Pain Facts and Self Care Strategies

This month we are revisiting the topic of pain because it is such a common phenomenon in our patients. Many people come to our clinic struggling with pain that they have had for years and looking for help. Luckily, new research is continually improving our understanding of pain which allows us to help those affected by chronic pain.

What is pain?

The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage” (1). Let’s break this down.

  • We all know that pain is not fun.
  • Pain results in many emotions such as worry or fear, anxiety, and depression. This can increase your pain experience. (More on this later).
  • Pain can occur whether you have an injury (tissue damage) or not! If your brain thinks you are in danger of being injured you can experience pain, even if nothing has happened to you! This leads to the next interesting pain fact.


Pain and tissue damage do not have a one-to-one relationship

Simply put, the amount of pain you feel does not equal the amount of damage done to your body (2). Consider these two examples:

  • A tiny paper cut is not a life threatening injury, but it can hurt like heck!!
  • People who experience significant trauma, such as soldiers in battle who lose limbs, have reported feeling no pain at all. If you lost a limb in an explosion, you would expect this to hurt, right?


Pain is an output of the brain

What does this mean? Let’s break it down. Your brain is constantly taking in large amounts of information from the external environment—everything you see, smell, taste, touch, and hear—as well as from your internal environment—stretch and pressure receptors from your skin and muscles, as well as information regarding your joint position and location in space. All of this information is analyzed nearly instantaneously in your brain (2,3).


At the same time your brain takes into account your prior experiences, memories, thoughts, and beliefs about the situation. All of this information is put together. If your brain determines that you are in danger, then it will cause you to feel pain. If your brain decides that your body is not threatened, then the end result will be no pain. There are no “pain receptors.” Pain is an experience created by your brain to motivate you to change your behavior. Yes, the pain is all in your head; however, that does not mean that your pain is not real to you (2,3).


Your brain and nerves adapt to chronic pain

Peripheral adaptation: changes in nerves

Having pain for a long period of time changes the way your brain and nerves function. In chronic pain, the endings of your nerves build more ion channels. This causes the nerve endings to be more sensitive. As a result, your nerves are more easily excited. This is why a light touch can cause pain. Normally, this type of sensation would not excite the free nerve endings that transmit danger messages; however, when you have chronic pain, even harmless stimuli can trigger these nerves and result in pain (1-3).

Central adaptation: changes in the brain

Changes also occur in the brain. The primary somatosensory cortex is the area of the brain where we become aware of sensations in different parts of our body. This area is organized like a map of the whole body with larger areas devoted to the most sensitive parts of our body. The hand, lips and mouth have relatively large areas in the brain because they are so sensitive. When someone touches you on your hand, this area of your brain lights up (2).


In chronic pain, this virtual map of the body, instead of being crisp becomes “smudged.” The result is that when someone touches your hand, you may feel pain at your wrist. This is because the brain area of the hand has become smudged into the area associated with the wrist. Similar smudging can happen in the primary motor cortex, the area of the brain that allows us to use different body parts. Smudging in the motor area can make it more difficult to use a body part. The result may be weakness or poor coordination (2).


Why would our bodies do this? Researchers think these strategies help our bodies heal by making it harder to use a body part that is injured. Also, when surrounding areas are more sensitive, we are are more likely to protect the injured area. The good news is that smudging can be reversed.


Different things can increase or decrease the level of pain you feel

Many factors can cause you to feel more pain. The good news is that these things can be controlled. Some examples include (3):

  • Your own attitudes and beliefs about pain, what causes it, and whether you have control over it
  • Stress, anxiety and depression
  • Negative mood states and negative thoughts
  • Increased attention/focus on pain
  • Lack of sleep
  • Trigger foods including sugar, fats (especially trans fats), dairy, gluten, and processed foods


Luckily, there are many factors that can decrease the level of pain that you feel. These are often ways of coping with pain and can include (3):

  • Your own attitudes and beliefs about pain, what causes it, and whether you have control over it
  • Relaxation
  • Positive mood states and neutral/positive thoughts
  • Distractions that engage your brain in other activities such as recreational pursuits, work related tasks, chores around the house, interactions with other people, etc.
  • Getting enough restful sleep
  • Eating a plant forward diet
  • Movement and exercise!
  • Learning about pain
  • Graded motor imagery
  • Reconnecting to what gives your life purpose and makes you a unique individual
  • Meditation and mindfulness training
  • Massage therapy, acupuncture/dry needling, chiropractic, etc.


Additional resources

If you are interested in learning more about pain, here are some very useful books, workbooks, podcasts, and YouTube videos.

  • Explain Pain Handbook Protectometer, Butler and Moseley
  • Explain Pain, Butler and Moseley
  • Painful Yarns, Moseley
  • Pain Reframed podcast
  • Understanding pain in 5 minutes (YouTube)
  • The Pain Management Workbook (Amazon)


  1. International Association for the Study of Pain. “IASP Announces Revised Definition of Pain.” Accessed August 25, 2021.
  2. Butler, David and Moseley, Lorimer. (2013) Explain Pain. NOI Group.
  3. The Painful Truth—Lies, Deceptions, and a Hopeful Way Forward Conference, Colorado Chapter of the APTA, 16 May, 2021. Lecture.

