The sweetness of the squash really goes nicely with the asparagus and the creamy dollops of cheese here.  This dish could easily be enjoyed for a breakfast or dinner option.   While out shopping I couldn't find any delicata squash, even though I went to 3 grocery stores!  I found that the butternut squash filled in just fine for it. I also totally forgot to get goat cheese, and do not usually have this on hand, so I filled in with ricotta cheese and it was also a fine substitute.  However, I do think the goat cheese would be a little more flavorful.  Enjoy!

Ingredients:
1 medium delicata squash (or 1 small butternut squash)
1 bunch fresh asparagus, cut into bite sized pieces
10-12 eggs
1/2 teaspoon garlic powder
1/2 teaspoon turmeric
4 oz goat cheese
salt and pepper to taste

Instructions:
Preheat oven to 400 degrees.

Cut the squash in half, scoop out the seeds and then slice it into 1/2 inch discs.  Toss with a little oil and then roast for 20-25 minutes.  While this starts, toss the asparagus in oil and add it to the sheet of squash with about 7-8 minutes to go.    (note:  You can eat delicata squash rind, but I'm not sure you want to eat the butternut squash rind.  I trimmed the peel off my butternut squash prior to roasting it using a potato peeler!)

Whisk the eggs, garlic, turmeric and salt and pepper to taste.  Grease a 9x13 casserole dish.  When the squash and asparagus are done roasting, place them in the dish.  Turn the oven down to 375 degrees.  Pour the egg mixture over the veggies and crumble the goat cheese evenly over the top.  

Bake for 30-35 minutes or until it is fully set.  

This dish is similar to the well-loved Pad Thai, but it has more peanut flavor and less spice. You can use any noodles you prefer—we made it with rice noodles and stir-fried some vegetables before mixing everything together. Feel free to swap the vegetables for whatever you have on hand or substitute the tofu with chicken or another protein if you prefer.  




Ingredients:

5 tablespoons tamari or soy sauce
½ teaspoon ground ginger
1 pound firm or extra-firm tofu, rinsed, patted dry, and cut into ½-inch cubes
⅓ cup natural peanut butter
3 tablespoons pure maple syrup
1 tablespoon water
1 tablespoon sesame seeds
1 garlic clove, minced
½-1 teaspoon chili paste
1 pound fettuccine, wide rice noodles, or other pasta
1 red, orange or yellow pepper, sliced
1 medium head of broccoli, cut into bite sized pieces
2 scallions, thinly sliced (both green and white parts)

Instructions:

Make the tofu:  Preheat broiler on high.  Stir together 2 tablespoons of the tamari and ginger in a medium bowl.  Add the cubed tofu and stir gently to coat.  Mist a baking sheet with nonstick cooking spray.  Spread the tofu on the baking sheet in a single layer.  Place under a broiler for 5 minutes.  Flip the tofu and broil for 5 minutes or until light brown and crispy.  Then set this aside.

Make the sauce: In a medium bowl, whisk together the remaining 3 tablespoons tamari with the peanut butter, maple syrup, rice vinegar, water, sesame seeds, garlic, and chili paste and set aside.

Make the noodles according to the package.

Stir fry the veggies while the noodles are cooking:  Heat 1 tablespoon oil in a wok or large frying pan.  Place your cut veggies in the pan and sauté for 3-5 minutes, or until they begin to soften.  If using broccoli, add 2 tablespoons of water and cover to let steam at the end for 2-3 minutes.

Toss the veggies, tofu and sauce all together in the wok, frying pan, or in a large bowl.  Top with scallions and enjoy!

By Jess Kehoe

For Christmas Santa gave me the book "What I Ate in One Year" by Stanley Tucci.  If you are unfamiliar with him, he's an actor with strong Italian heritage who has made a travel and food show called "Searching for Italy".  I was mildly obsessed while riding the stationary bike two winters ago, I would like to go to Italy and eat all that food too.  This book was a fun little read that gives insight to the life of a famous actor, who also is obsessed with good food.  In it he shares a few recipes and I tried two of them, with good results.  I will share how I made them with you.  

