Neuropathy "The Painful Enigma"

For individuals about to engage in physical activity or exercise, how does warming up the body help prepare for the work ahead?

Central Nervous System Activation

A proper warm-up before physical activity or working out prepares the mind and body to reduce risks of injury, mentally and physically transition to physical activity work, and enhance performance. A well-designed warm-up also primes the central nervous system/CNS for activity. The central nervous system transmits messages to the muscles to prepare them for action. Central nervous system activation increases motor neuron recruitment and engages the sympathetic nervous system so the body can better handle the physical stressors. The process may seem complex, but priming the nervous system is as simple as warming up with light aerobic activity before getting into more explosive movements.

CNS

The CNS consists of the brain and spinal cord. This central communication system uses another part of the nervous system known as the peripheral nervous system or PNS to transmit and receive messages throughout the body. The PNS is connected to the entire body and the brain and spinal cord (CNS).

• Nerves run throughout the body, receiving signals from the CNS to the muscles, fibers, and organs, transmitting various information back to the brain. (Berkeley University. N.D.)
• There are two types of systems within the peripheral nervous system - somatic and autonomic.

1. Somatic nervous system actions are those controlled by the person through voluntary actions like choosing to pick something up.
2. The autonomic system is involuntary and generates actions like breathing or heartbeat. (Cleveland Clinic. 2020)

Properly preparing the body for an intense strength training session or other physical activity needs the correct messages to be sent through the autonomic nervous system.

Parasympathetic and Sympathetic States

The autonomic nervous system consists of two subcategories, which are parasympathetic and sympathetic.

• The sympathetic nervous system helps the body get ready to face stress which includes physical stress. (R. Bankenahally, H. Krovvidi. 2016)
• The fight, flight, or freeze response describes the sympathetic nervous system's aspect.
• The parasympathetic nervous system is responsible for relaxation and de-stressing.

Individuals are recommended to perform a few calming movements and actions after a workout to return the body to a parasympathetic state. This can be:

• Stretching
• Lying with the legs elevated
• Relaxing yoga poses
• Box breathing
• Taking a warm shower or bath
• Foam rolling
• Massage

Returning the mind and body to a calm state helps with recovery and reduces stress hormone production. (National Academy of Sports Medicine. 2022)

Why Activate the CNS

Activating the CNS can increase performance and prevent injuries. The process wakes up and alerts the body for the activity. Individuals are recommended before beginning a training session, to communicate to the body about the physical stress it is about to endure and to prepare for the work ahead. This is a concept known as post-activation potentiation/PAP. (Anthony J Blazevich, Nicolas Babault. 2019) PAP helps increase force and power production, which enhances physical performance.

• Whenever an individual trains, the brain adapts and learns what the body is doing and the purpose of the training.
• Muscle memory describes this interaction.
• Individuals who have started up a new strength training routine or after an extended break report feeling awkward for the first few sessions, or even weeks, depending on their experience. (David C Hughes, Stian Ellefsen, Keith Baar, 2018)
• However, after a few sessions, the body is more adept at performing the movements and ready to increase resistance, repetitions, or both.
• This has to do with the neural drive and muscle memory than it has to do with true potential physical abilities. (Simon Walker. 2021)
• Training the CNS to be alert and pay attention can increase the development of a healthy mind-muscle connection combined with muscle memory. (David C Hughes, Stian Ellefsen, Keith Baar, 2018)

General Warm-Up

The first step is a general warm-up that should use large muscle groups and be of low intensity so as not to exhaust the body before beginning the actual training. General warm-up benefits central nervous system activation and the entire body include: (Pedro P. Neves, et al., 2021) (D C. Andrade, et al., 2015)

• Increases blood circulation.
• Assists the release of oxygen from hemoglobin and myoglobin.
• Warms the muscles, so they contract more effectively.
• Increases nerve impulse speed.
• Increases nutrient delivery.
• Lowers joints' resistance through increased synovial fluid/joint lubrication.
• Increases joint range of motion.
• Improves joint resiliency.
• Removes metabolic waste quicker.
• Reduces risk of injury.

A general warm-up can be simple as any aerobic activity will work. This can include:

• Performing bodyweight movements - light jumping jacks or jogging in place.
• Treadmill
• Rowing machine
• Stair climber
• Elliptical trainer

It is recommended to use the rating perceived exertion scale/RPE to determine the general warm-up effort. An exertion rating of between 5 to 6 is equivalent to moderate walking or a slow jog. Individuals should be able to speak clearly without taking a pause.

Try this strategy before the next workout to see increased performance and reduced injury risks.

Ankle Sprains Recovery

General Disclaimer *

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

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

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

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

The nervous system. Berkeley University.

Cleveland Clinic. Nervous system: What it is, types, symptoms.

