Be Wise Portion Size when Eating Out


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


Below are a number of strategies to help you make healthier low calorie choices when you are eating out. Be wise and portion size when you are eating out.

Eating Out Strategies:

  1. Go online to see what choices you have available to help you manage your waist.
  2. Be assertive.
  3. Get the Doggie Bag with dinner, split the meal before eating it.
  4. Don’t feel guilty about eating.
  5. Eat slowly and taste every bite.
  6. Eat till you feel full not stuffed!
  7. Concentrate on the atmosphere.
  8. Don’t drink your calories!
  9. Make appetizers the meal.
  10. Breads are fattening but the added butter is.
  11. Salads aren’t always low calorie fare.
  12. Beware of Reduced Calorie salad dressings.
  13. Always ask for your dressing served on the side of the salad.
  14. Vinegar like balsamic, red wine & tarragon, no calories.
  15. Split an Entrée & have an extra salad.
  16. Share a dessert if you must.
  17. Order the luncheon  or Appetizer  Portion


Know Menu Terminology

  1. Leaner ways to cook meats & vegetables: broiling, roasting, char grilling, grilling, poaching, stir-frying, boiling & steaming.
  2. Restaurants may brush or baste meats with fats during or after the cooking process.
  3. Some meat may be marinated in oil or a high fat substance.
  4. The term PRIME means very high in fat due to marbling



Terms that Indicate High-fat, High Calorie Prepared Food









In its Own Gravy



Au Gratin

In a Butter Sauce



In a Cream Sauce

In a Cheese Sauce

Pot Pie


Choose These Foods Lower Calorie Prepared Food







Herbs & spices








Stir -Fried

Tomato Sauce


Hamburger Fast Food Green Light Choices

  • Single hamburger or cheeseburger
  • Grilled chicken sandwich
  • Grilled chicken salad
  • Baked potato with chili or broccoli
  • Small order French fries
  • Garden and side salad – use light dressing
  • Frozen yogurt


Mexican Green Light Choices

  • Black bean, tortilla soup or gazpacho
  • Mexican or taco salad (don’t eat the fried shell)
  • Arroz con pollo (chicken and rice)
  • Burritos and Enchiladas
  • Fajitas
  • Soft tacos
  • Black or pinto beans (not refried beans with cheese)
  • Mexican rice
  • Pico de gallo
  • All hot sauces


Chinese Restaurant Green Light Choices

  • Wonton, egg drop or hot & sour soup
  • Teriyaki beef or chicken
  • Chop suey or chow mein
  • Vegetarian stir-fry dishes

Italian Restaurant Green Light Choices

  • Marinated vegetable salad
  • Minestrone soup
  • Shrimp cocktail
  • Pasta with tomato sauce or marinara sauce
  • Chicken or veal cacciatore, light wine or light tomato sauce
  • Chicken or shrimp primavera (no cream in sauce)

American Food Restaurant Green Choices

  • Broth-based soups
  • Chili (hold the cheese and sour cream)
  • Peel and eat shrimp
  • Salad with light or fat free dressing on the side
  • Salad with grilled tuna or chicken
  • Teriyaki or BBQ chicken breast
  • Fajitas





Fiesta Lime Chicken with Sauce, Cheese, Tortilla Strips, Salsa & Rice

1,285 calories, 47 g fat, 1,443 mg sodium

Grilled Steak Caesar Salad with Toast

1,295 calories, 82 g fat, 2,199 mg sodium

Southwest Philly Roll-Up with Salsa

1,605 calories, 121 g fat, 2,338 mg sodium

Smart Options but…

Grilled Cajun Lime Tilapia with Black Beans & Corn Salsa

310 calories, 6 g fat, 1,250 mg sodium

Crispy Buttermilk Shrimp with Potatoes & Toast

843 calories, 34 g fat, 1,563 mg sodium

Teriyaki Steak & Shrimp Skewers

370 calories, 7 g fat, 1,475 mg sodium



Roast Beef & Swiss Market Fresh Sandwich

810 calories, 42 g fat, 1,780 mg sodium

Chicken Salad w/Pecans Sandwich

789 calories, 39 g fat, 1,240 mg sodium

Santa Fe Salad

773 calories, 52 g fat, 1,823 mg sodium

Smart options but…

Grilled Cajun Lime Tilapia with Black Beans & Corn Salsa

440 calories, 19 g fat, 1,061 mg sodium

Chicken Cordon Bleu Sandwich

488 calories, 18 g fat, 1,560 mg sodium

Martha’s Vineyard Salad with Light Buttermilk Dressing

339 calories, 14 g fat, 923 mg sodium

Jimmy John’s


Turkey Tom w/Alfalfa Sprouts, Tomatoes, Lettuce, & Mayo

555 calories, 26 g fat, 1,342 mg sodium

Pepe Sub-Ham, Provolone, Lettuce, Tomato, Mayo

684 calories, 37 g fat, 1,659 mg sodium

Gourmet Veggie Club-Provolone, Avocado, Cucumber, Alfalfa, Lettuce, Tomato, Mayo

856 calories, 46 g fat, 1,500 mg sodium

Smart options but…

Turkey Breast Slim Sub w/Alfalfa Sprouts, Tomatoes, Onion, Cucumber & Avocado Spread

