Knowledge is Power!                  

                                      &         Motion is Lotion! 


Out of work? Forced to stay home to stay safe? On top of that your gym has closed…(our gym has)…Maybe even the neighborhood trails & parks have closed! COVID-19 coronavirus has forced us all to STOP MOVING AROUND! And maybe even added a bit of stress too – social isolation, home schooling the kids, uncertainty about food, gas, clothing,…the list goes on…!  In times like these, it’s important to be in touch with our current physical state (i.e. our body): what’s stiff, tight, or even painful? Where am I carrying stress? And what can I do if I find an area or movement that’s stiff, restricted, or stuck – what happens if I gently and calmly move in & out of that restriction? Does it get better? Does it get worse? Lastly, when do I need to go see an expert?

Here is my daily simple, 15-minute toes to neck body scan you can do anywhere, anytime, to detect areas of stiffness, tension, or pain, and help release them on the spot. Throughout this practice ask yourself 3 things: 1). does anything feel stuck / stiff? 2). is the movement symmetrical side to side? 3). do I notice any sounds or feelings that aren’t quite right – clicks, pops, catches, or pain? Pain research tells us that often simply gaining awareness of an area of dysfunction allows our brain to acknowledge it and become familiar with it. That begins to de-escalate the fear & anxiety around it. Then, having a few tricks or tools for releasing problem areas can begin to restore normalcy. The only thing required for this exercise is a space where you can move around a bit, with minimal distraction, and a somewhat smooth surface (where you can take your shoes off, if possible).

NOTE: If you have pain or ‘hard stopping points’ that don’t resolve during these moves, don’t force things! Look at it as an educational practice more than a physical one – approaching it with curiosity & the goal of building awareness, rather than as a treatment with ‘fixing it’ as the goal. If it persists or worsens, you should schedule an appointment to see 1 of our expert Physical Therapists to diagnose the problem and recommend the best treatment approach for your condition.

1). Toe spreading / scrunching:  spread all of your toes out as wide and flat to the floor as possible, then scrunch them in and curl them in as tightly as possible…go in & out, in a slow & controlled manner, as far each direction as possible.

2). Foot inward roll / outward roll:  roll inward onto the inside edge of your feet, lifting the outside edge as high as possible; then roll the other way, onto the outside edge & lifting the inside edge up as high as possible.

3). Ankle-Knee rolling (the ‘Elvis Pressley’):  roll up onto the inside of the ball & big toe of 1 foot, lifting the heel, while the other side stays put. Then, circle around to the outside of the ball & little toe, then down the outside edge of the foot, to the heel, then the foot back down flat. Now it’s the other side’s turn. Alternate each foot back & forth, then if you speed it up going right to left it should resemble one of the King’s epic dance moves.

4). Toe & Heel Raises:  rock back onto heels, lifting toes and ball of feet as high as possible; then lift the heels and come onto ball & to the tippy tips of the toes…initially slow & controlled, lifting each as high as possible (without losing your balance!). Then, for an added challenge: do the heel raise part FAST! Lift the heels quickly, even jumping off the ground!

5). Butt-kickers:  bend 1 knee, attempting to ‘kick’ your heel to your buttocks; then do the other side. Alternate back & forth, increasing the range, trying to get the heel all the way to the butt if you can. Try different ankle positions, pointing the toes down / away, then pulling them up. Next change the angle so the heel go towards towards the opposite buttock. Lastly, move the heel in an oval pattern, lifting the heel towards the outside, across the top, then inside & down. Then switch it up, going in the opposite direction. Try the different ankle positions in this motion too – toes pointed up, toes pointed down / away.

6). Hip rotations (the ‘Twist’): lift heels slightly, coming up onto the balls of both feet at the same time, then twist side to side from the hip so the toes (and knees) are pointing in the same direction; rotate side to side, focusing the rotation to the hip ball & socket joints. Get the arms into it, going the opposite direction of the toes and knees – now you’re doing ‘the Twist’ (YouTube search that if you want a good laugh!).

7). High knee marches: simply lift the thighs & knees into a high march, trying to get them as high as you can while maintaining spine / trunk neutral. Then circle them: lifting up, then out, then down, and back in; now reverse it: out, up, in, & down.

8). Swings: this is an open-chain straight leg swing. Don’t just throw it up, do it deliberately, all the while paying attention to your ‘comfortable range.’ Go as far in both directions as you can – going forward releases your hamstrings and Sciatic nerve, the backward part targets your quads and Femoral nerve.

9). Pelvic tipping / tilting: this gets your ‘core’ abdominal & low back muscles firing.

          Fwd / Bkwd – think of the pelvis as a big bowl; tip the bowl fwd & bkwd, ‘pouring liquid’ out each side.

          Side / side – same thing here: envision tipping the ‘bowl’ side to side, lifting 1 side up towards the ribs, then the other.

          Circles – combine the fwd/bwk and the side/side to make an ‘around the clock’ type motion around each edge of the ‘bowl.’

