibers.
- The slowest conducting fibers of the body are the C fibers
RECEPTORS IN MUSCLES AND JOINTS DETECT MUSCLE STATUS AND LIMB POSITIONMUSCLE SPINDLESMuscle spindles (Fig. 9-14) are long, thin stretch receptors scattered throughout virtually every striated muscle in the body. - These muscle spindles sense muscle length and proprioception (“one’s own” perception).
- They are quite simple in principle, consisting of a few small muscle fibers with a capsule surrounding the middle third of the fibers.
- These fibers are called intrafusal muscle fibers (fusus is Latin for “spindle,” so intrafusal means “inside the spindle”), incontrast to the ordinary extrafusal muscle fibers (“outside the spindle”).
- The ends of the intrafusal fibers are attached to extrafusal fibers, so whenever the muscle is stretched, the intrafusal fibers are also stretched.
- The central region of each intrafusal fiber has few myofilaments and is noncontractile, but it does have one or more sensory endings applied to it.
- When the muscle is stretched, the central part of the intrafusal fiber is stretched, mechanically sensitive channels are distorted, the resulting receptor potential spreads to a nearby trigger zone, and a train of impulses ensues at each sensory ending.
GOLGI TENDON ORGANS- Golgi tendon organs are spindle-shaped receptors found at the
- junctions between muscles and tendons. They are similar to Ruffini endings in their basic organization, consisting of interwoven collagen bundles surrounded by a thin capsule (Fig. 9-16).
- Large sensory fibers enter the capsule and branch into fine processes that are inserted among the collagen bundles. Tension on the capsule along its long axis squeezes these fine processes, and the resulting distortion stimulates them.
- If tension is generated in a tendon by making its attached muscle contract, tendon organs are found to be much more sensitive and can actually respond to the contraction of just a few muscle fibers.
- Thus Golgi tendon organs very specifically monitor the tension generated by muscle contraction and come into play whe
- n fine adjustments in muscle tension need to be made (e.g., when handling a raw egg).
- Thus the mode of action of Golgi tendon organs is quite different from that of muscle spindles (Fig. 9-17). If a muscle contracts isometrically, tension is generated across its tendons, and the tendon organs signal this; however, the muscle spindles signal nothing because muscle length has not changed (assuming that the activity of the gamma motor neurons remains unchanged).
- In contrast, a relaxed muscle can be stretched easily, and the muscle spindles fire; the tendon organs, however, experience little tension and remain silent. A muscle, by virtue of these two types of receptors, can have its length and tension monitored simultaneously.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4668288/ https://www.ncbi.nlm.nih.gov/pubmed/23709641 By RYAN CEDERMARK, DC DACNB RN BSN MSN
Neuroembryology: As an embryo all of the cells in the body are identical. But as time passes, some cells develop into neurons and others develop into skin, hair, or muscle cells. Why do some cells become neurons? How do neurons become organized in the spinal cord and brain in order to allow us to walk, talk, see, recall life events, feel pain, keep balance, and think? The answers will help us understand how we develop from an embryo into a full-grown person and how our body and brain constantly adapts, throughout our lives to the environments changes. El Paso, TX. Chiropractor, Dr. Alexander Jimenez discusses neuroembryology, with the intent of educating patients, past and present, and the general public about the how the spine is connected to everything and where everything begins. INTRODUCTION- Focusing attention on the development of the nervous system can increase a clinician's insight into brain functionality and treatment possibilities.
- Dysfunctions that may be associated with developmental abnormalities of the brain may range from a mild reduction in cortical function to conditions such as autism and schizophrenia.
- The development of the nervous system is influenced by both endogenous and exogenous mechanisms.
- Endogenous referring to genetics, exogenous referring to the embryo’s environment.
- Development is an ongoing process....NEUROPLASTICITY
Neuroembryology: DEVELOPMENT- Development of the nervous system can first be identified at about 3 weeks after conception.
- At 3 weeks, in response to underlying chemical signaling from the mesoderm, the neural plate forms, which quickly transitions into the neural groove.
- At the beginning of the 4th week, the two folds forming the neural groove begin to fuse starting the formation of the neural tube
- Fusion proceeds cranially and caudally and the entire neural tube is closed by the end of the 4th week.
- This process is known as primary neurulation.
- As the neural tube closes, it progressively separates from the ectodermal surface and leaves behind neural crest cells.
- Neural crest cells develop into the PNS.
- The neural tube develops into virtually the entire CNS.
- A longitudinal groove forms on the lateral wall of the neural tube during the fourth week of development
- This is known as the sulcus limitans, which separates the tube into dorsal and ventral halves.
- The gray matter of the dorsal half forms an alar plate and the ventral half forms a basal plate.
- This distinction is of great functional importance because the alar plate plays a role in sensory processing and the basal plate plays a role in motor output.
- This similarity is seen in the adult spinal cord with the posterior gray matter receiving sensory input and the anterior gray matter producing motor output.
THREE PRIMARY VESICLES- Prosencephalon
- Mesencephalon
- Rhombencephalon
FIVE SECONDARY VESICLES- Telencephalon
- Diencephalon
- Mesencephalon (remains unchanged)
- Metencephalon
- Myelencephalon
ESTABLISHMENT OF NEURONAL CONNECTIONS- Neurons may have innate predetermined programs that lay out the basic patterns of connections to be formed initially in their development.
- Theoretically, neurons gravitate to areas of attraction and move away from areas of repulsion – Chemoaffinity hypothesis
- Several mechanisms allow axons to accurately find their way to their target destinations:
- Selective axonal fasciculation
- Axon substrate interactions
- Axonal tropisms
- Gradient effects
SYNAPTOGENESIS- Synaptogenesis
- The formation of synapsis between neurons.
- This is VERY important during the embryological development for good neuronal growth
- Based on the laws of plasticity, if you don’t use it, you will lose it (or never really get it).
NEUROPLASTICITY - There is both good and bad plasticity.
- Good plasticity is adaptation to positive environmental stimulation.
- Bad plasticity can be related to insult or injury to the nervous system or chronic pain pathways.
By RYAN CEDERMARK, DC DACNB RN BSN MSN
Allergy Sufferers! As winter gives way to spring, seasonal allergies can really get you down. Whether you get a few sniffles and some sneezing or you are down for the count with every terrible allergy symptom known to man, it can make spring pretty unbearable. There is no shortage of allergy medications on the market, but they come with their own issues. The majority of them cause drowsiness and other unpleasant side effects, leaving you barely able to function. Those that are made from a “non drowsy” formula sound great, but if you have certain health conditions, like high blood pressure, you are out of luck – and stuck either taking the ones that make you sleep sucking it up and dealing with your allergies sans medication. That’s no way to live. What Are Allergies?When your immune produces histamines in response to an allergen that you encounter the physiological reaction that you experience is broadly referred to as allergies or hay fever. The allergens may be simple substances that normally do not affect people, but when your body is out of balance, it can cause a variety of problems. Symptoms of allergies include: - Runny nose
- Stuffy nose
- Headache
- Sneezing
- Itchy eyes
- Coughing or scratchy throat
- Skin Rash or Hives
- Swelling
- Diarrhea
- Nausea
- Fatigue
Anaphylaxis, severe, life threatening allergies can include swelling of the airways, tongue, and throat, inability to breathe due to blocked airway, and other dangerous symptoms. The allergens can be something you come in contact with, like poison ivy, something you breathe in, like mold or dust, or it can be something you ingest, like strawberries or peanuts. Different people will have different allergies, but those who are allergic to the same things may not have the same reaction. Often a doctor or allergist will diagnose your allergies. Chiropractic Care For Allergy SufferersChiropractic treatments have been found to be very effective for relieving allergy symptoms and even stopping allergies at their source. It reduces the severity of allergy symptoms as well as the frequency of occurrence. It does not work like allergy medications which have an anti-histamine effect and only work as a short term fix for your allergy symptoms. Chiropractic treatments help your body become more balanced so that it is better equipped for combating allergies at the source. When your spine is not aligned it can impact your nervous system leading to a variety of problems – including allergies. Your immune system can be affected, causing it to malfunction. A chiropractor can help relieve the stress on your nervous system by aligning your spine. This takes the pressure off of nerves, allowing your immune system to function at a more optimal level. This makes it easier for your body to ward off infections while recognizing allergens as harmless. When your immune system encounters allergens it doesn’t overreact to them. Instead, the reaction is much more subdued, or even nonexistent. Chiropractic has also been found to help asthma patients breathe easier. Asthma symptoms are diminished. Chiropractic care is more than just spinal manipulation, though. It promotes whole body wellness. Patients are taught exercise, stress relief, and nutrition so that the entire system is treated. The whole body treatment plan for chiropractic patients will help you be allergy free in a short time. It is important to follow your chiropractic plan thoroughly and consistently. Get plenty of rest and take time to destress. The more you can relax and take care of yourself, the healthier you will be overall. Chiropractic care can help so many health conditions; it can actually make you healthier. Allergy sufferers or if you are struggling with allergies for the first time, give chiropractic care a try you just might be surprised.
Hydration: There is no denying that a healthy diet is integral to overall wellness and staying hydrated is absolutely vital. Every organ, every cell in your body contains water. In fact, when you don’t drink enough water and keep your body properly hydrated, it does not function as it should. The health of your spine and back depends heavily on whether you are properly hydrated. In fact, if you don’t drink enough water plain, pure water, it could affect your back, causing pain and limiting mobility. HydrationOverview Of Spinal ConstructionTo understand water’s role in spinal health, you first need to understand how the spine is constructed. The row of bones that make up the spine are called vertebrae. Between each vertebrae is a disc. This disc works like a shock absorber so as you bend, flex, and move about the disc provides a buffer so the bones do not rub together. Each disc is comprised of two parts. The center of the disc is the nucleus pulposis. It is made up mostly of water. The nucleus pulposis is surrounded by a tough, flexible ring that contains a gelatinous substance. It protects the inner area which is the cushion for the vertebrae. Two factors that further complicate the rehydration of the discs are aging and sedentary lifestyles. How Water Is Good For Your BackAs you go about your daily activities, each time you move, the spine compresses the disc, squeezing out the water within. Even walking or sitting upright can cause this as gravity causes the spine to compress. When the disc does not have adequate water, the result is pain and lack of mobility as well as increased risk of spinal injury. When you are not properly hydrated your body cannot replenish the water in the discs, causing them to remain compressed. Beverages like soda are not adequate for effective hydration. You need to make sure that you drink enough water every day. For years we were told that 8 eight ounce glasses of water a day was the rule for proper hydration, and that works for many people. However, an article in the Harvard Health Letter suggests that the body can be properly hydrated with 30 to 50 ounces of water a day. The article goes on to suggest that water can also be found in foods like spinach, watermelon, soups, and lettuce are also good sources for hydration. Spinal Problems Caused By DehydrationWhen the body is dehydrated the discs remain compressed instead of refilling. When that happens the overall function of the spine is compromised. Your constant back pain may actually be caused by dehydration. When the discs cannot refill they can’t do their job. This leads to immobility and a compromised range of motion. Hydration also plays an important role in how the cerebrospinal fluid moves and works. While it does require more than water to function properly, water does play an important role. When the body is dehydrated this fluid cannot move as it should which can even affect brain function. On a larger scale, when the body is dehydrated it begins to retrieve water from other parts of the body so it can reroute it to the vital organs and sustain life. The extremities are the first places it pulls water from and the spine is another. When it deprives the spine of water in order to supply the organs then you remain in a constant deficit which can cause pain and mobility problems. How The Spine RehydratesAs the body rehydrates itself, it does not assign the spine as a priority. The vital organs take precedence so the spine basically gets what is left over. If there is already a deficiency present, then there is nothing left over to rehydrate the spine. When there is adequate water in the body, normal activity and movement aids in the rehydration of the discs. The most significant rehydration occurs while you sleep though. When you lie down and rest your body is best able to initiate the process of rehydrating your spinal discs via osmosis. Chiropractic care is another way to adjust the spine and encourage the refilling of the discs. That depends, of course, on proper water intake. Be good to your spine; it’s the only one you have.
Chiropractic care for spinal disc problems is steadily increasing in popularity. As more and more research proves the effectiveness for chiropractic for these types of problems, doctors and therapists are incorporating it into treatment plans for their patients. Spinal disc problems can be debilitating, causing significant pain and severely limiting mobility. Degenerative disc disease is one of the most common spinal problems, causing back pain that, like other spinal conditions, can extend into the hip and leg or even the arm and hand. It is caused by degeneration or thinning of the spinal joints or discs which can disrupt the mechanics of the spine and contribute to bulging discs that press on spinal nerves. Traditional treatment of this condition usually consists of strong pain medication and sometimes surgery. Patients who are dealing with pain from discs that are bulging or ruptured as well as herniated, or slipped discs, do respond well to chiropractic care. Where surgery has long been a primary medical answer to pain relief for these spinal conditions, chiropractic treatments offer a nonsurgical alternative that has been shown to be very effective. Most spinal or disc problems are marked by a specific set of symptoms including neck and back pain, stiffness, arm pain, leg pain, and tenderness in the spinal muscles or the spine itself. Other more serious symptoms can present at the onset of the condition or over a period of time. These symptoms indicate a dangerous problem that could even be life threatening; they include: - Back pain accompanied by fever
- Loss of control of bladder or bowel
- Severe weakness that inhibits the ability to use arms, legs, walk, etc.
- Loss of sensation in both arms and/or both buttocks
- Inability to defecate or urinate
More serious or life threatening symptoms may require medical intervention, but most spinal conditions can be helped or even corrected with chiropractic care. Through the careful, precise manipulation of the spine, a chiropractor can make adjustments to the body that help relieve the pain and pressure. This treatment can halt the debilitating progression of certain spinal problems while relieving pain and increasing mobility. Spinal problems are usually diagnosed by a combination of complete physical examination and a thorough patient history. During the examination the patient’s musculoskeletal and nervous systems are carefully assessed. A doctor of chiropractic will examine the patient by moving the patient into different positions using their legs, arms, and back while applying pressure to the joints. Other diagnostic tools include x-rays and magnetic resonance imaging (MRI). The preferable course of treatment for spinal problems is more conservative in nature. The earlier the problem can be diagnosed and treatment can begin, the better. There are several different treatments that a doctor of chiropractic may do to control and treat the pain. Modalities such as heat and ice applied to the affected area have been proven effective in controlling injury related pain in the lower back. Movement is also crucial to healing and the sooner the patient gets back on their feet, the better. For most injuries or back problems, those problems are exacerbated when the patient stays in bed or coddles their back instead of walking and moving. It can result in long term back problems. Spinal manipulation by a doctor of chiropractic has been proven to be an effective, safe treatment for disc problems and associated pain. In some cases therapeutic exercise may be added to the treatment and this too has been shown to be very effective. In most cases, chiropractic care is sufficient and surgery of the spine or injections are unnecessary to manage the problems. In fact, these more invasive therapies often create more problems than they cure. Chiropractic care should be the first course of action for spine related pain, injury, or problems. So if you or a loved one are suffering from spinal disc problems, make sure you give us a call. We’re here to help!