426 calories, 2 g fat, 1,439 mg sodium

Totally Tuna Sub

507 calories, 20 g fat, 1,279 mg sodium

Vegetarian Sub w/Avocado Spread, Cucumber, Lettuce, Tomatoes, Alfalfa Sprouts

290 calories, 1.5 g fat, 628 mg sodium




Chicken Caesar Cool Wrap

480 calories, 16 g fat, 1,640 mg sodium

Chick-fil-A Chicken Sandwich

420 calories, 16 g fat, 1,300 mg sodium

Chick-fil-A Chick-n Strips Salad with Buttermilk Dressing

800 calories, 60 g fat, 1,745 mg sodium

Chicken, Egg & Cheese on Sunflower Multigrain Bagel

500 calories, 20 g fat, 1,260 mg sodium

Smart options but…

Chick-fil-A Nuggets (8-pack) with Barbecue Sauce

305 calories, 13 g fat, 1,020 mg sodium

Chick-fil-A Southwest Chargrilled Salad with fat-free honey mustard dressing

360 calories, 8 g fat, 1,170 mg sodium

Biscuit & Gravy

330 calories, 15 g fat, 970 mg sodium



Spaghetti with Marinara Sauce & Spicy Italian Sausage w/ Caesar Side Salad

1,030 calories, 53.5 g fat, 2,040 mg sodium

Baked Spaghetti with Meatballs

940 calories, 40 g fat, 2,370 sodium

Original Submarine

940 calories, 58 g fat, 3,040 mg sodium

Parmesan Chicken Salad with Ranch Dressing

580 calories, 39 g fat, 1,270 sodium


Spaghetti with Marinara Sauce & Spicy Italian Sausage w/ Caesar Side Salad

1,030 calories, 53.5 g fat, 2,040 mg sodium

Baked Spaghetti with Meatballs

940 calories, 40 g fat, 2,370 sodium

Original Submarine

940 calories, 58 g fat, 3,040 mg sodium

Parmesan Chicken Salad with Ranch Dressing

580 calories, 39 g fat, 1,270 sodium



KFC Famous Bowl with Mashed Potatoes & Gravy

740 calories, 35 g fat, 2,350 mg sodium

Popcorn Chicken – Individual

400 calories, 26 g fat, 1,160 mg sodium

Crispy Caesar Salad w/Creamy Parm Caesar Dress w/ Croutons

670 calories, 48 g fat, 1,755 mg sodium

Apple Pie Minis (3)