10). Spine glides: envision your vertebra as individual blocks stacked on top of each other, separated by liquid gel-like discs, & kept aligned with rubber bands (muscles, ligaments, & tendons). With age, as well as poor lifestyles, postures, & nutrition, the “rubbery-ness” of both the discs & the rubber bands decreases. This decreases the natural amount and quality of spinal movement. So, envision trying to glide each vertebra forward and back on top of  the one below it, creating a natural ‘bowing’ motion in the anterior direction, then in the posterior direction…work that motion from your low back (Lumbar) up to the mid (Thoracic) spine, moving each upper segment on top of the one below it. It helps me to think about a rod running front to back through my spine, at each level, and I’m trying to slide that vertebra along the rod, front to back…

11). Rib opening: Ribs open & close with breathing, to the front & out to the side. So imagine them opening & separating from each other on inhalation, then relaxing and closing back down on exhalation. Then try to do 1 side at a time, inhaling all the air you can into 1 side of your lungs, then closing that side and do the other side. Combine this with the spine glides, so that the vertebras glide forward as ribs expand on inhalation, then they glide back and the ribs close on exhalation.

12). Shoulder / shoulder blades (posture): the shoulder is made up of 2 joints – the shoulder blade with the rib cage / torso, and the ball & socket (glenohumeral) joint. Begin with the shoulder blade by pulling them back, trying to pinch them together with your spine between –  be sure to keep them down, don’t shrug them up. Go back and forth, letting them come forward, caving in the chest cavity, then pull them back, opening the chest. Next start to simultaneously rotate your ball & socket shoulder joint, rotating in when the shoulder blades come forward, then rotating out when the shoulder blades go back. Then bend your elbows and use your wrists / hands as a guide to see how far out you can rotate on each side – look for symmetry between the 2 sides. Lastly, as you keep rotating in / fwd & out / back, gradually raise your elbows out to the side and go up to about 90 degrees, all the while rotating your shoulders and shoulder blades, then gradually come back down. Again, look for symmetry in terms of how far up each shoulder can go and what you feel throughout the movement.

13). Neck Range of Motion: I start with simple neck circles, starting small and gradually growing bigger and bigger until / if / when I feel a catch or tight spot, then I’ll stay at that range (circle size) until it starts to release. Then I go back down in circle size until where I started, then switch directions. Next I flex down & forward, moving my chin towards my armpit, then up & out in the opposite direction. Again, I start out in a smaller range of motion and gradually increase if it feels ok. If I find a sticky / stiff / uncomfortable range I just stay there for a while until it starts to release. After doing 15 or 20, I switch to the other diagonal. 

Combination movements / patterns: At the end I usually combine a few of these different movements into a fun, dance-like routine that gets my blood pumping, energy flowing, and starts my day off right!  [WATCH THE VIDEO at the top for these movements]

I hope this helps you as much as it helps me. And remember, this is as much an educational practice as it is a physical one.

Happy Learning!



Every Workout needs a B.O.S.S.!

What do I mean a B.O.S.S.?



A trainer – barking orders at you to complete another set?





Circuit training at Asheville Family Fitness


An instructor – guiding you through complex, multi-plane movements?




NOPE! This BOSS simply stands for:

B – Burn

O – Out of breath

S – Sweat

S – Struggle

And these are CRITICAL elements to a successful workout! In order to experience the benefit of a workout, no matter what kind of workout it is or what your goals are – strength, cardiovascular, stretching / mobility, Yoga, Pilates, dance…whatever it is doesn’t matter. What matters is that it has AT LEAST 1 OF THESE ELEMENTS. And most likely the more of these elements it has, the more benefit you’ll get out of  it.

B – Burn: this is especially true for strength training. Muscle burn is the sensation of work! The muscle is demanding blood as it’s challenged, so usually there’s a warming sensation first…then, as it’s continued to be loaded it may be recruiting all available muscle fibers, eventually reaching a fatigue point, where it feels like it’s going to give out – that’s good – after this challenge, your body will make it stronger!

O – Out of breath: just like it says, at the very least you should feel a bit out of breath to know your cardiovascular fitness exercise is achieving anything. The talk test is simple: if you can carry on a conversation with little difficulty, you’re not doing enough! 

S – Sweat: Ok, some of us sweat more than others. So, if you’re like me and don’t sweat a lot, this one doesn’t necessarily mean you’re not getting any benefit. The surrounding temperature plays a role too, of course. But the more you  sweat, typically the better workout you’re getting. And you get the added benefit of flushing toxins out too! Side note: this is the primary basis for the health benefits of steamrooms & saunas.

S – Struggle: Last, but certainly not least, struggle is the key metric for almost any workout. If you’re not struggling much, you’re not going to achieve much either. Struggle is essentially how your body says to itself, “Ok, that was hard! I’d better build myself up so that I can meet that challenge if it ever comes my way again.” Or, put another way, I often say to my patients, “Get comfortable with being a bit uncomfortable.”

Follow these simple principles and your body will thank you…eventually…after the soreness subsides.






Don’t do new year’s resolutions without 20/20 vision!

