Regional Interdependence: Treat the knee without treating the knee.


By Josh Bixler PT, DPT

           Picture this: You’re an avid runner and you’ve recently ramped up your training for the upcoming mini-marathon.  In doing so, you’ve developed some nagging pain in your right knee.  Being the pro-active person you are, and aspiring to do well in the race, you decide to seek the care of a physical therapist.


During the evaluation, the physical therapist takes a thorough history from you, examines your right knee, but also assesses the rest of your body.  They end up treating your left foot and providing home exercises for your hips and trunk.  Curious as to why this was the choice of treatment, since the right knee is clearly the source of pain, not the hips or the foot, you ask the therapist for clarification.  The therapist responds “regional interdependence.”  They explain that your left foot lacks the mobility (motion) you need, your hips and trunk are weak, and it appears these deficits caught up with you during your training.


In this instance the right knee was the victim, and the foot and hips were the problem.  The therapist went on to explain the importance of looking at the body as a whole, and not chasing symptoms.  With this treatment approach, they feel confident you’ll be back to pain-free running in no time.


The aforementioned case is one example of the musculoskeletal examination model termed “regional interdependence.”  Regional interdependence is the concept that potentially unrelated impairments above and/or below the patient’s area of complaint; this is necessary to determine if those areas are contributors or not.  Intervention is then applied to those areas deemed as impaired with the expectation of producing a result at the source of complaint.  The interventions could be anything from hands on techniques to exercise.  The result could be improved range of motion, decrease pain, or improved strength just to name a few.  Now this is not to say the area of symptoms is not impaired, it very well may be, however there are often additional areas involved that may have contributed to the problem and deserve attention.


The regional interdependence model came about due to the need for a better approach to explaining and treating musculoskeletal and treating musculoskeletal disorders.  As the field of rehabilitation has progressed, so too has our knowledge of how the body works and the limitations of the old approaches to treatment.  It is important to note that regional interdependence applies to addressing impairments above and below one’s source of symptoms, and not that of referred pain, or pain being felt in a different area from the actual source.


Given this information, you might be saying to yourself, “This concept sounds great in theory, but is there evidence to support it?”  Absolutely!  The current literature has many articles referencing regional interdependence either directly or indirectly.  The literature contains thoracic spine (mid-back) interventions for the cervical spine interventions for the shoulder; cervical spine interventions for the elbow; hip interventions for lumbar spine (low back); hip, ankle, and foot interventions for the knee.


Clinically speaking, assessments of an athletic population may involve impairments even further up or down the body.  When assessing a baseball pitcher with elbow or shoulder pain, one must not only look at those areas, but also consider the neck, shoulder blade, thoracic spine, lumbar spine, hips, legs, knees, and feet.  This approach is similar for runners, where abnormal breathing patterns could also potentially contribute to impairments.


With the acceptance and growth of the regional interdependence examination model, assessments have been developed to further assist healthcare professionals.  One of those assessments is the Selective Functional Movement Assessment, or SFMA.  The SFMA is a tool that allows clinicians to assess patient movement patterns starting at the neck and working down to a body-weighted squat. From there, movements identified as “dysfunctional” can be further broken down into mobility versus stability problems.  This approach, along with best current evidence and clinician expertise, can help guide the clinician with decision making.


In a time with rising healthcare costs and with money tight, patients have come to want and expect care that produces meaningful outcomes.  In the case of the runner, the right knee was the victim and a thorough assessment using the regional interdependence examination model helped to “treat the knee without treating the knee.”


DO you have pain or just a want to take a pro-active approach like this runner?  Consult your physician, the professionals at KORT, or visit www.kort.come to learn more.


KORT Old Brownsboro Crossing Clinic Physical Therapist Josh Bixler
 PT, DPT, graduated with his Doctorate of Physical Therapy from Bellarmine University, and also has a BS in Exercise Science from the University of Indianapolis. He is currently finishing up an orthopedic residency and is trained in using both the Selective Functional Movement Assesment and Functional Movement Screen. Josh is a University of Michigan sports fanatic (Go Blue!) and also enjoys rooting for the Colts, White Sox, and Red Wings. His personal interests include anything relating to physical therapy, injury prevention, fitness, nutrition. For more information go to

Dealing with Carpal Tunnel Syndrome

By Kellye Olson, OTR/L, CHT

Everyone knows someone who has had or does have carpal tunnel syndrome.  The first question I usually get asked when people find out that I’m a hand therapist is, “do you think the pain in my hand could be carpal tunnel?”  Carpal tunnel syndrome (CTS) is very common in the hand, but just because you have pain in your hand doesn’t always mean you have CTS.  There are not only more specific symptoms you can have other than just pain, but those symptoms occur in specific parts of your hand.

Look down at your right wrist, palm side up.  At the bottom of your palm, just above where your wrist and hand meet lies your carpal tunnel.

The carpal bones of your wrist serve as the floor of the carpal tunnel.  Passing through the carpal tunnel and over the carpal bones are nine flexor tendons and the Median nerve.  Everything is held nice and tight within the carpal tunnel by the Transverse carpal ligament that spans over the top of the nerve, tendons, and carpal bones.

Diagnoses such as arthritis, pregnancy, and diabetes can cause the pressure within the carpal tunnel to increase and cut off nutrition to the nerve.