370 calories, 20 g fat, 260 mg sodium

Smart options but…

3 Crispy Strips, Green Beans, & 3” Corn on Cob

470 calories, 22 g fat, 1,775 mg sodium

Honey BBQ KFC Snacker

210 calories, 3 g fat, 530 mg sodium

Roasted BLT Salad w/Fat Free Ranch Dressing

235 calories, 6 g fat, 1,290 mg sodium

Sweet Life Oatmeal Raisin Cookie

150 calories, 5 g fat, 135 mg sodium

Olive Garden


Stuffed Chicken Marsala w/Garlic Parmesan Mash Potatoes

1,315 calories, 86 g fat, 2,550 mg sodium

Mixed Grill w/Vegetables & Mashed Potatoes

839 calories, 43 g fat, 1,541 mg sodium

Pork Filettino w/Potatoes & Bell Peppers

1,011 calories, 57 g fat, 2,479 mg sodium


Smart options but…

Linguine Alla Marinara with a Breadstick

691 calories, 9.5 g fat, 1,040 mg sodium

Shrimp Primavera

706 calories, 18 g fat, 1,220 mg sodium

Chicken Giardino

448 calories, 11 g fat, 1,670 mg sodium


Outback Steakhouse


Ayers Rock Strip Steak w/Sautéed Mushrooms & Loaded Jacket Potato

1,450 calories, 85 g fat

Outback Special (11 oz) w/Sautéed Mushrooms

960 calories, 61 g fat

Half a Bloomin’ Onion

1,155 calories, 67 g fat

Smart options but…

Prime Minister’s Prime Rib w/Fresh Veggies & Sweet Potato

730 calories, 39 g fat

Victoria Filet (9 oz) with Steamed Vegetables

639 calories, 45 g fat

Half an Order of Shrimp on the Barbie w/Bread

330 calories, 21 g fat

PF Chang’s


Sriracha Shrimp Salad

1,130 calories, 46 g fat

Salt & Pepper Calamari

770 calories, 50 g fat

Kung Pao Chicken

1,240 calories, 80 g fat

Spicy Green beans


Smart options but…

Wild Alaskan Sockeye Steamed with Ginger

750 calories, 50 g fat

Seared Ahi Tuna

260 calories, 6 g fat

Ginger Chicken & Broccoli

660 calories, 26 g fat

Sichuan-Style Asparagus

200 calories, 6 g fat



Small Honey Mustard Chicken Sub

550 calories, 30 g fat, 1,140 mg sodium

Small Prime Rib Cheesesteak

680 calories, 42 g fat, 1,070 mg sodium

Small Turkey Ranch & Swiss Sandwich

450 calories, 22.5 g fat, 1,380 mg sodium

Smart options but…

Small Honey Bourbon Chicken on Wheat Bread

310 calories, 4 g fat, 920 mg sodium

Small Black Angus Sandwich

520 calories, 16.5 g fat, 1,550 mg sodium

Small Tuscan Turkey

390 calories, 14 g fat, 1,185 mg sodium

Red Lobster


North Pacific King Crab Legs with Melted Butter w/Rice Pilaf

883 calories, 35 g fat

Snow Crab Legs w/Melted Butter & a Cheddar Bay Biscuit

611 calories, 34.5 g fat

Crab Alfredo

1,170 calories, 66 g fat

Smart options but…

Live Maine Lobster (1.24 lbs) w/Cocktail Sauce & Seasoned Broccoli

288 calories, 3 g fat

Garlic Grilled Jumbo Shrimp

329 calories, 5 g fat

Broiled Flounder w/Lemon Juice & a Garden Salad w/Red Wine Vinaigrette

344 calories, 10 g fat

Romano’s Macaroni Grill


Chicken Caesar

920 calories, 69 g fat, 1,660 mg sodium

Chicken Portobello

1,020 calories, 66 g fat, 7,300 mg sodium

Grilled Salmon Teriyaki

1,230 calories, 74 g fat, 6,590 mg sodium

Half Order of Mozzarella Fritta

Smart options but…

½ Pizza Margherita & Caesar Della Casa w/Low Fat Caesar Dr

645 calories, 24 g fat, 1,665 mg sodium

Pollo Magro

330 calories, 5 g fat, 770 mg sodium

Simple Salmon

590 calories, 40 g fat, 1,390 mg sodium

Half Order of Mozzarella Alla Caprese

260 calories, 21 g fat, 410 mg sodium

Ruby Tuesday’s


Turkey Burger with Fries

1,171 calories, 58 g fat

Parmesan Shrimp Penne

1,221 calories, 64 g fat

Southwestern Spring Rolls (4 rolls)

708 calories, 40 g fat

Broccoli & Cheese Soup

443 calories, 34 g fat

Smart options but..

7 oz Top Sirloin w/Baby Green Beans & Baby Portabella Mushrooms

464 calories, 24 g fat

Creole Catch w/Couscous w/Baby Green Beans

580 calories, 26 g fat

Asian Dumplings (4 dumplings)

440 calories, 20 g fat

White Bean Chicken Chili w/Tomato & Mozzarella Salad

370 calories, 15 g fat

Taco Bell


Baja Beef Chalupa

410 calories, 27 g fat, 780 mg sodium

Zesty Chicken BORDER BOWL

640 calories, 35 g fat, 1,800 mg sodium

Grilled Stuff Chicken Burrito

640 calories, 23 g fat, 2,160 mg sodium

Caramel Apple Empanadas

290 calories, 14 g fat, 300 mg sodium

Smart options but…

Two Grilled Steak Soft Tacos, Fresco Style

320 calories, 9 g fat, 1,100 mg sodium

Chicken Fiesta Taco Salad w/out Shell

470 calories, 24 g fat, 1,780 mg sodium

Two Spicy Chicken Soft Tacos

340 calories, 12 g fat, 1,160 mg sodium

Cinnamon Twists

170 calories, 7 g fat, 200 mg sodium



Chicken Club Toaster Sandwich

690 calories, 35 g fat, 1,900 mg sodium

Jumbo Popcorn Chicken Salad

490 calories, 28 g fat, 1,440 mg sodium

Fish Sandwich

640 calories, 31 g fat, 1,1180 mg sodium

Large Hi-C Fruit Punch

290 calories, 0 g fat

Smart options but…

Sonic Burger with Mustard

540 calories, 25 g fat, 730 mg sodium

Grilled Chicken on Ciabatta w/BBQ Sauce

375 calories, 9 g fat, 1,310 mg sodium

Grilled Chicken Wrap

380 calories, 11 g fat, 1,300 mg sodium

Junior Banana Split

200 calories, 4.5 g fat



Roasted Turkey & Swiss Frescata w/Med Fries & Med Coke

1,100 calories, 40 g fat, 1,950 mg sodium

Chicken Club Sandwich

610 calories, 31 g fat, 1,460 mg sodium

2 Junior Cheeseburgers

720 calories, 32 g fat, 1,720 mg sodium

Medium French Fries

420 calories, 20 g fat, 430 mg sodium

Smart options but…

Ultimate Chicken Grill Sandwich w/Side Salad w/Red fat Ranch & Med Iced Tea

540 calories, 22 g fat, 1,780 mg sodium

Small Chili & 5 piece Crispy Chicken Nuggets

450 calories, 21 g fat, 1,300 mg sodium

Single w/ Everything

430 calories, 20 g fat, 900 mg sodium

Sour Cream & Chives Potato

320 calories, 4 g fat, 55 mg sodium


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.    


Nutrition 101 for Seniors

seniors shopping healthy

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


The fact is less active seniors need less calories or they may end up gaining weight as they age. Even though less calories are needed as we age, you need just as many nutrients. Therefore, choosing nutrient dense foods over calorie dense foods are warranted. For example, choosing skim milk over whole milk; choosing reduced fat cheese over full fat cheese; baking, grilling, or broiling meats rather than frying with lots of fat. Seniors should choose small portions of foods high in fat, sugar and sodium. Using spices to help flavor foods may be helpful since smell and taste are affected as we age. Protein needs don’t change as we age but some seniors tend to eat less meat. Choosing foods that are higher in dietary fiber will help prevent constipation. Beans are high in dietary fiber but also contain protein and lots of nutrients such as folate, manganese, potassium, iron, copper and magnesium. But when you eat more dietary fiber, you need to make sure you drink enough fluids as well. Adequate fluid intake for seniors is essential! The number one problem that typically sends seniors to the emergency room is dehydration. Water, juice, milk, coffee and tea contain fluids. In addition, high fluid foods like melons, berries, and grapes offer dietary fiber and also lots of nutrients.


As we age, it is important that we eat more calcium to help prevent osteoporosis.  Including 2 to 4 servings of dairy products like vitamin D enriched milk, yogurt or cheese each day. If you can’t tolerate these foods, check with your doctor about appropriate nutritional supplements. Make sure these supplements contain a source of Vitamin D as well. Other nutrients that are important as we age are: iron, vitamin C, and zinc.  Iron and zinc are found in meats, eggs and seafood. Vitamin C rich foods include: citrus fruits, green and red peppers, broccoli, tomatoes, strawberries and potatoes.