It’s NOT a news flash: new year’s resolutions DON’T WORK! A plethera of research over the last 2 decades has shown us that on average 75% fail within 6 weeks, 85% within 3 months. Simply listing a few things we want to “be” or “change about ourselves” in the new year is a recipe for failure! Whether we lose sight of them, lose motivation or willpower to achieve them, get lazy, or just plain bored is different for everyone. But most experts in motivation psychology agree that in order to make positive, forward progress in our lives in some way, we need to shift our focus from a ‘new me for the new year,’ to more of a permanent, lasting altered version of ourselves that we want to become, and it takes a few very important elements:

  1. A clear, compelling VISION of what you want to become / change / do…and the more exciting and attractive it is to you, the more likely it is to continue it’s pull on you, even when the going gets tough. But the vision MUST be backed up by:
  2. A deeply felt PURPOSE or REASON for becoming or doing whatever it is that you envision becoming or doing
  3. An ACTION PLAN that is realistic, well thought out, and even shared with others who can help support you in your quest
  4. New HABITS & RITUALS that bring your vision to fruition!


Number 3 & 4 is where the actual goals (or would be new year’s resolutions), come from. But they MUST be born out of # 1 & 2, or else they will fall by the wayside, as happens with 85% of people, in less than 3 months.  

So, if a vision of what you want to do or be is not clear, start with that. Ask yourself a few questions, like:

  1. What is my best version of myself? 
  2. What do I enjoy doing / being the most? (you may find you lose track of time or forget to eat or go to the bathroom when doing this)
  3. Who are people I admire, respect (or possibly even envy) the most & what do I like so much about them or what they do?

Often your purpose, or reason, also becomes more clear by answering these questions.

Then it’s time to setup an action plan – clear steps to take in order to realize the vision / dream. This includes the time frame, any resources (knowledge, time, money) you’ll need and either have or don’t have, and what are the most important / powerful  steps needed to take in order to succeed. These need to be specific, measurable, & written down!

Lastly, establish clear & consistent habits / behaviors / rituals that become automatic and you DON’T SACRIFICE, under almost any circumstance.

Remember, change is something that happens to all of us all the time, automatically, without us doing anything – the weather, the economy, our energy & mood, our age, etc…- but making it be positive, forward progress or growth is deliberate and requires CONSISTENT EFFORT & COMMITMENT! You must have the vision, see the end result, and decide that it’s important enough to take on the commitment & make the effort to become something different / better / more…

….may the force of positive change (& good vision) be with you….

Sitting = the new SMOKING….Really???

Like everything in life, there’s always 2 sides to a story…and the case of modern life (in this country at least) is no different. The advancement in our quality of life afforded by all of the incredible machines, technology, and products we’ve invented in the last 100 years is astounding, with many positive aspects to all of it. However, the other side of the story is that with all of this brilliant machinery and gadgetry that do so many thing for us, we have “evolved” to what I believe is a tipping point of diminishing returns. What I mean by that is that now that we have so much at our fingertips and can get so much accomplished in our daily lives with very little physical effort – from single click online ordering of just about anything, to homes that turn on / off and open / close by simply voicing it, even automatic car doors – we have become downright LAZY!

This is perhaps most evident by the amount of time the modern American (at any age) spends sitting. The average American is now sedentary 11-12 hours / day! And the average office worker 15 hrs / day! Compared to 1950, the prevalence of sedentary jobs has increased 83%, according to the American Heart Association, and computers have had a lot to do with it. Most Americans 16 years and older spend at least 50% of their “free” time on computers or other electronic devices. And it doesn’t appear to be getting better – just in the last decade, this has increased by 1 hour / day.

The health hazards of sitting are becoming well known and documented, as shown in this 2014 Washington Post article. It is now contributing $24 billion a year to treating medical conditions such as obesity, hypertension, diabetes, & cardiovascular disease, plus increases in certain types of cancers like colon, breast, and endometrial. Not to mention early death – if one sits for 4 or more hours / day, they have a 50% greater risk of death. Every hour of sitting slashes 22 minutes off of your life expectancy!   “OUCH!” (I’m thinking as I sit here writing this on my laptop…ok, now I’m standing)

So, what can be done to combat “Sitting Disease,” as it’s now called? Well, the easy answer is: DON’T SIT! Thanks, Captain Obvious! But what if you have a job that requires it, like some of our very own support staff who have to be in front of computers at the front desk all day long…? Or what if you’re a delivery driver and sit in a car or truck all day? You can’t just quit your job (…or can you…)? The way I like to think about it, and talk to my patients about it, is that it’s like a bank account, or credit card. Sitting or being sedentary is like making a withdrawal on your bank account, or making a purchase on your credit card. By contrast, moving, exercising, or doing something physical is like making a deposit, or a payment. Eventually, the account has to be balanced, right? You can only make so many withdrawals or purchases before you have to make a deposit or a payment. If you’re not balancing the account, you may be able to get away with it for a while, but eventually that “interest” is going to add up and you’re going owe a lot more than you spent! This is pretty much what happens to your physical body – muscles, tendons, joints & ligaments, nerves, heart & blood vessels – all of it. The longer you deplete the “account,” the more damage you do and the more costly the repair is (if that is even an option) down the line.