Other times, the wrist is held in a flexed position for long periods of time and the nerve gets compressed within the carpal tunnel, also cutting off nutrition to the nerve.  People who fold their hands into their blankets at night are prime candidates to have symptoms of CTS.  They tend to sleep with their wrists in this flexed posture, compressing the Median nerve for a prolonged period of time, and waking up because their hand is still very soundly, and very painfully, asleep.   When the nutrition to the Median nerve is compromised, it can send out distress signals in the form of pain, but more specifically people feel numbness and tingling in the thumb, index, and long fingers.

The CTS is usually pretty easy for a Certified Hand Therapist to diagnosis and treat.  Therapy for CTS spans from learning how to do the appropriate stretches and changing positions all the way up to custom splinting to allow the median nerve time to rest and recover.

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Kellye Olson
, OTR/L, CHT earned her Bachelor of Science in occupational therapy from Eastern Kentucky University in 2004 after completing a Bachelor of Arts in Psychology from the University of Kentucky in 2000, and is currently pursuing her occupational therapy doctorate with an emphasis on hand therapy from Rocky Mountain University of Health Professionals. She became a Certified Hand Therapist in 2011, which requires a therapist be an OT or PT, have at least 4,000 hours in hand therapy experience, and pass a comprehensive exam of advanced clinic skills. Kellye also has experience with industrial job site analysis, functional capacity evaluations, and industrial rehab. She is a member of KOTA and the ASHT, as well as an Alumni member of the Taylor County/Campbellsville Leadership program. Previously from Lexington, Kellye has worked in Campbellsville, KY for 3 years and is now returning to the area to begin a hand therapy program for KORT Lexington at the Bryan Station location.


Eat your Beans!

By Nancy Clark MS RD CSSD

Remember this jingle: “Beans, beans, the musical fruit. The more you eat, the more you toot”? The embarrassment associated with tooting explains why many athletes shy away from beans (pinto, kidney, black) and also legumes (lentils, peanuts, soy, chick peas). But far more than being a musical fruit, beans can be a nutrient-rich bonus for a sports diet.

To my dismay, the popular but faddish Paleo diet advises against eating beans because:

1) they need to be cooked to be edible (the cavemen ate only raw foods),

2) they contain compounds that might influence your hormones (that is, if you were to eat them in super-human amounts), and

3) they contain phytates that can diminish the absorption of certain nutrients (insignificant in US diets where beans are not the primary food).

In this era of over-abundant processed foods, I contend that eating cooked beans enhances intake of a variety of important vitamins and minerals for athletes. But before I offer reasons why you should include beans in your sports diet, here are tips to minimize the “toots” so you’ll want to even entertain this suggestion.


Beans and gas

The average adult produces one to three pints of gas per day which is passed through the anus 14 to 23 times each day. Beans can be gas-producing because they contain raffinose, a type of carbohydrate. Humans do not possess the enzyme needed to digest raffinose, so it passes undigested through the stomach and upper intestine. In the lower intestine, it gets fermented by gas-producing bacteria which do possess the necessary enzyme. The by-product of raffinose digestion is carbon dioxide and methane (odorless) but also hydrogen sulphide (stinky). To help you blow fewer “bombs”—

1. Gradually introduce beans into your diet so your body gets used to digesting them. The jingle should actually say, “the more often you eat beans, the less likely you will toot.”

2. Drain the liquid from canned beans and rinse them well. This will decrease the amount of gas-producing carbs.

3. Try Beano, a product with the digestive enzyme that breaks down raffinose; it may help some people.


Nine reasons why you want to eat more beans

Beans are a positive addition to a sports diet. Here’s why.

1.Beans are a natural protein-carbohydrate combination. As an athlete, you need carbs to fuel your muscles and protein to build and repair your muscles. A bean burrito, hummus wrap, or bowl of chili is a great way to fuel-up or refuel from a hard workout (if you don’t get gas propelled, that is).

2. Beans are a good source of plant protein—but take note: you do need to consume generous portions of beans if you are a vegetarian. Athletes need at least 10 grams per meal to trigger muscular growth, and most athletes need at least 60 to 90 grams of protein per day. Half a can of refried beans offers only 10 to 12 grams of protein, the amount of protein in 1.5 eggs or a few bites of chicken. One spoonful (1/4 cup) of garbanzos on a salad offers only three grams of protein.

3. Beans have a low glycemic index, which means they are slow to digest and offer sustained energy. Low GI foods are good choices before endurance exercise if you cannot eat anything during the workout.

4. Beans are rich in vitamins and minerals, such as folate, manganese, potassium, iron, copper and magnesium. All these “spark plugs” help your body’s engine run smoothly.

5. Beans are good for heart-health. (Remember this jingle: “Beans, beans are good for your heart. The more you eat, the more you ___.”?) Yes, the soluble fiber in beans helps protect against heart disease by lowering the cholesterol in your blood. Also, beans are naturally low in fat and dietary cholesterol, so replacing meats with beans is a heart-healthy swap.

6. Beans are high in fiber (7 to 8 grams fiber per half-cup). This sharply contrasts to the chicken or meat they replace that has no fiber. This fiber acts as a “broom” and assists with regular bowel movements. Snacking on hummus with baby carrots contributes 8 to 10 grams of fiber towards the recommended daily target of 25 to 35 g.

7. Beans are inexpensive. By enjoying bean-based meals such as chili or lentil soup, you are likely eating less animal protein and saving a lot of money.

8. Bean-based meals are better for the environment than meat-based meals. If everyone were to eat one less meat-meal a week, we’d need fewer beef cattle (major producers of greenhouse gasses) and this could assist in the war against global warming.

