Jessica Kehoe, DPT
So, my husband and I did a little Whole 30 style cleanse for the month of April. Last week, after we made it 28 days (ok we didn’t quite do a full 30) we had a celebration. Not only did we celebrate the end of the cleanse, but it was my brother’s 40th birthday, AND we have all been vaccinated, so I had to make something special.
I’m a fan of baking and decorating cakes, and sometimes this means I work way too hard, but my mom helped me out by sharing this recipe. Turns out it was really easy, and really yummy! A great combo. This cake is nice and moist and I enjoyed the whipped cream icing. It was lighter and not as sweet as the usual frosting I make with cream cheese. I also added some frozen cherries for a little extra fun, but some raspberries or shredded chocolate on top would be nice too.
So if you need a little chocolate cake for some kind of celebration, or just because, give this one a try.
¾ cup salted butter
2.5 oz bittersweet chocolate
1 tsp vanilla extract
1 cup Guinness
½ cup sour cream
1 cup white sugar
⅓ cup packed brown sugar
2 tsp baking soda
2 cups flour
⅓ cup cocoa powder
½ cup brown sugar
1 ½ cup heavy cream
3 tablespoons cocoa powder
Preheat oven to 350 degrees. Butter and line a 9 inch loose bottomed (spring form) cake pan with parchment.
Melt the butter, Guinness, chocolate and vanilla in a medium pan over low heat, stirring frequently until smooth. Remove from heat and let stand for 5 minutes to cool slightly.
When the chocolate butter mixture is cooled, wisk in the eggs, and then the sour cream until smooth. Mix together the dry ingredients in a large bowl, and then wisk the wet ingredients into the dry until batter is smooth.
Pour into the prepared pan and bake for 60-75 minutes (mine was done right at 60 minutes, and maybe could have been taken out sooner even) until a toothpick inserted into the center comes out clean. Leave it to cool in the pan.
Make the icing by putting the cream, sugar and cocoa powder in a bowl and beat to soft peaks. Dollop this icing on the cake and spread it out with the spoon.
For aging adults, this can be a tough situation as the term "advanced" is more of a subjective conclusion and not well tied to objective data. Many people are told they have the dreaded "bone-on-bone" on X rays and feel consigned to having surgery as though all hope is lost. There is some research though to show that bone-on-bone imaging results do not always correlate with pain levels experienced, and decisions related to knee surgery are typically driven by pain.
We need to be clear here. Even as physical therapists, we know that sometimes surgery is appropriate. “If you are limiting the things you like to do because of your knee pain, and you have tried PT and your imaging shows end stage arthritis then it may be time to consider surgery.” says Francisco Quinones, DPT. “However, it should be noted that outcomes for total knee replacements are heavily influenced by how much you were able to do pre-surgery.”
In other words, whether you're committed to the idea of a total knee surgery or not, a physical therapist can play a critical role in either your post-surgical outcomes or avoiding surgery all together.
“We have seen people who thought they had no other option but surgery realize that with a little guidance and the right combination of exercise, they could do everything they want to do, eliminating the need for surgery at that time.” says Leah Versteegen, DPT. “Of course I am biased as a PT, but I would tell everyone to consult with a PT before deciding on the timing for a total joint replacement. Even if you end up needing surgery in the end, a course of PT prior to surgery will prepare you for better outcomes after the procedure. It is a win - win situation.”
You’ve decided surgery is right for you. How can you improve your outcome?
“One of the fastest growing and most successful trends for those considering total joint replacement over the past 5 years has been the concept of pre-operative rehabilitation. With this model, patients attend PT before deciding on surgery, sometimes for just a few sessions and other times for a full course of care lasting 8-12 weeks. The goal is to see what movement and strength can be regained to either avoid surgery all together or improve post-operative outcomes.” says Versteegen.
“If you end up having surgery anyway then the time you spend on PT will not be lost. The stronger you are and the more you are able to do going into surgery, typically the better your recovery will go.” says Quinones.
What can I do right now to decrease my chances of needing surgery in the future?
“My advice for people looking to delay knee surgery is to stay active. Research has shown that both a regular walking program or cycling program can improve function and reduce pain for people with Arthritis. It may seem counterintuitive when your knee is hurting, but joints need motion to stay healthy, and all of our systems, including cardiovascular, benefit from regular exercise.” says Jess Kehoe, DPT. “My advice if you haven't been active like this for a while would be to start by finding a tolerable amount of time on either the bike or walking and work toward doing this 5-7 days per week. Then slowly increasing the time up to 30-60 minutes per day, 5-7 days a week.”