Nutrition and Pain: How the Foods You Eat Affect Pain

We are learning more and more about the importance of diet to our health. We know that poor diets are related to developing many chronic diseases such as obesity, diabetes, heart disease, and cancer.1 However, we are now beginning to appreciate the relationship between diet and pain, and how the foods we eat can directly increase or decrease the level of pain that we feel.

Central Sensitization

Central sensitization is a process that happens in our nerves and brain when we have pain for long periods of time. Changes occur in how our nerves and brain operate, so that our nervous system is more easily activated and has a lower threshold for pain.2 There are special cells inside the brain called microglia which are involved in central sensitization. Microglia are activated in several ways:3

  • Poor diet
  • Peripheral inflammation
  • Oxidative stress (from a poor diet)

Trigger Foods

Certain foods are more likely to increase pain intensity because of the effects they have on the body via oxidative stress and inflammation. Examples of trigger foods include the following:3

  • Fat, especially added fats and trans fats. Avoid fried foods and processed foods that are high in these types of fats. Healthy fats, such as olive oil are okay.
  • Sugar, especially high fructose corn syrup. Avoid sugary beverages such as soda pop.
  • Dietary guidelines suggest that women can drink one alcoholic beverage every other day (4 ounces of wine) and men can drink 1-2 alcoholic beverages per day. Any more than this is too much.
  • Dairy products, especially cheese, are pro-inflammatory
  • Processed meats including smoked/cured lunch meats and sausages
  • Caffeine

What Should I Eat?

Researchers recognize that plant forward diets are the key to overall good health.3-6 A plant forward diet means that 80% of the food you eat is from plants. Luckily this way of eating is also the best way to manage chronic pain and inflammation.3-6 Plant forward diets include:

  • FODMAP diet
  • Mediterranean diet
  • Vegetarian diet
  • Vegan diet

Try to get 10 servings of fruit and vegetables daily. A serving size is:

  • 1 cup of leafy greens
  • ½ cup of chopped vegetables or fruits
  • 1 medium sized fruit

Another way to consider this is to look at your plate. Half of the food on your plate should be vegetables and fruits, ¼ of your plate should be whole grains, and ¼ should be a healthy protein.7


Studies show that dietary changes can improve your pain levels within 3-7 days depending on what condition you have and what changes you make.3 So, look down at your plate and see what you can do to improve your diet and decrease your pain at your next meal!



  1. “Poor Nutrition.” National Center For Chronic Disease Prevention and Health Promotion. Accessed 8/2/2021.
  2. “What is Central Sensitization?” Institute For Chronic Pain. Accessed 8/2/2021.
  3. Tatta, Joe. “How to Use Nutition to Target Pain and Central Sensitization.” The Painful Truth—Lies, Deceptions, and a Hopeful Way Forward Conference, Colorado Chapter of the APTA, 16 May, 2021. Lecture.
  4. Tatta, Joe. Heal Your Pain Now: The Revolutionary Program to Reset your Brain and Body for a Pain-Free Life. Da Capo Lifelong Books, 2017.
  5. Barnard, Neal. Foods that Fight Pain: Revolutionary New Strategies for Maximum Pain Relief. Harmony, 1999.
  6. Bulsiewicz, Will. Fiber Fueled. The Plant-Based Gut Health Program for Losing Weight, Restoring Your Health, and Optimizing Your Microbiome. Avery, 2020.
  7. “Healthy Eating Plate.” Harvard School of Public Health. Accessed 8/2/2021.

Resistance Training for Older Adults: Part 3

This month we are going to build on previous posts by going into the specifics of how to build a strength training routine. Check out Part 1 and 2 first before diving into this one. To recap, resistance training at least 2 days per week is recommended by most top health organizations in the country. This recommendation is also directed specifically towards all adults, including individuals in their 70’s, 80’s, and up. In fact, research has shown that continued resistance training late into life is a safe and effective way to slow many of the normal effects of aging such as loss of strength, muscle mass, bone density, and cognitive function. It can also slow cardiovascular disease and lower your risk of all-cause mortality by around 20% (1,2).

Building Your Routine: Variables to Consider


  1. Frequency: For most adults, resistance training should be performed 2-3x per week.
  2. Intensity: Higher intensity resistance training will lead to greater improvements in strength and bone density. Beginners should start with light intensity and focus on good quality movement with the goal of building up intensity over the course of several months. Aim to reach a point when the difficulty of the movement is great enough, you cannot perform more than 8-10 repetitions before failure or losing form. Doing 3-4 sets of 6-8 repetitions at this resistance is a safe and effective amount of exercise. From here, you should be able to add resistance every few weeks as your body adapts to the stresses applied.
  3. Rest: Rest between sets is important to recover and replenish your body’s energy stores.  With lighter resistance, your body only needs 20-30 seconds of rest between sets. As intensity increases towards maximal effort, you should take up to 2 minutes of rest between sets.
  4. Volume: Think of this as the total amount of effort in a workout, or the product of the number of different exercises, sets, and repetitions. Volume should vary depending on your level, but here are some guidelines. Start with 4-6 exercises, 2-3 sets of each, and 10-20 repetitions. Work up to around 8 exercises, 3-4 sets of each.
  5. Progressive overload: As your body adapts to your new workload, the benefits will plateau unless you increase and vary the stimulus. By altering the above variables periodically (frequency, intensity, rest, volume) and adding 5-15% resistance every 1-2 weeks, you can ensure you will continue making progress.