9. Beans are good sources of fuel for the harmless, health promoting bacteria that live in your gut. We each have about 2 to 4 pounds of gut bacteria that strongly influence our immune system. In fact, about 70% of our immune response is generated from the gut. The bacteria love to eat the undigested raffinose provided by beans (and other vegetables such as broccoli, cauliflower, cabbage, brussel sprouts, and asparagus). Having well-nourished gut microbes invests in overall good health. A strong intake of prebiotics (bacteria food) helps strengthen the immune system and optimizes wellness. In contrast, antibiotics kill the good bacteria along with the bad bacteria.

Easy ways to boost your bean intake

Here are a few ways to easily add more beans and legumes to your sports diet.

• Hummus–A tasty dip with carrot sticks, or an alternative to mayonnaise on a turkey sandwich.

• Refried beans–canned vegetarian refried beans are fat-free. Heat some beans in a microwave oven, spread them on a tortilla, spoon on some cottage cheese and salsa, and then wrap it up like a burrito. Voila: a tasty breakfast, lunch, snack or dinner that fits into a meager food budget.

• Chili with beans–make a potful and enjoy planned-overs for lunch or dinner that week.

• Salads–spoon on black, white, or red beans and you’ll have a super sports salad that offers carbs to fuel and protein to build muscles.

• Soups–minestrone, lentil, black bean, and split pea soups make hearty, wholesome meals, You can also add beans to almost any soup to add substance and nutrients.

• Baked beans—served on toast (a popular breakfast item in England). A small can of baked beans can also be a filling snack.

• Pasta–toss a can of pinto or white beans into spaghetti sauce. Serve over pasta shells (they “catch” the beans).

Beans? No thanks!

Some athletes get terrible intestinal distress when they eat beans (and likely some other foods as well. Think onions, garlic, and wheat).  The poorly digested fiber/carbohydrate in these foods become a feast for gut bacteria. When microbes eat these undigested carbs, they create gas bombs. In some people, this fiber causes diarrhea too. Not fun.

If you fall into this category of avid bean avoiders and want to learn more, you may want to read The Complete Idiot’s Guide to IBS by Kate Scarlata, RD (

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Nancy Clark, MS, RD CSSD (Board Certified Specialist in Sports Dietetics) counsels active people at her private practice in Newton, MA (617-795-1875). For more information, read her Sports Nutrition Guidebook and food guides for marathoners, soccer players, and cyclists. They are available at Also see for online CEUs.



Fueling the ULTRA- Distance Athlete

By Nancy Clark, MS RD CSSD

If you are an endurance athlete who is training for an Ironman triathlon, century bike ride, or a swim across the English Channel, you need a food plan. Don’t be the fool  who comments, “My training program is good, but my eating is bad.” Performance starts with fueling, not training! This article provides nutrition tips for ultra-endurance athletes as well as ordinary exercisers who want ultra-energy.

Tip #1. Acknowledge the power of being well fueled. I counsel many already-lean athletes who are convinced they will perform better if they lose just a few more pounds. They fail to realize they will perform better by eating, not dieting, and by being properly fueled. Despite popular belief, the lightest athlete may not be the best athlete. The best athlete tends to be well fueled, well trained, and genetically gifted.

If your hours of exercise have not resulted in loss of those last few pounds, listen to what your training buddies and loved ones are saying about your body. If they agree you have fat to lose, perhaps you do. But if your mother or spouse complains you are too thin, listen up! It’s time to stop dieting and focus more on fueling better to perform better.

Tip #2. Optimize your daily training diet. Your goals are to constantly be fueling-up before workouts and then re-fueling afterwards by eating on a regular schedule carbohydrate-based meals and snacks (that also include some protein). By feeding your body evenly throughout the day (as opposed to skimping on wholesome breakfasts and lunches, then overindulging in “junk” at night), you’ll have steady energy all day with no lags. The trick is to make your breakfast and morning snacks bigger and your evening food intake smaller.

When I counsel athletes, I sketch out a sample meals that fulfill their energy needs. One ultrarunner needed at least 4,000 calories a day to fuel his 15-mile daily runs. I divided his calories into four 1,000-calorie meals/food buckets. The first bucket (6:00-10:00 a.m.) was to fuel-up and refuel from his morning run; the second bucket (10:00-2:00 pm) was for an early hearty lunch; the third bucket (2:00-6:00 pm) was for a second smaller lunch plus energy bar and sports drinks to energize his 5:00 pm workout; and the fourth bucket (6:00-10:00 pm) refueled his muscles after the second workout of the day. Knowing his calorie goals for each 4-hour block helped him maintain high energy so he could train hard yet still enjoy the training sessions.

As a hungry athlete, you need to develop a similar eating strategy to fit your training schedule. One triathlete devised this routine: he drank 16 oz. of juice (i.e., carbs) before his morning swim, refueled afterwards while commuting to work with breakfast in his car (big bagel with peanut butter, a banana, milk in a travel mug). He ate a hot dinner-type meal at lunchtime (from the worksite cafeteria). He also bought at lunchtime a yogurt to add to his second lunch (granola and raisins, stocked in his desk drawer) and his evening meal (turkey sub, chocolate milk). He kept those items in the office refrigerator. This program ensured healthful food would be conveniently waiting for him and prevented him from overeating fatty take-out food at night.