Problems Facing Seniors

Eating alone can affect the amount and type of food you eat.  Loss of teeth or improper fitting dentures may affect your eating style as well. Affordable food is also an issue if you are on a fixed income. Drug therapy can also affect your taste & your appetite. Depression can either decrease your food intake or increase your intake. Gas and heartburn become an issue as we get older. Overeating, avoiding fatty foods, alcohol & carbonated beverages may help to relieve heartburn problems. In addition, eating slowly, chewing food thoroughly, & eating smaller more frequent meals may help.

Senior Nutritional Tip Sheet

  • Eat breakfast every day.
  • Drink plenty of water or water based fluids & high fluid foods.
  • Select high fiber foods like whole grain breads & cereals, beans, & brightly colored fruits and vegetables.
  • If poor appetite is a problem, eating smaller more frequent mini-meals may be helpful.


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.    

How Sure Are You About Your Surefootedness This Winter?


By Matt Hall, PT, DPT, OCS.

How sure are you about your surefootedness this winter? As we approach the heart of winter in Kentucky, this is the opportune time to seriously ponder this question.  Your response may portend idyllic enjoyment of the outdoors, or could reveal your heightened risk for injury.  In attempting to answer this question it may first be helpful to consider a wide spectrum of influences.  Here are just a few:

Shoes– Due to the increased risk of slipping, it is advisable to utilize aids that provide added traction.  While spray-on resins can provide rubbery grip to the soles of any shoe, for those tackling more serious terrain or who require maximum traction, screw in metal cleats can be manually attached using a specialized tool.  A more likely option for most  might be crampons like YakTrax, or Sandys that can be easily secured to and removed from the soles most styles of shoes before stepping out into inclement weather.  Additionally, these devices spare the floor from damage.

Canes or walking sticks– Whether you routinely use one or not,  a cane or walking stick can provide added support and enhanced stability when walking on slick or uneven terrain.  However, before you venture forth into the elements one very important modification should be made.  The rubber tip should be replaced by one that has small spikes that does not slip when planted.  The tip may need to be switched again to rubber for indoor use or may be retractable.  Check with the vendor before purchasing.

Eyewear– This one can be easily “overlooked”, no pun intended, because the risk usually occurs when returning to the warmth of a shelter.  Often the sudden temperature change causes glasses to fog up for a few moments and this could lead to a trip or fall.  Another risk is the self- tinting feature that can likewise render the wearer’s vision momentarily impaired when coming from sunlight into an indoor lighting environment.  One solution is simply pausing upon entry until the glasses stabilize; another is to leave a spare pair near the entry way that can be swapped.

Clear walk ways– Sidewalks and porches should be cleared of snow as soon as possible.  Walking on freshly fallen sow only serve to compact it making it more difficult to remove latter, and hastening its transformation to ice.  However, as we Kentuckian’s are all too acquainted, snow is usually not the issue but rather it seems that ice is our nemesis.   One effective solution is to spread deicer upon walkways.  Keep a container near doorways for convenient use when needed.  Sand and cat litter can be substituted but they will not melt the ice and can be a bit messy.

Finally, I’d like to leave you with a few additional suggestions to keep you safer this winter.

  1. Walk like a penguin, exit your automobile like a cat burglar, and if you find yourself falling, do so like a gymnast.
  2. Keep a wide stance and walk “flat footed”.  Imitating a penguin greatly increases your stability on slick surfaces.
  3. When exiting a car, do not jump out!  Think cat burglar.  Gingerly step out and down while holding onto the handle, seat and door until your footing is assured.
  4. And lastly while the physicality of a gymnast is well beyond the capabilities of most, their approach to tumbling does effectively illustrate my point.   Gymnasts use their hands to “soften” their landing.  Therefore, if you are carrying objects attempt to throw them out of the way don’t try to hold onto them.  It is paramount, in the event of a fall, to protect your head and you can only do this if your hands are free.  Furthermore, don’t attempt to twist away from or stiffen as one falls.  Instead, roll with the fall as this can reduce the potential for injury.

While there can never be a 100% guarantee that winter falls can be prevented, following some or all of the aforementioned suggestions can only serve to improve your overall safety.  Godspeed.

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Matt Hall PT, DPT, OCS is a graduate of Transylvania University and the University of Kentucky. A board certified specialist (OCS), he is a member of both the Kentucky and the American Physical Therapy Associations. He has been a practicing physical therapist since 1995 and has experience in both inpatient and outpatient facilities. Matt’s areas of professional interest include general orthopedics, industrial/workplace preventative and rehab services, and foot orthotics to correct mechanical gait deviations. For more information about injury prevention and treatment, check  out 

Fueling on a Budget for Traveling Sports Teams

sports teams

By Nancy Clark MS RD CSSD

“When we travel as a team, we eat at fast food places because they fit with our small budget.What’s the best fast food for athletes…?”

“After my workout, the last thing I want to do is cook dinner. Where can I buy affordable but healthy sports meals…?”

A limited food budget creates a fueling challenge for many athletes, including college teams traveling to games, students responsible for their own meals, parents of active kids, and semi-pro players hoping to get to the next level. The name of the fueling game is: How can you buy enough healthy calories with the least amount of money? These practical tips can help optimize a low-budget sports diet.