Ingredients:

For the Chard:
one bunch of Swiss Chard, strip the leaves from the stems and chop up both leaves and stems
one garlic clove, halved
salt to taste
a drizzle of olive oil

For the fish:
Enough cod for 2-4 people (I used flounder because it was available for a good price, it worked great, you could probably also use tilapia)
1/2 onion, chopped
2 garlic cloves, minced
one 15 oz can of diced tomatoes
4-5 fresh basil leaves, torn
1/2 cup white wine (I didn't want to open a bottle for this, so I used chicken broth instead)
8 green olives
1 tablespoon capers, drained
salt to taste
olive oil
rice for 4

Instructions:

Make the rice per package instructions, or however you usually do it!

For the fish and chard, you can have them going at the same time.  I started by prepping all the ingredients.  Then it went something like this...

In a medium to large sauce pan, cover the chard stems and the garlic with water and bring to a boil, then lower the heat and simmer covered for 10 minutes.  

While this is going, heat two tablespoons or so of olive oil in a medium to large frying pan.  Add the onion and garlic and sauté until soft.  Then add the tomatoes and their liquid, the basil and a pinch or two of salt.  Cook for a few minutes.

When the first 10 minutes of the chard is up, add the leaves and a bit more salt.  Cover and leave on low to steam and wilt the leaves for about 10 minutes.  When this is done strain the liquid and drizzle with some olive oil.

In the tomato sauce, increase the heat to high and add the wine.  Let it boil for a minute to burn off the alcohol, if using broth, just bring to a boil to heat it.  Then turn the temp down to a simmer, add the olives and capers.  Place the fish in the pan and cover with some of the sauce.  Cover and cook for 3-5 minutes, then flip the fish and cook and other 3 minutes.  The fish should be flaky and opaque in the middle.  

Serve with a side of rice, the sauce is nice on all of it!

​My 11 yr old received a cookbook, How to Cook, for her birthday this August, and it has been a game changer.  So far she has actually cooked dinner with minimal help one night a week in September, it's like a miracle!  This meal turned out really good, and can easily be adapted with lots of different ingredients to use what you have or what you like best.  

Ingredients:
1 14-oz package of firm or extra-firm tofu
3-4 tablespoons olive oil, separated
2 tablespoons soy sauce
1 garlic clove, minced
1 tablespoon sherry vinegar
4 eggs
4-6 small heads of baby bok choi, rinsed and sliced in half
1-2 carrots
1 red pepper, sliced
4 packages of instant ramen

Instructions:
**Feel free to use any veggies you have on hand, sauteing up a few sliced mushrooms, broccoli, or zucchini would be a nice addition or substitution to any of the ingredients above. 

Make the tofu:  This step can take anywhere between 15 min to 6 hours, depending on what time you have.  The longer you drain the tofu and marinade it, the more flavor it will have in the end.  But a quick squeeze and marinade also works in a pinch!  Pat the tofu dry, then wrap it in cheese cloth or a few paper towels.  Place it between two plates and place a moderately heavy thing on top, careful it may slide as this sits.  Let this arrangement sit for 15-60 minutes.  By "squeezing" out some of the liquid in the tofu it is able to take on more flavor from the marinade and also bakes up to be nice and crispy.  Slice the tofu into 6 rectangles.  Wisk together 2 tablespoons of the olive oil, the soy sauce, garlic and vinegar.  Place this in a bowl or plastic bag with the tofu.  Let sit for at least 10 min or up to several hours, even overnight in the fridge.  Preheat the oven to 325 degrees.  Place the tofu on a baking dish and roast it until the tofu has a firm texture and has a light brown color flipping half way, about 40 minutes.  Set aside on a plate.

Soft boil the egg:  Fill a medium bowl with enough water to submerge your eggs.  Place some ice in the water, and set aside.   Place the eggs in a medium pot and cover with water by about 2 inches.  Set over high heat and bring the water to a boil.  As soon as it comes to a boil, cover it and remove it from the heat, let it sit for 6 minutes.  Then place your eggs carefully into the ice bath, let them sit for 5 minutes.  Gently peel the shells, slice in half.