Example Exercises

Now that you have an idea of how to structure your program, let’s talk about what movements to include. First, let’s go over 4 of the main compound movements humans perform regularly.

  1. Squat: Basically this is just sitting and standing from a chair. Try it without putting your weight in the chair, progress to no chair, and then add resistance.
  • Tips: keep even weight on both legs,  keep your knees in line with your hips and ankles, and look forward to help keep your back flat.
  • Why squat: squatting is a full body movement that we use daily, so getting strong in this pattern will help you with everyday tasks. Research has shown that squatting at a high intensity can be as effective to build core / abdominal strength as common core exercises like planks or sit-ups.
  1. Hinge: This one is a little harder for many people, but it is the most efficient way to lift something off the ground. Stand with feet shoulder width apart. Keep your back flat as you push your hips back and let your shoulders move forward toward the ground. Knees should be soft with a slight bend. Push the hips up and forward to stand.
  • Tips: this is a hip dominant movement, so let your hips lead by pushing hips back on the way down and forward on the way up. Your knees should not go forward over your toes and your back should stay flat throughout the movement.
  1. Press: This is any pushing movement with the upper body. Variations include push-ups, chest press, and overhead presses. 
  • Tips: always keep your wrist under your elbow to avoid a rotational force at the shoulder. When holding weight, the path of your hands should be vertical – push straight up and lower straight down. Push-ups from a countertop are a good starting point for many people if weights are unavailable.
  1. Pull: This is any upper body pulling movement such as rowing, pull-ups, or lat pulldowns. There are many variations depending on the equipment available.
  • Tips: Lead the movement by pinching your shoulder blades together (down and back) to use your shoulder blades as much as possible with these movements.

Putting it Together

To summarize, here are the main points to remember.

  • Train 2-3 times per week
  • Pick 4-8 exercises from the list above or others you have learned
  • Perform 2-4 sets of each exercise
  • Start with lower intensity and higher repetition: 15-20 reps of each
  • As you are stronger and more comfortable with the movements, increase your intensity
  • A good intensity goal is that you can only perform about 8 repetitions before you lose form or can’t complete the rep
  • Vary the intensity, duration, volume, and rest breaks periodically 
  • It’s always good to consult a personal trainer, strength and conditioning coach, or physical therapist if you are unsure about how to perform these exercises, or how to safely increase the intensity



  1. Lichtenberg T, von Stengel S, Sieber C, Kemmler W. The Favorable Effects of a High-Intensity Resistance Training on Sarcopenia in Older Community-Dwelling Men with Osteosarcopenia: The Randomized Controlled FrOST Study. Clin Interv Aging. 2019;14:2173-2186. Published 2019 Dec 16. doi:10.2147/CIA.S225618
  2. Peterson MD, Rhea MR, Sen A, Gordon PM. Resistance exercise for muscular strength in older adults: a meta-analysis. Ageing Res Rev. 2010;9(3):226-237. doi:10.1016/j.arr.2010.03.004
  3. Law TD, Clark LA, Clark BC. Resistance Exercise to Prevent and Manage Sarcopenia and Dynapenia. Annu Rev Gerontol Geriatr. 2016;36(1):205-228. doi:10.1891/0198-8794.36.205
  4. Selye H. Stress and the general adaptation syndrome. Br Med J. 1950;1(4667):1383-1392. doi:10.1136/bmj.1.4667.1383
  5. van den Tillaar R, Saeterbakken AH. Comparison of Core Muscle Activation between a Prone Bridge and 6-RM Back Squats. J Hum Kinet. 2018;62:43-53. Published 2018 Jun 13. doi:10.1515/hukin-2017-0176

Resistance Training for Older Adults: Part 2

Following up on our blog from April, here is some more information about resistance training for older adults including some common misconceptions about lifting weights, as well as recommendations to get you started.

Common Misconceptions

Many people have misconceptions about weight lifting. Here are some of the most common assumptions.

  1. Heavy lifting is not safe
  • Multiple high quality studies (in references below) have demonstrated that not only is high intensity resistance training safe for people in their 60’s, 70’s, and 80’s, it is the most effective way to build strength and maintain bone density.  If you are a novice lifter, starting with heavy lifting is not safe. Just like anyone, you need to start easy and build slowly.

2. I’m too old to lift weights

  • Maintaining strength may be more important as you age than it was when you were younger. As your risk of injury and disease increase, maintaining strength is an extremely effective way to stay out of the doctor’s (and PT’s) office and reduce your risk for joint replacements, low back pain, and broken bones.

3. Squatting is bad for my knees

  • Poor quad strength is bad for your knees, and can lead to reduced functional capacity. Squatting can improve your quad strength and reduce the risk of needing surgery or treatment by a physical therapist for knee pain or injury.
  • In a review of over 2000 adults ages 60-80 years old, quadriceps strength was significantly correlated to knee pain, independent of x-ray findings. This shows that regardless of the degree of arthritis, people with stronger legs have less knee pain.
  • If you already have significant knee pain, consult your doctor or physical therapist before starting this type of strength training.

Exercise Recommendations

The American College of Sports Medicine, American Heart Association, and American Diabetes Association all recommend resistance training at least twice per week. While this post has focused on resistance training, it is also important to maintain your cardiovascular fitness. These organizations also recommend moderate intensity cardiovascular exercise at least 150 minutes per week.