Bankenahally R, Krovvidi H. (2016) Autonomic nervous system: anatomy, physiology, and relevance in anesthesia and critical care medicine. BJA Education. 16(11):381-387. doi:10.1093/bjaed/mkw011

National Academy of Sports Medicine. Sympathetic vs. parasympathetic overtraining.

Blazevich, A. J., & Babault, N. (2019). Post-activation Potentiation Versus Post-activation Performance Enhancement in Humans: Historical Perspective, Underlying Mechanisms, and Current Issues. Frontiers in physiology, 10, 1359. https://doi.org/10.3389/fphys.2019.01359

Hughes, D. C., Ellefsen, S., & Baar, K. (2018). Adaptations to Endurance and Strength Training. Cold Spring Harbor perspectives in medicine, 8(6), a029769. https://doi.org/10.1101/cshperspect.a029769

Walker S. (2021). Evidence of resistance training-induced neural adaptation in older adults. Experimental gerontology, 151, 111408. https://doi.org/10.1016/j.exger.2021.111408

P. Neves, P., R. Alves, A., A. Marinho, D., & P. Neiva, H. (2021). Warming-Up for Resistance Training and Muscular Performance: A Narrative Review. IntechOpen. doi: 10.5772/intechopen.96075

Andrade, D. C., Henriquez-Olguín, C., Beltrán, A. R., Ramírez, M. A., Labarca, C., Cornejo, M., Álvarez, C., & Ramírez-Campillo, R. (2015). Effects of general, specific, and combined warm-up on explosive muscular performance. Biology of sport, 32(2), 123–128. https://doi.org/10.5604/20831862.1140426

Fibromyalgia pain is not just physical. Around 30% of individuals experience depression, anxiety, or some form of mood disturbance/swing. Fibromyalgia is still being researched if it causes these conditions or vice versa, but what is clear is that when the mental state gives in to the physical pain, your pain gets worse and worse.

A doctor may recommend a:

• Counselor
• Psychologist
• Psychiatrist

Symptoms are varied and impact an individual's life in ways that go beyond physical pain. Fatigue alone can be enough to alter lifestyle in a negative way, which affects mood.

Taking control of symptoms usually means taking a multi-disciplinary approach that includes:

• Medications
• Physical therapy
• Psychology

Mental and emotional therapy could be a part of a treatment plan.

Depression and Anxiety Difference

Depression and anxiety are sometimes put in the same category. Symptoms can include depression and anxiety occur at the same time but they are not synonymous disorders. Depression is characterized by chronic sadness. Individuals handle depression, their own way. Some cry or lash out in anger/frustration. Some days are spent in bed, other days/nights are spent eating excessively, as a response to the pain. The most important thing is recognizing the change in behavior. Talk to your doctor or a therapist.

Anxiety is known for feelings of panic, fear, and excessive worry. Individuals feel their heart is racing that can get confused with a heart problem.

Fibromyalgia Depression Connection

To understand how fibromyalgia relates to depression and anxiety, and see the difference between depression and anxiety, here are some symptoms.

The symbols show symptoms most associated with the disorder. However, it's possible to experience less sleep than normal if you have depression, but the more common symptom is sleeping more than usual.

Finding a Mental Health Professional

Professionals include:

• Licensed professional counselors (PCs)
• Psychologists
• Psychiatrists

These professionals are trained to diagnose and treat mental/emotional issues. Your doctor can help in figuring out which is best for you.

• Licensed professional counselors require a master's degree in counseling and are approved to diagnose and treat mental and emotional disorders.
• Psychologists are considered as a separate group of non-physician mental health professionals. They have a doctorate and are approved to treat emotional problems using therapies like cognitive-behavioral therapy.
• Psychiatrists are medical doctors that are licensed to prescribe medications to help depression and anxiety, along with several mental disorders.

Adding the impact this disorder has on a person's mental and emotional state can seriously damage their quality of life. Recognizing when the pain is not just physical is difficult. Therefore setting up a telemedicine/video conference with a mental health professional could help in dealing with the mental stresses that come with fibromyalgia. Even for those that don't require medication seeing a mental health professional can be highly beneficial.

You can openly talk about experiences having to do with fibromyalgia, how it affects your family, etc,  which is therapeutic in itself. Do not hesitate to seek the help of a mental health professional. The focus is to help you feel better, become educated on ways to help yourself and improved quality of life.

Peripheral Neuropathy Causes & Symptoms

More individuals are reporting extreme levels of stress. Studies indicate that an increasing number of individuals are feeling worried, anxious, or depressed regularly from various stressors. Maintaining the body's health includes:

• Following a balanced diet
• Getting enough exercise
• Taking vitamins or supplements to ensure the body gets what it needs for optimal function.