Sauté your veggies: Heat up 1 tablespoon of olive oil in a medium pan.  When your oil is hot sear the bok choi for about 2-3 minutes or until it chars a bit.  Put this on a plate.  Then add another tablespoon of oil and sauté the red pepper until just crisp tender.  

Shave the carrots: Wash and peel the carrots.  Then using your peeler, shave the carrot into long ribbons.  

Cook the ramen according to the package then serve, adding the tofu and veggies to the bowls of ramen.

Enjoy!

Don't want to take the time to flip all those pancakes? Here's a one bowl, one pan breakfast that cooks up easy with ingredients you probably have already in your cupboard  Feel free to use frozen berries, and any fruit would work great.

Ingredients:

4 tablespoons butter
6 eggs
1 cup milk
1 cup flour
1/2 teaspoon salt
pinch of cinnamon
1 teaspoon vanilla
1 1/2 cup blueberries
optional toppings: whipped cream, maple syrup, powdered sugar, yogurt, bananas, etc.

Instructions:

Combine the eggs, mild, flour, salt, cinnamon, and vanilla in a blender. Pulse until evenly combined and smooth.  Let batter rest for 15 minutes at room temperature.  Or leave overnight in the fridge.

Preheat oven to 425 degrees when you are ready to make the Dutch baby.

Place the butter, cut into pats, in a 14 inch cast iron pan or a 9x13 inch baking dish.  Spread out the fruit with the butter.  Place this in the oven for 2 minutes, or until the butter melts.

Pour the batter over the melted butter and berries, then return immediately to the oven.  Bake for 22-25 minutes or until the edges have puffed up and started to turn a golden brown.

Cut and serve immediately, using any desired toppings.

​

Here's a healthy option when you get a huge head of lettuce at the farmers market, and you're looking for something tasty other than salad.  This recipe is pretty quick to whip up, if you skip the marinating of the chicken.  Our family used chicken here, but you can sub tofu for a vegetarian dish as well.

Ingredients:
1-1 1/2 lbs diced chicken (you can use breasts or boneless thighs)
1 large egg white
1 tablespoon and 2 teaspoons cornstarch (divided)
2 tablespoon rice wine or dry sherry (divided)
2 tablespoons oyster sauce
1 tablespoon hoisin sauce
1 tablespoon soy sauce
1 teaspoon toasted sesame oil
4 tablespoons peanut oil
3 cloves garlic, minced
1 teaspoon minced ginger
4 scallions (2 minced and 2 cut into 1-inch pieces)
salt
1/4 teaspoon sugar
1/2 lb mushrooms, stemmed and diced
12-14 large lettuce leaves.  (Bib or Butter lettuce is preferred)
Soy sauce, chili paste for serving

Instructions:  (total time about 1 hour with marinating step)
Prepare the chicken: Wisk the egg white with 1 tablespoon rice wine and 1 tablespoon of cornstarch in a small bowl.  Add the chicken and toss to coat.  Cover and refrigerate for at least 30 minutes.

While the chicken is chilling, make the sauce:  Wisk 1/3 cup water, the oyster,  hoisin and soy sauces, 1 tablespoon rice wine, and the sesame oil in a bowl or small mason jar.  Then add 2 teaspoons of cornstarch, mix until dissolved.

Make the stir-fry:  Heat 2 tablespoons of peanut oil (you can sub vegetable oil in a pinch, but the peanut oil will give it a nice flavor) in a large skillet over medium high heat.  Add the chicken and cook, stirring for 2-3 minutes or until cooked.  Remove the chicken with a slotted spoon and place on a plate.  Add the remaining 2 tablespoons of peanut oil, then stir in the garlic, ginger, and minced scallions.  Add the sugar and 1/2 teaspoon salt, stir-fry for 30 seconds.  Then add the mushrooms and scallion pieces and stir-fry for about 2 more minutes.  Return the chicken to the pan and then add the sauce.  Cook for 1 minute.  

Serve with lettuce for wraps.  Enjoy!
​

By Brace Hayden, DPT and Miya Ensley

If you are interested in learning more about the causal factors and differential
diagnostics for Medial Tibial Stress Syndrome (MTSS) or “Shin Splints” please read the first of this two part article “Running with Medial Tibial Stress Syndrome - What is Causing My Shin Pain?”