Tip #3. Create a feeding plan for during exercise. Knowing your hourly calorie targets can help you maintain high energy during exercise. A sports nutritionist can help you estimate your energy needs per hour. You should try to replace at least one-third or more of the calories burned during the ultra-distance event. A good target is about 240 to 360 calories of carbohydrate per hour (60-90 g carb/h). For example, during an extended ride a cyclist could stay well fueled by consuming 1 quart sports drink (200 cals/50 g carb) + 3 fig newtons (165 cals/33 g carb) per hour, or a Clif Bar (240 cals; 45 g carb) + a gel (100 cals, 25 g carb). The goals are to maintain a normal blood glucose; if you feel dizzy or lightheaded, you are failing to consume enough calories!

Tip #4. Practice your event-day fueling. An essential part of your training is to train your intestinal tract so you can minimize undesired pit stops. During long training sessions, you want to determine which food and fluids you prefer for fuel during exercise. That is, you need to know which settles better: Gatorade or PowerAde? energy bars or  gels? liquids or solids? By developing a list of several tried-and-true foods, you need not worry about making the wrong food choice on race day.

Also think about “taste-bud burn-out.” That is, how many gels per hour can you endure in a triathlon? When hiking, how many days in a row will you enjoy oatmeal for breakfast? Will you get “sugared-out” on sports drink during the century bike ride? Plan to have a variety of options available.

Tip #5. Good nutrition starts in the grocery store. All too often, in the midst of juggling work, family, friends, sleep plus training, endurance athletes have little time left to plan, shop for, and prepare balanced sports meals. By having the right foods ready and waiting for you, you’ll eat better.

Tip #6. Plan rest days. Because ultra-distance athletes commonly feel overwhelmed by their impending task, they tend to fill every possible minute with exercise. Bad idea. Rest days are essential to reduce the risk of injury and provide muscles with time to refuel. (Remember: The bad things happen when you train; the good things happen when you rest.) Rest days also allow time for you to—tah dah—food shop!!!

Tip #7. Drink enough fluids. Ideally, you should learn your sweat rate by weighing yourself naked before and after an hour of race-pace exercise with no fluid intake. One pound lost = 16 ounces of sweat. You can then target the right amount to drink/hour so you don’t get into a hole.

On a daily basis, monitor your urine. You should be voiding a light-colored urine every 2 to 4 hours. Morning urine that is dark and smelly signals dehydration. Drink more!

Tip #8. Be flexible. Although you will have a well-planned fueling program that ensures adequate calorie and fluid intake, you also need to be flexible. Tastes change during extended exercise! Your initial approach to consume   “healthy foods” may deteriorate into gummy bears and Pepsi. Worry more about survival than good nutrition during events. Any fuel is better than none, and sugar can help delay fatigue.

Eat wisely and have fun!

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Nancy Clark, MS, RD offers personal consultations to athletes of all abilities at her office in Newton MA (617-795-1875). Her Sports Nutrition Guidebook is filled with great tips. See for more info. Also see for online education.





Chronic Pain: The False Alarm

By Chad Garvey, PT, DPT, OCS, FAAOMPT

Everyone who has heard a car or house alarm over and over again in their neighborhood understands how annoying, stressful, and unhelpful they can be.  It doesn’t serve its purpose anymore and only makes life more miserable for everyone within earshot of it.

Chronic pain behaves very similarly in the body, and its message is not only inaccurate, but having it makes everything else in your body unhealthier.  1 out of every 6 people lives with chronic pain and 75% of those adjust their lifestyle because of it.

So how do you turn the alarm off?  There is a growing amount of research in this area with good news!  You can help manage this alarm system and “turn the volume down”.

One of the best 1st options is regular aerobic exercise. This can be as simple as a daily 5-10 minute walk to start, as long as it is something that doesn’t cause the pain to “flare up” and increase stress chemicals in the body.  This type of activity helps produce “feel good” chemicals in the brain which can help “rewire the alarm”.

Another technique is visualizing the activity, pain free, that normally accompanies pain, paired with deep, slow breathing.  This also helps “rewire the brain” by preventing the pain from being expected every time the activity occurs.

These are just a few of the activities that can be done to effectively help the brain “relearn and rewire” itself to better know that “PAIN DOES NOT ALWAYS EQUAL HARM.”  To learn more about chronic pain and how to better deal with it feel free to speak with a KORT physical or occupational therapist to gain more strategies and education about dealing with chronic pain. Visit us at or call 1-800-645-KORT.

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Chad Garvey KORT Downtown Clinic Director, PT, DPT, OCS, FAAOMPT earned his Doctorate of Physical Therapy from Regis University as well as a post-Doctoral Certificate in Manual Therapy. He is a Board Certified Specialist in Orthopaedic Physical Therapy (OCS) and is a Fellow in the American Academy of Orthopaedic Manual Physical Therapists (AAOMPT). In addition, Chad is a certified Strength and Conditioning Specialist (CSCS). Chad is the clinic director. He is a lead instructor for KORT’s orthopaedic residency program in addition to being an instructor to practicing physical therapists and physical therapy students at both the local and national level. He regularly conducts and shares his own research at national physical therapy conferences.

Healthy Back. Healthy Life.

By Julie L. Lyles, DC

One of the least understood but most important parts of the human body is the spine.  The spine is the lattice work and foundation for every other soft tissue and organ.  The spine is composed of 26 moveable segments.  Hear that?  Moveable! Each joint is angled in a certain way to provide optimal motion and optimal protection.  When loaded correctly and free of fixation, there is nothing more brilliant!   So, why such confusion?  Why such a lack of respect?  Why so little education on the value and importance of healthy joint mobility and postural balance?  Maybe it’s a lack of understanding of the complex simplicity of the spine and its care.