So now that we have covered some benefits of strength training, how do you begin? If you are unsure how to start, a safe option is to consult a personal trainer, strength coach, or physical therapist. In next month’s blog we will discuss how to begin, as well as exercises, volume, intensity and progressions! For now, to get started at home, one of the best things you can start to do is a squat to and from a chair. It sounds simple, but try sitting and standing slowly from a chair without using your hands 20-40 times per day. Try to keep equal weight on both legs, stand all the way upright, and come down softly! If you do this, you’ll be ready to up the intensity by next month.

Other Resources

American College of Sports Medicine – Exercise Guidelines As We Get Older: 


American Heart Association – Exercise Recommendations:


American Diabetes Association – Exercise Recommendations:



What is Ehlers-Danlos Syndrome?

The Ehlers-Danlos Syndromes (EDS) are a collection of 13+ disorders of the genes that impact connective tissues.  Connective tissues make up the membranes and linings of all the organ systems of the body as well as skin, ligaments, and tendons.  As a result people with EDS deal with symptoms that can involve every system of the body.  Modern healthcare is provided by doctors with an expertise in a single body system, like cardiologists for the heart and dermatologists for the skin.  This can make it very challenging for a person with Ehlers-Danlos [and their healthcare providers] to recognize that the wide variety of health problems they experience are actually all part of one underlying condition.  Since our healthcare system does not include a doctor that is a ‘connective tissue specialist’ there is no one field of medicine dedicated to recognizing, diagnosing, and helping people manage EDS.  As such, many patients go undiagnosed for years to decades.

Diagnosing EDS

The first step of diagnosing EDS is recognizing the signs and symptoms of connective tissue dysfunction. Signs may include:

  • Joints that seem to be hypermobile (move further than typical)
  • Skin that is atypical (stretchy, fragile, soft, velvety, bruises easily, slow healing, or unusual scarring)
  • Additional medical issues that seem unusual or excessive (heart abnormalities, bleeding issues, chronic pain, musculoskeletal anomalies)

In today’s world, many patients &/or their loved ones take to the internet and ultimately stumble across EDS as a possibility, which they then bring to their providers.  Sometimes a dentist who notices fragile gums or an orthopedist who notes overly stretchy tissues may suggest EDS.  Once the suggestion is made, however, the journey to diagnosis is far from over.

Awareness of EDS

Healthcare providers’ awareness of EDS is often based on out-of-date information. Advances in science led to updates of EDS criteria in 2017.  EDS is rare (1 in 2,500-5,000) and underdiagnosed, so most providers have not knowingly worked with a person with EDS. Additionally, the severity of EDS vary widely among individuals. Some people have minor annoyances and others suffer disability that impacts basic activities. Some consequences of EDS can be life threatening. This further complicates recognition of the disorders.

Examination and Testing

Once a potential EDS is recognized, the next step is a clinical exam with a knowledgeable provider.  All of the Ehlers-Danlos Syndromes have established clinical criteria to indicate potential presence of the disorder.  With a clinical exam and thorough review of the person’s medical history, a working diagnosis can be established.  At that point, genetic testing can be used to confirm the diagnosis for most types of EDS.  This is usually done after referral to a genetics clinic, but in some cases the testing can be ordered by primary care or other specialty. [Final interpretation of results may still require genetics consult.]  At present, geneticists who evaluate EDS are rare and often have waiting periods of up to 1-3 years for consultation.

Diagnosing Hypermobile EDS and Hypermobility Spectrum Disorders

Unfortunately, the most common type of EDS, hypermobile Ehlers-Danlos Syndrome (hEDS) does not yet have identified genetic variants.  In other words, there is no ‘lab test’ to rule in or rule out this type of EDS at present. Unless exam or history indicate the possibility of another type of EDS or identifiable connective tissue disorder, there is no benefit at present for persons who likely have hEDS to consult a geneticist or undergo genetic evaluation.


Further, the 2017 updates of EDS criteria differentiate between hEDS and HSD (hypermobility spectrum disorders).  Prior to 2017, hEDS & HSD did not exist in the medical terminology.  Anyone with excessive joint hypermobility and significant disruption of their lives but no other confirmable disorder was diagnosed with EDS-III (EDS type 3), EDS-HT (EDS hypermobility type), BJHS (benign joint hypermobility syndrome), or JHS (joint hypermobility syndrome).  These terms were used synonymously to represent hypermobility that was not life threatening.

The renaming and differentiation of hEDS from HSD was done to improve the potential of identifying causative genetic variants with research.  At present, the symptoms/treatment/management for hEDS, HSD, EDS-III, EDS-HT, JHS, and BJHS are all exactly the same. Treatment is based on the same limited research, and is guided by each individual’s unique symptoms and response to treatment.

For some individuals, this means that a confirmed diagnosis provides limited benefit.  However, for others, a diagnosis seems to open the gateways to more and better options for evaluation and treatment of symptoms as well as to necessary accommodations for their disability.