The autonomic concomitants of cervical pathomechanics
(the posterior cervical sympathetic syndrome) have been
widely reported. The literature documenting the autonomic
manifestations of thoracic and lumbar articular dysfunctions
has not been as extensive. The present study
attempts to determine the incidence and nosography of
vertebrogenic autonomic dysfunction (V.A.D.) in a sample
of 250 consecutive back pain subjects. Thirty-nine per cent
of all back pain subjects exhibited probable evidence of
V.A.D. The incidence of V.A.D. was distributed as follows:
cervicogenic cephalalgia - 60%76 (i.e., disturbed
vision, dysequilibrium, gastrointestinal upset); thoracalgia
- 54% (ie., nausea, flatus); and lumbalgia - 31% (i e.,
constipation, urinary frequency, menstrual disturbances). It is a well known clinical fact that diseases of the internal
organs may produce functional changes and symptoms
or signs in the musculoskeletal system of the body. These
somatic manifestations of visceral disease are fairly commonplace
and are considered to be of importance in the
diagnosis and localization of internal disease. All clinicians
have observed the conspicuous costovertebral angle muscle
spasm resulting from acute renal disorders (1). Abdominal
wall tension and tenderness are characteristic of certain
intra-abdominal and intrapelvic diseases (2-7). Coronary
disease is frequently accompanied by painful trigger areas
in the muscles of the chest and shoulder (8-9).
The premise that disorders of the musculoskeletal
system may reflexly cause autonomic dysfunction and
symptoms attributable to visceral malfunction is common
to both the chiropractic (10) and osteopathic schools (11),
but is not widely accepted by the medical profession. Physiologic
research, based primarily on animal experimentation,
has demonstrated that somatovisceral reflex activity
is indeed a physiologic fact (12-19); however, much remains
to be done to understand the importance of these
reflexes in normal and abnormal human physiology. The
literature of the osteopathic and chiropractic disciplines
has historically contained an abundance of anecdotal and
conceptual data in support of the somatovisceral reflex
hypothesis as a mechanism for symptom production in
man. Very little controlled clinical data has been presented
to support this hypothesis. Palmer in 1895 (20) was probably one of the first to
report a simple cause and effect relationship regarding
somatovisceral symptom production in a patient. His subject
had apparently been working in a cramped position
and felt something "give in his back." He claimed that he
simultaneously became deaf. Palmer examined the
patient's spine and found a "displaced fourth dorsal vertebra"
(sympathetic vasomotor nerves to the cranium) and
corrected it with a manipulation. The patient's hearing
was restored. Palmer thus deduced that the hearing loss
had been vertebrogenic in origin. Three decades later, the allopathic observers, Barre in
1925 and Lieou in 1928, reported similar series of cases in
which disorders of the cervical spine were accompanied by
dysfunction of the organs of the head (21,22). In addition
to hearing loss, the following cervicogenic symptoms have
been observed: vertigo, dysequilibrium, tinnitus, scotomata,
decreased vision, dysphagia, dysphonia, cough, anxiety
and asthenia. (23) The Barr6-Lieou syndrome (posterior cervical sympathetic
syndrome) has been repeatedly recorded in the literature
since 1928. This syndrome represents a generally
accepted classic example of somatovisceral reflex
pathology and is to be found in much of the authoritative
orthopaedic literature of today (24). Reports of somatically-induced visceral dysfunction have
not been confined to the cervical region, nor have they
been restricted to the literature of the chiropractic and
osteopathic schools. This is noteworthy, insofar as allopathic
training does not usually emphasize (or even include)
studies of somatovisceral reflex physiology. One
would therefore expect that allopathic observers would
approach their clinical observations with an absence of
bias and a low index of suspicion for somatovisceral
pathology. Nevertheless, such disorders have been obvious
enough to be noted and reported. Table 1 summarizes allopathic
observations in this regard as reported by Wills
(25), Ussher (26), Travell (27,28,29), Jackson (24), Cooper
(30), Lewit (31), Ushio et al (32), Love (33) and Ver Brugghen
(34). The literature cited here would tend to indicate that
somatically induced visceral dysfunction and symptom
production is indeed a clinical problem. The prevalence of
the problem is not known. The investigators reviewed in
Table 1 have for the most part, not attempted to discover
the percentile incidence of autonomic symptoms in musculoskeletal
disease, nor have they made it clear whether
their data was based on consecutive groups of first-contact
patients or on treatment-resistant subjects who were referred
to their departments for special care. The purpose of this investigation was to determine the frequency of symptoms attributable to vertebrogenic autonomic dysfunction in a consecutive group of first-contact chiropractic patients. MethodA pilot study, of the prospective-descriptive format, was designed. The focus of the study was on the anamnesis, with particular attention given to the sequence of clinical events. (For example, do patients with back pain simultaneously develop autonomic symptoms? If so, how often? 52 Do the autonomic symptoms disappear upon recovery from the spinal pain?) The emphasis then, was on seeking a parallelism between the development and disappearance of back pain with the development and disappearance of visceral symptoms. Inclusion/Exclusion and Data Gathering:The following guidelines for data gathering were adhered to throughout the study: 1. Two hundred and fifty consecutive first-contact patients who presented with back pain (cervical, thoracic or lumbar) comprised the sample for analysis. 2. After a thorough case-history was obtained from each subject, careful notation was made of associated symptoms. The phrasing of this latter aspect of the interview was as follows: "Have you, since the onset of your back pain, developed any other seemingly unrelated symptoms for example, have you felt generally ill? Have you been constipated? Have you had to empty your bladder more frequently - or less frequently?" Usually, four or five examples of known vertebrogenic symptoms were mentioned. See Table 1. A systems review followed. As additional symptoms were uncovered, it was determined whether or not their onset in any way paralleled the onset of back pain. 3. The patient was not given a r6sume prior to the beginning of treatment for his back pain. No further comment was made regarding the subject's visceral symptoms, if present. No mention was made of any relationship between the spinal pain and the visceral symptoms. A chart of the autonomic nervous system was removed from the office. The patient was not told that analytical data was being gathered. The attempt here was to limit, as much as possible, the introduction of accentuated placebogenic and/or Hawthorne effects (35) into the study. 4. The subjects who were accepted as chiropractic patients were treated with spinal manipulative therapy (primarily chiropractic high velocity, controlled amplitude adjustment). In some cases, ancillary physical therapeutic methods were utilized as indicated. Patients who were referred to other health disciplines for care (i.e. surgery) remained in the study providing that follow-up data were available. (This study was not designed to test the effectiveness of manipulative therapy its sole purpose was to investigate spinovisceral symptom parallelism see illustrative case 4.) 5. The subjects were re-evaluated when they became asymptomatic with respect to their back pain or were much improved (at least 80%o by mutual patient-examiner agreement). The patients were at this time questioned regarding the status of any associated visceral symptoms that had been previously reported. The observation that recovery from visceral symptoms paralleled recovery from the spinal pain was taken to be confirmatory evidence of vertebrogenic autonomic dysfunction in that subject. Subjects were excluded from the study for the following reasons: non-acceptance as a patient because of organic pathology or other contraindications, non-compliance, self-discharge from care, unsatisfactory recovery from the spinal complaint and incomplete admission or follow-up records. When a patient was dropped from the study, the next consecutive patient history was admitted to the data pool so that the target number of 250 subjects could be met. A survey of drug usage by patients in this study revealed the following: 52% of patients did not use drugs at all; 32% has self-administered approximately 1 to 6 non-prescription analgesic tablets (i.e. aspirin, codeine) and had subsequently sought professional care; 16% were on regular therapeutic dosages of physician prescribed or self-administered pharmaceuticals either for spinal pain or for other unrelated conditions. Most of the subjects who had used pharmaceuticals remained in the study. They were included or excluded after careful analysis of the individual data (see data analysis guidelines). Vertebrogenic Data Analysis:The presence or absence of vertebrogenic autonomic dysfunction (V.A.D.) was determined from the admission and follow-up records on each subject. The likelihood of vertebrogenicity was determined on the strength of the gathered data. The information on each case was then categorized as yielding probable, possible or negative evidence of vertebrogenic autonomic dysfunction. The guidelines for categorization were as follows: 1. Probable: Patients who exhibited an unequivocal parallelism between the onset and abatement of back pain with the onset and abatement of visceral symptoms were considered to have evidence of probable vertebrogenic autonomic dysfunction. 2. Possible: If there was any doubt regarding the accuracy of the gathered data (e.g. inconsistency of the subject's responses to questions) the findings were categorized as "possible V.A.D." If any discrepancies were noted in spinovisceral symptom parallelism, the data was considered to yield evidence of possible vertebrogenic autonomic dysfunction. For example, patients who fully recovered from spinal pains, but were left with vestiges of autonomic symptoms or patients who recovered from autonomic symptoms but were left with some spinal pain, were placed in the V.A.D. possible category. 3. Negative: Subjects who developed back pain but did not experience any symptoms attributable to autonomic dysfunction were classified as "V.A.D. negative". As stated in the previous section, data from patients who had used pharmaceuticals were individually scrutinized for inclusion or exclusion, and categorization. This analytical process would best be illustrated by the following examples: Case 1: This patient developed acute lumbalgia. He self-administered four 222 tablets® (total 32 mgs. codeine) on day 1 and presented here the next morning. He reported constipation as an associated symptom. The constipation resolved on day 3 although the lumbalgia continued. He remained in the study and was classified as "negative V.A.D." Case 2: This patient developed cervicalgia and self-administered 6 aspirin over day 1. She presented on day 2 and reported dizziness, gastric upset and flatus as associated symptoms. She discontinued her aspirin, but the autonomic symptoms persisted throughout the course of her treatment. All spinal and associated symptoms abated during the 3rd week. She remained in the study and was classified as "possible V.A.D." Case 3: This patient developed a severe cervical-brachial neuralgia. Her family physician prescribed Tylenol® and diazepam. She presented on day 10. She reported anorexia, nausea, flatus, blurred vision, dizziness and mental fogging as associated symptoms. On day 24 her cervicalgia and all associated symptoms had cleared, yet she remained on the prescribed medication. She was classified as "probable V.A.D." ResultsOf the original 250 subjects who met the criteria for admission to the study, 22 were subsequently lost (20 with self-discharges and/or poor results, 2 with organic disease found on continuing examination) and replaced by next consecutive patients. Ninety-eight (39%) of all subjects exhibited "probable" and thirty-three (13%) exhibited "possible" autonomic dysfunction. Also noteworthy was the observation that four (2%) of the subjects experienced reactivation (relapse) of previously quiescent visceral disease during their back pain episodes (2 duodenal ulcers, 2 lower genitourinary infections). The levels of spinal complaint fell into the following four categories: 1. cervicalgia with cephalalgia, 2. cervicalgia (with or without upper extremity pain), 3. thoracalgia, and 4. lumbalgia (with or without lower extremity pain). The frequency of autonomic dysfunction for each category is given in Table 2. The frequency distributions of the various autonomic manifestations observed are given in Tables 3 - 6. While Tables 3 - 6 give the frequency of symptoms observed in the present study, they do not give an accurate picture of vertebrogenic autonomic dysfunction as actually seen in clinical practice. Many of the subjects had multiple autonomic symptoms and these symptom complexes are not accurately portrayed by tables. The following case studies are instructive: Case 4: Mrs. F. presented with neck pain and headaches. She had sustained a whiplash injury 2 years previously and her symptoms had cleared with chiropractic therapy. Her present symptoms had recurred 2 months prior to her consultation here. She complained of a constant, moderate to severe upper cervical ache which radiated into the occipital-frontal regions. The cephalalgia occurred daily and intensified in the mid afternoon. She reported associated dizziness and difficulty in focusing her eyes. She could not clearly focus on close objects and stated that while driving, the windshield seemed to move back and forth in relation to her eyes. She was constantly squinting in an effort to see clearly. She had been seen by an optometrist 3 weeks previously with negative findings. On examination, cervical extension, right side-bending and left rotation were painful and limited. There was palpable paravertebral muscle spasm and restriction of motion in the upper cervical articulations. Trigger points were found here which reproduced the cephalalgia. Cervicogenic autonomic dysfunction was objectivated with the following manoeuvres: 1. Triggers: Firm pressure over the right lamina of C2 precipitated an immediate bout of blurred vision and diplopia. 2. Resisted Motion: Resisted cervical extension (with the head fixed so as to exclude vestibular motion) resulted in an episode of "swooning" and vertigo. 3. Cervical Torsion: The patient's head was fixed by an assistant (so as to exclude vestibular motion) and the torso was rotated, flexed, extended, side-bent and circumducted under the immobilized cranium. These maneuvers precipitated vertigo. Cervicogenic autonomic dysfunction was further confirmed by the therapeutic test. The patient was treated with the manual adjustment of the upper cervical spine. The results were as follows: 1. The initial manipulation caused a transitory aggravation of the dizziness and the visual symptoms. 2. This was quickly relieved by manual traction. 