1. Encourage the team bus (or your car) to stop at a large supermarket.

Everyone can find something they like: vegetarians,  gluten-free eaters, picky eaters who want to lose weight, and chowhounds who need lots of calories. By walking around the inside perimeter of the store, you will find the makings for a balanced meal—even hot meals, if desired. Shop for:

Fresh fruit: Banana, apple, pear, grapes. Buy what’s on sale.

Fresh veggies: While you can easily create a colorful salad at the salad bar area, it might be a bit pricey. The simpler option is to simply buy: a green  or red pepper (eat it whole, as you might eat an apple), a bag of baby carrots (along with a container of hummus), or a container of cherry tomatoes. Enjoy the whole thing; a hefty dose of veggies on one day can help compensate for another day when you have none.

(To clean the fresh produce, plan ahead. Pack extra water to rinse the produce before getting on the bus. Or nicely ask  an employee in the store’s produce area if he or she could help you by giving the fresh produce a quick rinse.)

Protein: Buy a quarter-pound of deli turkey, roast beef, or ham along with a few whole wheat rolls to make sandwiches. Small or large tubs of cottage cheese, tuna packets, and peanut butter are other popular protein options. Share a rotisserie chicken with friends (or save the leftovers if you can refrigerate them within an hour.)

Grains and other carbs: Pita, wraps, baked chips, whole-grain crackers and  pretzels are carb-based options that refuel your muscles. Look for freshly baked whole-wheat rolls, hearty breads, and whole-grain bagels. You might be able to find a plastic knife at the salad bar so you can slice the rolls to make a nice sandwich with deli meat and lowfat cheese. Pop a few cherry tomatoes between bites, and you’ll have a balanced meal with all 4 foods groups: 1) lean meats/beans/nuts, 2) lowfat dairy or calcium-alternative, 3) fruit/vegetable, 4) grain.

Calcium-rich foods: You can easily buy a small or large tub of lowfat yogurt, a single milk chug—or even a whole a quart of chocolate milk if you are really hungry. For athletes who are dairy-free, soymilk is a fine alternative. Pick up some pre-sliced lowfat cheese in the dairy or deli area. (Note: Hard cheese, such as cheddar, is lactose-free and comes in convenient single portions.) Add an apple and whole grain crackers—voila, a balanced sports meal! While it may not be the hot meal your mom had in mind, it will do the job of contributing needed nutrients to refuel from the day’s event, fuel-up for tomorrow, and invest in future good health.

Beverages: You can save a lot of money (plus save space in landfills) by packing your own gallon jug of water. To spend money on plain water (void of calories, carbs, and vitamins) seems wasteful when tap water is free. Instead buy 100% juice (orange, grape, carrot, V-8) to boost your fruit/veggie intake and simultaneously boost your immune system with anti-inflammatory phytochemicals. Plus, 100% juice is a strong source of carbohydrate to refuel depleted muscles, as well as fluid to replace sweat losses. Chocolate milk is another winning beverage, with protein to build and repair exhausted muscles, as well as carbs to refuel them.

If the team bus (or your car) is pulling into a fast food restaurant, at least choose one that will support the nutritional needs of athletes. Here are a few suggestions:

• At Taco Bell, you can get the most amount of healthy calories for a bargain price when you order their bean burrito. Two bean burritos cost only $2.20 and provide 750 (mostly quality) calories.

• At a burger place, choose a grilled chicken sandwich (no fries). It will be more expensive and offer fewer calories than a burger, so plan to supplement the sandwich with some Fig Newtons, pretzels or raisins that you pre-packed from home.

•At a pizza place, order the cheese pizza, preferably with veggie toppings like mushroom, pepper, and/or onion. Nix the pepperoni, sausage and other greasy meat options, as well as the double cheese. You’d end up fat-loading with that type of pizza. It would fill your stomach but leave your muscles poorly fueled. Remember: muscles need carbs (such as thick pizza crust) to replenish glycogen stores.

• Be cautious of super salads. While they have a seemingly healthy glow, they can be unfriendly for many sports diets, particularly if you are weight-conscious.Making a substantial salad with not only colorful veggies but also grated cheese, chopped egg, diced chicken, slivered almonds, pumpkin seeds, and olives offers you a hefty dose of calories, but not enough grains/carbs to refuel your muscles. Adding even a little bit of dressing to a big salad often adds  400 or more calories. A sandwich can have fewer calories….

• Hungry athletes who need lots of inexpensive calories can do well by packing sandwiches made with peanut butter & jelly (or PB & jam, honey, raisins, banana, pickles or even cottage cheese—whatever tastes good to you). Peanut butter is versatile and a great sports food because it offers protein, B-vitamins, and good fats that knock down inflammation. It’s inexpensive, travels well without refrigeration, is good for you, and tastes great! It’s even good for dieters because it keeps you feeling fed, and curbs the urge to eat cookies. For the $2 needed to slap together a hefty 600-calorie PB&J (made with 2 slices Pepperidge Farm Bread, 3 Tbsp. Teddie all-natural peanut butter, and 2 Tbsp. Welch’s grape jelly), you couldn’t even buy a Muscle Milk ($3.69 for 230 calories). Shop wisely and fuel well!