When a child is born, she has 2 curves in her spine:  the mid-back and the sacrum.  As the child starts to get nosey, she lifts her head while on her belly and starts to develop the curve in her neck.  The forces that the back part of her neck feels is what triggers her body to pour calcium in the right places until the age of 25.  (Wolff’s Law” of Physics states that bone models and remodels in response to the mechanical stresses it experiences so as to produce a minimal-weight structure that is ‘adapted’ to its applied stresses.”)

Later on, she gets a little more nosey and goes to all fours, dropping her belly with her head lifted up, developing the curve in her low back.  And, off she goes…through a stage of crawling, building necessary brain and body strength, and mechanical and neurological synchronization.  Then, only when she and her spine are ready, she will start to pull up, with ideally, a properly curved spine that has been fortified by normal instinctive motions and body positions.

When the curves in the spine are not properly formed, as is becoming the norm due to a decrease in “belly-time,” walking too soon without first crawling, more sedentary lifestyles and of course, technology posture, the body reacts profoundly!  Look at the body this way, the back or posterior, is the foundational structure, whereas, the front or the anterior, is where all of the organs and pipes are that supply the body with nutrition and eliminate waste.  If you place the weight of your head, shoulders, and hips in the back and heels, you are correctly putting stress in the purposefully larger, denser bones intended to carry such weight and leaving the front to “flow.”  If you place the weight of the head, shoulders, and pelvis in the front, you are blocking flow of nerve supply, blood supply, and lymphatic supply and compressing all of your vital organs, ultimately leading to dysfunction and disease.

What are common symptoms of joint fixation and postural distortion?  Headaches, neck and back pain, numbness, tingling, and weakness in the upper and lower extremities.  Big deal?  Motrin or Tylenol can help you live with those symptoms, right?  Well, every seven years when the body remodels bone and every year when your organs try to replace their tissues, you are allowing dysfunction and disease to continue…until, of course, you get the symptoms that you can no longer cover up and no longer live with.  What are some conditions that are on the rise, linked to postural distortion and joint fixation: hypertension, migraine headaches, ADD/ADHD, sinusitis/allergies/asthma, reflux and GERD, osteopenia/osteoporosis, infertility, and constipation to name a few.  All of these conditions typically lead to a less active you.  The decreased motion in your body further accelerates the deterioration of the joints and the organs through fixation and stagnation.

What can you do?  Look at yourself and your family and notice if the center of your ear is close to the back of your neck and in line with your shoulders?  Are your shoulders lined up with your hips?  Are your hips lined up with your heels?  Do you have any of the aforementioned conditions and use a lot of over the counter medications? Do you have trouble turning your head or bending it forward, backward, or sideways?  Do you avoid bending over or leaning back? Have you become less active and accepted “feeling bad” as your norm?  Or, has disease set in?

Seek out a health care professional whose specialty is the structure and function of the human form, one whose skills, through manual correction, proper education, and physical retraining can help restore your body to the strong balanced flowing structure capable of brilliant healing powers: The Doctor of Chiropractic.

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Dr. Julie Lyles, DC is a doctor of chiropractic who practices chiropractic care and also owns GetWell Solutions which is focused on Nutrition Counseling, Well Coaching, and Corporate Wellness Programs. For more information, contact Dr. Lyle directly at  




Losing Weight: Dieting, Food & Exercise

By Nancy Clark MS RD CSSD

As an athlete, you are unlikely obese, but you may have concerns about your weight or have relatives who struggle with their weight. To address the complexities of how to deal with undesired body fat, the Weight Management Group of the Academy of Nutrition & Dietetics held a conference (Indianapolis, April 2013). Here are some highlights.

Dieting and weight

•  An estimated 35% of all US adults are not only overfat but also pre-diabetic, including 50% of adults over 65 years. Relatives who have watched a loved one needlessly die from diabetes see first-hand the need to prevent themselves from going down the same road. There are clear benefits from eating wisely and exercising regularly! Losing just 5% of body weight can reduce health risks attributed to diabetes.

•  Most dieters want to lose weight quickly. The problem is that plan tends to backfire. You can lose weight fast or lose weight forever—but not lose weight fast and forever.

• Most dieters regain about two-thirds of their weight loss within a year and all of it within 3 to 5 years. Tips to maintain weight loss include: exercise regularly, eat fewer fatty foods, watch less TV, have strong social support, and sleep more than 5 hours a day.

• Chewing gum can help lean people consume fewer calories, but that is not the case for obese gum-chewers. (Perhaps the act of chewing increases their desire to eat?)

•  To stay on track, successful dieters should plan ahead by predicting everything that could possibly go wrong with their eating plan and develop strategies to deal with the unexpected. For example, if the waiter serves the salad soaked with dressing (not on the side, as requested), the dieter knows he can send it back, not eat it, or eat less of it.

• If you “blow your diet,” please don’t hate yourself. Just regret you over-ate and learn from the experience. You learned to overeat for a reason. (For example, overindulging in birthday cake may have been your “last chance” to eat cake before your diet started again the next meal.) The better plan can be to enjoy a reasonable slice of cake for several days. You’ll feel less need to overindulge when you know you can have more cake the next day (just fit it into your calorie budget).

• Other success-promoting dietary habits include using portion-controlled foods and keeping food and weight records. High-tech diet aids include: tracking steps by wearing a pedometer (goal: 10,000 steps a day), and wearing an armband or other body-activity monitor that detects changes in activity over time. Some popular high-tech tools include New Lifestyles-1000 pedometer, FitBit Zip, and Nike Fuel Band.  (Note: Accuracy of the high-tech tool is less important than day-to-day reproduce-ability.)