3. The patient was fully recovered from all articular (pain) and non-articular (autonomic) symptoms by the tenth office visit. She remained asymptomatic over a 4 month follow-up period. Case 5: Mrs. J. presented with low cervical, right scapular and right mid-thoracic pain of several months duration. There was associated dizziness, staggering and blurred vision. She had been referred to an ENT specialist who was non-commital in regards to a diagnosis. On examination, a trigger point was located on the antero-lateral aspect of C6-7 which reproduced her pain. The cervical torsion test was strongly positive the patient requiring support because of the precipitated vertigo. The lower cervical segments were adjusted and all symptoms abated after 5 visits. The patient has had several relapses over the ensuing months. Dysequilibrium has been a constant concomitant of each attack. Case 6: Mr. R. Complained of a constant, dull mid-thoracic ache of 3 weeks duration. The symptoms had occurred after the patient spent several days working in the stooped forward position. The patient also complained of nausea and a feeling of a "lump" in the epigastric region. He stated that his food remained in his stomach for several hours after ingestion. He regurgitated frequently and was troubled with belching and flatus. He occasionally had crampy abdominal pains. On examination, the spinous processes and right costotransverse articulations of T4 to T7 were exquisitely tender. There was rhomboid. spasm on the right and mid-thoracic motion was restricted. A single adjustment to this level was followed by immediate pain relief together with several minutes of massive gaseous eructation. All other symptoms cleared over the next few hours and did not recur over a 3 month follow-up period. Case 7: Mr. V. presented with acute lumbo-sciatica of one week's duration. The pain had occurred after a straight-legged lift. Mr. V. reported that since the occurrence of his injury he had been troubled with alternating bouts of constipation and diarrhea, urinary frequency, nocturia, partial urinary retention, impotence and "retraction" of the testes. He exhibited sciatic kyphoscoliosis. All trunk movements were limited and painful. Straight-leg raising, foot dorsiflexion and Valsalva maneuvers were positive. Deep springing of the L4 vertebra aggravated his pain. Sphincter tone was normal. A trial of manipulation afforded only temporary (hours-days) relief. The left Achilles reflex became sluggish and the patient was referred for neurosurgery. An L4 discotomy resulted in complete recovery from all spinal and visceral symptoms. Case 8: Mrs. R. presented with an acute lumbalgia which referred to the left groin. The pain had occurred 4 days previously and since that time she had been troubled with constipation, flatus, urinary frequency and a burning dysuria. Her urinalysis was negative for abnormality. Lower lumbar and left sacroiliac dysfunctions were corrected with manipulation. All symptoms had cleared by the fourth office visit. At the time of discharge from care, Mrs. R. asked if her bowel and bladder symptoms could have anything to do with the lower back. She stated that every time she had a lower back episode she developed the same pelvic symptoms. She, had had several unremarkable bowel, gall bladder and urinary investigations in regards to these symptoms. Discussion: Vertebrogenic Autonomic DysfunctionThe exact mechanism of spinovisceral symptom production is not conclusively known. Several pathophysiologic hypotheses could be advanced to explain these clinical phenomena. It is also possible that different pathological processes are operant in different individuals. Postulated mechanisms of spinovisceral symptom production are summarized below: Pain: The autonomic concomitants of severe pain are well known. They are due to mass sympathetic stimulation and include such symptoms as agitation, hyperhidrosis, pupillary dilation and vomiting. Stress-Endocrine: Selye (36) has pointed out that many disease states are accompanied by two groups of symptoms - the symptoms produced by the stressor and another group of symptoms resulting from the body's endocrinal defense responses to the stressor. Using the eosinophil count as a stress indicator, I presented evidence which would suggest that 54% of severe lumbalgic episodes are accompanied by an alarm-endocrine reaction (37). It is possible that some of the symptoms observed in this study have an endocrine-chemical basis. Somato-Psycho-Visceral Reflexes: It is well known that certain patients look at their pains through a psychological magnifying glass and develop all manner of unrelated symptoms. Psychogenic symptom production, no doubt, introduces an artifact into this study. It is, however, very interesting to note that most of the symptoms observed here, bear a segmental relationship to the level of spinal lesion (only one patient in this series had any knowledge of the anatomy of the autonomic nervous system). These segmental spino-psycho-visceral relationships may be explained by osteopathic research. In a brilliant experiment, Korr et al have shown that when the psyche is stimulated, maximum sympathetic outflow occurs at hyperirritable cord levels which have been previously sensitized (facilitated) by proprioceptive input from preexisting spinal joint lesions (38). Somato-Visceral Reflexes: Somato-autonomic reflexes in the laboratory animal are a physiologic fact. They are observed under certain conditions in man. The postulated modus operandi in spinal lesions is as follows: the lesioned spinal joints trigger an increased afferent input (pain, proprioception) into the related cord segments. The lateral horn cells are facilitated via the internuncial neurons and impulses spill over into the sympathetic efferents causing activation (motor, vasomotor, secretory) of the target 56 viscera. Such sustained pathophysiologic activity could well be responsible for spinovisceral symptoms observed in back pain subjects. Nerve Compression: It is well known that discal lesions, vertebral exostoses and stenosis may compress nervous tissue and cause autonomic dysfunction or paresis. It is also possible that root compression may interfere with axoplasmic flow. If, for the purpose of survey, one considers paresthesia/anesthesia to be indicative of nerve-tissue compromise, then 30% of first-contact patients presenting at this office have nerve compression syndromes. This could be responsible for autonomic dysfunction in selected patients. Vascular Compromise: Cervical degenerative lesions may compromise the vertebral arteries and cause cranial symptoms. This mechanism could have been operative in aged patients; however, the slowly progressive cerebral dysfunction (39), which allegedly occurs with sustained neck torsion in this condition, was not observed in any of the subjects. Proprioceptive Cross-Talk: It is possible that unequal cervical muscle tensions might feed the central nervous system with confusing proprioceptive information so as to disturb normal righting reflexes. This mechanism could explain the high incidence of dysequilibrium in subjects with neck injuries. Other: The constipation observed in severe lumbalgic patients may be antalgic or due to lack of exercise. The spinovisceral syndromes described here are typical of the symptom complexes observed in the everyday clinical practices of all manipulative practitioners. Further studies, to more precisely explore these common clinical problems, are warranted. The present study represents a first-attempt prospective investigation and the presented statistics may be considered to be "ball-park" figures only. A much larger subject population is required. Analysis of the gathered data in a preliminary study such as this, almost invariably exposes deficiencies in the original prospective design which could be corrected to improve future investigations (40). The following recommendations should be considered: Investigator Artifact: Solo investigators who study their own patient populations may be subject to impaired objectivity. Future studies should utilize a multi-disciplinary team of investigators to design and carry out the project. Data Artifacts: All data gathering methods (verbal interviews and questionnaires) are subject to error (40,41). The interview method was used in the present study. Future studies should include both verbal interviews and written questionnaires to facilitate cross-checking of the accuracy of the gathered data. Psychologic Artifacts: Clinical studies are frequently criticized for failing to establish psychological base-lines for the studied subjects. Written questionnaires could incorporate standard psychological testing proforma. Pharmacologic Artifacts: Investigator judgement (bias) was used in categorizing data on drug users. Future studies should exclude these subjects, or at least analyze their data in a separate category. Statistical Artifacts: A much larger study population is required in order to establish accurate prevalence rates for vertebrogenic autonomic dysfunction. Formal statistical analysis is also required. Follow-Up: The foregoing study was designed to be an acute investigation of a common clinical syndrome. It asked simple, straight-forward questions regarding the sequence of events during back pain episodes. While many of the subjects were followed for months, and even years, it is debatable if long term follow-up would bring forth any additional answers to the questions asked. It is important to note, however, that historical chiropractic and osteopathic theory, in common with the psychosomatic school, hypothesizes that long standing functional disorders may eventually lead to organic pathology. Follow-up of patients with recurrent spinal lesions, over many years, might constitute one way of testing this hypothesis. Conclusions: Vertebrogenic Autonomic DysfunctionThe autonomic manifestations of back pain have been explored. This preliminary study indicates that 39%o of all back pain subjects have symptoms attributable to irritation of the- autonomic nervous system by spinal lesions. Further studies, which incorporate more rigid protocol, are required to accurately describe the nosographic features of these common clinical syndromes. References: 1. Guyton A. Textbook of medical physiology. Fifth edition. Philadelphia:
W B Saunders, 1976.
2. Brobeck JR. Physiologic basis ofLmedical practice. Tenth edition.
Baltimore: Williams and Wilkins, 1979.
3. Guyton A. Basis human physiology. Second edition. Philadelphia:
W B Saunders, 1977.
4. Beeson P, McDermott W. Textbook of medicine. Fourteenth edition.
Philadelphia: W B Saunders, 1975.
5. Cecil R, Loeb R. Textbook of medicine. Ninth edition. Philadelphia:.
W B Saunders, 1955.
6. Adams J. Outline of orthopaedics. Sixth edition. Edinburgh: Livingston,
1967.
7. Pottenger F. Symptoms of visceral disease. Seventh edition. St Louis:
CV Mosby, 1953.
8. Pinzler S, Travell J. Therapy directed at the somatic component of
cardiac pain. Am H J 1948; 35: 248-268.
9. Travell J, Pinzler S. The myofascial genesis of pain. Postgraduate
Medicine 1952; 11: 425-430.
10. Verner J. The science and logic of chiropractic. Englewood: J Verner,
1941.
11. MacDonald G, Hargrave-Wilson W. The osteopathic lesion. London:
Heinemann, 1935.
12. Sato A, Schmidt R. Somato sympathetic reflexes: afferent fibers,
central pathways, discharge characteristics. Physiological Reviews
1973; 53: 916-947.
13. Sato A, Sato Y, Shimada F, Torigata Y. Changes in vesical function
produced by cutaneous stimulation in rats. Brain Research 1975; 94:
465-474.
14. Sato A, Sato Y, Shimada F, Torigata Y. Changes in gastric motility
produced by nociceptive stimulation of the skin in rats. Brain Research
1975; 87: 151-159.
15. Sato A, Sato Y, Shimada F, Torigata Y. Varying changes in heart
rate produced by nociciptive stimulation of the skin in rats at different
temperatures. Brain Research 1976; 110: 301-311.
16. Haldeman S. Interactions between the somatic and visceral nervous
systems. JCCA 1971; 15(3): 20-25.
17. Sato A. The importance of somato-autonomic reflexes in the regulation
of visceral organ function. JCCA 1976; 20(4): 32-38.
18. Coote J. Somatic sources of afferent input as factors in aberrant
autonomic, sensory and motor function. In: Korr IM, ed. The neurobiologic
mechanisms in manipulative therapy. New York: Plenum
Press, 1978: 91-127.
19. Appenzeller 0. Somatoautonomic reflexology - normal and abnormal.
In:- Korr IM, ed. The neurobiologic mechanisms in nmanipulative
therapy. New York: Plenum Press, 1978: 179-217.
20. Palmer D. The science, art and philosophy of chiropractic. Portland:
Portland Printing House, 1910: 18.
21. Barre J. Rev Neurol 1926; 33: 1246
22. Lieou Y. Syndrome sympathique cervical posterieur et arthrite cervicale
chronique. These de Strasbourg, 1928. (Fre)
23. Gayral L, Neuwirth E. Oto-neuro-ophthalmologic manifestations of
cervical origin. NY State J Med 1954; 54: 1920-1926.
24. Jackson R. The cervical syndrome. Springfield: Charles C Thomas,
1966: l31-144.
25. Wills 1, Atsatt R. The viscerospinal syndrome: a confusing factor in
surgical diagnosis. Arch Surg 1934; 29: 661-668.
26. Ussher N. The viscerospinal syndrome - a new concept of visceromotor
and sensory changes in relation to deranged spinal structures.
Ann Int Med 1940; 13(2): 2057-2090.
27. Travell J, Bigelow N. Role of somatic trigger areas in the patterns of
hysteria. Psychsom Med 1947; 2: 353-363.
28. Travell J. Referred pain from skeletal muscle. NY State J Med; 1955
Feb: 331-340.
29. Travell J. Mechanical headache. Headache 1967 Feb: 23-29.
30. Cooper A. Trigger-point injection: its place in physical medicine.
Arch Phys Med Rehab 1961; 704-709.
31. Lewit K. Menieres disease and the cervical spine. Rev Czechoslovak
Med 1961; 7(2): 129-139.
32. Ushio N, Hinoki M, Hine S, Okada S, Ishida Y, Koike S, Shizuba S.
Studies on ataxia of lumbar origin in cases of vertigo due to whiplash
injury. Agressologie 1973; 14(D): 73-82.
33. Love J, Schorn V. Thoracic disc protrusions. JAMA 1%5;
43-62.
34. Ver Brugghen A. Massive extrusions of lumbar intervertebral discs.
Surg Gynecol Obstet 1945; 81: 269.
35. Treece E, Treece J. Elements of research in nursing. First edition.
Saint Louis: CV Mosby, 1973.
36. Selye H. The stress of life. New York: McGraw-Hill, 1956.
37. Johnston R. Vertebrogenic stress eosinopenia. JCCA 1974; 18(4):
14-20.
38. Korr l, Thomas P, Wright R. Symposium on the functional implications
of segmental faciliation. JAOA 1955; 54: 173.
39. Houle J. Assessing hemodynamics of the vertebro-basilar complex
through angiothlipsis. JCCA 1972 June: 35-36, 41.
40. Friedman G. Primer of epidemiology. First edition. New York:
McGraw-Hill, 1974.
41. Koran L. The reliability of clinical- methods, data and judgments.
New Engl J Med 1975; 293: 642-646.
Golfers, does this sound familiar? It's a warm sunny day with a bit of a breeze, you are on the back nine about to sink a putt. When you swing, your back seizes up with severe pain. The beautiful day of golf turns into painfully riding in the golf cart back to the clubhouse, and you limping painfully to your car. If you have ever strained your back during a golf game, you are not alone. It's estimated of the 30 million golfers in the United States, 80% have experienced some sort of back pain. As fun as it is, swinging at golf balls puts an individual's body in an awkward position, opening up the opportunity for injury. While some golfers suffer through the pain by popping over-the-counter medications, others back away from playing as often, or stop altogether. There's another way to combat back injuries caused by golfing, without meds. It's not a magic wand, it's chiropractic care! Golfers are increasingly finding chiropractic care to be a valuable tool to help them deal with back injuries. Here are FORE! ways chiropractors can help injured golfers get off the couch and back on the green. Golfers: Consistent Adjustments Can Avoid Injuries In The First Place.Golfing, or any activity, is more enjoyable and causes less chance of injury if an individual's body is in top condition and operating normally. Periodic spinal adjustments keep the body functioning at maximum capacity, and reduce the chances of being injured. If the neck and back are aligned correctly, awkward positioning such as a golf swing will have a less negative impact. Chiropractic Treatment Can Reduce A Golfer's Pain.Back injuries can be extremely painful, and many turn to pain medications to gain relief and comfort. By treating the origin of the pain instead of just the symptoms, a chiropractor helps their patients manage the pain through manipulations, instead of drugs. Over the course of a few treatments, pain is often drastically diminished and much more manageable. A Golf Injury Can Heal Quicker With Chiropractic Care.Injuries to the back or neck can heal faster when chiropractors treat them than on their own. An experienced chiropractor can adjust the spine, and also work on the joints and surrounding tissue that can cause pain and hinder healing. Chiropractic evaluation considers the body as a whole. By treating the entire body, it promotes quicker healing of the injury. Increased Mobility Can Be Gained With Chiropractic Visits.Golfers who play often as well as those who only play a few times a year know mobility is essential to a good golf game. Stiff joints and a weak back not only mess with the golf game, but can be the very issues that end up causing an injury. A chiropractic treatment schedule keeps the body loose and strong, and working in optimum fashion. This prevents injuries and increases the chances of playing the game of your life. Golfers need to realize the sport can cause serious injuries just like "rougher" sports like football and rugby. It's a good idea to stretch before playing, stay hydrated, and avoid overexertion. If you are a golfer, chiropractic care is a valuable tool in staying healthy. Regular adjustments and manipulations keep your body on track and performing with maximum mobility at the top of your game. If you do suffer an injury, a chiropractor can help you manage your pain and decrease the time it takes to heal. Contact us today for more information on how we can help reduce the chance of injury for golfers, and promote healing.