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Boston-area sports nutritionist Nancy Clark MS RD counsels both casual and competitive athletes at her private practice in Newton (617-795-1875). Her Sports Nutrition Guidebook and her food guides for runners, cyclists and soccer players are available at For online education, visit and

Super Sports Foods: Do They Really Need to be Exotic?

clark super foods

By Nancy Clark MS RD CSSD

 Do you ever get tired of reading yet-another headline about The 10 Best Super Sports Foods, only be instructed to buy exotic fruits, ancient grains, and other unusual items? Do we really need chia, spelt, and quinoa? Is anything wrong with old-fashioned peanut butter, broccoli and brown rice? Doubtful! Powerful nutrients are found in standard foods that are readily available at a reasonable cost. You know, oranges, bananas, berries, oatmeal, almonds, hummus, lowfat yogurt, brown rice, tuna … the basic, wholesome foods recommended by the government’s My Plate ( Are those foods exotic? No. But do they still do a great job of offering super nutrition? Yes!

To add to the confusion about exotic sports foods, the sports food industry touts their list of engineered super sports supplements. Ads lead you to believe you really need to buy these products to support your athletic performance. The question arises: Are there really special nutrients or components of food that can help athletes to go faster, higher or stronger? If so, can they be consumed in the form of whole foods or do we actually need special commercial supplements?

At a 2014 meeting of Professionals in Nutrition for Exercise and Sport (, exercise researchers from around the globe discussed that topic and provided the following answers to the following thought-provoking questions.


Is there any difference between consuming pre-exercise caffeine in the form of pills, gels or coffee?

Regardless of the source of caffeine (pill, gel, coffee), it is a popular way to enhance athletic performance. Take note: High doses of caffeine (2.5 to 4 mg/lb body weight; 6 to 9 mg/kg) are no better than the amount athletes typically consume in a cup or two of coffee (1.5 mg/lb; 3 mg/kg). Hence, drinking an extra cup of coffee is unlikely to be advantageous, particularly when consumed later in the day before an afternoon workout and ends up interfering with sleep.


Do tart (Montmorency) cherries offer any benefits to sports performance? If so, what’s the best way to consume them?

Tart cherries (and many other deeply colored fruits and veggies) are rich in health-protective antioxidants and polyphenols. Tart cherries can reduce inflammation, enhance post-exercise recovery, repair muscles, reduce muscle soreness, and improve sleep. Athletes who are training hard, participating in tournaments, or traveling through time zones might be wise to enjoy generous portions. Yet, to get the recommended dose of cherries that researchers use to elicit benefits, you would need to eat 90 to 110 cherries twice a day for seven days pre-event. Most athletes prefer to swig a shot of tart cherry juice concentrate instead!


What about food polyphenols such as quercetin and resveratrol?

Polyphenols are colorful plant compounds that are linked with good health when they are consumed in whole foods. Yet, polyphenol supplements, such as quercetin or resveratrol, do not offer the same positive anti-oxidant or anti-inflammatory benefits. An explanation might be that once in the colon, where most polyphenols go, parts leak into the bloodstream during heavy exercise. These smaller compounds create the anti-inflammatory effect. Athletes who routinely eat colorful fruits during endurance training offer their gut the opportunity to distribute good health!


Does curcumin reduce chronic inflammation?

Curcumin (an active constituent of tumeric, the spice that gives the yellow color to curry and mustard) has beneficial properties that have been shown to help prevent cancer, enhance eye health, and reduce inflammation. Subjects with osteoarthritis (an inflammatory condition) who took curcumin supplements for 8 months reported less pain (due to less inflammation) and better quality of life. Unfortunately, curcumin is rapidly metabolized and therefore has low bioavailability when consumed in the diet. To increase absorption, supplements often contain curcumin combined with piperine (black pepper extract).


Does green tea help improve body composition in athletes? What is the best way to take it?

Green tea reportedly enhances fat oxidation and helps with weight loss, particularly when combined with caffeine. But the amount of additional fat burned is minimal, and the 10 to 12 cups of green tea needed to create any effect is a bit overwhelming. (Hence, most studies use a green tea extract.) Because green tea has not been studied in lean athletes, we can only guess that it is unlikely to offer a significant improvement in body composition.


Is watermelon juice a powerful stimulant for sports performance?

Watermelon juice is a source of L-citrulline, an amino acid that contributes to production of nitric oxide. Nitric oxide helps relax the blood vessels and thus enhances blood flow so more oxygen can get transported to the working muscles. One study with athletes who consumed L-citrulline supplements reports they attained a 7% higher peak power output as compared to when they exercised without L-citrulline.

Yet, when athletes were given watermelon juice (contains L-citrulline) or apple juice (that has no L-citrulline), the peak power was only slightly higher and the L-citrulline gave no significant benefits. The bottom line: Watermelon is a nourishing fruit and a welcome refreshment for thirsty athletes. You would need to eat a lot of watermelon to get the equivalent of L-citrulline found in (expensive) supplements. Your best bet is to enjoy watermelon in standard portions as a tasty addition to your sports diet.


What can be done with pea, hemp, or other plant protein to make them as effective as whey for building muscle?

In general, plants (such as peas, hemp) contain less leucine than found in animal proteins. Leucine helps drive the muscle’s ability to make new protein. Hence, to increase the muscle-building properties of plant proteins, you need to either eat large portions of, let’s say, hemp or pea protein (to get a bigger dose of leucine), or you can combine those plant-foods with leucine-rich proteins, such as soy, egg, or dairy foods.


The bottom line: Your best bet to optimize performance is to optimize your total sports diet. No amount of any supplement will compensate for lousy eating, though a few just might enhance a proper diet.