• Websites or apps like,,, and can also be helpful. In the near future, you’ll be able to take a photo of your meal and an app will then calculate the calories. This info will be very helpful when eating in restaurant with super-sized meals.

Food and weight

•  An estimated 80% of weight loss happens by eating fewer calories; 20% relates to exercise. You need to change your diet to lose weight and change your exercise to keep weight off.

• Overweight people tend to eat by time cues. Noon is lunchtime, regardless if the clock is significantly wrong!

• Adults may eat more of a food if it is deemed healthy. That is, subjects ate more oatmeal cookies when they were described as high fiber, high protein as compared to high sugar, high butter. And yes, even healthy high fiber and high protein calories count!

• In contrast, adolescents (who are heavily influenced by their peers) tend to eat less of a food labeled healthy.  For teens, eating carrots is just not as acceptable as eating chips.

• People who eat a high protein diet (25% of calories) tend to eat fewer calories per day. A protein-rich breakfast with 25 to 35 g protein helps manage appetite for the rest of the day.

• The decline in hearty breakfasts mirrors the rise in obesity. Try eating an 800-calorie protein-rich breakfast and see what that does to your appetite for the rest of the day!  You’ll undoubtedly notice you feel less need to “reward” yourself with evening treats.

• A 100-calorie portion of natural whole almonds actually has only 80 available calories due to digestibility. The same likely holds true for other high fiber, high fat “hard” foods, such as other kinds of nuts. People who frequently eat nuts are actually leaner than folks who avoid nuts;; hence, you need not fear them as being “fattening” (in moderation, of course, as with all foods).

Exercise and weight

• Weight loss is about quality of life; exercise is about health. However, exercise strongly predicts who will be able to maintain their lost weight. While the reason for this is unknown, some researchers wonder if purposeful exercise allows the reduced obese person to eat more calories? (You know—the more you exercise, the more you can eat.) Or perhaps exercise is a marker of discipline and dedication to maintain a healthier eating style and lifestyle?

• Lifting weights is a good entry point for unfit people who want to start exercising. First they get strong, and then they can add on the walking, jogging, and aerobic activities.

• Lifting weights reduces the loss of muscle that occurs with diet-only reducing plans and creates the same health benefits of slimming the waist-line and improving blood glucose levels (hence reducing the risk of diabetes).

• Because weight loss without exercise contributes to loss of muscles and bone-density, some health professionals advise against weight loss for older people. Instead they recommend that people over 60 years focus on adding on exercise rather than subtracting food. You are never too old to lift weights!

• An effective exercise program includes 110 minutes per week of moderate to vigorous physical activity and two times a week of lifting weights for about 20 minutes.

• Men who maintain a stable weight tend to be active about 70 minutes a day. In comparison, obese men are less active and likely to be frail. Do obese people become frail—or do frail people become obese?

The bottom line: Keep active, enjoy whole foods that are minimally processed, live lean, and be well!

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Nancy Clark MS RD CSSD (Board Certified Specialist in Sports Dietetics) counsels both fitness exercisers and competitive athletes in her private practice in the Boston-area (617-795-1875). Her Sports Nutrition Guidebook, Food Guide for Marathoners and Cyclist’s Food Guide all offer additional weight management information. The books are available via See also



Preventing Gardening Injuries

By Amanda Edsell, OTR/L, CHT   

Many Americans give up their love of gardening every year due to persistent pain and stiffness in their hands, hips, knees, and back. According to the Arthritis Foundation, over 46 million men, women, and children have doctor-diagnosed arthritis (osteoarthritis, rheumatoid, or juvenile).

Practical Pain Free Gardening Tips

  • Break up large tasks into several timed sessions.
  • Work at a steady pace; take intermittent rest periods during the course of the day to avoid over-fatigue and over-stress of joints.
  • Stretch upper and lower limbs before going to work.
  • Take frequent breaks, and use the strongest and largest joints and muscles available for each job.
  • Use proper body mechanics to lift objects so that the legs are being used to lift rather than the arms and back. Keep the weight of the object close in to the center of your body.
  • Use ergonomic equipment such as long-handled spades, bulb planters, and weeding forks to avoid back strain, extreme postures of the knees and hips, and extended reach of the shoulders.
  • Avoid loose-fitting, bulky gloves as they can actually increase the workload on your hands as they attempt to hold onto and maneuver tools/items.
  • Spring-loaded pruners, loppers or any tools that increase leverage while cutting will decrease the amount of force exerted through the hands and upper extremities.
  • When kneeling is preferred or necessary, individual strap-on knee pads or padded mats can reduce mechanical stress on the resting surface of your lower extremities.
  • Consider raised flower beds or flower boxes for easier access or utilize a wagon or stool for prolonged sitting.
  • Stack the most commonly used tools in a cart, wagon, or other gardener’s helper that does double duty as a seat for planting and weeding.
  • Consider low-maintenance plants such as daylilies, hydrangeas, hostas, boxwood or yew shrubs, and groundcover (i.e. English ivy) when planning new landscaping.

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Amanda L. Edsell OTR/L, CHT graduated from Spalding University in 2002 with a Bachelor’s degree in Occupational Therapy. In 2008, she became a Certified Hand Therapist (CHT). Amanda is certified to perform augmented soft tissue mobilization (ASTYM), Functional Capacity Evaluations (FCEs), and is trained in the application of kinesiotaping as well. She joined our KORT team in 2004.