Bottom line: DON’T PUT IT OFF! DON’T DENY IT! DON’T IGNORE IT! You must find a way to add physical activity into your life, EVERY DAY! If you’re not a gym person or hate working out, then find something you enjoy and make it more physical. If you like yard / garden work, instead of renting / buying a machine to till the garden or blow the leaves, get a good hand tool or a rake and do it the old fashioned way. Just be sure to allow yourself the extra time to get the job done (remember, it’s your “workout”); or if you like walking but don’t have a safe place to do it, then find a safe place in your community and make an agreement with yourself that you MUST go walking there before you’re allowed your T.V. or internet time. Do a lap or 2 around the grocery store or huge box store before you do your shopping. Of find a way to walk or ride your bike to work 1 or 2 days a week. In all areas of your life, instead of trying to find the  easiest or fastest way to do something, find the way that makes you work a bit.  Second, whatever the activity, try to find a friend / buddy / partner – research shows again & again that compliance and long-term staying power with an exercise routine or activity goes way up when you have someone or a group to do it with. Lastly, try keeping a log or journal – research also shows that if you have a consistent way of measuring, tracking, and/or recording your physical activity you’re much more likely to see your progress & continue the activity.


Part II – Falls in the Elderly: What can be done about it?

Part I of this 2-part series addressed ways to properly assess one’s fall risk.

In Part II, we help provide answers to these 2 questions:

       Can we decrease the fall risk in an elderly person?

       If so, how?       

Let’s look back at the most common causes of falls in the elderly: medications, age-related system decline, environment / home hazards, & cognitive impairments

Now, can we (and if so, how) influence these factors to lessen one’s fall risk?

Medications: YES, in many cases. Although some medications that affect balance carry great risks if an attempt is made to reduce or eliminate (such as cardiac arrythmia medications), many medications do not carry such risks and can be reduced or eliminated simply by changing our lifestyle habits. Take for example pain medications. Currently 1 in 3 elderly Americans are taking or have recently taken analgesics for pain control. Social norms & thus medical treatment in the U.S. have dictated pain-elimination strategies rather than pain-coping strategies. This has been 1 contributing factor to the general over-prescribing of pain medications, as evidenced by the nationwide Opioid epidemic we are now in the midst of. Other medications that are powerful balance influencers like anti-hypertensives and anti-depressants can be reduced or eliminated by appropriate stress management / reduction practices like meditation, Yoga, or social bonding.

Age-related system decline: YES, in almost all cases. Age-related system decline can be due to various reasons, but one primary reason is slowed nerve signal conduction speeds. This happens due to a process called demyelination, whereby myelin, the fat + protein substance surrounding a nerve fiber that helps the nerve function optimally, degrades with age. The result is a slowing of the speed of a nerve signal, meaning the message to your brain that you are starting to lose your balance, and the message back from the brain of what to do to correct, are slower. To make up for this loss of conduction speed, the brain centers that monitor and control balance must react more quickly to respond with the appropriate corrective movement strategies to prevent the fall from happening. This is done through specific balance exercises & coordination activities that challenge these brain centers to recognize incoming signals and respond more quickly with the appropriate muscle or movement action. Current research supports balance-targeted physical therapy (like AFFPT’s weekly Balance Class ) T’ai Chi, and other balance focused programs like Matter of Balance or the Netherlands balance training program as effective methods of helping optimize the body’s response strategies and lessen one’s fall risk.

There are also plenty of home exercises one can do to help lessen their fall risk – here are a few simple ones:        

1. Standing Balance: Simply standing in 1 place and concentrating on not losing your balance can be a very helpful, and easy, strategy to do almost anywhere, anytime. be sure you’re next to something solid you can use in case you start to lose your balance, like a wall (or 2 in a hallway), counter top, etc..

Easy:  put feet together as close as you can and look up; make it a bit more challenging by looking around side to side, up/down, or diagonals; make it harder by closing your eyes!

Moderate: same as above, but put 1 foot directly in front of the other, like walking a tightrope

Challenging: stand on just 1 leg


2. Add in head & eye movements: Changing the visual field and/or focal point that your eyes see (and your brain has to process), all while maintaining balance, can be a challenging task. Add these to exercise #1, just be sure you have a safety grab if needed!

Easy:  hold 2 pieces of paper out (or stick them on the wall), then quickly look back and forth between them; then try without moving the head; 

Moderate: same as above, but with more papers and in different locations (up, down, side to side, even diagonally)

Challenging: now do the same thing but while standing on an unstable surface (pillows or couch cushion) or try standing on just 1 leg!

3. Sit & stand as slow & fast as you can: this exercise helps work the muscles (both slow & fast twitch muscle fibers) that control sitting, standing, & walking.

Easy:  choose a surface about chair height or higher, then practice slowly lowering and quickly raising; use your hands on the arm rests if you need to

Moderate: try from a lower surface (low chair, stool, footrest, or a soft couch); go even slower on the decent and quicker getting back up; try NOT to use arms or armrests.

Challenging: no hands, & go slow enough so that as soon as you feel the sitting surface on your buttocks, you come right back up quickly; try with eyes closed.

4. Walking Challenges: Find an open area with a fairly flat surface. As always, be near an object to grab if you need to.

Easy:  practice walking different ways: a). mix up the size of your steps – make some big, some small; b). mix up the direction of movement: sideways, backwards, or diagonally; 

Moderate: now mix up the pace – go fast, then quickly slow down, then speed up, then slow down; add a turn each time you change pace (Note: you can use a timer or electronic alarm that beeps every ___ seconds to tell you to when to switch)

Challenging: add cross-over maneuvers, like grape-vines, where 1 foot has to cross the other one; try any of these options with your eyes closed to make it much more challenging!