Your PT is your choice! Let your referring doctor know you choose Alpine.
Jessica Kehoe, DPT, OCS, CSCS
This gives it away, I’m currently obsessed with sheet pan dinners. This one is pretty simple with very minimal prep, and the sauce is really flavorful and fresh. The recipe calls for chopping and mixing the ingredients for the sauce in a small bowl, but I used my immersion blender to make the sauce without needing to chop everything, so easy. I also cooked up some quinoa as a base for this, but some rice would be a good choice too.
1 ½ lbs chicken thighs, boneless and skinless is easiest
½ cup plus 2 tablespoons olive oil
1 lb mixed mushrooms (I used mostly brown cremini and added a small container of shiitake)
1 lemon, thinly sliced
½ cup finely chopped parsley
2 tablespoons red wine vinegar
1 large clove garlic, minced
Preheat oven to 450 and place a large rimmed baking sheet in the oven to heat.
Rinse and pat dry your chicken, then season with salt and pepper. When the oven is ready, drizzle the pan with olive oil and arrange the chicken on the pan, roast for 5 minutes.
Toss the mushrooms and lemon slices with 2 tablespoons of olive oil, then scatter around the chicken. Roast for 30 more minutes, or until the mushrooms are browned and the chicken cooked through.
As the chicken is cooking make the sauce. In a small bowl mix 6 tablespoons olive oil with the ½ cup parsley, vinegar and garlic, season to taste with salt and pepper. Drizzle sauce over the chicken and mushrooms.
What you see in the picture above is in fact not a medieval torture device, but instead one of the most powerful tools we use in our clinics to get people moving, strengthening, and pain free. The CoreAlign and Reformer machines (shown above) have bridged the gap between recreational fitness and restorative healthcare. So, what's the big deal? Let's explore a bit.
What is the pilates method?
It is highly likely that either you or somebody you know is currently a member of a Pilates studio. As a means of recreational fitness, Pilates has rapidly grown in popularity over the years. But where did it come from?
Pilates takes its name from Joseph Pilates. A German-born emigré to Britain and then America, he devised the Pilates method as a new approach to exercise and body-conditioning in the early decades of the last century. His method included the use of equipment referred to by him as: apparatus. Perhaps the best known piece of equipment, is the Pilates reformer, which is in use in the Pilates studios today.
If practiced with consistency, Pilates improves flexibility, builds strength and develops control and endurance in the entire body. It puts emphasis on alignment, breathing, developing a strong core, and improving coordination and balance.
So, what does that have to do with Physical Therapy?
"Being able to perform exercises without pain is a powerful step in returning ones' confidence in their body." says Physical Therapist Jessica Kehoe. Kehoe has been a PT for over 13 years and saw the potential in the Pilates technique early on. "As I have gained experience and worked towards certification in Pilates this method has become indispensable to my practice. I feel that the underlying principles driving Pilates fit with my core beliefs in recovery from injury."
The 6 Pilates Principles are: concentration, control, center, flow, precision and breathing. Pilates emphasizes the need for the body to move normally and smoothly, to include awareness of the breath and to gain strength and stability throughout the body. For many, Pilates can feel therapeutic while also providing the benefits of a fitness routine.
"Pilates is FUN - the equipment and method allows patients to play again, finds challenges for adaptations and increases confidence in their bodies for the next step, the next layer of fitness, and ultimately the next adventure!" Says Sam Schmidt, Physical Therapist and Master Pilates Instructor. "Those individuals working through injury, surgery or disease often present with strategies for movement that served the purpose of protection or adaption at a specific time but these strategies impair the capacity of the systems to respond to real world demands and desires with the most ease. These strategies can limit one's body in being robust - and that is our job as PTs - to help our patients build a capacity of performance without failure under a wide range of conditions. Pilates is a great tool for this process of building."
What does this mean for you?
Our treatment philosophy is reflected in our extensive certification and use of the Pilates Method. Our three clinics are fully equipped with Balanced Body reformers and accessories. Alpine is also home to our international Balanced Body University Training Center. We work with area doctors and other referral sources in designing rehabilitation programs that successfully incorporate Pilates-based approaches. Our clients comment on how much they enjoy this form of care, particularly because they often find that they can get a good workout without flaring their symptoms.
Interested in seeing what our Physical Therapists can do for you?
Book an appointment by clicking here.
Jess Kehoe, PT, DPT, CSCS
Easy dinner? Kids ask for seconds? Yes please!!