Treatment Options for Shin Splints

As this article was compiled by a PT, we can only stress the benefits of getting yourself in for a proper professional and structured PT assessment.  This will give you the most personalized treatment plan for optimal healing and expedited return-to-run results.

However, the DIY options include:

• Pausing high impact training (ie. running) or ramp down your training until MTSS symptoms improve.
• While taking a hiatus from run training or reducing your run volume, don’t throw out your metaphorical running baby with the bathwater and lose your fitness by stopping all physical activities. You can increase your odds of a faster healing process by diversifying your workouts and cross-training. Consider pool running, kick-boarding drills in the pool, biking on road/gravel/trails, or hiking/walking with ski/trek poles.
• Ice cup massage your shin(s) to reduce acute inflammation or hot pack them to improve blood flow. There is debate in the current sports medicine literature as to which is best, so a little self-experimentation is recommended to see what helps your system more.
• Always try to do a light warm-up jog for 5-10 minutes and then perform run-specific dynamic mobility exercises as a pre-run / cross-training workout to reduce future injuries. See these two prior RWM articles on some selected exercises and benefits of performing some pre-run stretches.
• Post-run sustained stretches (hold each for 5 to 30 seconds, back off/relax muscle, and repeat stretch 5 times). Like cooking, some people spend hours preparing a meal, others pop a frozen burrito in the microwave.  Customizing the duration of a recovery stretching routine is largely an individual’s preference based on time availability and what works best for their body.  Most importantly, just do it. Some people find adding tooled assistants (ie. foam-rolling or percussive massage guns) can add value to the routine. The bottom line is, performing a stretching routine after a run has a lot of supportive evidence on keeping muscles more flexible, less sore and reduce occurrence of injuries.
• “Toe-ga exercises” and more: Here are a few popular PT-recommended foot/ankle drills links to improve your leg strength, mobility, and MTSS-rehabilitating exercises. Dosing (repetitions, sets, times per day/week) of each can generally be started with 2-3 sets of 10-30 repetitions depending on respective fatigue and relative fitness. 
  • Ankle alphabets
  • Split lunge on BOSU
  • Eccentric tibialis ankle pull ups with loop band and weight
  • Heel-walking drill
• Wrapping and taping: Wrapping the shin musculature with a compression wrap prior to exercising can reduce some of the stress response and shin pain. There are a multitude of available taping techniques (Kinesio Tape, McConnell, etc) for supporting / binding the medial arch and lower leg musculature some athletes have found helpful.

Preventing Medial Tibial Stress Syndrome

• Make sure you wear the correct running shoes for your foot type. If you're unsure, visit a local running store that offers professional fitting and analysis.
• Have two pairs of (reasonably recently purchased) running shoes with good cushioning and alternate wearing them can vary the stresses on your feet / legs.
• If you enjoy running on roads or paved roadside paths that have a significant camber to aid rain run off, run out and back on the same side of the road (if traffic / safety allows). Similarly, consider alternating directions if you are doing long-distance track workouts.
• Strength train two to three times a week. Long-distance running requires a solid routine of weekly strength and conditioning workouts to maintain healthy joints and supportive musculature. Some runners can get away with just running, but the best evidence leans on a balanced (strength, cardio, stretching, sleep, nutrition, etc) routine. See the “Toe-ga exercises” section above for a few suggested starters.  Visit with a PT for a more personalized plan.
• Perform pre and post-run stretches. Especially if you are prone to developing sore shins, take the extra time to stretch the muscles of your calf and anterior shin once you’ve warmed up.
• When returning to your running routine, a good rule of healing is to gradually increase your mileage by no more than 10 percent of total distance / mileage each week.
• Choose your return-to-run surfaces and incline angles wisely. Hills and hard surfaces (ie. concrete) can increase impact loads on tendon bone connection causing the aforementioned increased potential for inflammation on the legs. Softer surfaces (ie. grass, trail, or the synthetic rubber track) and lower angle profile runs are recommended until MTSS pain has resolved. Reinstating hills and hard-pack surfaces gradually after injuries is helpful.
• Nutritional recommendations for reducing inflammation, healing and improving bone density are summarized nicely in these two articles on healing and bone health and healthy dietary tips on reducing inflammation.
• Improve your running stride and cadence. New evidence on shortening your stride and optimizing the rate your feet strike the ground each minute can reduce injury risk and improve gait efficiency. Getting an appointment with a PT trained in running assessment is one helpful route or measuring and progressing your cadence to 170-180 steps per minute has been deemed optimal. The benefits of shortening your running stride length and increasing the frequency are summarized nicely in this systematic review article.
• Orthotics and supportive insoles may be helpful for some foot types or people suffering from shin splints. People with particularly flattened arches or recurring MTSS issues, may find either off the shelf or custom fit corrective orthotics beneficial for reducing stresses on the lower leg. Supportive insoles may also improve alignment and stability of the legs and feet, thus improving the strain potentials of the musculature affecting shin splints.