Environment / Home hazards:   Absolutely! This starts with awareness of what is a trip or fall hazard & then making changes, often simple ones, to eliminate that hazard. Here is a great checklist anyone can use to do a home assessment of what may be a hazard.

Cognitive impairments: This is bit of an unknown. Despite the fact that we know that elderly people with dimentia have a 2-3x greater fall risk than those without, we still aren’t sure what the exact cause or mechanism is. It could be due to actual muscle or motor impairments, behavioral factors like forgetting to use grab bars or an assistive device like a cane, or it could other functional limitations associated with cognitive deficits. No matter what the cause, these folks should definitely be assessed regularly and in an active balance / fall prevention program. 


Remember – keep the doctor informed! As with any medical condition, even if the primary care doctor is not a specialist in balance or fall prevention, they should be informed and know what’s going on so they can help get the right professionals involved, with the right resources, and monitor changes.




It’s nice to feel supported…but not in this case! Mother Earth, combined with gravity, can be deadly. But it’s not the fall that is the problem, it’s that sudden hard stop of hitting the ground (or some other immovable object) that is. And it’s a big problem! Every 19 minutes an older adult dies from a fall! It’s the leading cause of fatal injury AND non-fatal trauma related trips to the ER in older adults. 

So why are falls so common in older adults? Is it just an inevitable part of aging or can something be done about it?

A lot of research has tried to answer that question: why do people fall. In 2012 a group of researchers in British Columbia, Canada used 24-hour video monitoring in a long-term care facility and found that most of the 227 falls they captured on camera occurred because of a momentary loss of balance, not because of a slip or trip. But the cause of these were hard to pinpoint. There are many possible reasons, and often several are present simultaneously, so it can be hard to determine the exact cause. Here are the top reasons experts in the field attribute most falls to:

  • Medications: many medications have a negative influence on other systems in the body that help maintain balance, movement control, and  awareness of one’s surroundings.
  • Age-related system decline in critical systems like muscle strength & endurance, vision, & nerve conduction velocity
  • Cognitive impairments: changes in mental function like memory, perception, & self-regulation. 
  • Safety of the environment / home: trip and slip hazards like thick carpet or rugs, poor lighting, or the presence of clutter.

Many of these risk factors are controllable, to a degree at least. Meaning individuals can make changes in their lifestyle or environment to decrease their fall risk. Here are some of the most powerful changes one can make:

  • Medications: the medications that increase fall risk the most are analgesics / pain medications, anti-psychotics / anti-convulsants / sedatives. These typically cause sedation & slower reaction times, impaired cognitive function, & resultant increases in loss of balance. The next most risky medications are anti-hypertensives, anti-depressants, cardiac drugs (anti-arrhythmics). Lastly, but still having a negative influence, are the diuretics. So can an elderly individual influence what medications they take? In some cases, no. But in many cases – absolutely! Lifestyle has a HUGE impact on what medications and how much of them are needed in all 3 of these categories. But this discussion must first start with one’s doctor. Then a safe plan can be developed to change lifestyle factors that may allow a decrease in medications and the subsequent fall risk.
  • System decline: it’s true, physiological systems like natural muscle strength & vision decline with age, but that doesn’t mean they can’t be improved. Many studies over the past 2 decades have proven that the health & effectiveness of these systems can, and usually do, improve with the right approach.

It starts with the right testing. Our clinicians are trained in evidence-based tests to determine an individuals fall risk, then prescribe the right type and amount of exercises to help lessen it. Regular exercise, even just simple seated movement routines, help prevent postural hypotension – a leading cause of dizziness, weakness, & fatigue. Balance-focused programs like T’ai Chi and A Matter of Balance are proven to have huge impacts on those balance systems that regulate our position in space and relay changes to the brain that require quick corrective action. For visual and tactile (also known as proprioceptive) systems, it is recommended that feet and eyes are checked at least once a year in individuals over age 65, and more often if there are known impairments. 

          Here are a few of the tests we use to determine one’s fall risk, from simplest to more complex:

           Functional Reach Test: standing distance a person can reach an outstretched arm without losing their balance.

                       Score / Rating: < 18 cm = fall risk

           30-second Chair Rise test: how many times can an individual sit / stand in 30-seconds.

                       Score / Rating to maintain independence: 

                   Age:          60-64           65-69          70-74        75-79        80-84        85-89         90-94 

                  Female:       15                  15                 14              13               12                11                9

                  Male:            17                 16                  15              14               13                11                9

           TUG (Timed Up & Go) test: speed with which an individual can stand up, walk 3 meters, turn around & walk back, then sit back down.

                       Score / Rating:   > 14 seconds = 83% increase in fall risk

           Dynamic Gait Index: how well a person can adjust their gait speed, turn, and stop / start on cue without losing their balance.

                       Score / Rating:   < 19/24 = increased risk of falls

           Berg Balance Test: a variety of tasks, from easy to difficult, measuring ones ability to complete the task all while maintaining balance. 