I have embraced the popular sheet pan trend and it’s no wonder it’s so popular. It really makes for good food, fast prep, and quick clean up. This is a recipe I found that we really like in our house. I’ll even whip up a double batch of the spice mix for even faster prep the next time I want to make these yummy fajitas.
One pound Chicken (I use skinless and boneless thighs, but you can also use breasts, your choice)
2 tablespoons olive oil
1 tablespoon chili powder
½ tablespoon garlic powder
½ tablespoon onion powder
1 teaspoon paprika
1 teaspoon cumin
1 teaspoon dried oregano
½ teaspoon salt
½ teaspoon balck pepper
1 yellow onion
3 bell peppers (any color combo you like...I think red and yellow ones are sweeter when roasted…)
Preheat oven to 425
Mix your spices in a small bowl.
Slice your chicken into strips, about ½ - 1 inch wide. Coat the chicken in one tablespoon of olive oil and then coat the chicken with your spice mix.
Slice the bell peppers and onion into strips and toss with one tablespoon of olive oil.
Place chicken and veggies on your pan (a piece of foil will make for a much quicker clean up!) and place in the hot oven for 20-25 minutes, or until the chicken is cooked through.
Serve with warm tortillas, salsa, avocado, sour cream or any other toppings you like.
While it is true that every person who comes into our clinic has a unique story, there is one commonality that we see month after month, year after year.
Signs of degeneration in MRI results.
For most who receive this diagnosis from their primary care provider, degeneration can feel like an impending doom looming over them. “When will I have surgery?” or “How long before I have trouble getting out of bed?” are concerns we hear all too often from patients in fear of their MRI findings.
But what is degeneration exactly? What does it actually mean?
Here we seek to shed more light on this subject, uncover the realities of this common diagnosis, and reset years of misleading language.
The medical definition of degeneration is at its most basic ‘the state and process of decline’. And contrary to popular belief, it is the natural changes that our tissues experience as we age. “A colleague of mine calls degenerative tissue 'the wrinkles on the inside”, says physical therapist Leah Versteegen. “That paints such a clear picture for many of my patients.”
There is research that indicates that certain muscle fibers begin their decline in our 30s, and other tissue decline begins in our 40s and 50s. In regards to surgery, degenerative changes that show up on your MRI certainly don't always require surgery. Just like wrinkles and saggy skin on the outside don't require surgery.
“Research has shown us over and over again that there is very little relationship between degenerative changes on imaging and the pain you are experiencing”, says physical therapist Angela Listug-Vap. “Imaging is mostly used to rule out significant problems but it's very sensitive so it shows us all the changes of normal aging as well.”
“...there is very little relationship between degenerative changes on imaging and the pain you are experiencing”
So what is to be done? How can our healthcare system be better about educating our patients?
“Good clinical reasoning has to be used by a skilled healthcare practitioner to match the clinical presentation with the results of your image”, says Listug-Vap. “Degeneration on an image may mean nothing at all”.
“We need to advocate for treating patients and their symptoms, not their MRIs.”
In short, We need to advocate for treating patients and their symptoms, not their MRIs. There is a certain level of human decency in not allowing patients to spiral into uncertainty after a diagnosis such as common degeneration, and we need to hold that to a higher standard. Healthcare professionals are not only responsible for the identification of conditions, but education about the condition as well.
Jess Kehoe, DPT
I love having some recipes that are flexible. This is one that fits any mood, be that meatless Monday or left over chicken. Whatever veggies you have in the fridge with chicken, tofu, beef, chickpeas, or just all veggies, it all turns out good. Traditionally you would find carrots, bell peppers, and broccoli as a good combo, but I have used cabbage, zucchini, snow peas, or green peas as additions or replacements with good results. It’s also a nice addition to add a handful of cashews at the end if you like, or some sesame seeds. This teriyaki sauce is so easy and so delicious, it will make any combo you can throw together delicious. Don’t forget to make the rice, quinoa, soba noodles or lo mein noodles. So many options!
1 ½ tablespoons corn starch
1 tablespoon chopped ginger
3-4 medium cloves garlic, minced
½ cup water
⅓ cup tamari or soy sauce
3 ½ tablespoons maple syrup or honey
1 tablespoon lemon juice
Place all ingredients in a food processor or blender to puree.
Veggies: 1-2 cups of each veggie you choose
If using meat, cut 1-1.5 lbs into bite size pieces. Use 1-2 tablespoons of oil in a pan over medium heat, and saute until fully cooked.