Finding a Knowledgeable Provider

The Ehlers-Danlos Society provides an international directory of healthcare providers that are qualified to work with people with EDS:


Since a ‘connective tissue expert’ does not exist in our healthcare model, these providers of knowledge may be from almost any branch of medicine bearing any title (MD, DO, PT, PA, FNP, etc).  To address the lack of awareness and knowledge about EDS, the Ehlers-Danlos Society launched a program called the EDS ECHO in 2019. This training is available to providers all over the world and connects them to each other and experts in the field so that any healthcare provider can learn to expertly care for people with EDS.  Patients can direct their providers to for access to this program.

At Foothills Orthopedic & Sport Therapy, both Dr. Kimberly Saunders, PT and Kara Creaghe, PTA at the Fort Collins office have completed EDS ECHO training programs, allowing us to provide the most informed care available for people with EDS or HSD.

Help Us Spread Awareness About EDS

If you’d like to help spread awareness about EDS, you can:

  • Share this article with friends on the web
  • Let your healthcare providers know about EDS ECHO training opportunities
  • Join the Ehlers-Danlos Society’s awareness campaign

Resistance Training for Older Adults

Do you feel like you’re getting too old to lift weights? Have others warned you it’s not safe? Or have you never really considered it? Aging unfortunately can lead to the loss of strength, lean muscle mass, and bone density. But it doesn’t have to cause a problem!


Resistance training with good body mechanics at a high intensity is the best way to make sure these side effects of aging don’t affect your quality of life. The benefits of resistance training are many, but here I’m going to talk about a few well documented ways that strength training can have a positive effect on your life. Building strength is just the tip of the iceberg. The effects of resistance training also influence the nervous system, cardiovascular system and endocrine system, which can help reduce your risk of injury and slow disease progression.[1][2]


Increased Strength and Lean Muscle Mass

  • Strength deficits in a variety of muscle groups have been linked with injury. For example, weakness in the hips and trunk (abdominals and back) has been linked with low back pain, hip pain, arthritis, and knee injuries.[3]
  • Even into your 60’s, 70’s and 80’s, strength training can reverse some of the normal effects of aging such as muscle loss. Research is clear that you can still get stronger, improve muscle firing rate, and build muscle mass to help reduce injury.[4]
  • Improved strength can also reduce your risk of falling.


Increased Bone Density

  • Reduced bone mineral density significantly increases your risk of fractures which can be painful, expensive to manage, and cause long term disability in some cases.
  • Bone is actually one of the most adaptive tissues in our body. All tissues and organisms adapt based on the stresses applied to them.[1] This is particularly noticeable with bone.
  • Bone density increases significantly with the stress of muscle contraction, impact such as running, or compressive loading.  But the opposite is true as well. The absence of impact, load, and contraction at a high enough intensity will lead to the loss of bone density.
  • Resistance training, especially at high intensities, has been shown to be one of the most effective ways to improve bone density and reduce the risk for fractures in older adults.
  • Bone density in women decreases significantly after menopause, which leads to a 3x higher rate of hip fractures in women than men. This makes premenopausal strengthening for women especially important. Don’t wait to get started – it is much easier to maintain density than reverse the effects of osteoporosis.

Improved Cardiovascular Health

  • Regular resistance training also helps modify many risk factors of cardiovascular disease.[1]
  • Research has also shown improved aerobic capacity and a reduced resting heart rate.[2]

Other Benefits of Resistance Training

  • Improved glucose control, hormone regulation, and insulin sensitivity
  • Improved sleep, and reduced stress levels
  • Increased mobility for daily function
  • Improved cognitive function
  • Reduced all cause mortality
  1. Consistent strength training actually improves longevity and reduces the risk of all cause mortality. In other words, strong people are harder to kill and live longer.[3]
  2. One study showed 21% reduction in mortality among individuals who engage regularly in resistance training, including a reduction in cardiac events.[4]


Hopefully I have convinced you that resistance training is not only safe, but worth your time and effort. In our next blog I will discuss some common misconceptions surrounding weight lifting and provide specific recommendations.



[1] Mayer F, Scharhag-Rosenberger F, Carlsohn A, Cassel M, Müller S, Scharhag J. The intensity and effects of strength training in the elderly. Dtsch Arztebl Int. 2011;108(21):359-364. doi:10.3238/arztebl.2011.0359

[2] Williams MA, Haskell WL, Ades PA, et al. Resistance exercise in individuals with and without cardiovascular disease: 2007 update: a scientific statement from the American Heart Association Council on Clinical Cardiology and Council on Nutrition, Physical Activity, and Metabolism. Circulation. 2007;116(5):572-584. doi:10.1161/CIRCULATIONAHA.107.185214

[3] Saeidifard F, Medina-Inojosa JR, West CP, et al. The association of resistance training with mortality: A systematic review and meta-analysis. Eur J Prev Cardiol. 2019;26(15):1647-1665. doi:10.1177/2047487319850718

[4] Kamada M, Shiroma EJ, Buring JE, Miyachi M, Lee IM. Strength Training and All-Cause, Cardiovascular Disease, and Cancer Mortality in Older Women: A Cohort Study. J Am Heart Assoc. 2017;6(11):e007677. Published 2017 Oct 31. doi:10.1161/JAHA.117.007677


We’re Getting Vaccinated- And We Hope You Will Too!

After a year of pandemic lifestyle, COVID-19 vaccines offer a path toward safe and healthy social gatherings, travel, and return to ‘business as usual’.  But until enough of us are vaccinated, staying home, wearing masks, and keeping our distance will still be necessary to keep the community healthy.1  We know that many people have concerns about getting vaccinated and we urge you to discuss those with your healthcare team to make the right decision for you.