Although chiropractic is dedicated to finding and correcting vertebral subluxations (also known as spinal misalignments), many patients seek chiropractic care to alleviate pain and other health-related symptoms. One condition that chiropractic patients seek relief from is consistent low back pain. According to the American Chiropractic Association, 31 million Americans experience low back pain at any give time. Even though low back pain plagues many people, finding the exact cause can be a challenge. However, chiropractors are spinal specialists that are trained extremely well to not only help alleviate your pain but also find the cause of the problem. As you seek help from your local chiropractor, you’ll want to keep the following things in mind: Low Back Pain: Prevention Is KeyPrevention is often the best cure for low back pain. When a patient sees a chiropractor, they’ll not only find relief for the low back pain they’re experiencing, but they’ll also learn ways to prevent such pain in the future. By using proper exercise and ergonomic techniques, they can ease their pain before it even starts. Amazing results are easily obtained simply by patients listening to the instructions given by their chiropractic doctor. Treatment Options Are AvailableFortunately, there are many treatment options for low back pain. Based off of the diagnosis provided by your Doctor of Chiropractic, he or she will be able to suggest the ones that will benefit you the most. These treatments may include one or more of the following: - Spinal adjustments delivered either by hand or instrument like an Activator
- Hot or cold compresses
- Physical therapy modalities like Interferential Therapy or TENS
- Massage Therapy or some other form of soft tissue work
- Spinal decompression therapy
Getting Relief From Your PainIf you were prescribed pain medication by a medial doctor before seeing your chiropractor, it may still be required to help reduce your pain levels. However, the good news is that you may be able to decrease your pain medication quicker than usual as spinal misalignments are corrected, nerve compression is alleviated and inflammation is reduced. That alone is well worth the investment of time and money to see your local chiropractor. Rehab Through ExerciseAs your care progresses from pain relief to rehabilitation of the spine, your chiropractor will recommend certain exercises to help strengthen your core muscles which, in return, will help stabilize and protect your lower back. Typically, these exercises are performed at the chiropractic office to make sure you understand how to do them without re-aggravating your original complaint. Once you’ve been educated on their purpose and know how to perform them correctly without supervision, you’ll be able to continue them at home in conjunction with the spinal adjustments you receive at the office during maintenance care. Surgery May Be AvoidedDepending on your condition, you may be able to avoid surgery if you choose to see a chiropractor before your injuries or pain become worse. In some instances, a chiropractor can help you to avoid surgery entirely by helping correct the problem instead of just masking it through pain relief. The key is to make sure you follow the recommendations of your chiropractor after a thorough consultation and examination are performed. Part of the examination procedures may require X-rays or MRIs. These not only benefit the chiropractor when he or she is developing your treatment plan but will also give you the peace of mind that the problem will be found. The bottom line is that a chiropractor is the ideal professional to consult with for any unexplained pain in the musculoskeletal system. They’re not only well-qualified to treat conditions like low back pain but also achieve great results in a very affordable and effective manner. If you or a loved one are suffering from low back pain, gives us a call. We’re here to help!
Chiropractor, Dr. Alexander Jimenez brings insight to a cool diaper changing technique created by fellow chiropractor Emily Puente, that will protect your baby’s spine. According to Puente changing diapers the traditional way, involves lifting both of the baby’s legs up over his or her head—puts a lot of stress and strain on the low back. And since babies who are not crawling have not yet developed their lordotic curve in their lumbar spine, all this stress can have a negative impact as baby grows. Instead, Puente recommends rolling your baby to change diapers in order to limit the strain on the spine. Watch her demonstrate the handy technique in a video she made for the Bridge Family Chriopractic website: Diaper Changing Video “By doing this roll technique it’s going to take the stress off that low back and make it so we’re not going to have an effect on the cervical curve,” she explains. “After your baby is crawling you don’t have to be as careful about that…but up until that point we do want to be more careful.” So easy, in fact, that Puente told us she employs the method with her 20-month-old! Looks simple enough, right? What do you think--will you try it? Source: Parents
(HealthDay News) — Chronic lower back pain affects millions of Americans. Many try steroid injections to ease their discomfort, but researchers now say this remedy provides only short-term relief.
In their study, investigators from France focused on 135 patients with back pain seemingly caused by inflammation between the discs and bones (vertebrae) in the lower spine.
The researchers found that a single steroid injection eased pain for one month. After that, however, effectiveness waned. Virtually no difference was seen one year after treatment between patients who did or didn’t get the injection.
“Our results do not support the wide use of an injection of glucocorticoid in alleviating symptoms in the long term in this condition,” said lead researcher Dr. Christelle Nguyen.
The findings are consistent with earlier studies, said Nguyen, an assistant professor of physical medicine and rehabilitation at Paris Descartes University.
Nguyen said she and her colleagues had hoped that targeting local disc inflammation with an anti-inflammatory steroid would help alleviate long-term pain.
To test their theory, they selected patients with chronic lower back pain and signs of disc inflammation on an MRI. On average, participants had suffered from back pain for six years. Half were assigned to a single steroid shot; the other half got no injection.
Patients rated their pain severity before the injection and again one, three, six and 12 months after the treatment.
One month after treatment, 55 percent of those who got the steroid injection experienced less lower back pain, compared with 33 percent of those who weren’t treated.
“However, the groups did not differ for the assessed outcomes 12 months after the injection,” Nguyen said.
For example, patients who did or didn’t received a steroid injection ended up in similar circumstances, with the same incidence of disc inflammation, lower quality of life, more anxiety and depression and continued use of non-narcotic pain pills, she said.
Overall, most patients found the steroid injections tolerable, and would agree to have a second one if necessary, Nguyen said. “We had no specific safety concerns and found no cases of infection, destruction or calcification of the disc 12 months after the injection,” she added.
The results were published March 20 in the Annals of Internal Medicine.
Dr. Byron Schneider, of Vanderbilt University School of Medicine in Nashville, noted there are many different causes of back pain.
In this study, the patients suffered from chronic back pain, he pointed out. “Patients with chronic lower back [pain] probably have more than one cause of their pain, which may be why the good results they found at one month weren’t there a year later,” said Schneider, an assistant professor of physical medicine and rehabilitation.
The study results don’t mean steroid injections should be avoided altogether, he noted.
Patients with a sudden episode of back pain — so-called acute pain — probably don’t need a steroid injection, he said.
Chiropractic Care Boosts Surgery Avoidance
“But if they’re not getting better after a month or two the way we would expect them to, at that point it would be reasonable to discuss the pluses and minuses of a steroid injection,” said Schneider, co-author of an accompanying journal editorial.
Chronic (long-term) back pain is a different situation, he said. Treating chronic back pain means treating the pain itself, but also using cognitive behavior therapy and “pain psychology” to help patients cope with pain, he said.
“For chronic pain, physicians need to address the musculoskeletal reasons that cause the hurt, but also other reasons that patients may be experiencing pain,” Schneider said.
According to the editorial, psychological distress, fear of pain and even low educational levels can affect pain levels.
More information
For more on lower back pain, visit the U.S. National Institute of Neurological Disorders and Stroke.
Doctor of Chiropractic, Dr. Alexander Jimenez looks at high heels at what they do to the back.
Ladies, ever wonder why you suffer from regular bouts of lower back pain? Achy hips? How about crazy tight leg muscles? Don’t blame it on your cycling class, or too many squats or, the trainer you only see once or twice a week. Look down. Are you wearing high heels? Bingo! You’ve heard high heels are bad for you. But it’s not just because they cause all kinds of pain and trauma to your feet. High heels are also messing up your physical fitness. They throw you out of proper postural alignment causing your joints and spine to take on more wear and tear, which means aches and pains.
Is it possible to still look rockin’ and save your joints? My suggestion is more Athleisure-wear. I know some fashion hard-liners say, no way will I walk around in yoga pants on a weekday! But we’ve come a long way since those flare-leg, fold-over yoga pants.
Let’s chat for a moment about the evils of high heels.
First there’s the obvious. They make your feet hurt. Blisters, calluses and swelling are par for the course. And pointy toes, fuhgeddaboutit! I’m sure they were invented by someone on the Marquis de Sade’s payroll. Second, they can lead to foot injuries like plantar fasciitis (usually from a bone spur that makes your heels hurt), hammertoes, bunions, and neuromas. Then there’s the domino effect.
Not only do high heels make your feet hurt, but problems with the feet can travel up the leg and cause injuries in the back, knees and hips. Your knees take on extra pressure from the weight being pushed forward onto the balls of the feet. Walking in this position makes your hip flexors and calf muscles short and tight. And it doesn’t stop there. Back problems are incredibly common in women who don’t give up their high heels.
Back Problems are incredibly common in women who don’t give up their high heels
Here’s why:
- Postural changes: The S-curve of your spine has cushiony discs in between the vertebrae that act as a shock absorbers to protect them from stress. Like when you’re bending or jumping. Wearing heels causes the lower back to arch more than normal because the body weight is pushed forward. To compensate, the upper body has to lean back to maintain balance. This puts extra stress on the discs. Spending hours with your body in funky alignment can lead to muscle spasms and back pain. Tight hamstring muscles, which attach to back of the pelvis and lower back, can also make your back ache.
- Anatomical changes: Wearing high heels on a daily, or very regular basis, over years, can actually cause anatomical changes to your body. In addition to the extra strain on your back and knees, the calf muscles can also shorten and the tendons can get tighter and thicker.
And It Can Get Even Nastier If You Get One Of These Spine Injuries:
- Spondylolisthesis: it’s a mouthful, but is a common injury that can happen in the lower back from too much hyperextension (arching the back). It’s when one vertebra slips forward over another.
- Foraminal stenosis: I have this one congenitally and it sucks. This is a spine and nerve issue that occurs when anatomical abnormalities reduce the spaces the nerves travel through as they exit the spinal column. The spaces are called foramina, and when they get blocked, the nerves get squeezed. The pain can radiate through the buttocks and down the legs. Symptoms are shooting pains, numbness, tingling, muscle weakness, spasms and, or cramping.
- Sciatica: The sciatic nerve is the longest one in the body. It runs from the bottom of the lumbar spine all the ways down the legs. When the sciatic nerve gets compressed it causes radiating pain, tingling, numbness and muscle weakness down the leg and can The pain can travel all the way to the bottom of the foot.
What Can You Do? My Case for Athleisure-Wear To Combat Back Pain
It’s time for stuffy office attire to retire. Comfy clothes and flat shoes can be very chic. Have you seen the boards on Pinterest? Thanks to this hopefully permanent fashion style, my jeans and heels spend more time in my closet than on my body. Leggings and cute kicks are my go to’s. Night out? No prob. I reach for my sleek workout leggings, a ruched top or off the shoulder top with some high heel sneaks (they’re wedges so not nearly as bad for you). I also discovered these by Bluprint which I put to the test at 2 huge conventions where I walking and standing for hours on end. The soles made of memory foam – like those beds!
My podiatrist friend, Steven Rosenberg, DPM has been preaching the need for comfy shoes to his female clients for years. (Fortunately for his practice, not everyone listens!) Dr. Steve says, wearing shoes designed more for comfort can help you live more pain-free. “Because comfort shoes are made of soft cushiony materials with soft foam innersoles, those are what you should turn to for shopping, walking or standing for long periods of time to avoid blisters, muscle spasms or arch cramps.” He also says to check for arch support in your shoes. If there’s none, you can buy ones to put inside.
Even after reading this, you may still not be willing to give up high heels for good. Me either. I still get glammed up once in a while.
Here Are Some Tips For When You Must:
- Wear them for as little time as possible.
- Try to opt for heels around 2” high
- Steer clear of pointy toes.
- Buy shoes with leather insoles to so your foot doesn’t slide.
- Buy arch inserts or use orthotics to support your arches.
- Vary your footwear so you’re not wearing high heels every day.
- Gradual or lower slopes are a little better, go for platforms or wedges instead of stilettos
- Thicker heels are better than spiky heels
- Stretch and strengthen the overworked muscles.
Here’s How:
- Stretch your leg muscles and hip flexors before and after wearing heels. For the calves, stand on a step and let one heel hang down until you feel a stretch.
Try this convenient device, the foot rocker by Vive. It stretches the calf and the sole of the foot relieving pain from plantar fasciitis.
- Massage and stretch the muscles in the soles of your feet. Roll your foot on a golf ball before and after wearing heels and, get regular foot massages.
- Strengthen and increase the range of motion in your ankles and feet. Put a rag on the floor. Using your foot, write the letters of the alphabet. Also put a bunch of marbles on the floor. Pick one or a few of them up using just your foot. Put them down about 6 inches away without lifting your foot off the floor. Try that 10 times. If you don’t have marbles, you can do it with a hand towel.
So next time you’re shopping for shoes, think about your foot fitness first. Look for fashion that keeps you closer to the ground and that will hopefully keep you farther away from the doctor.
Doctor of Chiropractic, Dr. Alexander Jimenez looks at the cervical spine and low back pain.
Low back pain and leg pain are the most common cause of disability worldwide. As such new research based treatment approaches are needed. This new randomized trial by BCP Non-profit and Cairo University tested the ability of the cervical Denneroll orthotic to improve cervical spine curvature and its consequent effect on low back and leg pain.
Great short term results were found where patients receiving the cervical spine Denneroll improved with low back pain, leg pain, neurological outcomes and disability compared to a PT only interventional group.
|
El Paso, TX. Chiropractor, Dr. Alexander Jimenez continues the discussion on the anatomy of nerve fibers, receptors, spinal tracts and brain pathway/s. As the spinal nerve nears the spinal cord, it splits into the dorsal and ventral roots. The dorsal root only contains the axons of sensory neurons. While the ventral roots contain only the axons of motor neurons. Some of the branches synapse with local neurons in the dorsal root ganglion, posterior (dorsal) horn, and even the anterior (ventral) horn, at the spine where they enter. Other branches travel short distances up or down the spine to interact with neurons at other levels of the spinal cord. A branch can also turn into the posterior (dorsal) column white matter to connect with the brain. Spinal nerve systems that connect to the brain are contralateral, in that the right side of the body is connected to the left side of the brain and the left side of the body is connected to the right side of the brain. Cranial nerves convey specific sense information from the head and neck directly to the brain. Whereas spinal information is contralateral, cranial nerve systems are for the most part ipsilateral, meaning that a cranial nerve on the right side of the head is connected to the right side of the brain. Some cranial nerves contain only sensory axons. Other cranial nerves have both sensory and motor axons, including the trigeminal, facial and glossopharyngeal. General senses of somatosensation for the face travel through the trigeminal system. PATHWAYSTHE POSTERIOR COLUMN– MEDIAL LEMNISCUS SYSTEM CONVEYS INFORMATION ABOUT TOUCH AND LIMB POSITIONPOSTERIOR COLUMN MEDIAL LEMNISCAL PATHWAY- The term posterior column refers to the entire contents of a posterior funiculus, exclusive of its share of the propriospinal tract. The posterior columns consist mainly of ascending collaterals of large myelinated primary afferents carrying impulses from various kinds of mechanoreceptors (although substantial numbers of second-order fibers and unmyelinated fibers are also included). This has traditionally been considered the major pathway by which information from low-threshold cutaneous, joint, and muscle receptors reaches the cerebral cortex.