Alcohol, Athletes & Pressure to Drink

By Nancy Clark MS, RD

Ask any coach or college athletic director, and you’ll hear concern
about alcohol and athletes. Rightfully so. Alcohol and athletics is a
dangerous duo, associated with negative consequences including
hangovers, nausea and vomiting, poor grades in school, fights,
arguments, memory loss, driving under the influence, and trouble with
the law—to say nothing of injuries. Yet, tailgating before football
games, quenching thirst at the pub after a team workout, and celebrating
victories with champaign is perceived as the norm.
College athletes are more likely to drink than non-athletes. Serious
recreational runners drink more than their sedentary counterparts.
Unfortunately, alcohol is a highly addictive substance and is the most
abused drug in the United States, more so than steroids. Prolonged
drinking can damage the liver, heart, and brain, and result in
cirrhosis, pancreatitis, irregular heart beats, stroke, and
malnutrition. More oral cancer is seen among those who are just moderate
drinkers as compared to abstainers.

What can be done about this problem?
To address the problem of alcohol abuse among student-athletes, many
college campuses are educating students about social norms—the beliefs
about what is normal and expected in social situations. For example,
despite popular belief, “everyone” does not drink nor do “most students”
get drunk all the time.
A 1999 survey at Southern Methodist University asked these four
questions to students on a Friday about alcohol use on the previous night:
Did you drink last night?
Did you get drunk last night?
What percentage of SMU students do you think drank last night?
What percentage of SMU students do you think got drunk last night?

The answers showed major misperceptions about alcohol norms:
-Only 20% of students surveyed reported drinking the previous night, yet
they believed that over half drank.
-Only 8% reported getting drunk, yet they believed at least one-third
got drunk.
-Of students who drank, most reported consuming only a few drinks per
week. Yet they believed most students were drinking 10 to 15 drinks per
-35% reported abstaining from alcohol, but very few believed that many
of their peers were non-drinkers.

With ongoing social norm education, students will actually change their
drinking practices. For example, a three-year social-norm education
program targeted Division III athletes in a NY State college. It
contributed to a 30% drop in both excessive alcohol consumption and the
negative consequences of drinking. Among student-athletes with the
highest exposure to the program, personal alcohol misuse dropped 50%.
(1) Given that athletes are often role models, this change can have a
positive impact on the entire campus and potentially (eventually) our
entire sports society.

Minimizing negative consequences
If you are among the athletes who chooses to drink large amounts of
alcohol, take note:
• Alcohol is a depressant. Apart from killing pain, it offers no edge
for athletes. You can’t be sharp, quick, and drunk. Pre-competition
alcohol has a deleterious effect on reaction time, accuracy, balance,
eye-hand coordination and endurance. It will not help you exercise
faster, stronger, longer.
• Late night partying that contributes to sleep deprivation before the
next morning’s event hurts performance.
• Alcohol is a poor source of carbohydrates. You can get loaded with
beer, but your muscles will not get carbo-loaded. A 12-ounce can of beer
has only 14 grams of carbs, as compared to 40 grams in a can of soft
drink. Eat pretzels, thick-crust pizza or other carbs along with the beer.
• Alcohol on an empty stomach can quickly lead to a drunken stupor. Be
wise; enjoy the natural high of exercise rather than get brought down by
a few post-exercise beers.
• Alcohol has a diuretic effect–the more you drink, the more fluids you
lose. This is bad for recovery and the next exercise bout. While
low-alcohol beer allows for proper rehydration, regular beer sends
athletes running to the bathroom. One study showed that athletes who
drank beer eliminated about 16 ounces more urine (over the course of 4
hours) than those who drink low-alcohol (2%) beer or alcohol-free beer. (2)
• Your liver breaks down alcohol at a fixed rate (~1 can beer or 4
ounces wine per hour). Exercise does not hasten the process, nor does
coffee. Caffeine just makes you a wide-awake drunk.
• Drinks that contain congeners—whiskey, cognac, and red wine—are more
likely to cause hangovers than other alcoholic beverages. The best
hangover remedy is to not drink excessively in the first place. But if
you have a hangover, drink a salted beverage with carbs, such as
Gatorade or brothy chicken noodle soup.
• The calories in alcohol are easily fattening. People who drink
moderately tend to consume alcohol calories on top of their regular
caloric intake. These excess calories promote body fat accumulation.
• Alcohol stimulates the appetite, making it harder to feel full. If you
are trying to maintain a lean machine, abstaining is preferable to

The good news
Alcohol in moderation can have health benefits. Red wine, for example,
contains health-protective phytochemicals that may reduce the risk of
heart disease. What’s “moderation”?—two drinks per day for men, and one
for women. And have at least one glass of non-alcoholic beverage for
every drink…

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Nancy Clark MS, RD counsels casual exercisers and competitive athletes
at Healthworks, the premier fitness center in Chestnut Hill, MA
(617-383-6100). Her NEW 2008 Nancy Clark’s Sports Nutrition Guidebook
4th Edition, and her Food Guide for Marathoners and Cyclist’s Food Guide
are available via

1. Perkins H and Crais D. 2006. A Successful Social Norms Campaign to
Rreduce Alcohol Misuse Among Collge Student-Athlets. J. Stud Alcohol

2. Sherriffs, S., and R. Maughan. 1997. Restoration of fluid balance
after exercise-induced dehydration: Effects of alcohol consumption. J
Appl Physiol 83(40):1152-1158.

How Many Calories Do You Need Each Day?

By Barbara Day, M.S., R.D., C.N.