References
Bhusari, N., & Deshmukh, M. (2023, January 18). Shin splint: a review. Cureus, 15(1). 10.7759/cureus.33905

Budde, K. B. (2018). Physical therapy guide to shin splints (medial tibial stress syndrome). Choose PT. https://www.choosept.com/guide/physical-therapy-guide-shin-splints-medial-tibial-stress-syndrome-

MacLean, K. (2023, November 16). 9 healthy eating tips that can help reduce inflammation. UC Davis Health. https://health.ucdavis.edu/blog/good-food/9-healthy-eating-tips-that-can-help-reduce-inflammation/2023/11

McCrann, P. (2018, September 1). Choosing the correct running cadence. Endurance Nation. https://www.endurancenation.us/run/choosing-the-correct-running-cadence/

McNamara, W., Longworth, T., Sunwoo, J. Y., Rizvi, S. M., Knee, C. J., & Cole, B. F. (2023). Treatment of medial tibial stress syndrome using an investigational lower leg brace. A pilot for a randomised controlled trial. BMJ. 10.1136/bmjinnov-2022-001054

Schubert, A. G., Kempf, J., & Heiderscheit, B. C. (2014). Influence of stride frequency and length on running mechanics: a systematic review. Sports Heatlh, 6(3), 210-217. 10.1177/1941738113508544

Shin splints | medial tibial stress syndrome (exercises, rehab, strengthening). (2021, October 3). YouTube. https://www.youtube.com/watch?v=_OyNx5VMzzc

Shin splints: symptoms, causes & treatments. (2023, June 14). Cleveland Clinic.
https://my.clevelandclinic.org/health/diseases/17467-shin-splints

Vasudevan, J. (n.d.). Shin Splints: Causes, Symptoms, Treatment and Prevention. Runner's World. Retrieved June 24, 2024, from https://www.runnersworld.com/health-injuries/a19595626/shin-splints/

Winters, M., Eskes, M., Weir, A., Moen, M. H., Backx, F. J., & Bakker, E. W. (2013). Treatment of medial tibial stress syndrome: a systematic review. sports medicine, 43(12), 1315-1333. 10.1007/s40279-013-0087-0

Apparently this rice bowl has, at one time, gone viral on social media.  I think I missed that, but I can see why...it's easy, yummy and versatile.  I even sent left overs to school with my kids as make your own sushi rolls!  This is a recipe that you can be creative with for toppings, make your favorites and mix your own bowls.  This recipe will feed about two people.  It makes extra Sriracha mayo, but I would make more of everything else if you have more people!

Ingredients:
4 oz salmon
1 tsp avocado oil
salt to taste
1 cup brown rice (cooked according to package)
2 tbsps  mayonnaise
1 1/2 tsp Sriracha
2 tsp tamari or soy sauce
1 1/2 tsp mirin
1/2 tsp freshly grated ginger
1/4 crushed red pepper
1/4 tsp salt
1/2 cup chopped cucumber
1 chopped avocado
1/4 cup kimchi, optional
one small head of broccoli
12 4 inch sheets of nori (roasted seaweed)

Instructions:
Prepare your rice per the package instructions, we use an Instapot, but a rice cooker is super easy too.  As the rice is cooking you can prepare the rest of the meal.