Vaccine Facts

Here are a few things we want you to know about the COVID-19 vaccines available in the USA:

  • The vaccines are safe and were thoroughly tested according to established protocols even though they were developed very quickly2
  • ALL the vaccines are extremely effective at preventing severe illness, hospitalization, and death3,4
  • The mRNA found in the Moderna and Pfizer vaccine does NOT impact an individual’s DNA and it degrades and leaves the body very quickly after triggering the production of proteins that signal the body to develop immunity1,5
  • Vaccines are free of the most common allergens and animal products (latex, preservatives, corn, dairy, soy, eggs). People with a history of allergic reactions should make a plan with their healthcare team to manage a potential reaction, but can be safely vaccinated6,7
  • They have been deemed ethically developed and do not contain products that might go against a person’s faith traditions [fetal cells, beef, pork]5,8
  • The vaccines do not contain live virus and CANNOT cause COVID-19 infection4
  • They do NOT contain microchips or tracking devices9–11
  • People with immunocompromise, autoimmune disorders, and inflammatory disorders CAN be vaccinated safely, and it is recommended in most situations. Unfortunately, it may not be as effective because of a decreased immune response6,12
  • Those who have had COVID-19 are recommended to receive the vaccine any time after they meet criteria to end isolation & 90 days after receiving antibody therapy for the disease4,12


Special Populations

While the vaccines are safe for most people, there are some people who should not get vaccinated or will need to carefully consider the risks vs. benefits of vaccination.  The safety of these individuals will depend on all of us who are able to get our vaccines to decrease the prevalence of COVID-19 in our communities.1 The people who need your help include:

  • All children & adolescents under the age of 1613
    • Safety of the vaccine has not been sufficiently studied for this group
  • Pregnant and breastfeeding individuals7,13
    • People working directly with individuals who may be ill (caregivers or front line healthcare providers) or with high potential for exposure (essential workers) may be safer to receive vaccine than risk severe illness with COVID-19 and should discuss this with their care team
  • People who are allergic to polyethylene glycol (PEG) or polysorbate6,7
    • The vaccines do contain PEG; allergic individuals are not eligible to receive the vaccine


Why Our Staff is Getting Vaccinated

We also want to share with you why we chose to get vaccinated.  We hope these stories inspire you to do your best for our community and get vaccinated. Or, if vaccination is not safe for you, then encourage others to get vaccinated and thank them for helping to make you safe and allowing us all to get out of our homes and get close to our loved ones again!


  • For me it was “the light at the end of the tunnel.” It will not only keep me safe, but my friends and family. And dang it- I want to go out and have some fun with all of them !!!!! -Lisa, Front Desk, Fort Collins


  • I believe in the science, and I trust in the process of vaccine development. Also, I live in a multi-generational household, so this vaccine is as much for me as it is for my mother and grandmother. I vaccinate myself to protect not only myself, but others including my family, friends, co-workers, patients, and fellow citizens of Northern Colorado. -Megan, PT, Loveland


  • I got the vaccine to help protect my parents and family. And because I miss hugs! -Kara, PTA, Fort Collins


  • Getting vaccinated is certainly beneficial to me and to my wife and extended family – especially since my wife is also in healthcare (we have the potential for a good deal of exposure). But bigger than that, it is a major component in the path to reduce the impact of the pandemic world-wide. It is my opportunity and responsibility to help the human race through this pandemic – along with being diligent with social distancing, hand washing, etc. -Duane, PT, Loveland


  • I am very grateful to have gotten my first vaccine. Considering my age, I felt it was a privilege to get my first “Fauci Ouchie” and look forward to getting my second one in 2 weeks. -Debbie, Front Desk & Billing, Loveland


  • Getting the COVID-19 vaccine is a safe way to build protection around yourself, your co-workers, patients, family, and friends. The vaccine is designed to boost and reinforce your immune system, which enhances the other safety precautions we have all been doing for months now. These include wearing masks, social distancing, and frequent hand washing. It is very important to all of us at Foothills Therapy to do as much as we can to minimize the spread of COVID-19 and still be able to provide the care that the community expects from us. -Robert, PT, Loveland


  • I received my first dose of Moderna vaccine on Jan. 28 which was a surprise since notification for me came the day before. My only reaction to the actual vaccine was soreness of my middle deltoid (as the side of the shoulder is known in our world). Having the vaccine is important to me because, with me being of a certain age (63), I have some heightened risk and have decreased my hours in the clinic to only 3 days a week to avoid exposure. A couple of weeks after I get my second dose of vaccine on board, I will be able to 1) treat my patients with some less anxiety, 2) hug my 87 year old Mom, 3) get a haircut (which hasn’t happened in over a year) and 4) MAYBE return to some bike racing. -Jeff, PT, Fort Collins


  • I’ve always approached vaccines for me and my kids as a matter of public health- we do it out of love for humanity, not personal benefit. But the COVID-19 vaccine has been a personal gift to me- I can’t describe the wave of emotion and relief when I scheduled for that first shot. I had no idea the invisible burden I had been carrying as I cared hands-on for so many beloved individuals with chronic illness each workday and then came home to my own precious kids each night. I never felt fearful, but I did feel a huge sense of responsibility to keep everyone I touched safe.  Having hEDS, MCAS and POTS, the vaccination process has been physically challenging for me and I had to take special precautions with each injection to avoid anaphylaxis. That said, the post-vax symptoms are similar to my usual flare-ups, but this ‘flare-up’ has a clear trigger, a clear benefit, and a clear ending point.  All in all, it is SO worth it! 