                       Score / Rating:   41-55 = low fall risk           21-40 = medium fall risk            0-20 = high fall risk

  • Cognitive impairments: there are many degrees and types of cognitive impairments that can happen with age. Some impact fall risk  more than others, so it’s important that an elderly person’s primary care doctor be made aware of changes and be the one to determine the most appropriate testing and course of treatment. A large 2017 study involving 7 developed countries collected data on 2,496 adults of average age of 76 years old and found that impaired executive function (neurological skills involving mental control & self regulation) & dementia, but not memory impairment, is associated with higher incidence of falls in elderly.
  • Environment / home safety: this is the category that individuals probably have the most control over, and it can mean the difference between living independently and not! Even though tripping or slipping may be the least common factor contributing to falls, it just takes 1. Many simple things like getting rid of rugs, installing brighter light bulbs, or clearing clutter from a home can greatly decrease the risks. Checklists, like this one from the CDC’s STEADI program can help point out trip hazards. 

The bottom line: elderly individuals & their family members / care givers should speak up to their doctor or physical therapist about any changes they notice, either cognitively or physically, and be evaluated regularly by their medical professional, like our staff of trained Physical Therapists.  Then, once a program is initiated, stick with it! A regular exercise regimen can lessen the risk of falling and experiencing the devastating, life-changing effects of a fall-related trauma. 


Look for next month’s blog on what type of exercise & training can be done to DECREASE YOUR FALL RISK!

Strength vs Flexibility: the age-old question



At some point in your life you might have wondered: “what’s MORE important for me: STRENGTH or FLEXIBILITY?” Maybe it was trying to answer the question of why you continue to have that nagging back pain? Or perhaps it was during that Yoga class when a static warrior pose was SO hard to hold for 10 breaths? Or maybe you’ve worked with various medical or fitness professionals in which 1 tells you that you need to have more strength and another tells you that you need more flexibility…???

The short answer is: you need both, at least some, to maintain good body balance and minimize injury risk. As with any fitness discussion, start with FUNCTION: what is your body required to do every day (or what are you asking it to do)? Secondly, look at your particular body type and tissue characteristics: are you flexy-bendy like a Gumby doll? Then you most likely need to concentrate more on core strength & endurance. Are you a bulky mass of power? Then you most likely need to focus more on flexibility & joint mobility. We know that there is an inverse relationship between length and tension, meaning basically the more lengthened a muscle is the weaker it is. So very flexible people typically should NOT do more flexibility exercises, which is often exactly what they end up doing because they’re ‘good’ at them and they come easy. Conversely, very bulky, strong people should NOT spend all their time just power lifting, but also putting time & energy towards maintaining good joint mobility and tissue flexibility.

Picture these 2 very different body types and see if you can figure out what each one would benefit most from:

Body #1: the thin, lean body (age is irrelevant, imagine any age you like) who is always doing Yoga so gracefully and beautifully, and no matter what the pose she can always go the full distance no problem…but if you asked her to carry a 5-gallon bucket of water up & down 2 flights of stairs she’d be pooped out after 2 minutes…

Body #2: that big, strong guy you see out working for the utility company, who can probably lift & set those power poles by himself…but if you asked him to bend forward and touch his toes he could barely reach his kneecaps…

Ok, so these are 2 extreme cases, but they’re not that far off from many of the patients I’ve treated over my nearly 20-year career as a Physical Therapist. Most people fall somewhere in the middle, but almost everyone who naturally (genetically) has more flexible tissues struggles with strength (often core muscle strength) and visa-versa; those that have lots of strength often lack flexibility. Of course a person’s lifestyle also effects their strength & flexibility. But how often do you see a skinny person working in a job requiring lots of heavy lifting or moving? By contrast, how often do you see big, bulky people teaching Yoga class? Finding out where your body falls on this strength / flexibility spectrum is a key first step to discovering where to best focus your efforts.

The best option is to see a Physical Therapist experienced in fitness testing and training. Two of our clinicians are Certified Strength & Conditioning Specialists (CSCS) by the National Strength & Conditioning Association and can help define very specifically areas of a person’s body that are more of 1 than the other. 

Here are a few simple, generic tests that can help determine where your body generally lies on the strength vs flexibility spectrum:

 1). Sit and Reach Test: this is often used as a flexibility test of both the hamstrings and the low back. Recent research, however, has shown it to be a poor measure of low back flexibility. Start in seated position, knees fully straight, ankles in neutral (placing feet flat against a step helps keep you from cheating). Slide fingertips along the ruler as you lean forward, reaching as far as you can without pain, then measure the distance.

Scores & Rating:

Adult Men – results in centimeters (cm)

  • Above 34 = Excellent
  • 28 to 34 = Above average
  • 23 to 27 = Average
  • 16 to 22 = Below average
  • Below 16 = Poor

Adult Women – results in centimeters (cm)

  • Above 37 = Excellent
  • 33 to 36 = Above average
  • 29 to 32 = Average
  • 23 to 28 = Below average
  • Below 23 = Poor

2). Side plank hold test: downside elbow may be placed on a pad or pillow, upside hand placed on hip, only lower foot touching the ground. Lift hips up to where trunk + hips + knees are straight (like a plank) and hold. Remember to breathe!

Scores & Rating for adult Males & Females:

  • > 90 seconds = Excellent
  • 75-90 seconds = Good
  • 60-75 seconds = Average
  • <60 seconds = Poor

3). Shoulder Range of Motion (“Back Scratch”) test:

Reach 1 hand behind neck and down along spine as far as able, while the other hand comes up from the low back. Try to get them as close to each other as possible without pain and measure their distance apart.