DAMAGE TO THE POSTERIOR COLUMN–MEDIAL LEMNISCUS SYSTEM CAUSES IMPAIRMENT OF PROPRIOCEPTION AND DISCRIMINATIVE TACTILE FUNCTIONS“As might be expected from the types of afferents contained in the posterior columns, this pathway carries information important for the conscious appreciation of touch, pressure, and vibration and of joint position and movement. However, because input from cutaneous receptors also reaches the cortex by other routes, damage to the posterior columns causes impairment, but not abolition, of tactile perception. Complex discrimination tasks are more severely affected than is the simple detection of stimuli. Other functions, such as proprioception and kinesthesia, are classically considered to be totally lost after posterior column destruction. The result is a distinctive type of ataxia (incoordination of movement); the brain is unable to direct motor activity properly without sensory feedback about the current position of parts of the body. This ataxia is particularly pronounced when the patient’s eyes are closed, preventing visual compensation.” Given the role of the posterior column, the patient should be screened for any abnormalities regarding their sense of fine touch, vibration, barognosis, graphesthesia, stereognosis, kinaesthesia, two-point discrimination and conscious proprioception: - A common way of testing for fine touch is to ask the patient to recognize common objects placed within a cloth using their touch.
- Vibration sense can be tested using a low pitched C128 tuning fork placed along a bony prominence of the desired corresponding spinal level(s) to be tested.
- Barognosis refers to the ability to determine the approximate weight of an object.
- Graphesthesia refers to the ability to recognize writing on the skin by touch. The practitioner can draw out a letter on the patients skin as a way of testing.
- Kinaesthesia refers to ones own sense of body motion (excluding equilibrium which is controlled in part by the inner ear) and is commonly tested using the subject’s ability to detect an externally imposed passive movement, or the ability to reposition a joint to a predetermined position.
- Proprioception is often assessed using the Rombergs test. This examination is based on the notion that a person requires at least two of the three following senses to maintain balance while standing: proprioception; vestibular function and vision. A patient who has a defect within their proprioceptive mechanism can still maintain balance by using vestibular function and vision. In the Romberg test, the patient is stood up and asked to close their eyes. A loss of balance is interpreted as a positive Romberg sign.
THE SPINOTHALAMIC TRACT CONVEYS INFORMATION ABOUT PAIN AND TEMPERATUREA GOOD BRAIN CAN MODULATE PAINSPINOTHALAMIC TRACT- Pain is a complex sensation, in that a noxious stimulus leads not only to the perception of where it occurred but also to things such as a rapid increase in level of attention, emotional reactions, autonomic responses, and a greater likelihood that the event and its circumstances will be remembered. Corresponding to this complexity, multiple pathways convey nociceptive information rostrally from the spinal cord. One of them (the spinothalamic tract) is analogous to the posterior column–medial lemniscus pathway.
SPINOTHALAMIC TRACTSTwo main parts of the Spinothalamic Tract (STT)- Lateral Spinothalamic Tract
- Transmission of pain and temperature
- Anterior Spinothalamic Tract
- Transmission of crude touch and firm pressure
DAMAGE TO THE ANTEROLATERAL SYSTEM CAUSES DIMINUTION OF PAIN AND TEMPERATURE SENSATIONSExamination:Given the role of the spinothalamic tract, the patient should be screened for any abnormalities regarding their sense of touch, pain, temperature, and pressure sensation. Screening for such abnormalities is commonly done using gentle pin pricks and cotton wool, to contrast between sharp and soft, following cutaneous sensory nerve root distributions. Hot and cold discrimination can be ascertained using the cold metal arm of a tuning fork, and a warm palm or heated object. HAUSER ET AL. FIBROMYALGIA, 2015- “Pain processing and its modulation: Activation of peripheral pain receptors (also called nociceptors) by noxious stimuli generates signals that travel to the dorsal horn of the spinal cord via the dorsal root ganglion. From the dorsal horn, the signals are carried along the ascending pain pathway or the spinothalamic tract to the thalamus and the cortex. Pain can be controlled by nociception- inhibiting and nociception-facilitating neurons. Descending signals originating in the supraspinal centers can modulate activity in the dorsal horn by controlling spinal pain transmission. CNS, central nervous system.”
SPINAL INFORMATION REACHES THE CEREBELLUM BOTH DIRECTLY AND INDIRECTLYThe spinal cord is an important source of information used by the cerebellum in the coordination of movement. This information reaches the cerebellar cortex and nuclei both directly, by way of spinocerebellar tracts, and indirectly, by way of relays in brainstem nuclei. A number of spinocerebellar tracts have been described, some representing the upper extremity and others the lower extremity. Only three have been well characterized. DESCENDING PATHWAYS INFLUENCE THE ACTIVITY OF LOWER MOTOR NEURONSBy RYAN CEDERMARK, DC DACNB RN BSN MSN
Neurons are believed to establish neuronal connections through innate predetermined programs during the developmental process of the brain. It’s also believed that neurons gravitate to areas of attraction and move away from areas of repulsion in a theory known as the chemoaffinity hypothesis. The Chemoaffinity hypothesis claims that neurons first make connections with their targets based on interactions with specific molecular markers and, therefore, that the first wiring diagram of an organism is indirectly determined by its genotype. These markers are created during cellular differentiation and aid not just with synaptogenesis, but also act as guidance cues for their individual axon. The development of the mature nervous system formations demands axons to navigate to their correct targets in order to establish neuronal connections or synaptic connections. Growing axons create highly motile structures, known as growth cones, which direct the axon to its goal. They do it by responding to specific guidance molecules that either attract or repel the growth cone.
Daniel Alvarado, owner of PUSH Fitness, first met Dr. Alex Jimenez through the connection of a good friend and they became workout partners. Daniel Alvarado learned a lot regarding chiropractic alignment and physiology by training with Dr. Jimenez. After experiencing upper and mid back pain as well as shoulder pain, Daniel Alvarado began receiving regular chiropractic care with Dr. Alex Jimenez in order to restore the original alignment of his spine and improve the symptoms of his injury. Daniel Alvarado highly recommends Dr. Jimenez as the non surgical choice for sports injuries, as he discusses how Dr. Alex Jimenez's relationship with his patients can ensure a positive environment for a better, more improved treatment. Together with Dr. Alex Jimenez's chiropractic care and his own rehabilitation and sports therapy, Daniel Alvarado emphasizes the dynamic of their services. Sports injuries are injuries which occur in athletic activities or exercising. There are kids and approximately 30 million teens alone that participate in some form of sport. About 3 million sports athletes experience sports injuries annually, which causes some loss of time of participation in the sport. Prevention helps reduce sport injuries. It's crucial to set up participation in warm-ups and exercises which focus on primary muscle groups utilized in the game of interest. Also, establishing an accident prevention program as a staff, including education on rehydration, nutrition, tracking staff members "in danger", tracking behavior, skills, and techniques. Our team has takes great pride in bringing our families and injured patients only clinically proven treatments protocols. By teaching complete holistic wellness as a lifestyle, we also change not only our patients lives but their families as well. We do this so that we may reach as many El Pasoans who need us, no matter the affordability issues. Our uplifting southwest community surrounded by it limitless beauty is an amazing place to live and enjoy our families; it is therefore our mission to help each of our patients to live, to love, to matter and to thrive pain free in this wonderful special place. There is no reason we cannot help you. �� If you have enjoyed this video and/or we have helped you in any way please feel free to subscribe and share us. Thank You & God Bless. Dr. Alex Jimenez DC, C.C.S.T Facebook Clinical Page: https://www.facebook.com/dralexjimenez/ Facebook Sports Page: https://www.facebook.com/pushasrx/ Facebook Injuries Page: https://www.facebook.com/elpasochiropractor/ Facebook Neuropathy Page: https://www.facebook.com/ElPasoNeuropathyCenter/ Facebook Fitness Center Page: https://www.facebook.com/PUSHftinessathletictraining/ Yelp: El Paso Rehabilitation Center: http://goo.gl/pwY2n2 Yelp: El Paso Clinical Center: Treatment: https://goo.gl/r2QPuZ Clinical Testimonies: https://www.dralexjimenez.com/category/testimonies/ Information: LinkedIn: https://www.linkedin.com/in/dralexjimenez Clinical Site: https://www.dralexjimenez.com Injury Site: https://personalinjurydoctorgroup.com Sports Injury Site: https://chiropracticscientist.com Back Injury Site: https://www.elpasobackclinic.com Rehabilitation Center: https://www.pushasrx.com Fitness & Nutrition: http://www.push4fitness.com/team/ Pinterest: https://www.pinterest.com/dralexjimenez/ Twitter: https://twitter.com/dralexjimenez Twitter: https://twitter.com/crossfitdoctor
George Lara, now retired, found relief with Dr. Alex Jimenez, back pain specialist and chiropractor, for his degenerative disk disease following two back injuries he experienced several years ago. After using drugs/medications and experiencing constant symptoms due to his DDD, Mr. Lara describes how Dr. Jimenez's chiropractic treatment greatly helped restore his quality of life as well as promote his overall health and wellness. George Lara highly recommends Dr. Alex Jimenez as a non-surgical treatment choice for degenerative disc disease, and praises his dedication for treating his patients. Degenerative disk disease, or DDD, refers to the natural breakdown of an intervertebral disk of the spine. Despite its title, DDD isn't regarded as a disorder, nor is it degenerative. To the contrary, disk degeneration is frequently the consequence of ordinary daily stresses and minor accidents that cause spinal disks to slowly eliminate water in the anulus fibrosus, or even through the stiff outer layer of a disk. As water content decreases, they start to collapse. This could lead to pressure being placed on the nerves causing weakness and pain. While not necessarily symptomatic, DDD may lead to acute or chronic low back or neck pain in addition to nerve pain based on the positioning of the affected disk and the amount of strain it puts around the surrounding nerve roots. Please Recommend Us: If you have enjoyed this video and/or we have helped you in any way please feel free to recommend us. Thank You. Recommend: Dr. Alex Jimenez – Chiropractor Health Grades: http://www.healthgrades.com/review/3SDJ4 Facebook Clinical Page: https://www.facebook.com/dralexjimenez/reviews/ Facebook Sports Page: https://www.facebook.com/pushasrx/ Facebook Injuries Page: https://www.facebook.com/elpasochiropractor/ Facebook Neuropathy Page: https://www.facebook.com/ElPasoNeuropathyCenter/ Yelp: http://goo.gl/pwY2n2 Clinical Testimonies: https://www.dralexjimenez.com/category/testimonies/ Information: Dr. Alex Jimenez – Chiropractor Clinical Site: https://www.dralexjimenez.com Injury Site: https://personalinjurydoctorgroup.com Sports Injury Site: https://chiropracticscientist.com Back Injury Site: https://www.elpasobackclinic.com Linked In: https://www.linkedin.com/in/dralexjimenez Pinterest: https://www.pinterest.com/dralexjimenez/ Twitter: https://twitter.com/dralexjimenez Twitter: https://twitter.com/crossfitdoctor Recommend: PUSH-as-Rx ®™ Rehabilitation Center: https://www.pushasrx.com Facebook: https://www.facebook.com/PUSHftinessathletictraining/ PUSH-as-Rx: http://www.push4fitness.com/team/
Chiropractic Benefits: Curvature of the spine, even slight, can cause pain and postural problems. When the curve is more than 10 degrees, it is considered to be scoliosis. The primary symptom of scoliosis is a significant curvature of the spine and is the majority of cases the cause is not known. Even mild cases can cause pain and a decrease in mobility. In more advanced cases the effects of the condition are more pronounced. Chiropractic has been a regular course of therapy for many scoliosis patients and recent studies provide even more evidence that it is highly effective and that there are many benefits to using it as a treatment. Chiropractic BenefitsDetection Of Scoliosis In Early StagesTypically, slight curvatures in the spine are ignored in traditional medicine. Many times scoliosis is not diagnosed until the curvature presents significant distortion, pain, or indications of structural destruction. Chiropractic treatment enables early detection by identifying minor degrees of curvature or distortion. This essentially has the probability of detecting scoliosis at an early enough stage to halt progression of the condition or treat it before the symptoms negatively impact the patient’s mobility or quality of life. Relieve Pain And Mobility Caused by ScoliosisPain and mobility can be debilitating for the scoliosis patient. While there is no solid evidence at this time that supports chiropractic as a cure for significant scoliosis but it also has not been shown to worsen the curvatures either. However, adjustments of the spine through chiropractic treatment, both pain and mobility have been shone to improve. Studies are currently being conducted and some recent research suggests that chiropractic can significantly improve the pain and mobility caused by scoliosis, as well as help with other symptoms the patient may have. Improvement In Cobb AngleCobb angle is a term used to describe the degree of spinal deformities a patient experiences. It is broadly used to describe spinal damage due to injury or disease, but it is also commonly used to describe the curvature of a scoliosis patient’s spine. This measurement is used to track progression of the condition and determine what therapies or treatments are required. In a study published in September 2011, 28 patients were evaluated and monitored in two clinics in Michigan. All patients, ranging from age 18 to 54, had been diagnosed with scoliosis. The study involved exposing the subjects to regular, consistent multimodal chiropractic rehabilitation treatment over a period of time. Once their treatment cycle was complete, the patients were monitored or a period of 24 months. At the conclusion of the study, the patients reported improvement in pain and mobility. Additionally, the Cobb angle of each patient as well as the level of disability improved during the treatments and at the conclusion of the treatment cycle. What was most remarkable, though, was that in the subsequent follow ups, even at the end of the study 24 months later, the patients were still reporting these improvements. Current StudiesCharles A Lantz, D.C., Ph.D. of the Life Chiropractic College West in San Lorenzo, California, where he is the Director of Research, is currently involved in a research project studying the effectiveness of chiropractic for scoliosis in children. The subjects range from 9 years old to 15 years old and have been diagnosed with scoliosis at a mild to moderate level (curve is less than 25). Lantz embarked on this project to answer a need for more research on the topic. Currently, there are few formal research endeavors regarding scoliosis and chiropractic as an effective treatment. In 1994, Lantz published an article in the October issue of Chiropractic: The Journal of Chiropractic: Research and Clinical Investigation, Volume 9, Number 4. The article, titled Conservative Management of Scoliosis, stressed Lantz’s observation that more clinical trials are needed to be conducted for adults as well as adolescents with scoliosis to study and measure how chiropractic benefits scoliosis.