Preheat your oven to 400 degrees F.  Line a small baking sheet with foil and place the salmon on this pan.  Drizzle with oil and season with a little salt.  Bake until the salmon flakes easily with a fork, about 8-10 minutes.

Cut up the broccoli into bite-sized pieces and in a small pot with a vegetable steamer basket, steam for 3 minutes.  Set aside.

Mix up the sauces, mixing the mayonnaise and Sriracha in a small bowl.  Wisk together the tamari, mirin, ginger, red pepper and sale in another small bowl.  Set these aside.

Chop up your cucumber and avocado.

Divide the rice in bowls, top with salmon, and any other toppings you prefer.  Drizzle with the Sriracha mayo and the tamari.  Serve with the nori and enjoy!

By Brace Hayden, DPT and Miya Ensley

​Medial tibial stress syndrome (MTSS) has replaced the more alarming and antiquated term “Shin Splints” as the more helpful and broader regional pain diagnosis in the lower leg that can occur on either or both of the inner (medial) or the outer (anterior) part of the shin.  Many sore runners have joined the time-honored MTSS Club when they ramp up their mileage too quickly, or drastically alter their training routine (ie. by vigorously up-training plyometric exercises, track drills or increasing volume of hill workouts).

There are many working theories in sports medicine about what is going on when the tibia is stressed to the point of causing this painful and limiting condition. These theories include:

• Microtears and inflammation in the tibialis anterior muscle’s tendon (effectively a tendinitis) along its insertion to the shin/tibia (the muscle that helps lift and evert the foot, as well as decelerate the body during the running stride)
• An irritation of the tibia’s periosteum or a “periostitis” (the fibrous sheath that helps supply nutrition and blood to the bone, repair injured bone and contribute it’s to growth)  
• Combination of both uncomfortable theories

Differential Diagnosis of Medial Tibial Stress Syndrome: 
Pain in your lower leg doesn’t always fit the criteria for an MTSS diagnosis. There are two other similar unpleasant running ailments that can be confused as shin splints: 

• Compartment syndrome has a similar pain presentation along the outside of the shin, but typically has more swelling/pressure, nervy sensations and eventually progressive ankle weakness if untreated. Getting a proper medical diagnosis sooner than later is important, as compressed nerve injuries take a lot longer to heal. 
• Stress Fractures of the tibia can also present as shin pain when the repetitive impact of running causes partial fractures in the bone. These bone injuries can also be more sinister than shin splints, so getting a proper diagnosis from a medical provider (PT, MD, RN… not Dr. Google) is helpful and warranted. 
  • The typical pain of MTSS usually spans north and south along the tibia, whereas a stress fracture tends to be more point tender. 
  • Another differential point lies in their time of day presentation. MTSS tends to feel worse with the initial steps in the morning, as the muscles and connective tissue tighten up while resting. Stress fractures tend to feel better first thing in the morning as the bone has been unweighted throughout the night. 
  • Lastly, MTSS is typically more sore when you flex shin muscles, effectively lifting your toes toward your shin. Stress fractures conversely are usually not painful with resisted ankle flexion. 

Known Knowns That Can Contribute to Medial Tibial Stress Syndrome

• Too much, too fast: the aforementioned training error of increasing mileage or load too aggressively. 
• Hyperpronation: excessive rotation of the midtarsal (midfoot ankle bones) inward and downward, effectively collapsing the foot’s middle arch. Miles of running with 2.5-3x your body weight pounding through each over-pronated step could contribute to excess MTSS. 
• Sub-optimal pre/post-run stretching: stiff musculature in the lower leg can further stress on the connection area of the tibialis muscle on the tibia creating a higher potential for injuries.
• Worn-out shoes: this is not an exact science, as many people joyfully complete marathons barefoot. However, some aches and pains that accrue with higher mileage training can be improved with a new pair of supportive running shoes. 
• Imbalanced leg loading:  Uneven loading on one leg (ie. only running on the right side of a cambered road or only running around the track in one direction).
• Leg muscle strength deficits: an imbalance of pull between your calf muscles and the shin muscles can unevenly load, stress and cause running injuries.  See this prior RWM article on the importance of strength training your calves.