Scores & Ratings for Men:

Age below average normal (inches) above average
60-64 < -6.5 -6.5 to 0 > 0
65-69 < -7.5 -7.5 to -1.0 > -1.0
70-74 < -8.0 -8.0 to -1.0 > -1.0
75-79 < -9.0 -9.0 to -2.0 > -2.0
80-84 < -9.5 -9.5 to -2.0 > -2.0
85-89 < -10.0 -10.0 to -3.0 > -3.0
90-94 < -10.5 -10.5 to -4.0 > -4.0

Scores & Rating for Women:

Age below average normal (inches) above average
60-64 < -3.0 -3.0 to 1.5 > 1.5
65-69 < -3.5 -3.5 to 1.5 > 1.5
70-74 < -4.0 -4.0 to 1.0 > 1.0
75-79 < -5.0 -5.0 to 0.5 > 0.5
80-84 < -5.5 -5.5 to 0 > 0
85-89 < -7.0 -7.0 to -1.0 > -1.0
90-94 < -8.0 -8.0 to -1.0 > -1.0


If you’re not sure about whether your body falls more towards the strength side or the flexibility side, or if you simply want to know more about your body and how it functions best, please call us at 828-225-3838 and schedule your initial evaluation today!


So, you’ve just finished your workout, you’re heading for the shower, and you’re feeling great – tired, maybe even exhausted, but your endorphins are still high and your mind is clear of all the stress and worry that was in there not so long ago…here are 3 things to do to maximize the benefit of your hard work:

1. Re-hydrate! Not an option, a must – especially if you sweat a lot… 


2. Suck down a healthy carb + protein post-workout smoothie! Quickly replacing spent glucose stores and boosting concentrations of amino-acid protein building blocks for muscle repair is definitely a good idea…



3. Think! Yes, THINK!

Studies in the U.S., the UK, and British Columbia have shown that our brain’s cognitive might, including problem-solving abilities, are significantly improved both during & after moderate to intense (‘cardio’) exercise. Studies from the University of British Columbia and Harvard showed increase in both the growth & the activation of the thinking, learning, & memory areas of the brain with just 1 hour of intense walking twice a week. Maintaining this regular moderate to intense ‘cardio’ exercise routine for 6 months or longer resulted in even more benefit. And the benefits don’t stop there – behavioral & learning researchers at Stanford showed that creative problem solving abilities were significant improved for a moderate-paced treadmill walking group versus a sitting group. Some studies have shown that even a single bout of exercise can produce cognitive benefits extending 2-3 months after! These types of changes are now being credited with holding off early onset of Dimentia, memory loss, and Alzheimer’s – talk about game (& life) changers!








Bottom line: some type of moderate to high intensity cardio workout, even if it’s just a brisk walk around the neighborhood, needs to be bumped up to high priority on your to-do list, especially when life throws you a mental challenge. Whether it’s that work-related issue you’ve been stressed about, a project you’ve been stewing on, or a personal / relationship problem you’ve been trying to hammer out, this is just 1 more reason to NOT skip that trip to the gym!


5 Myths about Healthy Bones & Osteoporosis

  1. Osteoporosis is only in older people.
  2.  It’s genetic – I’m either going to get it or not
  3. As long as I drink milk or eat cheese every day I’ll avoid getting Osteoporosis.
  4. As long as I do some weight bearing exercise once a month I won’t get it.
  5. If I do get it, I can take medications for it.



  1. Officially declared a “major health problem” in the U.S., osteoporosis affects 1/2 of older adults (50 or over), especially post-menopausal women more than any other. But the density of one’s bones is established in the young adult years, typically peaking in the mid to late 20’s. So ignoring it or NOT behaving in ways that maximize bone density – such as adequate exercise & proper nutrition – in the teens and 20’s is a big gamble!  Side note: recent statistics show that in the U.S. the prevalence and early onset of osteoporosis will continue to increase with trends towards less physical activity (increased sitting) and poorer overall nutrition. 
  2. Genetics definitely plays a role. You cannot change your body (frame) size, your ethnicity, or your family history – all factors that influence your risk of developing Osteoporosis. But just like every tissue in our body, bone is in a constant state of cellular remodel (new bone cells are built to replace old ones). As we get older, however, the production line gets a bit slower and can’t keep up with demand, so bone cell deterioration out-paces replacement. This sounds hopeless & depressing, but it’s an opportunity for influence! Also like other bodily tissues, bone is constantly responding to it’s environment. So, increasing weight bearing exercise along with adequate intake of bone-building minerals, good overall nutrition, & a healthy gut to maximize mineral absorption can help tremendously.
  3. Calcium & Vitamin D are the key players here and must be in plentiful supply for bones to even have a fighting chance. Yes, dairy products have high levels of Calcium, however there are other foods that have as much or more Calcium per gram. Because many people cannot (or have trouble) digesting dairy foods, these other foods should be added in as much as possible: collard greens, sardines, broccoli rabi, kale, and Calcium fortified milk alternatives like almond or rice milk. As for Vitamin D the highest concentrations are in fatty fish and fish liver oils, such as salmon & cod liver oil. Just 1 tablespoon of cod liver oil contains 340% of your recommended daily allowance of Vitamin D!  
  4. This is definitely the other very important piece: weight bearing, or load-compression, exercise. Bone responds to the stresses it is subjected to. So if it’s being repeatedly stressed, and even better if it’s in various planes or directions (think bending or twisting, but not too far!) it will respond by triggering bone-building cells called osteoclasts to get workin’.  Safe bone-building exercises come in many different forms & variations. What’s best depends on a person’s age and body type, exercise history, presence of high fracture-risk areas, and actual bone density. The important thing is to get evaluated by a specialist before starting any program. Then, once started, that it’s done REGULARLY-at least 3x / week. Our Physical Therapists can help guide this process AND design a safe & effective bone-building exercise program for any level of fitness or function.                                   
  5. Several osteoporosis medication options exist with varied levels of success and severity of side effects. Most studies done by the drug manufacturers show a statistically significant improvement in a percentage of the population to make it worth the risks of the side effects. However, many of the listed side effects are quite serious, life-altering, and more harmful than the potential benefits they pose in many patients. As such, a serious and frank conversation with the prescribing medical practitioner should begin prior to any medications being taken.