Back pain is a daily issue for millions of Americans, with a variety of medial issues being the culprit. The results of lower back pain on the economy as a whole are far reaching, from tons of lost work time to enormous medical costs. Maignes Syndrome is estimated to be the cause of a great deal of the instances of lower back pain. Never heard of it? Lucky you because those who are diagnosed with Maignes Syndrome suffer pain that sometimes lasts for weeks or even months, and can become quite severe. Discomfort is increased sometimes when the patient twists his torso, or lifts a heavy object. What Is Maignes Syndrome?Also called Thoracolumbar Junction Syndrome, Maignes Syndrome is a spinal disorder that is located in the nerves in the upper lumbar region of the back, causing pain to radiate along the nerves from the site. This spinal condition creates difficult to diagnose symptoms, since it often results in pain in a different part of the body than the actual source. It is believed this "condition exists because of the facet joint issues at the junction between the middle spine and lower spine.". The pain from Maignes Syndrome usually shows up in the hip, lower back, or groin. If you are experiencing lower back pain, you may suffer from Maignes Syndrome. Schedule a chiropractic visit as soon as possible, because a chiropractor benefits Maignes Syndrome sufferers in four important ways. Doctor Of Chiropractic Can……Help Correctly Diagnose ItUnfortunately, the nature of the pain and location of the condition frequently cause Maignes Syndrome to be misdiagnosed. Sacroiliac joint pain is sometimes the diagnosis they receive, which hinders proper treatment. For this reason, the patient needs to make certain they are working with an experienced chiropractor who understands the subtle differences of the two conditions. …Adjust The Area Where The Issue OriginatesIn order to minimize the symptoms of the condition, a chiropractor can administer adjustments on and around the area causing the issue, the thoracolumbar facet joints. Aligning this area correctly, and loosening the area that may have become tight from overcompensation, assists in relieving pain from Maignes Syndrome. …Offer At Home Exercises To Help With HealingFortunately, there are exercises that can aid Maignes Syndrome, both in loosening the tightness of the afflicted area, and building up the surrounding muscle strength so the body can compensate for the issue. A chiropractor who understands this spinal condition can walk you through a step-by-step exercise regimen of the types of exercises that will help your body adapt to and heal from Maignes Syndrome. …Promote Your Body's Ability To Heal ItselfChiropractic care is a broad-based approach to the body's inner function and balance. Experienced chiropractors understand that all parts fit together for overall health. A patient with Maignes Syndrome benefits from chiropractic care because of this. Your chiropractor will make a series of adjustments that help the nervous system work at optimum capacity, which promotes healing to the entire body. Attacking Maignes Syndrome directly at the site and through the body as a whole promotes faster healing and increased mobility. Individuals with Maignes Syndrome unfortunately face an uphill battle that begins with being correctly diagnosed. The complexity of the spinal condition is the primary reason to seek a professional chiropractor's opinion at the first sign of ongoing lower back pain. Once Maignes Syndrome is correctly pinpointed, the chiropractor will be able to design an in-house and at-home blend of treatment options to minimize your healing time and achieve a pain-free, fully functioning back.
"Mom, it hurts. It hurts!" Parents of children suffering from ear infections are all too familiar with this cry. Tugging at their ears, crying, and trouble sleeping are all signs of an ear infection in your little one. Children are more susceptible to ear infections than adults because of their smaller Eustachian tubes, and their less effective immune systems. Unfortunately, chronic ear infections can quickly become a painful, ongoing problem. Parents have a variety of options at their disposal to treat their child's ear infections. Drops, antibiotics, and ventilation tubes placed by surgical procedure are all commonly used treatments for chronic infections. Chiropractic care is another option available and is rapidly gaining acceptance and popularity for the effective treatment of ear infections. According to HealthyChild.com, ear infections are the reason for 35% of pediatrician visits, and ear pain is the number one reason a child visits a chiropractor. Children who suffer from recurring ear infections benefit from chiropractic care in several ways that are not available through other, more traditional forms of treatment. Here are a few of the benefits chiropractic care offer for ear infections are: Ear Infections: It Is Non-InvasiveUnlike the surgical procedure that is often used to combat ear infections by inserting tubes in the child's ears, chiropractic adjustments provide a non-invasive form of treatment. This treatment option works well because a little one's spine may be moved out of alignment from the birthing process, or from any number of spills he or she makes learning to walk, run, or navigate stairs. An experienced chiropractor can map out a treatment plan that includes gentle adjustments of the child's neck and spine. The goal is to decrease fluid build up within the ear canals that bring on ear infections and pain. It Is A Painless Option Of TreatmentThe last thing parents want in any medical treatment is to cause their child more pain. A negative experience at a doctor's office can create a fear that lasts for years to come. Children with ear infections have nothing to fear from visiting a chiropractor. During a chiropractic visit, the child will participate in adjustments that are pain free. The treatments will be able to reduce the pain in a short amount of time in many instances, and reduce the chance of dealing with another ear infection down the road. It Treats The Underlying CauseOther options of treatment may decrease the symptoms of an ear infection, but never get to the actual root issue. Chiropractic care strives to return the body in its entirety to its normal function. This is the main building block concept for chiropractic in general. By re-aligning the spine, the body as a whole can be healthier and more resistant to infection and disease. Chiropractic care helps adjust the child's body back to a normal state, thus providing a way for it to heal itself and fight off future ear (and other) infections better than simply using drops and antibiotics. If your child is susceptible to ear infections, there are steps you can take to minimize the chances of an occurrence in the first place. Frequent hand washing to prevent the spread of germs and avoiding cigarette smoke are two simple ways to combat ear infections. Chiropractic treatment continues to show promise in treating the underlying issues that cause a child to suffer from ear infections. If you are looking for a treatment that is pain free, not intimidating to the child, and an alternative to invasive surgery, enlisting the help of a chiropractor is a fantastic option. So if your child is experiencing chronic ear infections, give us a call. Our Doctor of Chiropractic is here to help!
Sitting: It's no big secret that exercise is good for you. Many articles and books have been written and studies completed on the subject of physical fitness. However, lately it's been discussed as to whether that five mile run or spin class is really enough. Is our work environment undoing any positive effort we put into staying healthy? The short answer is YES. Human bodies were not built to sit for long periods of time. Our twenty-first century workplace — working behind a desk, typing on the computer, endless video conferences — unfortunately stacks against us to keep us on our… well, not our feet. There are four harmful results on a person's body that stem from sitting at work. Sitting For Many Hours Each Day Takes A Toll On Our Backs.Working at a desk for many hours a day causes employees to stay in one position for an extended length of time. This puts a great deal of pressure on their backs. Over time, painful back problems can develop and, if left untreated, continue to worsen. Sitting Also Takes A Toll On Our Waistline.Obesity is at an all time high in the United States, and at least a good chunk of the reason is our sedentary lifestyle. Sitting for a long period (8 or more hours a day) decreases our metabolism, causing us to burn fewer calories. The time at our desks can end up packing on the pounds. Sitting Can Increase The Chance Of Developing A Life-Threatening Disease.Studies show individuals with sedentary jobs have more health problems than their active counterparts. Cardiovascular disease and Type 2 diabetes are both examples of health issues that arise more often in people who regularly sit down most of the day. Sitting Can Cause Premature Death.This may sound melodramatic, but it's true. As we talked about above, sitting for prolonged periods of time puts you at greater risk of diseases that may end up killing you. A study published in the Archives of Internal Medicine, "found people who sat for over 11 hours a day had a 40% greater risk of dying within three years from any cause than people who sat less than 4 hours a day." So, what should a sedentary office person do to improve their health and decrease the risk many hours of daily sitting causes? - Get on your feet! Schedule times during the day to stand up and walk around. If you can't remember to do it, add an alarm on your cell phone. Even a couple minutes on your feet every hour will help balance prolonged sitting.
- Learn to sit correctly. If you must sit, make certain your chair isn't causing more damage. Select a chair that is height and angle adjustable. The seat should support your lower body, and the back should fit the curves of your spine. Special bonus points go to chairs with lumbar support and that rock.
- Visit your chiropractor. Back problems brought on by a job behind a desk are not going to magically go away, and can get worse over time. Make a chiropractor appointment, get examined, and work to correct the issue.
- Invest in a standing desk. A growing trend is to turn a sitting job into a standing job. Desks that are taller have the ability to keep you on your feet longer, which will provide many health benefits in the long run.
Good health is one of our greatest assets, and it pays to protect it. By understanding the risks of a sedentary working environment, we can be proactive in increasing activity and promoting our individual fitness. If you or a loved one needs more insight on how chiropractic can guide you toward a healthier lifestyle, give us a call. We’re here to help!
Myth 1: You Only Have To Sit Up Straight.Back pain myths are like any other, however, your mom was not totally wrong; hunching can certainly be bad for your back. But the opposite is true as well. Strain can be also caused by sitting up for too long without a break. If you work make sure that your chair is at a height where your knees are at a 90-degree angle, your feet can rest flat on the ground, and you have back support. Make sure that you stand up, stretch, and take a walk several times each day to keep from becoming stiff or causing injury. Myth 2: You Need The Firmest Mattress Possible.Back pain sufferers can actually experience increased pain if their mattress is too firm since it puts more strain on heavy points like the hips and shoulders. On the other hand too soft a mattress could lack the support required to allow proper movement. In both instances, the person wakes up stiff and in pain. Studies show that a medium-firm mattress provides the right amount of support to help prevent injury. Myth 3: Back Pain Is Caused By Exercise.A poll by the North American Spine Society revealed this as the number one back pain myth. Sure, if you don't work out then try to win a competition, you could experience injury. You can help prevent back pain by preparing your body and workouts with proper warm-up and great stretching exercises. (Take a cue from professional athletes that factor stretching and warm ups in their everyday routine.) Strengthen your back by strengthen your core, through exercises focused on strengthening your stomach and back muscles as well as cardio. Myth 4: Back Pain Is An Unavoidable Side-Effect Of Getting Older.Getting older does not mean life has to be painful. While there are aches and pains that come with an aging body, staying physically healthy (see Myth #3) through exercises that keep our bodies strong, flexible and limber are a huge benefit. There are several exercise options to try, T’ai Chi, Pilates, yoga and treatment options which range from acupuncture to physical therapy to advanced treatment options both surgical and nonsurgical. Bottom line is you do not have to live with back pain. Treating Back Pain Myth 5: Back Pain Came Out Of Nowhere.Another back pain myth is sufferers often claim one wrong twist or simply bending over was the cause of their injury. But that was likely the result of several other factors. Overdoing a workout, using poor technique when lifting heavy objects, bad posture, and especially weight gain can all put strain on the spine and lead to "out of nowhere" spasms. As with more serious conditions such as joint and disk disorders a spine doctor is recommended to find the source of the pain. Myth 6: A Hot Bath Can Bring ReliefThere are few things as relaxing as a nice spa, but doing so after injuring your back may actually make your situation worse by increasing inflammation. Doctors recommend applying ice to the area for 20 minutes at a time during the first two or three times in order to reduce pain and inflammation. An exception, people who suffer from chronic pain can find relief taking a warm bath. Play it safe and check with your doctor for the best treatment. Myth 7: If I See A Doctor, I'll Probably Have Surgery.Most people will experience some level of back pain in their lifetime, but the overwhelming majority will find relief through modifications such as over the counter anti-inflammatory medicines, exercise, physical therapy, or even just by waiting it out. In actuality, spine surgery is recommended for a small percentage of patients and until all other treatment methods have been tried. These patients often suffer from degenerative spine or joint problems that cause pain that is chronic. Whether you understand the origin of your pain or not, a fear of surgery shouldn't prevent you from seeking medical help.
Is Your Mobility Slipping Away ?
Mobility is more than moving from one place to another. It’s freedom and independence.
Whether you have a back or other condition that impacts how you walk, or your body doesn’t move as effortlessly as it once did, decreased mobility impacts a lot of people. But, if you notice changes early on, you and your doctor may be able to work on a plan to keep you moving comfortably for longer.
To see some red flags that may signal a decline in healthy mobility. Do any sound familiar?
Short Walks Become Long Walks
How do you feel after walking a quarter of a mile? Is it painful or taxing on your body?
Unless you have a spine condition or other disease that limits your ability to walk, you should be able to walk your entire life. If it’s challenging to complete short walks, that’s a red flag your mobility is at risk.
Changes In Gait
It’s not just walking distance that foreshadows a decline in mobility—how you walk is just as revealing.
Gait is the medical term for how you walk. While gait changes are a typical part of aging, some gait characteristics aren’t normal. For example: If you walk in a shuffling, unsteady, or cautious manner, you should see your doctor. He or she will help assess your gait and hopefully find the reason for it and ways to improve your movement.
Your “Get Up & Go” Is A Bit Slow
Another way to test your mobility is by doing the “get up and go” test.
You’ll need a friend to time you during this task. First, start by sitting in a chair. When your friend says “go,” get up and walk 10 feet in a straight line, then turn around and walk back to the chair and sit down. Most people who have healthy mobility can complete the exercise in 10 seconds or less.
While speed is an important part of this exercise, think about how you feel afterward. Do you feel any pain in your back muscles or in your legs or joints? If so, you should talk to your doctor to find ways to ease these movements’ impact on your quality of life.
Golf & Chiropractic Care
Daily Tasks Aren’t So Routine
Is cooking a meal or taking a shower an ordeal when it used to be just a typical part of your day? Do you have work-arounds for tasks that were once easy?
One can overlook how a once simple part of your daily routine has slowly morphed into a challenging task. You may adjust your lifestyle to accommodate a decline in mobility (like putting a seat in the shower), but that’s a sign it’s time to see your doctor.
Your doctor can get to the bottom of your movement problems and suggest ways to help, such as using an assistive device, like a cane or walker, so you can move easier.
You Don’t Travel Far From Home
This isn’t about getting on a plane—you don’t travel to the other side of town. Avoiding going away from home, even if it’s a grocery store a few miles from your house, could be a sign your ability to move is declining.
Think about it: Running errands across town for an hour or two takes physical endurance. If you feel mentally and physically exhausted over the thought of completing a few errands, that’s a red flag your mobility health is at risk.
The Best Way To Improve Mobility
Want to keep walking well into your later years? The answer is simple: Stay active.
Physical activity is excellent for your heart, lungs, muscles, and spine, and helps preserve your independence. It’s never too late to start exercising.
Caring for your mobility is essential—not just for spine health but for your total health.
Doctor of Chiropractic, Dr. Alexander Jimenez reveals what the popping sound is during a spinal adjustment.
Chiropractic Care & Back Pain
Has this happened to you? You are at the chiropractor getting treatment for your own back pain, and during a spinal adjustment, a sizable popping sound is heard by you. It seems somewhat alarming, does not it? Rest assured, though: That pop within a chiropractic spinal adjustment is totally ordinary.
During a back adjustment, your back experiences rapid, mild stretching of the spinal joint, which means you may hear a snapping or popping sound. This really is brought on by little pockets of air or bubbles, which are in the fluid that surrounds your joints. When joint tissues are extended throughout a chiropractic adjustment, the pockets of atmosphere “pop,” which creates that cracking sound you hear.
Following this treatment, you could feel in your back for more movement. But, the muscles may still be raw and tight.
Your chiropractor might also incorporate other chiropractic care treatments like muscle therapy. You must notice more back pain relief with each session.
Your chiropractor could also advocate preventive care, including specific exercises, and he/she might give you ergonomic tips on the best way to accurately bend and lift, in addition to how to take good care of your back while at your desk (if you work in a office). Doing specific exercises and maintaining good posture might help keep movement that is healthy in your back.
Is Chiropractic Care Right For You?
It is crucial that you consider that chiropractic care is not a cure all for all conditions that are back. Some backbone conditions that cause back pain may require a combination of treatments, or other treatments, for example surgery and drugs.
But in the event you have a condition that causes pain back and you need to test a non-operative treatment, chiropractic care can be an excellent treatment choice for you personally. But remember, you need to not be alarmed by a popping noise during a spinal adjustment—it’s ordinary in chiropractic care.