Boston-area sports nutritionist Nancy Clark, MS, RD counsels both casual and competitive athletes. Her private practice is in Newton, MA (617-795-1875). For information about her Sports Nutrition Guidebook (new 5th edition) and food guides for runners, cyclists and soccer players, see For online education, also see




Getting Older, Day by Day


By Nancy Clark, MS RD CSSD

Like it or not, every one of us is getting older, day by day. As a fitness exerciser or an athlete, you might wonder how aging impacts performance—and what you can do to retain youthful fitness. The following information is gathered from a workshop ( presented by Dr. William Evans, an exercise physiologist and expert on aging, muscles, and protein. The following information can help you chart a healthy course into your future.

• The average person loses about 1% of their fitness per year. Aerobic capacity goes down, particularly after age 60. Staying active helps maintain a slighter higher ability to uptake oxygen than a non-athlete, but the rate of loss is the same.

• Muscle is an active tissue (as compared to body fat). The more muscle you have, the more calories you can eat without getting fat. Yet muscle loss creates a subtle change in metabolism that can contribute to weight gain with aging.

• We lose muscle as we age, starting as young as age 20, with a steady decline year after year. To treat this age-related loss of muscle, you need to lift weights or do other forms of resistance exercise. Yet, even strong athletes still lose some muscle with aging.

• With aging, the average person loses more fast-twitch muscle fibers (used in sprinting) than slow-twitch fibers (used for endurance). This loss starts early in life and explains why elite sprinters peak in the early 20s. In comparison, elite distance runners maintain their slow-twitch muscle fibers until age 40ish. But even top athletes notice they slow down after age 40, at which time the nerves that connect to muscles start to die off, resulting in a loss of both slow- and fast-twitch fibers. Athletes can lose about 20% of their muscle fibers between ages 40 and 70.

• With age, we not only lose muscle but also tend to gain fat. It’s easy to eat more even though we need less. The cause of weight gain is not due to a “slow metabolism.” Metabolic rate remains constant, but daily activity easily declines. A study with obese people suggests they sat three hours more per day than their lean peers; this saved them about 350 calories a day.

• Body fat secretes adipokines (hormones) that have negative effects on muscle strength and contributes to increased inflammation, particularly after ages 60 to 70. Inflammation leads to heart disease and diabetes. Hence, fatness can be a powerful predictor of disability in people ages 50 to 75. Stay lean!

• When young people gain weight, about one-third of the weight gained is lean muscle. When older people, in particular older women, gain weight, it’s all fat. When older people lose weight (due to illness or a low-calorie diet), half of the weight lost is muscle. Hence, yoyo dieters who gain fat and lose muscle are on a downward spiral. Being fat but fit is preferable to going on and off diets.

• Muscle loss is the key reason why older people become frail and end up in nursing homes. When they stop exercising, they experience a steep drop in strength. The good news is they can do something about frailty: lift weights! In only12 weeks, 60- to 70-year-old men regained the fitness they had lost over 15 years.

• To maintain (but not gain) strength, a person can lift weights just one day a week. Lifting weights does not stress the heart nor increase blood pressure. Aerobic exercise actually causes a greater increase in blood pressure because it uses more muscles and more oxygen, which means the heart has to pump more blood than with strength training.

• Even 90-year-olds in a nursing home can triple their strength in 10 weeks. That means they can walk faster, get to toilet by themselves, be less depressed, and stay in the independent living part of elder-care housing. Tell your parents and grandparents to start a weight lifting program so they can stay out of the nursing home!

• How much weight should people lift to build muscle? Three sets; the first two sets should have 8 reps; the final set is to exhaustion. If you can lift a weight 12 times in the final set, you need to lift heavier weights the next time. Because muscle damage stimulates muscles growth, you want to spend more time lowering the weight than lifting it.

• Most strength gains occur in the first 3 months of starting a lifting program, due to early neuro-muscular changes. The nervous system learns how to recruit muscles more efficiently and this stimulates more muscle cells.

• Strength training helps prevent bone loss. In a year-long study with post-menopausal women, all of the women who lifted weights improved their bone health. Those who did not lift weights lost ~2% bone density in one year. Exercise is better than osteoporosis drugs—plus, you’ll get stronger!

• By lifting weights and building muscle, older people should be able to eat more calories (which boosts their intake of health-promoting protein, vitamins, minerals). Yet, adding exercise does not always entitle a person to eat more calories. In a study with 62-year-old people who walked briskly for one hour a day (five days/week) for 3 months, their daily energy expenditure remained stable—despite the brisk walking. How could that be? They became more sedentary the rest of the day; they napped more and slept longer. They compensated for having exercised…

• About 25- to 33-percent of people older than 65 years are eating too little protein. This results in loss of muscle and bone—and leads to expensive medical problems. The goal is to eat at least 0.55 grams of protein per pound of body weight each day to maintain and build muscle. For a 140-pound person, this equates to about 75 grams of protein, or 25 grams per meal (for example, Breakfast: 3 eggs; Lunch: 1 can tuna; Dinner: 4 oz. chicken).

The Bottom Line: Stay young by staying active and by lifting weights or doing some type of resistance exercise to strengthen both muscles and bones. And remember the words of gerontologist Water Bortz: “No one really lives long enough to die of old age. We die from accidents and most of all, from disuse.” Use it or lose it!

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Nancy Clark, MS, RD CSSD (Board Certified Specialist in Sport Dietetics) counsels active people in her private practice in Newton, MA (617-795-1875). For more information, read the new 5th edition of her Sports Nutrition Guidebook or her food guides for marathoners, soccer players, and cyclists. They are available at Also see for online CEUs.


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.


What is Trigger Point Dry Needling and Can It Help Me?