Using a saute pan or wok over medium-high heat add 2 tablespoons of water and the carrots. Reduce the heat to medium and cover to steam the carrots for a few minutes. Remove the cover and add the remaining vegetables. If using zucchini put that in next to let it sear slightly for 2-3 minutes. Then add peas, cabbage, peppers, broccoli. Cook, stirring frequently for another few minutes, you can cover and steam with a little more water if using broccoli.
Add the teriyaki sauce and the meat (if using) to the vegetables. Mix to coat then let the sauce come to a boil over medium-high heat. When the sauce is thickened add the cashews and combine. Serve over your favorite rice or noodle choice.
Whether you're a pro athlete, or just recreationally active, a proper warmup routine can be the difference between performing your best or setting yourself up for injury.
But what is the best way to prepare for physical activity? This week, our PTs discuss the latest evidence surrounding dynamic warm ups, static stretching, and the most appropriate execution and timing for each.
There is solid evidence in the research, especially before performing a sport event, that warming up for 5-10 minutes, then performing a series of dynamic warm up drills that simulate some body movements of your sport in a progressive (slow to faster) fashion are quite beneficial. Dynamic warm ups can reduce stiffness & joint pain gradually, prevent some types of sport-related injury and improve your athletic performance by increasing the warmth to the joint, blood flow to the musculature and thus 'pre-stretch' your joints and connective tissues.
Static stretching (holding a stretch >10 seconds) prior to sport has actually been found to be detrimental before some competitive sports by temporarily stunning the muscle into a lower level of athletic performance. Otherwise, static stretches, especially after a 5-10 minute warm up, are wonderful and can be similarly helpful for improving joint mobility and reducing soft tissue tension. Static stretching tends to take longer and is often more of an intense stretch, which isn't preferable for some peoples' allocation of time toward fitness goals. The most important take-away is to adopt either static or dynamic stretches into your fitness routine and experiment with what feels best for your body, sport preference and dedicate the time to routinely performing a series of stretches twice daily.
- Brace Hayden, PT, DPT, OCS, CSCS
Dynamic warm ups are recommended prior to exercise and/or running for gradually getting the joints moving through a greater range of motion. These movements include, slow continuous movement through range without static holding or bouncing. Static stretching, or holding a position for an extended period, allows the muscles to relax into a lengthened position so the joints can again move through a full range. This type of mobility is better after the workout is done or at the end of the day. I recommend both for about ten minutes each as part of a pre- and post- workout routine.
- Kristina Pattison, PT, DPT
I think this argument has been pretty well settled with the research favoring a dynamic warm-up as there has been some research to suggest that static stretching can actually decrease athletic performance. That being said it all depends on your sport and your body (some sports require high levels of flexibility while many do not). The way I approach warming up is by breaking it up into two components. The first component is a general warmup where I am just trying to get the heart rate gradually up, increasing blood flow to all relevant musculature. Typically, this can be as short as 3-5 min and involve one or a few different movements depending on what you are about to do. The second part of the warm up is the specific portion and should focus on what your body needs to prepare for what you are about to do. Again the specific part can be as short as 2-5 min but it should focus on prepping the parts of your body that will be doing the most work and addressing any restrictions to movement that are specific to you while progressively recreating the types of movements you are about to do. The whole thing can take 5 min or 30 min depending on the demands of the sport, your injury history, and how much time you have available. In general, if you are doing it right if your warm up gets the heart rate up, addresses any restrictions in movement you may have and progresses toward the type of activity you are about to do.
- Francisco Quinones, PT, DPT
Dynamic warmup or stretching is moving multiple muscle groups to prepare for more vigorous activity, while static stretching is generally to relax and lengthen muscle to its optimal and normal length. Usually static stretching is done after vigorous exercise as part of a cool down and important to relax muscle after exercise. Having said that: it is probably more important to focus on your specific body type. And are you generally a stiff person who likes lifting wts and power sports and sprints, or are you someone who would rather do yoga and show your extreme flexibility? We tend to gravitate toward what we are naturally good at, but avoid things that are harder to us. What we really all need is full mobility. Full mobility is, full range of motion and strength throughout this range. So if you are extremely flexible but weak you need to work on strength, and if you are stiff you need to work on getting full range of motion. The stiff person may want to spend more time on their static stretching following vigorous exercise to prevent injury and get full range of motion. The flexible person may want to spend more time working on dynamic warmup ex to have full strength and control.
- Gary Gales, PT, DPT, CMP
Kinesio tape, KT tape, Rock tape, whatever you call it you’ve likely seen it or used it before. Popular among runners, the tool claims it “helps in reducing pressure to the tissue, which may reduce discomfort or pain. In addition, it is also believed that correct taping can help provide support to muscles by helping the muscle to not over-extend or over-contract.”-KTTape.com
The use of kinesio tape during competition has become widely popular, particularly within the running community, with athletes claiming they can really “feel the difference” and citing improvements in their performance/recovery.