There’s an App for this!

Knowing how many calories you need each day will help keep you energized while you are training for your event and doing all the things you need to do each day: work, manage a family, take care our your home or lose weight.  There are some FREE apps that you can use to help to determine how many calories you need each day.

A FREE app, My Fitness Pal, for your smart phone or online at can help to determine how many calories you need each day: and how many calories you burn when playing soccer or lifting weights: Add the calories plus the calories you burned practicing to get how many calories you need on most days.

Once you determine how many calories you need each day, the timing of your food intake is also important. Eating 5 – 6 times per day will help give you bullets of energy but keeping the calories in line with your overall calorie needs will maximize your performance. Never skip breakfast.

Other excellent apps and websites to determine calories are: LOSE IT! (, SPARK PEOPLE (

The Old Fashion Way to Determine Your Calories

To determine how many calories you need each day, you can calculate the calories the OLD FASHION WAY by using the HARRIS BENEDICT EQUATION to determine your resting metabolic rate (RMR) then choosing an activity factor to estimate the total calories per day.

Harris Benedict Equation


RMR = 88.362 + [1.889 X HT (in)] + [6.089 X WT (lbs)] – (5.677 X Age)


RMR = 447.593 + [(1.219 X HT (in)] + [(4.20 X WT (lbs)] – (4.7 X Age)

HT = height in inches   WT = weight in pounds   age = age in years

Activity Levels

Very Light-seating and standing activities, driving, no regular exercise.

Light – child care, walking on a level surface 2.5 – 3 miles per hour, some regular exercise.

Moderate – walking/running 3.5 to 4 mph, cycling, regular exercise 3 to 4 times/week -30 to 40 minutes duration.

Heavy – walking uphill with a load, basketball, soccer, regular exercise 4 times/week 40 minutes or more in duration.

Very Heavy – distance running, hiking with backpack up and down hills, regular exercise 5 times/week for at least 1 hour in duration.

TABLE 1.  Activity Factors. Choose your activity level from the table below. Then do the math.



Little to no exercise

RMR X 1.2

Light (1 – 3 days per week)

RMR X 1.375

Moderate exercise (3 -5 days/week)

RMR X 1.55

Heavy exercise (6-7 days/week)

RMR X 1.725

Very heavy (twice/day heavy workouts)

RMR X 1.9

Example, 1300 X 1.55 (moderate) = 2015 calories/day

You can also determine how many calories you burned by wearing a heart rate monitor that determines calories burned during exercise. (Not all heart rate monitors calculate calories). Then you can add those calories to your resting metabolic rate calories to get an estimate of active calories burned while exercising.  Example, 1300 X 500 calories = 1800 calories.  So, you could safely eat at least 1800 calories without gaining weight.

Again, it’s just an estimate. Weigh only once a week about the same time.  I suggest weigh after the first void in the morning before drinking anything with as few clothes as possible.

 Using Oxygen Consumption to Calculate your Personal RMR

The BodyGem Resting Metabolic Rate device is the handheld, portable and an effective tool that gives you an accurate RMR measurement result in 10 minutes or less. To perform a measurement, you simply breathe into the indirect calorimeter, which measures their oxygen consumption (VO2), the resulting RMR number is clearly displayed on the device’s LCD screen. It has been validated against the gold standard Douglas Bag, and other commonly used metabolic carts. The test costs anywhere from $75 to $150 per test. For the best results, you should take the test when you are fasted. But you still need to estimate the active calories you burn.

Body Media FIT™ On-Body Wellness Core Armband Monitor

The BodyMedia FIT CORE which is promoted by Biggest Loser is another way to determine how many calories you burn each day. The CORE’s biggest plus is that it track calories burned for 24/7. It cost about $119.  Unlike other fitness trackers, which estimate calories burned using an algorithm of steps and weight, the CORE uses special sensors to track not just your activity but also your body’s reaction to that activity. This makes it much more accurate as a calorie tracker, so you can realistically see how many calories you’re burning. But you have to buy subscription-based Activity Tracker in order to find out how many calories you have burned in the 24 hours.  The CORE Armband does not display any information on the device itself.  That will cost you  $6.95/month or you can opt to purchase a $69 optional display, which syncs with the CORE and lets you see a quick view of progress toward your daily goals. If you want to track your progress, you’ll still need to purchase the Activity Tracker.

What’s the Take Home Message?

I think it’s helpful to know how many calories you need each day so you can manage your health. In today’s world, lifestyle is the major contributor to increasing your risk of many diseases like heart disease, stroke, diabetes, and cancer.  Lifestyle includes your diet and also your daily activity.

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Barbara Day, M.S., R.D., C.N., is a registered dietitian with a Master’s Degree in clinical nutrition.  The former publisher of Kentuckiana HealthFitness Magazine, Kentuckiana Healthy Woman magazine and radio show host of Health News You Can Use, Barbara has over 30 years of experience in promoting healthy lifestyles to consumers.  Barbara worked as Nutrition Consultant to the Navy SEALs (8 years) and the University of Louisville Athletic Department (10 years). Barbara has private practice, DayByDay Nutrition,, where she counsels clients on weight loss, cholesterol management, performance nutrition and an array of other medical issues.  Visit Barbara’s new website which is an on-line health & wellness magazine, Barbara writes nutrition and health columns for as well as a weekly nutrition column for the Southeast Outlook. She also designs and presents employee wellness programs to small and large businesses. Barbara is a runner, cyclist, hiker and a mother and grandmother to 13 grandchildren.