However, research has found that a sudden increase in stress, specifically stress associated with anger, can trigger:

• Arrhythmias
• Heart attacks
• Sudden death

This type of stress can affect individuals that did not know they had heart disease. Intense short-term stress can have dangerous effects on the body's health, leading to chronic stress. Chronic stress continues at a low level for weeks, months, or years. It can significantly change the way the body functions. Stress management is crucial for overall well-being. Learning how to handle stress properly is the goal.

Poor Stress Management

When stress hits, it triggers the brain to release various hormones. These hormones increase heart rate and raise blood pressure. This comes from evolution that helped early humans escape from predators and stay safe from different types of physical danger. This same stress reaction is what we go through; however, it is not to escape danger but to deal with work, family, school, commuting, social issues, etc. And when the stress response happens regularly, it can have serious and long-term effects on the body's ability to function properly. Stress includes mental, behavioral, and physical symptoms. The most familiar effects of stress are related to mood. Mood changes that can result from chronic low-level stress include:

• Feelings overwhelmed
• Increased anxiety
• Generalized anxiety that is not connected with anything specific
• Unmotivated or unfocused
• Sadness
• Depression
• Irritability
• Impatience
• Unusually quick to anger
• Restlessness

These mood changes can be tied to changes in behavior. The following behaviors are associated with increased stress levels:

• Alcohol and/or drug abuse
• Starting or increasing tobacco use
• Eating changes - undereating or overeating
• Withdrawing from friends and family
• Avoiding social interaction
• Little to no physical activity

Physical effects that are associated with long-term stress.

Chronic stress that lasts for a long period can affect the whole body. The immune system, digestive system, sleep cycles, etc. Physical symptoms include:

• Tension in the neck and back
• Persistent headaches
• Stomach aches
• Constant fatigue, even after waking up
• Sleeping pattern changes
• Insomnia
• Muscle pain
• Changes in libido
• Being more prone to infections because of a weakened immune system
• Chest pain

Learning Healthy Stress Management

Mental health is now an important part of living a healthy life. Stress comes from all kinds of different places. We can’t always change these moments, but we can change our reactions to reduce the negative effects and results. To manage stress, it is important to know what is causing it.

• It could be an argument with a boss, co-worker, family member, or significant other.
• Work deadlines
• School grades, teachers, kids, etc
• Bills
• Repairs

Clearly identifying the main stressors will help individuals anticipate them and form a plan. There are different ways of dealing with it. The different strategies need to be researched and tried by individuals to see what works for them. Think about what helps the mind and body relax and unwind. A few recommended ways include:

• Watching favorite shows or movies
• Listening to music
• Breathing techniques
• Spend time with friends or family
• Make time for yourself to do something you love - alone time
• Unplug from devices like phones, tablets, or computer
• Play a sport
• Practice yoga
• Physical activity
• Take a nature hike
• Write, paint, sculpt, knit, sew, crafts, make music, play instrument/s - real media, or digital.
• Meditate and practice mindfulness techniques

These are strategies that can be incorporated into regular daily life. Be sure to set time aside to focus on mental wellbeing. Learn to recognize the signs when getting overwhelmed. Don’t hesitate to ask for help when needed. This can be a support system or mental health professional. This is to empower individuals to take better care of themselves in both body and mind.

Body Composition

Setting Attainable Goals

Individuals that have trouble achieving health goals might want to look at the goals themselves. Individuals typically have a general idea of their fitness journey. However, it is hard to reach those goals without a map. Losing weight or getting healthy is the goal, but these goals are not measurable. This is too broad that can be different things to different people. Trying to accomplish a vague goal makes it hard to plan, making it happen, or seeing progress. A recommended strategy for goal setting is to use the SMART system. The acronym stands for:

• Specific
• Measurable
• Attainable
• Realistic
• Timed

When goals fall into these parameters, it provides a clear picture of what is trying to get accomplished and plan accordingly. An example could be: An individual will work out at home or the gym for one hour, five days a week for one month. This is a specific and measurable goal when compared to I’m going to work out more. This provides clear guidelines of what needs to happen to achieve success.

General Disclaimer *

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

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

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

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Bailey, Ryan R. “Goal Setting and Action Planning for Health Behavior Change.” American journal of lifestyle medicine vol. 13,6 615-618. 13 Sep. 2017, doi:10.1177/1559827617729634

Carlson, Linda E et al. “Integrative Approaches to Stress Management.” Cancer journal (Sudbury, Mass.) vol. 25,5 (2019): 329-336. doi:10.1097/PPO.0000000000000395

Jamison, J R. “Stress management: an exploratory study of chiropractic patients.” Journal of manipulative and physiological therapeutics vol. 23,1 (2000): 32-6. doi:10.1016/s0161-4754(00)90111-8

Jamison, J. “Stress: the chiropractic patients' self-perceptions.” Journal of manipulative and physiological therapeutics vol. 22,6 (1999): 395-8. doi:10.1016/s0161-4754(99)70085-0