Doctor of Chiropractic, Dr. Alex Jimenez examines Tiger Woods’ and his latest back surgery.
We have a look at Tiger Woods’ extensive history of injuries during his career. USA TODAY Sports
Tiger Woods Won’t Be Back For Some Time
Woods, that has made just three starts in a couple of years, likely won’t play again this year after he’d his back surgery that is fourth in Texas. The latest procedure alleviated pain in his back and leg, Woods announced on his web site Thursday.
That I’m confident this will relieve my back spasms and pain, and The operation went well,” Woods said in a statement. When fixed, “, I anticipate playing with my kids getting back to a normal life, competing in professional golf and living without the pain I’ve been fighting so long.”
Woods, who also has had four surgeries on his left knee, first had surgery on his back and then had two procedures in the autumn of 2015.
According to his statement, a disc in Woods back seriously narrowed because of causing sciatica, the three surgeries and severe back and leg pain. During the recent operation, the damaged disc was removed and the collapsed disc space was elevated to levels that were regular. The goal is to relieve the pressure on the nerve, the statement said. The procedure was performed by Dr. Richard Guyer of the Centre for Disc Replacement at the Texas Back Institute.
A Look At Tiger Woods’ Injury History
Tiger Woods Video
RELATED:
About playing on Champions Tour, Tiger Woods jokes around
Woods, 41, last played in February, where he shot a birdie-free 77 in the very first round before removing. Where he missed the cut his only other start was in the Farmers Insurance Open the week prior.
His only appearance on the golf course in 2016 arrived at the Hero World Challenge in December. While he finished 15th in the 17-man field, he tied for the tournament lead in birdies (24), seemed healthy and upbeat.
Before beginning therapy, he will be resting for several weeks. The recovery interval is usually about half a year. That would mean Woods, a winner of 14 major tournaments and 79 PGA Tour titles, won’t play in any of the four majors for a second straight year. He is now rated No. 788 in the world.
Woods is in good spirits after the surgery, said his agent, Mark Steinberg.
USA TODAY Sports, he believes somewhat that the large weight was lifted off his shoulders,” Steinberg told. “The three previous operations were somewhat temporary repairs. But it got to the point where the pain was more common and this latest surgery was something he had to do.”
Steinberg said Woods decided to take a conservative approach along with his back previously three years with his difficulties. That alternative wasn’t accessible this time.
“This just isn’t a temporary repair,” Steinberg said. “ his physicians proposed him that this is the top path to a healthy, energetic lifestyle. He and his children were playing but he was in so much pain.
“Now he ’ll possess a healthy life without pain.”
One, Steinberg said, that can include playing golf.
“Entirely,” Steinberg said. “He desires to get out (on the PGA Tour) again.”
Woods’ last public appearance ahead of the operation was Tuesday in Hollister, Missouri, where he pronounced he’s designing his first public golf course. The course will probably be called Payne’s Valley in honor of Missouri native Payne Stewart. Woods is a partner on the project with CEO Johnny Morris and Bass Pro Shops founder.
Tiger Woods Stories
|
https://farmaciadimagrante.com/
https://farmaciadimagrante.com/Prodotto/acquista-mysimba-online/
https://farmaciadimagrante.com/Prodotto/acquista-mounjaro-online/
https://farmaciadimagrante.com/Prodotto/acquista-victoza-online/
https://farmaciadimagrante.com/Prodotto/acquistare-saxenda-6mg-ml-online/
https://farmaciadimagrante.com/Prodotto/acquista-ozempic-online/
https://farmaciadimagrante.com/Prodotto/acquista-wegovy-online/
https://farmaciadimagrante.com/Prodotto/acquista-nembutal-in-polvere-online/
https://farmaciadimagrante.com/Prodotto/acquista-online-nembutal-solution/
https://farmaciadimagrante.com/Prodotto/acquista-ketamina-hcl-500mg-10ml-in-linea/
https://farmaciadimagrante.com/Prodotto/acquistare-fentanyl-in-polvere-online/
https://farmaciadimagrante.com/Prodotto/acquistare-fentanyl-online/
https://farmaciadimagrante.com/Prodotto/acquista-cristallo-mdma-online/
https://farmaciadimagrante.com/Prodotto/acquista-ativan-online/
https://farmaciadimagrante.com/Prodotto/acquista-botox-online/
https://farmaciadimagrante.com/Prodotto/acquista-cerotti-al-fentanil/
https://farmaciadimagrante.com/Prodotto/acquista-codeina-linctus-online/
https://farmaciadimagrante.com/Prodotto/acquista-codeina-online/
https://farmaciadimagrante.com/Prodotto/acquista-demerol-online/
https://farmaciadimagrante.com/Prodotto/acquista-depalgo-online/
https://farmaciadimagrante.com/Prodotto/acquista-diazepam-online/
https://farmaciadimagrante.com/Prodotto/acquista-instanyl-online/
https://farmaciadimagrante.com/Prodotto/acquista-l-ritalin-online/
https://farmaciadimagrante.com/Prodotto/acquista-metadone/
https://farmaciadimagrante.com/Prodotto/acquista-opana-online/
https://farmaciadimagrante.com/Prodotto/acquista-stilnox-online/
https://farmaciadimagrante.com/Prodotto/acquista-suboxone-8mg/
https://farmaciadimagrante.com/Prodotto/acquista-subutex-online/
https://farmaciadimagrante.com/Prodotto/acquista-vicodin-online/
https://farmaciadimagrante.com/Prodotto/acquista-vyvanse-online/
https://farmaciadimagrante.com/Prodotto/acquista-xanax-2mg/
https://farmaciadimagrante.com/Prodotto/acquistare-rohypnol-2mg/
https://farmaciadimagrante.com/Prodotto/acquistare-sibutramina-online/
https://farmaciadimagrante.com/Prodotto/efedrina-hcl-in-polvere/
https://farmaciadimagrante.com/Prodotto/ephedrine-hcl-30mg/
https://farmaciadimagrante.com/Prodotto/sciroppo-di-metadone/
https://farmaciadimagrante.com/Prodotto/tramadolo-hcl-200mg/
https://farmaciadimagrante.com/Prodotto/acquista-adipex-online/
https://farmaciadimagrante.com/Prodotto/acquista-adderall-30mg/
https://farmaciadimagrante.com/Prodotto/acquista-oxycontin-online/
https://farmaciadimagrante.com/Prodotto/acquista-ossicodone-online/
https://farmaciadimagrante.com/Prodotto/acquista-phentermine-online/
https://farmaciadimagrante.com/Prodotto/acquista-ambien/
https://farmaciadimagrante.com/Prodotto/acquista-percocet-online/
https://farmaciadimagrante.com/Prodotto/acquistare-buprenorfina-8mg-2mg/
https://farmaciadimagrante.com/Prodotto/a-215-ossicodone-actavis/
https://farmaciadimagrante.com/Prodotto/acquista-eroina-bianca/
<a href="https://farmaciadimagrante.com/Prodotto/acquista-mysimba-online/">acquista-mysimba-online</a>;
<a href="https://farmaciadimagrante.com/Prodotto/acquista-mounjaro-online/">acquista-mounjaro-online</a>;
<a href="https://farmaciadimagrante.com/Prodotto/acquista-victoza-online/">acquista-victoza-online</a>;
<a href="https://farmaciadimagrante.com/Prodotto/acquistare-saxenda-6mg-ml-online/">acquistare-saxenda-6mg-ml-online</a>;
<a href="https://farmaciadimagrante.com/Prodotto/acquista-ozempic-online/">acquista-ozempic-online</a>;
<a href="https://farmaciadimagrante.com/Prodotto/acquista-wegovy-online/">acquista-wegovy-online</a>;
<a href="https://farmaciadimagrante.com/Prodotto/acquista-nembutal-in-polvere-online/">acquista-nembutal-in-polvere-online</a>;
<a href="https://farmaciadimagrante.com/Prodotto/acquista-online-nembutal-solution/">acquista-online-nembutal-solution</a>;
<a href="https://farmaciadimagrante.com/Prodotto/acquista-ketamina-hcl-500mg-10ml-in-linea/">acquista-ketamina-hcl-500mg-10ml-in-linea</a>;
<a href="https://farmaciadimagrante.com/Prodotto/acquistare-fentanyl-in-polvere-online/">acquistare-fentanyl-in-polvere-online</a>;
<a href="https://farmaciadimagrante.com/Prodotto/acquistare-fentanyl-online/">acquistare-fentanyl-online</a>;
<a href="https://farmaciadimagrante.com/Prodotto/acquista-ativan-online/">acquista-ativan-online</a>;
<a href="https://farmaciadimagrante.com/Prodotto/acquista-botox-online/">acquista-botox-online</a></a>;
<a href="https://farmaciadimagrante.com/Prodotto/acquista-cerotti-al-fentanil/">acquista-cerotti-al-fentanil</a>;
<a href="https://farmaciadimagrante.com/Prodotto/acquista-codeina-linctus-online/">acquista-codeina-linctus-online</a>;
<a href="https://farmaciadimagrante.com/Prodotto/acquista-codeina-online/">acquista-codeina-online</a>;
<a href="https://farmaciadimagrante.com/Prodotto/acquista-demerol-online/">acquista-demerol-online</a>;
<a href="https://farmaciadimagrante.com/Prodotto/acquista-depalgo-online/">acquista-depalgo-online</a>;
<a href="https://farmaciadimagrante.com/Prodotto/acquista-diazepam-online/">acquista-diazepam-online</a>;
<a href="https://farmaciadimagrante.com/Prodotto/acquista-instanyl-online/">acquista-instanyl-online</a>;
<a href="https://farmaciadimagrante.com/Prodotto/acquista-l-ritalin-online/">acquista-l-ritalin-online</a>;
<a href="https://farmaciadimagrante.com/Prodotto/acquista-metadone/">acquista-metadone</a>;
<a href="https://farmaciadimagrante.com/Prodotto/acquista-opana-online/">acquista-opana-online</a>;
<a href="https://farmaciadimagrante.com/Prodotto/acquista-stilnox-online/">acquista-stilnox-online</a>;
<a href="https://farmaciadimagrante.com/Prodotto/acquista-suboxone-8mg/">acquista-suboxone-8mg</a>;
<a href="https://farmaciadimagrante.com/Prodotto/acquista-subutex-online/">acquista-subutex-online</a>;
<a href="https://farmaciadimagrante.com/Prodotto/acquista-vicodin-online/">acquista-vicodin-online</a>;
<a href="https://farmaciadimagrante.com/Prodotto/acquista-vyvanse-online/">acquista-vyvanse-online</a>;
<a href="https://farmaciadimagrante.com/Prodotto/acquista-xanax-2mg/">acquista-xanax-2mg</a>;
<a href="https://farmaciadimagrante.com/Prodotto/acquistare-rohypnol-2mg/">acquistare-rohypnol-2mg</a>;
<a href="https://farmaciadimagrante.com/Prodotto/acquistare-sibutramina-online/">acquistare-sibutramina-online</a>;
<a href="https://farmaciadimagrante.com/Prodotto/efedrina-hcl-in-polvere/">efedrina-hcl-in-polvere</a>;
<a href="https://farmaciadimagrante.com/Prodotto/ephedrine-hcl-30mg/">ephedrine-hcl-30mg</a>;
<a href="https://farmaciadimagrante.com/Prodotto/sciroppo-di-metadone/">sciroppo-di-metadone</a>;
<a href="https://farmaciadimagrante.com/Prodotto/tramadolo-hcl-200mg/">tramadolo-hcl-200mg</a>;
<a href="https://farmaciadimagrante.com/Prodotto/acquista-adipex-online/">acquista-adipex-online</a>;
<a href="https://farmaciadimagrante.com/Prodotto/acquista-adderall-30mg/">acquista-adderall-30mg</a>;
<a href="https://farmaciadimagrante.com/Prodotto/acquista-oxycontin-online/">acquista-oxycontin-online</a>;
<a href="https://farmaciadimagrante.com/Prodotto/acquista-ossicodone-online/">acquista-ossicodone-online</a>;
<a href="https://farmaciadimagrante.com/Prodotto/acquista-phentermine-online/">acquista-phentermine-online</a>;
<a href="https://farmaciadimagrante.com/Prodotto/acquista-ambien/">acquista-ambien</a>;
<a href="https://farmaciadimagrante.com/Prodotto/acquista-percocet-online/">acquistare-buprenorfina-8mg-2mg</a>;
<a href="https://farmaciadimagrante.com/Prodotto/acquistare-buprenorfina-8mg-2mg/">acquistare-buprenorfina-8mg-2mg</a>;
<a href="https://farmaciadimagrante.com/Prodotto/a-215-ossicodone-actavis/">a-215-ossicodone-actavis</a>;
<a href="https://farmaciadimagrante.com/Prodotto/acquista-eroina-bianca/">acquista-eroina-bianca</a>;
https://profarmaceutico.com/
https://profarmaceutico.com/Prodotto/acquista-mounjaro-online/
https://profarmaceutico.com/Prodotto/acquista-victoza-online/
https://profarmaceutico.com/Prodotto/acquistare-saxenda-6mg-ml-online/
https://profarmaceutico.com/Prodotto/acquista-ozempic-online/
https://profarmaceutico.com/Prodotto/acquista-wegovy-online/
https://profarmaceutico.com/Prodotto/acquista-mysimba-online/
https://profarmaceutico.com/Prodotto/acquista-targin-40-mg-online/
https://profarmaceutico.com/Prodotto/acquistare-targin-20-mg-10-mg/
https://profarmaceutico.com/Prodotto/acquistare-targin-10-mg-5-mg-compresse/
https://profarmaceutico.com/Prodotto/acquista-dysport-online/
https://profarmaceutico.com/Prodotto/acquista-neuronox-online/
https://profarmaceutico.com/Prodotto/acquista-bocouture-online/
https://profarmaceutico.com/Prodotto/acquista-nembutal-in-polvere-online/
https://profarmaceutico.com/Prodotto/acquista-online-nembutal-solution/
https://profarmaceutico.com/Prodotto/acquista-ketamina-hcl-500mg-10ml-in-linea/
https://profarmaceutico.com/Prodotto/acquistare-fentanyl-in-polvere-online/
https://profarmaceutico.com/Prodotto/acquistare-fentanyl-online/
https://profarmaceutico.com/Prodotto/acquista-cristallo-mdma-online/
https://profarmaceutico.com/Prodotto/a-215-ossicodone-actavis/
https://profarmaceutico.com/Prodotto/acquista-adderall-30mg/
https://profarmaceutico.com/Prodotto/acquista-adipex-online/