As with any health issue or disorder, I strongly recommend finding out as much as possible about a person’s family history related to osteoporosis, including: a). who, if anyone, has(had) it; b). what age were they when they got it or got diagnosed with it; c). did they ever experience a fracture and if so what was fractured and was there another indirect cause (i.e. a trip or loss-of-balance-related fall)? This information can be incredibly insightful in helping not only predict risk or onset age, but also help see other risk factors that strongly contribute to life-altering events related to osteoporosis, like fractures.

Secondly, getting a bone density test is a good idea – even if you’re not worried or have cause to worry, it gives you a baseline measurement so if / when you get another test years down the road you’ll know which direction your bones are going…

The Importance of Having a “Spring” in your Step

Despite what seems like more general awareness of the importance of healthy feet, there’s still a lot of talk of how shoes and shoe-related products are the way to keep our feet happy instead of the brilliantly functional and adaptive structures of our feet. The “experts” tell us about the latest and greatest in shoe advancements, using terms like “bounceback,” “reinforced vamp,” “meta-flex technology,” and (my favorite) “Rope-Tec burn-protecting reinforcements.” I’m not a shoe expert, but these terms are most likely made-up by some marketing company hired by the shoe makers to make their newest product development sound innovative. They’re using terms and phrases that mimic what the foot, in all of it’s beautiful glory, actually does – bounceback, flex, etc….but, honestly, a healthy foot does these things much better than any of the shoe technologies will ever do. 

One of these structures is the Spring Ligament. This is a thick, highly elastic ligament deep in the arch of the foot that not only helps provide shock absorption and rebound (“spring”) with each step, but also helps protect other structures in the middle and inner foot from being overloaded, or even ruptured, during heavy or hard loading (e.g. running or jumping).

The Spring Ligament, like the other dozen plus ligaments in the foot, is made up of dense collagen tissue and is strong and resilient – when it’s healthy and working properly. But (there’s always a “but”) ligaments like this one can get overloaded, and thus injured, when other supporting structures of the foot either (a). DON’T do their job, or (b). CAN’T do their job. 

When (a) happens: other supporting structures DON’T do their job. There are over 100 total muscles, tendons, & ligaments in the foot and ankle, and they’re all beautifully designed to help support one another. Several key muscles, like the Posterior Tibialis, provide active support to the arch of the foot. But like any other muscle, if you don’t use it you lose it! So often after an injury, a surgery, or just not enough regular walking / weight bearing exercise, this muscle can get weak & fatigues prematurely, making it unable to support the arch. Other structures, like the Spring Ligament, then get overloaded. Another scenario is when the calf / Achilles tendon loses flexibility, such as in the aging or sedentary body. It is then unable to lengthen adequately during normal walking, thus transferring large loads (and force) onto the mid-foot and arch with every step. Plantar Fasciitis is a common, and very painful, condition that can come about when the Plantar Ligament gets overloaded due to tightness in the calf / Achilles.

When (b) happens: other supporting structures CAN’T do their job:   This can occur when we provide too much support, mainly in the arch, as is often the case with arch-supporting shoes or inserts. Like anything in the body, tendons & ligaments respond to the stresses we subject them to.  So, if we give too much support, then we don’t give them a chance to be loaded properly and, thus, do their job. This can lead to loss of fiber density, flexibility / elasticity, and strength of the tissue. This subjects other tissues, like the Spring Ligament, to overload and injury. 

The good news is there are simple things most of us can do to maintain strong muscle-tendon structures as well as healthy & elastic tendon tissues. Here are 3 simple strategies to help:

Posterior Tibialis strengthening, Level 1

To strengthen this very important arch-supporting muscle, use a standard resistance band anchored to something solid & wrapped around the ball (forefoot). Then slowly raise up towards ceiling and back down in a smooth motion, as many times as you can, several times daily.




Posterior Tibialis strengthening, Level 2-3

For a more challenging Posterior Tib strengthener, do a standing heel raise, but roll to the outside (little) toes as you raise up. Then lower down, slow & controlled.
For an even greater challenge, try this standing on 1 leg only!



Calf & Achilles stretch

This is commonly called the “runner’s stretch.” For most people, this stretch should be done daily and held for at least 1 minute.