  1. CDC. What You Need to Know about the U.S. COVID-19 Vaccination Program. Centers for Disease Control and Prevention. Published February 9, 2021. Accessed March 1, 2021.
  2. COVID-19 vaccines: Dive deep on emergency use authorization. American Medical Association. Accessed March 1, 2021.
  3. Commissioner O of the. FDA Issues Emergency Use Authorization for Third COVID-19 Vaccine. FDA. Published February 27, 2021. Accessed March 1, 2021.
  4. CDC. Facts about COVID-19 Vaccines. Centers for Disease Control and Prevention. Published February 3, 2021. Accessed March 1, 2021.
  5. Randall R. 3 Bioethical Questions About COVID-19 Vaccines. Accessed March 1, 2021.
  6. COVID-19 Vaccine Reported Allergic Reactions | Allergy & Asthma Network. Accessed March 1, 2021.
  7. CDC. COVID-19 and Your Health. Centers for Disease Control and Prevention. Published February 11, 2020. Accessed March 1, 2021.
  8. Zeiger H. Coronavirus Vaccine Ethics. Published online December 8, 2020. Accessed March 1, 2021.
  9. Miller AM Anna Medaris. 8 coronavirus vaccine myths debunked, from microchipping to DNA changes. Business Insider. Accessed March 1, 2021.
  10. Staff R. Fact check: COVID-19 vaccine labels would not microchip or track individuals, but serve logistical purpose. Reuters. Published December 14, 2020. Accessed March 1, 2021.
  11. Coronavirus: Bill Gates ‘microchip’ conspiracy theory and other vaccine claims fact-checked. BBC News. Published May 29, 2020. Accessed March 1, 2021.
  12. Interim Clinical Considerations for Use of mRNA COVID-19 Vaccines | CDC. Published February 18, 2021. Accessed March 1, 2021.

Tension Headaches

Tension headaches are the most common type of headache people experience. With so many of us working remotely on computers these days we are seeing an increase in headaches complaints. If you suffer from headaches, continue reading to learn more.

Tension Headaches: What Are They?

These headaches cause mild to moderate pain in the head, scalp, or neck. People often describe a “tight band feeling” around their head. Tension headaches tend to be episodic in nature. They “come and go.” The duration and frequency of these headaches are usually shorter than other types of headaches. Unfortunately, tension headaches can become chronic, which can make them more difficult to differentiate from migraines.

Tension headaches usually do not cause visual disturbances, nausea, vomiting, or increased sensitivity to light or sound. They do not get worse with physical activity. These signs are typical of migraines.

Tension headaches become more of a medical concern when:

  • Headaches disrupt your lifestyle
  • You need to use medication more than twice a week
  • If your headache is abrupt and severe
  • When your headache follows a head injury/accident
  • If your headache is accompanied by a fever, stiff neck, mental confusion, seizures, weakness, numbness or trouble speaking


Preventing Tension Headaches

Multiple factors can contribute to a tension headaches including:

  • Stress or anxiety
  • Lack of sleep
  • Poor posture

Preventing and managing tension headaches involves ways to reduce stress and strain such as: yoga, stretching, meditation, reduction of postural stress, regular exercise, consistent sleep, healthy diet, drinking plenty of water, and be careful with alcohol, caffeine, and sugar consumption.


Physical Therapy and Tension Headaches

Physical therapy can have a significant positive impact on tension headaches. After a comprehensive evaluation your therapist will develop an appropriate treatment plan based on your individual needs. Treatment can encompass a variety of techniques including: stretching, strengthening, joint and/or soft tissue mobilization, and use of ice or heat, along with a specific home exercise program.


The primary goals of physical therapy for tension headaches are to reduce pain/symptoms and identify headache triggers. Secondary goals are to increase strength and flexibility, increase neck mobility and function, and reduce postural stress/strain.


Suggested Exercises

Here are a few gentle exercises that can help alleviate stress and strain related to tension headaches. Each exercise can be held for 10 seconds. Release and repeat 5 times. Try to do 3 sessions per day if tolerated well.


  • Chin tuck stretch – look straight ahead, keeping your head level; pull your head gently backwards into a “chin tuck” position; then bend your head down towards your chest until you feel a stretch at the back of your neck.
  • Lateral flexion or side stretch – gently bend your head/neck to the left side, attempting to touch your left ear to your left shoulder, until a light stretch is felt on the opposite, right side. Do this same routine going the other direction.
  • Shoulder rolls – sitting or standing, shrug your shoulders forward, then shrug them up towards your ears, then pull them back, and lastly pull them down in the attempt to make a complete circle. Complete the recommended repetitions, then reverse directions.


Feel free to contact our office for questions or concerns you may have regarding treatment for tension headaches.

Exercising While Wearing a Mask: Common Misconceptions

Patients ask me questions about their face masks all the time. “Is it okay to exercise while wearing my mask?” “Is breathing my own carbon dioxide dangerous?” “How do you breathe in these things all day?!” “What is the best type of mask to wear?” If you have been pondering these same questions, then let’s clear the air, so to speak!