By Janelle Ciolek, PT, DPT, OCS

Trigger Point Dry Needling (TDN) is a treatment technique utilized by specially trained Physical Therapists to help treat neurogenic and musculoskeletal pain of either chronic or acute nature.  Many people with pain conditions are found to have active Trigger Points (TPs) in muscles, which exacerbate their pain.  Trigger points are taut, banded, irritable spots within skeletal muscle that cause pain, especially when they are compressed.  In scientific studies, trigger points have been found to demonstrate irregular electrical activity and shortened muscle structure, along with having pain causing chemicals within the muscle tissue.  These trigger points will often cause pain referral to other adjacent areas.  For example, a trigger point on the back of the shoulder blade, when compressed, may reproduce pain in the front of the shoulder or down the arm.

During treatment with dry needling, the physical therapist inserts a flexible, thin filament needle directly into the painful trigger point. The patient can feel a variety of sensations, most notably a deep aching or cramping sensation, and often will experience a localized muscle “twitch” sensation.  These sensory experiences help guide the treatment and let the therapist know they are treating a problematic area.  Dry needling, through scientific research, has been shown to promote healing in the affected painful areas.  It does this by releasing muscle tension, quieting electrical activity in the trigger points, and decreasing the chemical factors in the trigger points that cause pain.

Trigger point dry needling, in the hands of the trained and capable physical therapist, can be used to treat almost any musculoskeletal condition, including back pain, whiplash, frozen shoulder, elbow tendonitis, and plantar fasciitis, amongst many others.  It can even be used post-surgically to treat hypertrophic or adhered scar tissue.  Dry needling is used as valuable part of the whole physical therapy “package” which can include therapeutic exercises, joint mobilization or manipulation, patient education, and modalities.  Every patient has a unique program developed specifically for them, based on their symptoms and needs.

The American Physical Therapy Association as well as the Kentucky Physical Therapy Association support the use of trigger point dry needling in the hands of trained and licensed physical therapist.  For more information, please visit

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Janelle Ciolek PT, DPT, OCS, is the Clinic Director and has been part of our KORT team since 2005. Janelle is a 2004 graduate of the Doctor of Physical Therapy program at Bellarmine University, a Board-Certified Orthopedic Specialist (OCS), a certified  IASTM therapist, practitioner of Functional Dry Needling (FDN) and is a Clinical Instructor for the American Physical Therapy Association (APTA). Janelle also serves as adjunct faculty in the Bellarmine University Physical Therapy Department. Janelle loves the fast-pace and challenges of outpatient orthopedic physical therapy and has substantial experience in this area. Her clinical interests include manual therapy, sports injuries, and knee and shoulder reconstruction.


What is Fifth Disease?

By Ashli Collins, M.D.

My patients and parents often give me help in ideas for this column. This month, when I informed a dad that his child had Fifth Disease, he responded by saying, “Well, Doc, I don’t know…I’ll have to check with my wife to see if he’s had the first four yet.” Confusion over names of diseases is common but by adding a number, instead of a descriptive term (like hand, foot and mouth disease), makes it hard on both parents and medical students trying to learn all the different childhood illnesses!

Years ago, when diseases were being categorized and named, “first disease” was measles. Thankfully, with the help of vaccines, that is no longer a common illness we see. Second disease was scarlet fever or strep throat with a rash. Rubella, also vaccine preventable, was third disease, and fourth disease honors go to Staph aureus infections. Fifth disease has remained without a common name in our culture and mystifies parents with its name.

Fifth disease also goes by erythema infectiosum or slapped cheek disease. To our infectious disease physicians, it is parvovirus B19. I always thought that sounded like a parasite with a vitamin deficiency. With all this confusion and funny naming, a description of this common childhood illness follows.

Fifth’s is a viral illness that has infected around 50-60% of people by adulthood. In children, agesfour to tenare most affected. It can affect girls and boys equally and is most common in the winter and spring months.

Symptoms of fifth disease can range from mild to severe. Many adults who test positive as having the disease before do not recall ever having the illness. The most common symptoms are fevers and mild joint/muscle achiness followed by a slapped cheek appearing rash with a lacy rash on arms and legs. The rash itself may last five to seven days (on average), but it is not uncommon to see it last for a few weeks. While the child has the fever, it is often difficult to differentiate from many other viruses. It is the classic rash that makes the diagnosis.

Some children will have fairly severe myalgias and pain. Rarely, but occasionally, children will have lingering arthritis type pain for weeks to months. Knees, fingers and wrists are the most common joints to have arthritis, but interestingly, the arthritis is usually symmetric with both sides of the body affected.

While a child has the fever, they are generally considered contagious. However, once the fever dissipates and the rash occurs, they are no longer able to spread the disease. During the contagious period, the virus is spread via droplets. Sneezing, coughing, drooling and runny nose are all mechanisms to pass on the virus.

One major concern with this disease is for pregnant women. Pregnant women who have not had the disease should avoid people with fifth’s disease. Fifth disease virus can cause miscarriages in 2-10% of unprotected (not previously infected) moms. Protecting these moms from infected children is tricky in that the diagnosis is usually made at the time the rash appears, but during the rash phase, a patient is no longer contagious. If you are pregnant and find out a child you have had close contact with has fifth disease, you should contact your obstetrician.

Treatment for fifth disease is mostly supportive. Rest, acetaminophen and fluids are the mainstay. As with any virus, antibiotics will not be helpful. If there is significant joint pain/arthritis, anti-inflammatories, such as ibuprofen (Advil/Motrin) or naproxen (Aleve), may be helpful.

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Dr. Collins is a pediatrician with Oldham County Pediatrics, PLLC. They have offices in LaGrange and in Louisville near the Summit. For more information, call 502-225-6277 or


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.