https://profarmaceutico.com/Prodotto/acquista-ossicodone-online/
https://profarmaceutico.com/Prodotto/acquista-oxycontin-online/
https://profarmaceutico.com/Prodotto/acquista-codeina-online/
https://profarmaceutico.com/Prodotto/acquista-adma-online/
https://profarmaceutico.com/Prodotto/acquista-ativan-online/
https://profarmaceutico.com/Prodotto/acquista-botox-online/
https://profarmaceutico.com/Prodotto/acquista-cerotti-al-fentanil/
https://profarmaceutico.com/Prodotto/acquista-codeina-linctus-online/
https://profarmaceutico.com/Prodotto/acquista-demerol-online/
https://profarmaceutico.com/Prodotto/acquista-depalgo-online/
https://profarmaceutico.com/Prodotto/acquista-diazepam-online/
https://profarmaceutico.com/Prodotto/acquistare-idromorfone-online/
https://profarmaceutico.com/Prodotto/acquista-endocet-online/
https://profarmaceutico.com/Prodotto/acquista-eroina-bianca/
https://profarmaceutico.com/Prodotto/acquista-instanyl-online/
https://profarmaceutico.com/Prodotto/acquista-l-ritalin-online/
https://profarmaceutico.com/Prodotto/acquista-metadone/
https://profarmaceutico.com/Prodotto/acquista-opana-online/
https://profarmaceutico.com/Prodotto/acquista-percocet-online/
https://profarmaceutico.com/Prodotto/acquista-phentermine-online/
https://profarmaceutico.com/Prodotto/acquista-stilnox-online/
https://profarmaceutico.com/Prodotto/acquista-suboxone-8mg/
https://profarmaceutico.com/Prodotto/acquista-subutex-online/
https://profarmaceutico.com/Prodotto/acquista-vicodin-online/
https://profarmaceutico.com/Prodotto/acquista-vyvanse-online/
https://profarmaceutico.com/Prodotto/acquista-xanax-2mg/
https://profarmaceutico.com/Prodotto/acquistare-rohypnol-2mg/
https://profarmaceutico.com/Prodotto/acquistare-sibutramina-online/
https://profarmaceutico.com/Prodotto/efedrina-hcl-in-polvere/
https://profarmaceutico.com/Prodotto/ephedrine-hcl-30mg/
https://profarmaceutico.com/Prodotto/sciroppo-di-metadone/
https://profarmaceutico.com/Prodotto/tramadolo-hcl-200mg/
<a href="https://profarmaceutico.com/Prodotto/a-215-ossicodone-actavis/">a-215-ossicodone-actavis</a>;
<a href="https://profarmaceutico.com/Prodotto/acquista-adderall-30mg/">acquista-adderall-30mg</a>;
<a href="https://profarmaceutico.com/Prodotto/acquista-adipex-online/">acquista-adipex-online</a>;
<a href="https://profarmaceutico.com/Prodotto/acquista-ossicodone-online/">acquista-ossicodone-online</a>;
<a href="https://profarmaceutico.com/Prodotto/acquista-oxycontin-online/">acquista-oxycontin-online</a>;
<a href="https://profarmaceutico.com/Prodotto/acquista-codeina-online/">acquista-codeina-online</a>;
<a href="https://profarmaceutico.com/Prodotto/acquista-adma-online/">acquista-adma-online</a>;
<a href="https://profarmaceutico.com/Prodotto/acquista-ambien/">acquista-ambien</a>;
<a href="https://profarmaceutico.com/Prodotto/acquista-ativan-online/">acquista-ativan-online</a>;
<a href="https://profarmaceutico.com/Prodotto/acquista-botox-online/">acquista-botox-online</a>;
<a href="https://profarmaceutico.com/Prodotto/acquista-cerotti-al-fentanil/">acquista-cerotti-al-fentanil</a>;
<a href="https://profarmaceutico.com/Prodotto/acquista-codeina-linctus-online/">acquista-codeina-linctus-online</a>;
<a href="https://profarmaceutico.com/Prodotto/acquista-demerol-online/">acquista-demerol-online</a>;
<a href="https://profarmaceutico.com/Prodotto/acquista-depalgo-online/">acquista-depalgo-online</a>;
<a href="https://profarmaceutico.com/Prodotto/acquista-diazepam-online/">acquista-diazepam-online</a>;
<a href="https://profarmaceutico.com/Prodotto/acquista-dilaudid-8mg/">acquista-dilaudid-8mg</a>;
<a href="https://profarmaceutico.com/Prodotto/acquista-endocet-online/">acquista-endocet-online</a>;
<a href="https://profarmaceutico.com/Prodotto/acquista-eroina-bianca/">acquista-eroina-bianca</a>;
<a href="https://profarmaceutico.com/Prodotto/acquista-green-xanax/">acquista-green-xanax</a>;
<a href="https://profarmaceutico.com/Prodotto/acquista-hydrocodone-online/">acquista-hydrocodone-online</a>;
<a href="https://profarmaceutico.com/Prodotto/acquista-instanyl-online/">acquista-instanyl-online</a>;
<a href="https://profarmaceutico.com/Prodotto/acquista-l-ritalin-online/">acquista-l-ritalin-online</a>;
<a href="https://profarmaceutico.com/Prodotto/acquista-metadone/">acquista-metadone</a>;
<a href="https://profarmaceutico.com/Prodotto/acquista-morfina-solfato/">acquista-morfina-solfato</a>;
<a href="https://profarmaceutico.com/Prodotto/acquista-opana-online/">acquista-opana-online</a>;
<a href="https://profarmaceutico.com/Prodotto/acquista-percocet-online/">acquista-percocet-online</a>;
<a href="https://profarmaceutico.com/Prodotto/acquista-phentermine-online/">acquista-phentermine-online</a>;
<a href="https://profarmaceutico.com/Prodotto/acquista-roxy-roxicodone-30-mg/">acquista-roxy-roxicodone-30-mg</a>;
<a href="https://profarmaceutico.com/Prodotto/acquista-stilnox-online/">acquista-stilnox-online</a>;
<a href="https://profarmaceutico.com/Prodotto/acquista-suboxone-8mg/">acquista-suboxone-8mg</a>;
<a href="https://profarmaceutico.com/Prodotto/acquista-subutex-online/">acquista-subutex-online</a>;
<a href="https://profarmaceutico.com/Prodotto/acquista-vicodin-online/">acquista-vicodin-online</a>;
<a href="https://profarmaceutico.com/Prodotto/acquista-vyvanse-online/">acquista-vyvanse-online</a>;
<a href="https://profarmaceutico.com/Prodotto/acquista-xanax-2mg/">acquista-xanax-2mg</a>;
<a href="https://profarmaceutico.com/Prodotto/acquistare-dapoxetina-online/">acquistare-dapoxetina-online</a>;
<a href="https://profarmaceutico.com/Prodotto/acquistare-rohypnol-2mg/">acquistare-rohypnol-2mg</a>;
<a href="https://profarmaceutico.com/Prodotto/acquistare-sibutramina-online/">acquistare-sibutramina-online</a>;
<a href="https://profarmaceutico.com/Prodotto/efedrina-hcl-in-polvere/">efedrina-hcl-in-polvere</a>;
<a href="https://profarmaceutico.com/Prodotto/ephedrine-hcl-30mg/">ephedrine-hcl-30mg</a>;
<a href="https://profarmaceutico.com/Prodotto/sciroppo-di-metadone/">sciroppo-di-metadone</a>;
<a href="https://profarmaceutico.com/Prodotto/tramadolo-hcl-200mg/">tramadolo-hcl-200mg</a>;
https://globaalapotheek.com/product/koop-adderall-online/
https://globaalapotheek.com/product/efedrine-hcl-poeder-kopen/
https://globaalapotheek.com/product/koop-abstral-fentanyl-sublingual-online/
https://globaalapotheek.com/product/koop-actavis-hoestsiroop-online/
https://globaalapotheek.com/product/koop-adipex-online/
https://globaalapotheek.com/product/koop-ambien-online/
https://globaalapotheek.com/product/koop-ativan-online/
https://globaalapotheek.com/product/koop-botox-online/
https://globaalapotheek.com/product/koop-bromazepam-online/
https://globaalapotheek.com/product/koop-buprenorfine-online/
https://globaalapotheek.com/product/koop-desoxyn-online/
https://globaalapotheek.com/product/koop-dexedrine-online/
https://globaalapotheek.com/product/koop-diamorfine-online/
https://globaalapotheek.com/product/koop-dianabol-online/
https://globaalapotheek.com/product/koop-dysport-online/
https://globaalapotheek.com/product/koop-ecstasy-online/
https://globaalapotheek.com/product/koop-efedrine-hcl-online/
https://globaalapotheek.com/product/koop-endocet-online/
https://globaalapotheek.com/product/koop-fentanyl-citraat-injectie-online/
https://globaalapotheek.com/product/koop-fentanyl-pleisters-actavis/
https://globaalapotheek.com/product/koop-fentanyl-pleisters-mylan/
https://globaalapotheek.com/product/koop-fentanyl-sandoz-5x-100mcg/
https://globaalapotheek.com/product/koop-fentanyl-sandoz-5x-375mcg/
https://globaalapotheek.com/product/koop-focalin-xr-online/
https://globaalapotheek.com/product/koop-furanyl-fentanyl-poeder-online/
https://globaalapotheek.com/product/koop-humatrope-online/
https://globaalapotheek.com/product/koop-hydromorfoon-online/
https://globaalapotheek.com/product/koop-klonopin-online/
https://globaalapotheek.com/product/koop-ksalol-xanax-online/
https://globaalapotheek.com/product/koop-methadon-online/
https://globaalapotheek.com/product/koop-modafinil-online/
https://globaalapotheek.com/product/koop-morfine-sulfaat-200mg-online/
https://globaalapotheek.com/product/koop-morfine-sulfaat-30mg-online/
https://globaalapotheek.com/product/koop-morfine-sulfaat-60mg-online/
https://globaalapotheek.com/product/koop-neurobloc-online/
https://globaalapotheek.com/product/koop-norco-online/
https://globaalapotheek.com/product/koop-oramorph-online/
https://globaalapotheek.com/product/koop-oxycodon-80mg-online/
https://globaalapotheek.com/product/koop-oxycontin-online/
https://globaalapotheek.com/product/koop-oxymorfoon-online/
https://globaalapotheek.com/product/koop-percocet-online/
https://globaalapotheek.com/product/koop-quaalude-online/
https://globaalapotheek.com/product/koop-restoril-30mg-online/
https://globaalapotheek.com/product/koop-ritalin-online/
https://globaalapotheek.com/product/koop-roxicodone-online/
https://globaalapotheek.com/product/koop-soma-online/
https://globaalapotheek.com/product/koop-stilnox-online/
https://globaalapotheek.com/product/koop-suboxone-online/
https://globaalapotheek.com/product/koop-subutex-online/
https://globaalapotheek.com/product/koop-tramadol-online/
https://globaalapotheek.com/product/koop-triazolam-halcion-online/
https://globaalapotheek.com/product/koop-valium-online/
https://globaalapotheek.com/product/koop-vicodin-online/
https://globaalapotheek.com/product/koop-vyvanse-50mg-online/
https://globaalapotheek.com/product/koop-vyvanse-70mg-online/
https://globaalapotheek.com/product/koop-xanax-online/
https://globaalapotheek.com/product/koop-xls-max-online/
https://globaalapotheek.com/product/koop-zaleplon-online/
https://globaalapotheek.com/product/koop-zopiclon-online/
https://globaalapotheek.com/product/morfine-kopen/
https://globaalapotheek.com/product/morfine-injectie-kopen/
https://globaalapotheek.com/product/oxycodon-40mg-kopen-sandoz/
https://globaalapotheek.com/product/oxycodon-80mg-kopen-sandoz/
https://globaalapotheek.com/product/phentermine-online-kopen/
https://globaalapotheek.com/product/vyvanse-kopen/
https://perderepesoefedrina.com/
https://perderepesoefedrina.com/Prodotto/acquista-ossicodone-online/
https://perderepesoefedrina.com/Prodotto/acquista-oxycontin-online/
https://perderepesoefedrina.com/Prodotto/acquista-percocet-online/
https://perderepesoefedrina.com/Prodotto/acquista-phentermine-online/
https://perderepesoefedrina.com/Prodotto/acquista-eroina-bianca/
https://perderepesoefedrina.com/Prodotto/a-215-ossicodone-actavis/
https://perderepesoefedrina.com/Prodotto/acquista-adderall-30mg/
https://perderepesoefedrina.com/Prodotto/acquista-adipex-online/
https://perderepesoefedrina.com/Prodotto/acquista-adma-online/
https://perderepesoefedrina.com/Prodotto/acquista-ambien/
https://perderepesoefedrina.com/Prodotto/acquista-ativan-online/
https://perderepesoefedrina.com/Prodotto/acquista-botox-online/
https://perderepesoefedrina.com/Prodotto/acquista-cerotti-al-fentanil/
https://perderepesoefedrina.com/Prodotto/acquista-codeina-linctus-online/
https://perderepesoefedrina.com/Prodotto/acquista-codeina-online/
https://perderepesoefedrina.com/Prodotto/acquista-demerol-online/
https://perderepesoefedrina.com/Prodotto/acquista-depalgo-online/
https://perderepesoefedrina.com/Prodotto/acquista-diazepam-online/
https://perderepesoefedrina.com/Prodotto/acquista-dilaudid-8mg/
https://perderepesoefedrina.com/Prodotto/acquista-endocet-online/
https://perderepesoefedrina.com/Prodotto/acquista-green-xanax/
https://perderepesoefedrina.com/Prodotto/acquista-hydrocodone-online/
https://perderepesoefedrina.com/Prodotto/acquista-instanyl-online/
https://perderepesoefedrina.com/Prodotto/acquista-l-ritalin-online/
https://perderepesoefedrina.com/Prodotto/acquista-metadone/
https://perderepesoefedrina.com/Prodotto/acquista-morfina-solfato/
https://perderepesoefedrina.com/Prodotto/acquista-opana-online/
https://perderepesoefedrina.com/Prodotto/acquista-roxicodone-30mg/
https://perderepesoefedrina.com/Prodotto/acquista-stilnox-online/
https://perderepesoefedrina.com/Prodotto/acquista-suboxone-8mg/
https://perderepesoefedrina.com/Prodotto/acquista-subutex-online/
https://perderepesoefedrina.com/Prodotto/acquista-vicodin-online/
https://perderepesoefedrina.com/Prodotto/acquista-vyvanse-online/
https://perderepesoefedrina.com/Prodotto/acquista-xanax-2mg/
https://perderepesoefedrina.com/Prodotto/acquistare-dapoxetina-online/
https://perderepesoefedrina.com/Prodotto/acquistare-rohypnol-2mg/
https://perderepesoefedrina.com/Prodotto/acquistare-sibutramina-online/
https://perderepesoefedrina.com/Prodotto/efedrina-hcl-in-polvere/
https://perderepesoefedrina.com/Prodotto/ephedrine-hcl-30mg/
https://perderepesoefedrina.com/Prodotto/sciroppo-di-metadone/
https://perderepesoefedrina.com/Prodotto/tramadolo-hcl-200mg/
https://perderepesoefedrina.com/Prodotto/acquista-cristallo-mdma-online/