Is it Okay to Exercise While Wearing a Mask?

The short answer is yes!

Research studies show that wearing a mask while exercising does not significantly affect your heart rate, respiratory rate, blood pressure, oxygen level or time to exhaustion (1).

True, masks make it more difficult to breathe. This is because the mask increases resistance to airflow. You are still able to breathe, but your breathing muscles must work harder.

If you have any chronic lung disease, then you should talk to your doctor before exercising in a mask.

Is Breathing My Own Carbon Dioxide Dangerous?

No. This is a common misconception that people have. Masks do not trap carbon dioxide near your face. And this is why: a molecule of carbon dioxide (CO2) is 0.33 nanometers in diameter(2). A nanometer is one-billionth of a meter or 0.0000000001 meters across! This is so tiny that it’s hard to even comprehend.

Most face masks do not create an air-tight seal, so the carbon dioxide is able to escape out the sides and/or bottom of your face covering. Also, masks have pores in the fabric. The size of these openings varies depending on the material but the pores are all large enough to allow CO2 to escape, even from an N95 mask (3). (Specifically, N95 masks can filter particles up to 0.1-0.3 microns across. A micron is one-millionth of a meter, which is 1,000x bigger than the size of a molecule of CO2.)

On the other hand, a covid-19 virus particle is approximately 100 nanometers across (4), which is roughly 300x larger than a molecule of CO2. Covid-19, however, does not spread by itself. Instead, it attaches to droplets from the respiratory tract. These particles are formed when we talk, cough, or sneeze and are between 20-200 micrometers in size (5).

So, a mask is porous enough to allow tiny molecules of CO2 to escape while at the same time trapping large droplets that may be carrying the covid-19 virus.

How Do You Breathe in These Things All Day?

Honestly, it’s not that bad. After 10 months we healthcare providers are used to it.

What is the Best Type of Mask to Wear?

N95 masks without valves are the most protective against covid-19 for both the person wearing the mask as well as others. This type of mask is most appropriate for people who work in close proximity to covid-19 patients (6).

Cloth and medical grade face masks are also very good at reducing the spread of droplets, up to 80% effective. Look for a cloth face mask with three layers of fabric. The more layers, the better it will block droplets (6).

Bandanas and neck gaiters are not recommended. Although they are better than nothing, bandanas are open at the bottom which can allow droplets to escape. And gaiters are typically only made of one thin layer of fabric which is a poor barrier (6).

No matter what type of mask you choose, it should completely cover your nose and mouth without having any large openings at the sides or bottom. Be sure to wash your mask regularly and replace it when it begins to show signs of wear.

If you have any other questions or concerns about exercise and masks, feel free to ask your physical therapist.




3) Y Qian, K Willeke, SA Grinshpun, J Donnelly, CC Coffey. Performance of N95 respirators: filtration efficiency for airborne microbial and inert particles. Am Ind Hyg Assoc J. 1998 Feb;59(2):128-32.

4) YM Bar-On, A Flamholz, R Phillips, R Milo. SARS-CoV-2 (COVID-19) by the numbers. eLife. 2020; 9: e57309. Published online 2020 Apr 2. doi: 10.7554/eLife.57309

5) JP Duguid. The size and the duration of air-carriage of respiratory droplets and droplet-nuclei. J Hyg (Lond). 1946 Sep; 44(6): 471–479. doi: 10.1017/s0022172400019288

6) EP Fischer, MC Fischer, D Grass, I Henrion, WS Warren, E Westman. Low-cost measurement of face mask efficacy for filtering expelled droplets during speech. Science Advances  02 Sep 2020:
Vol. 6, no. 36, eabd3083. DOI: 10.1126/sciadv.abd3083

Exercising at Home in the Time of Covid-19

As we enter yet an additional phase of restrictions and isolation, it is more important than ever to stay active at home. We aren’t going out to the gyms or stores as often as we used to. Now with the snow moving in and temperatures plummeting it is becoming increasingly difficult to get outside to walk and exercise.

Consequences of Decreased Activity

With a reduction in activity level strength and balance deficits become more apparent. One in three people over 65 and half of people over 85 fall at least once a year. Of those falls at least 15% lead to injury. Are you finding it more difficult to get up out of your chair? Or are you feeling less confident waking out in your yard or even around the house? Do you find it difficult to go up and down the stairs? If so try adding a few of the following exercises into your daily routine.

Home Exercises

Start walking 10 minutes twice a day even if it is around your house. Set a timer or put your favorite music on and walk for the duration of three songs.
Try standing up and siting down 10 times a day from your kitchen chair. Make sure it is a steady chair that does not have wheels. Try to do this without your arms if you can. Focus on sitting down slowly with good control. Think “sit soft and quiet.”
Stand at your kitchen counter and place your hands on the counter for balance. Push up onto the balls of your feet 10 times.
Stand at your kitchen counter place your hands on the counter for balance. Lift your toes 10 times.
Stand at your kitchen counter and place your hands on the counter for balance. Stand on one leg for 30 seconds. Repeat on the opposite leg.
Perform only if you can do the above exercises safely and without pain. If, despite these tips, you are experiencing difficulty with waking or your daily activities we at Foothills Orthopedic and Sport Therapy are available to help.