* Tune in next week for Part 2: Running with Medial Tibial Stress Syndrome - What do about Splintering Shins!

Alpine PT believes that our services and Physical Therapy in general are a very worthwhile investment in your health.  But we understand that costs can be a burden and that insurance benefits can be confusing.  It is with this understanding that we have decided to transition toward a deposit due at the time of service.  We encourage people to check into their Physical Therapy benefits prior to beginning a course of PT.  We believe that understanding the estimated cost of each visit will prevent surprise bills after your treatment is over.  As always we feel communication is key!  We pride ourselves on trying to work with and understand where our clients are coming from, both in their physical health and their financial health.  So please feel free to ask questions and discuss with your PT any concerns you may have about your treatment.  As we describe below, there are lots of ways to help you reach your goals.  

Why do I have to pay if I have insurance?  
A: Your insurance benefits are dependent on your plan and may include a deductible that has not been met, a coinsurance, or a co-pay that is the patient's responsibility to pay. You are responsible to pay some amount at each visit. By paying toward the total balance at each visit, your final bill will be much lower. 
More info: Until your deductible is met, you will be responsible for the full amount of each visit. Ultimately this amount is determined by your insurance company. Once the deductible is met, the amount you pay at each visit will decrease significantly. With some insurances, once the deductible is met you pay nothing, for other insurances you will have a coinsurance to pay once your deductible is met. Check your benefits to understand more. 

How do you determine the amount I need to pay toward each visit if I have insurance? 
A: The deposit toward your visit is based on the average amount that gets passed to the patient after insurance processing plus considerations including a) if the deductible has been met and b) your co-pay or coinsurance associated with your plan.
 
What if I can’t afford that amount? Consider other options that currently include:

1. Adjusting frequency and duration of visits - focus on a plan of care with self-efficacy at the center
2. Cash pay plans (although this is not always better if they might meet their deductible this year as we will not bill insurance retroactively)
3. Direct Primary Care plans, such as the one at Cost Care, that include 5 visits/year with only a $40 copay
4. 10 Pack for $1600
5. We will work with people on an individual basis to set up payment plans, only if necessary. Experience has taught us they don’t often get paid. The billing team will work one on one in these cases.
6. Currently PhysioTrekk is $95/standard visit (~40 min), $129/premium visit (~55 min). (works great for something that requires less than a handful of visits, patients that are good managing their own care but not ideal for post-op, conditions that require frequent follow-up or individuals that need more managed care)

What if I end up paying more than I am billed? 
A: Once your PT course of care is complete, and your final claim has been processed through your insurance, any remaining credit on your account will be reimbursed to you from Alpine. 

Why is the cash pay rate lower than the insurance rate? 
A: We offer a discounted rate on our billed charges to patients who opt to self pay at the time of service because we cut out the administrative costs associated with insurance billing. 
More info: Theoretically, this discount is available to insurance companies, but they don’t pay at the time of service. 

Can I find out how much my total PT care will cost? 
A: In some cases we can, but it is only an estimate based on the number of visits we think you will need. 
More info:  It is best to meet with your physical therapist for your initial evaluation first, then they can take all of your health factors into consideration to provide an estimate of the number of visits you will need. If you are cash-pay, this is a bit easier since the cash pay rate is set. If you are using insurance and have a deductible or coinsurance it is trickier and will be less accurate.

Why do you charge so much for a PT visit?
A: In the US healthcare costs are only subsidized if you qualify for Medicare, Medicaid or VA benefits. Instead healthcare is provided by private businesses that have to set prices according to costs of doing business. For Physical Therapy this includes doctorate level providers who are highly trained experts in their field. At Alpine, we provide one-on-one care with your physical therapist for the full treatment session, which typically lasts between 50-60 minutes.
More info: The cost for a PT visit depends on the length of the visit, how much time is spent with the physical therapist rather than with an assistant, and the location of the PT clinic (both geographic location in the US and if it is a hospital vs private clinic). 

If I pay cash can I submit the bill to my insurance on my own? 
A: Typically, yes.  The process to do this is set by your insurance company.