Companies who sell it however, are careful to not over promise, using language like “It is believed that…” or “It may…”. Even going as far as to post disclaimers such as “Not Clinically Proven…”.
This week we hope to separate the fact from fiction when it comes to the use of kinesio tape amongst athletes. We asked our team of expert PTs for their opinion on the subject, here’s what they had to say.
“Always question something that claims to do everything. KT tape is one of these things. It is effective in the following ways:
1. Helping clear out swelling and bruising more quickly. This is because the tape stretches the skin in such a way that supports the lymphatic system. The results are typically visible.
2. Creating "proprioception." Any contact or stimulus with your skin will help your brain better identify where your body is in space. Because of this, KT tape is great for providing a little reminder to sit up straighter or can provide a little cue to move a little better through a joint's active range of motion--i.e. shoulder during overhead throw. That being said, however, does it protect a joint under the forces of quick, powerful load? Not really. Does it help "hold a joint together?" No. Can it provide a little relief to an overworked muscle? meh, debatable. Can it provide a nice placebo effect that helps you feel like you're doing something? Sure. And, if it does no harm and helps provide comfort, why not.”
- Antara Quinones, PT, DPT, CLT-LANA
“I think we can make the argument that kinesio tape or the like is not something that will provide a lot of support or stability but it can affect the neuromuscular system and provide increased feedback to a system that may be impaired by injury. An athletic trainer once said about KT tape..."It's like a hug" for the injured area!”
- Jess Kehoe, PT, DPT, CSCS
“I definitely think that KT tape is a legitimate tool for athletes to help unload their tissues and allow them to play/practice during the season while recovering from mild sprains and strains. Sure, there is probably some mental aspect to using KT tape, of feeling like you are 'doing something' to help your body heal but that is true for most every treatment and is also a part of recovering from an injury. It takes both physical changes and the right mental approach to heal and return to play. I don't think KT tape is a long term solution. It should be used in the short term to unload injured tissue. The real recovery comes in recognizing why those tissues were injured in the first place and working to fix the underlying cause.”
- Leah Versteegen, PT, MS, DPT
“The one theory of how KT tape works is that it lifts the superficial tissues away from the muscles and allows for normal blood flow and helps decrease swelling and helps with healing and another is that it provides support to strained muscles. Both which have value. However it does have a placebo effect because it does feel good and it also looks good with all the patterns of taping and variety of colors. So in the end it is a little bit of both legitimate value and placebo which is not a bad thing.”
- Dennis McCrea, PT, MPT
Jess Kehoe, DPT
I made it through the holidays! And like most of us, enter into January promising myself (as a rule I avoid resolutions!) to try to eat better. Really this means less sugar filled treats. As much as I love cookies, by the time January rolls around I’m ready to throw out the last few Christmas cookies and candy (don’t tell my kids!!). This recipe has been a favorite at my house for years, and always a go to when I feel I need to sneak some healthy eating in. It’s also easy to make a double batch and freeze for a crazy week day in the future, or share with your friends, these days with a less than satisfying, but likely still greatly appreciated drop off.
Also, a note about blended soups. All the recipes instruct you to transfer in parts to a blender for puréeing. But at the risk of sounding like an advertisement, I doubt I would ever make any blended soups with that method...so much mess! I have discovered that a stick blender was made just for this purpose Just use it in the pot when it’s all cooked. SO EASY.
1 onion, diced
2 cloves garlic, minced
1 large celery rib, diced
1 large carrot, diced
1 baking potato, peeled and cut into 1 inch pieces
1 rounded cup of red lentils
1 1/2 quarts stock (I’ve used vegetable and chicken here with equally yummy results)
1/2 teaspoon ground cumin
1/4 teaspoon cayenne
2 tablespoons fresh lemon juice
Salt and pepper to taste
In a large soup pot heat up 2 tablespoons olive oil over moderate heat. Add the onion and garlic and sauté until fragrant, about 2 minutes. Add the celery and carrot and continue to cook for about 5 more minutes. Add the potatoes, lentils and stick; bring to a boil. Cover and lower the heat to a simmer until veggies are tender, 40 minutes. Purée the soup (either in batches or with your stick blender). Add the cumin, cayenne, lemon juice, salt and pepper. Serve and enjoy! We like to have some good crusty bread to accompany this soup.
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